CARESCAPE Monitor B650

User's Manual
Software Version 1

English
1st edition
M1191150 (CD)
M1119626 (Paper)
22 April 2010
© 2010 General Electric Company.
All rights reserved.
For your notes
Contents
Intro.
Safety precautions . . . . . . . . . . . . . . . . . . . . . . . . . . 6
About this device . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
About this manual . . . . . . . . . . . . . . . . . . . . . . . . . 12
Startup
System introduction. . . . . . . . . . . . . . . . . . . . . . . . 14
Monitoring basics . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Putting the monitor into operation . . . . . . . . . . 48
Interfacing with peripheral devices . . . . . . . . . 51
Setup
Setting up the monitor before use . . . . . . . . . . 58
Alarms
Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Start/End
Starting and ending monitoring. . . . . . . . . . . . . 76
Pat. data
Trends and snapshots. . . . . . . . . . . . . . . . . . . . . . 84
Viewing other monitored patients. . . . . . . . . . . 96
What if?
Checking alarm function . . . . . . . . . . . . . . . . . . 100
System messages. . . . . . . . . . . . . . . . . . . . . . . . . 101
Care
Care and cleaning . . . . . . . . . . . . . . . . . . . . . . . . 142
4
ECG
ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
12 lead ECG analysis. . . . . . . . . . . . . . . . . . . . . . 163
Pacemaker detection . . . . . . . . . . . . . . . . . . . . . 167
Arrhythmia detection . . . . . . . . . . . . . . . . . . . . . 168
ST detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
QT detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Resp
Impedance respiration. . . . . . . . . . . . . . . . . . . . 180
SpO2
Pulse oximetry (SpO2) . . . . . . . . . . . . . . . . . . . . . 186
Pressure
Non-invasive blood pressure (NIBP). . . . . . . . 194
Invasive blood pressures. . . . . . . . . . . . . . . . . . 202
PA catheter insertion . . . . . . . . . . . . . . . . . . . . . 211
Pulmonary capillary wedge pressure (PCWP)
measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Temp
Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
C.O.
Cardiac output (C.O.) . . . . . . . . . . . . . . . . . . . . . . 218
SvO2
Mixed venous oxygen saturation (SvO2) . . . . 226
 5

Gases Print
Airway gases with E-modules. . . . . . . . . . . . . . 232 Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Patient Spirometry . . . . . . . . . . . . . . . . . . . . . . . . 242 Lab/Calcs
Gas exchange . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Laboratory data . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Entropy/NMT Hemodynamic, oxygenation or ventilation
Entropy 252 calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Neuromuscular transmission (NMT) . . . . . . . . 258 Drug calculations. . . . . . . . . . . . . . . . . . . . . . . . . 294
EEG Other
EEG and auditory evoked potentials (AEP) . . 264 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
BIS
Bispectral index (BIS) . . . . . . . . . . . . . . . . . . . . . . 274
Safety precautions
System safety messages apply to the entire system. Safety messages specific to parts of the system are found in the relevant section.
Safety message signal words
Safety message signal words designate the severity of a potential
hazard.
Danger Indicates a hazardous situation that, if not avoided, will
result in death or serious injury.
Warning Indicates a hazardous situation that, if not avoided, could
result in death or serious injury.
Caution Indicates a hazardous situation that, if not avoided, could
result in minor or moderate injury.
Notice Indicates a hazardous situation not related to personal
injury that, if not avoided, could result in property
damage.
Danger safety messages
No danger safety messages apply to this monitoring system.
Warning safety messages
The following warning safety messages apply to this monitoring
system.
Accessories warnings
• Single-use products are not designed to be reused. Reuse may
cause a risk of cross-contamination, affect the measurement
accuracy and/or system performance, and cause a malfunction
as a result of the product being physically damaged due to
cleaning, disinfection, re-sterilization and/or reuse.
• Use only approved accessories, including mounts, and
defibrillator-proof cables and invasive pressure transducers. For
a list of approved accessories, see the supplies and accessories
6
list delivered with the monitor. Other cables, transducers and
accessories may cause a safety hazard, damage the equipment
or system, result in increased emissions or decreased immunity
of the equipment or system or interfere with the measurement.
• ELECTRIC SHOCK — Only use protected leadwires and patient
cables with this monitor. The use of unprotected leadwires and
patient cables creates the potential for making an electrical
connection to ground or to a high voltage power source which
can cause serious injury or death to the patient.
Cables/strangulation warnings
• CABLES — Route all cables away from patient’s throat to avoid
possible strangulation.
• SITE REQUIREMENTS — Do not route cables or tubing in a way
that they may present a stumbling hazard.
Defibrillation warning
• Do not touch the patient, table, bed, instruments, modules or the
monitor during defibrillation.
Electrical warnings
• Do not under any circumstances remove the grounding
conductor from the power plug. Always check that power cord
and plug are intact and undamaged.
• If liquid has accidentally entered the system or its parts,
disconnect the power cord from the power supply and have the
equipment serviced by authorized service personnel.
 7
• DISCONNECTION FROM MAINS — When disconnecting the device
from the power line, remove the plug from the wall outlet first.
Then you may disconnect the power cord from the device. If you
do not observe this sequence, there is a risk of coming into
contact with line voltage by inserting metal objects, such as the
pins of leadwires, into the sockets of the power cord by mistake.
Equipment warnings
• If an error message appears during operation, it is the licensed
medical practitioner’s responsibility to decide whether the unit is
still suitable for patient monitoring. As a general rule, monitoring
should only continue in extremely urgent cases and under the
direct supervision of a licensed medical practitioner. The unit
must be repaired before being used again on a patient. If an
error message appears after power-up, the unit must be
repaired before being used on a patient.
• Ensure that modules are securely latched.
• The parameter modules are not able to withstand unpacked
drops from a height of 1 m without damage. If a module is
dropped, please service it before taking it back into use.
• If the monitor is dropped, please service it before taking it back
into use.
Caution safety messages
The following caution safety message applies to this monitoring
system:
• LOSS OF DATA — Should the monitor at any time temporarily lose
patient data, the potential exists that active monitoring is not
being done. Close patient observation or alternate monitoring
devices should be used until monitor function is restored. If the
monitor does not automatically resume operation within 60
seconds, power cycle the monitor using the on/standby button.
Once monitoring is restored, you should verify correct
monitoring state and alarm function.
Notice safety message
The following notice safety message applies to this monitoring
system:
• NOTICE - The warranty does not cover damages resulting from
the use of accessories and consumables from other
manufacturers.
Safety symbols
The following safety-related symbols appear on one or more of the devices:
ATTENTION: Consult accompanying documents.
Consult operating instructions.
DANGER - Shock hazard. Dangerous voltage. To
reduce the risk of electric shock, do not remove cover.
Refer servicing to qualified service personnel.
Electrostatic sensitive device. Connections should not
be made to this device unless ESD precautionary
procedures are followed.
LASER RADIATION: Do not stare into beam. Class 2
laser product.
Non-ionizing electromagnetic radiation. Interference
may occur in the vicinity of this device.
8
Type BF (IEC 60601-1) protection against electric
shock. Isolated (floating) applied part suitable for
intentional external and internal application to the
patient, excluding direct cardiac application.
Type BF (IEC 60601-1) defibrillator-proof protection
against electric shock. Isolated (floating) applied part
suitable for intentional external and internal
application to the patient, excluding direct cardiac
application.
Type CF (IEC 60601-1) protection against electric
shock. Isolated (floating) applied part suitable for
intentional external and internal application to the
patient, including direct cardiac application.
Type CF (IEC 60601-1) defibrillator-proof protection
against electric shock. Isolated (floating) applied part
suitable for intentional external and internal
application to the patient including direct cardiac
application.
WARNING - Safety ground precaution. Remove power
cord from the mains source by grasping the plug. Do
not pull on the cable.
 9
About this device
Indications for use of this device
The CARESCAPE Monitor B650 is a multi-parameter patient monitor
intended for use in multiple areas and intrahospital transport within
a professional healthcare facility.
The CARESCAPE Monitor B650 is intended for use on adult, pediatric,
and neonatal patients and on one patient at a time.
The CARESCAPE Monitor B650 is indicated for monitoring and
recording of, and to generate alarms for, hemodynamic (including
ECG, ST segment, arrhythmia detection, ECG diagnostic analysis and
measurement, invasive pressure, non-invasive blood pressure, pulse
oximetry, cardiac output, temperature and mixed venous oxygen
saturation), impedance respiration, airway gases (CO2, O2, N2O and
anesthetic agents), spirometry, gas exchange, and
neurophysiological (including electroencephalography, Entropy,
Bispectral Index (BIS) and neuromuscular transmission) status.
The CARESCAPE Monitor B650 can be a stand-alone monitor or
interfaced to other devices. It can also be connected to other
monitors for remote viewing and to data management software
devices via a network.
The CARESCAPE Monitor B650 is intended for use under the direct
supervision of a licensed healthcare practitioner, or by personnel
trained in proper use of the equipment in a professional healthcare
facility.
The CARESCAPE Monitor B650 is not intended for use during MRI.
Indications for use safety precautions
Indications for use warnings
• Read all the safety information before using the monitor for the
first time.
This manual contains instructions necessary to operate this
device safely and in accordance with its functions and intended
use.
This manual is intended for clinical professionals. Clinical
professionals are expected to have a working knowledge of
medical procedures, practices and terminology, as required for
the monitoring of all patients.
• SINGLE PATIENT USE — This equipment is designed for use on
one patient at a time. Using this equipment to monitor different
parameters on different patients at the same time compromises
the accuracy of data acquired.
• INSTRUCTIONS FOR USE — For continued safe use of this
equipment, it is necessary that the listed instructions are
followed. However, instructions listed in this manual in no way
supersede established medical practices concerning patient
care.
Indications for use cautions
• U.S. Federal law restricts this device to sale by or on the order of
a physician.
• SUPERVISED USE — This equipment is intended for use under the
direct supervision of a licensed health care practitioner.
Training requirements
No product-specific training is required for the use of this monitor.

Electromagnetic compatibility (EMC)
EMC safety precautions
EMC warnings
• Other equipment may interfere with the system, even if that
other equipment complies with CISPR emission requirements.
• Use only approved accessories. For a list of approved
accessories, see the supplies and accessories list delivered with
the monitor. Other cables, transducers and accessories may
cause a safety hazard, damage the equipment or system, result
in increased emissions or decreased immunity of the equipment
or system or interfere with the measurement.
• Pins of connectors identified with the ESD warning symbol
should not be touched. Connections should not be made to
these connectors unless electrostatic discharge (ESD)
precautions are used. See the “CARESCAPE Monitor B650
Technical Manual” for details.
• Do not use the monitor in high electromagnetic fields (for
example, during magnetic resonance imaging).
10
EMC cautions
• Use of known RF sources, such as cell/portable phones, or other
radio frequency (RF) emitting equipment near the system may
cause unexpected or adverse operation of this device/system.
Consult qualified personnel regarding device/system
configuration.
• The device/system should not be used adjacent to, or stacked
with, other equipment. Consult qualified personnel regarding
device/system configuration.
• Changes or modifications to this device/system not expressly
approved by GE may cause EMC issues with this or other
equipment.
Electrostatic discharge (ESD) precautions
• To avoid electrostatic charges building up, it is recommended to
store, maintain and use the equipment at a relative humidity of
30% or greater. Floors should be covered by ESD dissipative
carpets or similar, and non-synthetic clothing should be used.
• Discharge any static charge you may have built up before
handling ESD sensitive parts by touching a large metal object
located close to the equipment.
See the “CARESCAPE Monitor B650 Technical Manual” for details.
 11
Compliance classifications
WARNING - EXPLOSION — Do not use this equipment in
the presence of flammable anesthetics, vapors or liquids.
In accordance with IEC 60601-1:
- Class I equipment - the type of protection against electric shock
- Type BF or CF equipment. The degree of protection against
electric shock is indicated by a symbol on each parameter
module.
- Equipment is not suitable for use in the presence of flammable
anesthetic mixture with air or oxygen or nitrous oxide.
- Continuous operation according to the mode of operation.
In accordance with IEC 60529:
- IPX1 - degree of protection against harmful ingress of water.
NOTE: The degree of protection against harmful ingress of water
for each parameter module is indicated in the “CARESCAPE
Monitor B650 Supplemental Information Manual.”
In accordance with EU Medical Device Directive:
Class IIb.
Conformity according to the Council Directive 93/
0537 42/EEC concerning Medical Devices amended by
2007/47/EC.
In accordance with Canadian Medical Device Directive:
Class 3. Certification in Canada by the Canadian
Standards Association CAN/CSA C22.2. No 601.1
(1990).
In accordance with CISPR 11:
- Group 1, Class A
Responsibility of the manufacturer
GE is responsible for the effects of safety, reliability, and
performance only if:
- Assembly operations, extensions, readjustments, modifications,
or repairs are carried out by persons authorized by GE.
- The electrical installation of the relevant room complies with the
requirements of the appropriate regulations.
- The equipment is used in accordance with the instructions for
use.
- The equipment is installed, maintained and serviced in
accordance with the instructions provided in the related
technical manuals.
Product availability
Some of the products mentioned in this manual may not be
available in all countries. Please consult your local representative for
the availability.
About this manual
This manual contains instructions necessary to operate this device
in accordance with its functions and intended use.
Information which refers only to certain versions of the product is
accompanied by the model number(s) of the product(s) concerned.
The model number is given on the nameplate of the product.
All illustrations in this manual are provided as examples only. They
may not necessarily reflect your monitoring setup or data displayed
on your monitor.
Conventions used in this manual
Within this manual, special styles and formats are used to
distinguish between terms viewed on screen, a button you must
press, or a list of menu commands you must select:
- For technical documentation purposes, the abbreviation GE is
used for the legal entity names, GE Medical Systems Information
Technologies, Inc. and GE Healthcare Finland Oy.
- Names of hardware keys on the equipment, keypad, remote
control, and modules are written in bold typeface: Start
Cancel.
- Menu items are written in bold italic typeface: Monitor Setup.
- Emphasized text is in italic typeface.
- Menu options or control settings selected consecutively are
separated by the > symbol: Procedures > Cardiac Output.
- When referring to different sections in this manual, section
names are enclosed in double quotes: “Cleaning and care.”
- The word “select” means choosing and confirming.
- Messages (alarm messages, informative messages) displayed on
the screen are written inside single quotes: 'Learning.'
- Note statements provide application tips or other useful
information.
12
- In this manual, the CARESCAPE Monitor B650 is referred to as the
monitor.
Acquisition module naming conventions
In this manual, the following naming conventions are used to refer
to different modules and module categories:
- PDM: CARESCAPE Patient Data Module
- PSM: Patient Side Module: E-PSM and E-PSMP
- E-modules: all modules with prefix 'E-'. NOTE: In parameter
chapters, ‘E-modules’ refers to those modules that measure the
parameter(s) in question.
- Hemodynamic E-modules: E-PRESTN, E-PRETN, E-RESTN
- Cardiac output and SvO2 E-modules: E-COP, E-COPSv
- Pressure E-modules: E-P, E-PP, E-PT
- Compact airway modules: E-CO, E-COV, E-COVX, E-CAiO,
E-CAiOV, E-CAiOVX
- Single-width airway module: E-miniC
- Specialty E-modules: E-NMT, E-EEG, E-BIS and E-ENTROPY
- SpO2 E-modules: E-NSATX, E-MASIMO
See the “E-module and PDM parameters” section for a list of
parameters each module measures.
Printed copies of this manual
Further paper copies of this manual will be provided upon request.
Contact your local GE representative and request the part number
on the first page of the manual.
 13

Related documents Trademarks

- CARESCAPE Monitor B650 Clinical Reference Manual
DINAMAP, IntelliRate, MUSE, TRAM, Tram-Net, Tram-Rac, Trim Knob,
- CARESCAPE Monitor B650 Technical Manual
Aqua-Knot, Quantitative Sentinel, Unity Network, Multi-Link, 12RL,
- Module Frames and Modules Technical Manual
12SL, CIC Pro, and EK-Pro are trademarks of GE Medical Systems
- CARESCAPE Monitor B650 Supplemental Information Manual
Information Technologies, Inc.
- CARESCAPE Monitor B650 Supplies and Accessories
- CARESCAPE Monitor B650 Skills Checklist S/5, D-lite, D-lite+, Pedi-lite, Pedi-lite+, D-fend, D-fend+,
- Marquette 12SL ECG Analysis Program Physician's Guide Mini D-fend, Entropy, Patient O2, and Patient Spirometry are
- CARESCAPE Modular Monitors Mounting Reference Guide trademarks of GE Healthcare Finland Oy.
- Displays User’s Manual. See this manual for additional safety,
compliance classifications, technical specifications, and Datex, Ohmeda, and OxyTip+ are trademarks of GE Healthcare
installation information for the D15K and D19T displays. Finland Oy and Datex-Ohmeda, Inc.
- Unity Network Interfacing Device (ID) Operator’s Manual
iPanel is a trademark of GE Healthcare Finland Oy and GE Medical
- iCentral and iCentral Client, User’s Reference Manual
Systems Information Technologies, Inc.
- CIC Pro Clinical Information Center Operator’s Manual
CARESCAPE is a trademark of General Electric Company.
Revision history
Third party trademarks
Revision Comments Masimo SET is a trademark of Masimo Corporation. Nellcor is a
st Initial release of this document. trademark of Nellcor Puritan Bennett, Inc.
1 edition
System introduction
Safety precautions
System warnings
• Never install equipment above the patient.
• To prevent liquids from entering the monitor, do not tilt the
monitor more than +/-15 degrees.
• Operation of the monitor outside the specified performance
range may cause inaccurate results.
• Do not connect a monochrome display to the monitor. Visual
alarm indicators may not appear properly.
• Use of non-GE displays with the monitor may result in loss of
visual alarms and patient monitoring.
• EXCESSIVE LEAKAGE CURRENT — A secondary display or printer
that is a non-medical grade device and is used within the patient
environment, must always be powered from an additional
transformer providing at least basic isolation (isolating or
separating transformer). Using without an isolating transformer
could result in unacceptable enclosure leakage currents.
14
• EXCESSIVE LEAKAGE CURRENT — Laser printers are UL 60950/IEC
60950 certified equipment, which may not meet the leakage
current requirements of patient care equipment. This equipment
must not be located in the patient environment unless the
medical system standard EN 60601-1-1 is followed. Do not
connect a laser printer to a multiple socket outlet supplying
patient care equipment. The use of multiple socket outlet for a
system will result in an enclosure leakage current equal to the
sum of all the individual earth leakage currents of the system if
there is an interruption of the multiple socket outlet protective
earth conductor. Consult your local service representative before
installing a laser printer.
• PHYSICAL INJURY — Take care when mounting devices to an IV
pole. If a device is mounted too high the IV pole may become
unbalanced and tip over.
System caution
• To comply with the FCC RF exposure requirements, the monitor
with the wireless network (WLAN) option must be operated with
a separation distance of 20 cm or more from a person’s body.
 15

For your notes

System components
NOTE: Your system may not include all these components. Consult your local representative for the available components.

3 4
1 2

5
6 7
8

9 10

16
 17
(1) The CARESCAPE Monitor B650
(2) GE 15-inch non-touch display: Non-touch display that
provides integrated full-sized keypad and Trim Knob control.
(3) GE 19-inch touchscreen display: Touchscreen display that
provides integrated abbreviated keypad and Trim Knob
control.
(4) Laser printer: This device may be connected to the monitor,
network, or to a central station on the network. The laser printer
can print waveforms, alarm waveforms, numeric trends, and
reports.
(5) Acquisition modules: Two types of acquisition modules can
be used with the monitor: the Patient Data Module (PDM), and E-
modules.
(6) Standard keyboard: Allows data entry without using the on-
screen keyboard or touchscreen display.
(7) Mouse: Allows on-screen user selections and data entry.
(8) Barcode reader: Used to scan a Technician ID and Patient
Information Number from barcodes when admitting patients.
(9) Remote control and keypad: Used to provide all patient
monitor controls on a portable component with a Trim Knob
control.
(10) Unity Network ID connectivity device: Used with the
monitor to communicate with GE and other manufacturers’
peripheral bedside devices, such as ventilators and gas delivery
systems, to centralize patient data on one device.
Monitor front panel Monitor back panel

2 3

10

4 5

5 2 9 6

8 7
4 3 the other panel
option:
(1) Alarm light
(1) Pivoting module frame
(2) Trim Knob control (2) Slide mount, connector for PDM
(3) Integrated keypad (only Home and Silence Alarm keys with (3) Slide mount, connector for PSM
the touchscreen version) (4) Connector for secondary (clone) display
(4) Battery power/mains power indicators (5) Connector for ePort (PDM cable) *
(5) On/standby (6) Connector for remote on/off *
(7) Network connectors (one or four) *
(8) USB connectors (two or four) *
(9) Power and ground
(10) Cable release switch
* = optional

18
 19

Alarm light
Monitor side views
The integrated alarm light provides a visual alarm when an alarm
condition is present. It indicates the highest priority alarm. The alarm
light also provides a visual indicator when the audio alarms are
paused or when the audio alarms are off. See the “Alarms” chapter
for details.
1
1 2

(1) Audio alarm paused/off area 3

(2) Alarm light area (blue = low priority; yellow = medium priority; red
= high priority)

5 6
4

(1) Recorder*, see page 21

(2) Module slot* for one double-width or two single-width modules,
see page 21
(3) Release switch for the pivoting module frame
(4) Defibrillator (ECG) and IABP synchronization (E-modules only)
(5) Lock for battery cover*
(6) Battery cover*

* = optional

Software
The monitor is highly configurable and provides many monitoring
possibilities with software licenses. See the “CARESCAPE Monitor
B650 Supplemental Information Manual” for configuration
information.
Secondary display WARNING - To prevent liquids from entering the
The monitor supports one secondary (clone) display.
display casing, do not tilt the display more than +/-15
degrees.
1 1

WARNING - ELECTRIC SHOCK- Always unplug the

grounded cables when not in use. Leaving them
connected could result in an electric shock from the
ground contact in the other end.

WARNING - The secondary display will not sound the

audible alarms. Therefore, always keep the patient
under close surveillance.
The displays integrate visual alarms and provide USB connectivity.
5 4 3 2 5 4 3 2
There are two display sizes available. The GE 15-inch non-touch
display provides an integrated full-sized keypad and Trim Knob
(1) Alarm light
(2) USB connectors (back of display) control. The GE 19-inch touchscreen display provides an integrated
(3) Trim Knob control abbreviated keypad and a Trim Knob control.
(4) Integrated keypad
(5) On/standby button
NOTE: The On/standby button does not turn off the USB connectors
on the back of the display. To completely turn off the display, turn off
the mains power switch on the back of the display.

NOTE: The mains power switch is located on the back of the display.

20
 21

Using the pivoting module frame

Pivoting module frame

WARNING - Do not touch the electrical connector

located within the pivoting module frame.
The pivoting module frame provides an interface between the
monitor and acquisition modules.
(1) Press the pivoting module frame’s
There are four pivoting module frame options available: release switch and use the rail on top
- Frame with PSM and PDM support of the frame to help you in moving
- Frame with PSM, PDM and E-module support the frame as shown in the picture.
- Frame with PSM, PDM and recorder support
- Frame with PSM, PDM, E-module and recorder support

2 3

(2) Keep the release switch pressed and turn the module frame to
the position you prefer (0, 45 or 90 degrees). The module frame
clicks when locked in position. In this picture, the module frame
has been turned to the position of 45 degrees.
(3) The module frame in the position of 90 degrees.

To return the pivoting module frame to its original position (0

degrees), press the release switch and turn the frame. NOTE: Make
sure that the frame locks in place and that the red color in the upper
part of the switch is no longer visible.
 Inserting and removing the battery
Monitor battery (optional)
To insert or remove the battery:
1. Open the battery slot by turning the lock 90 degrees clockwise:
WARNING: Do not incinerate a battery or store at
high temperatures. Serious injury or death could
result.

WARNING: Using non-recommended batteries could

result in injury/burns to the patients or users. Only 2. Insert the battery with the test indicator side up and the
use batteries provided by GE. The warranty can be connector end first all the way into the battery slot. To remove
the battery, pull it out from the cord.
voided if non-recommended batteries are used.
3. Push the cover back up and lock it in place by turning the lock 90
If your monitor has the optional battery slot, you can insert a lithium- degrees counter-clockwise.
ion battery and use the monitor on battery power. The LED Checking the battery charge level
indicators on the monitor front panel indicate whether the monitor is
Using the monitor software
being used on battery or mains power, and also whether the battery
You can check the battery status through the monitor software:
is charging, full or missing:
1. Select Monitor Setup > Battery Status.
Indicator Meaning 2. Select the Monitor tab.
3. Check the status information.
(green, on) Monitor is operated on mains power.
Checking the monitor battery symbol on screen
You can also check the battery charge level from the symbol of the
(green, on) Monitor is operated on battery monitor battery on the right upper corner of the display. The higher
power. the charge, the bigger the green bar within the symbol. When the
battery is being charged, there is a white running bar inside the
(orange, Battery failure or no battery. symbol. In case of a battery failure, the symbol is crossed out.
flashing) Using the test button on the battery
When the battery is not inserted into the monitor, you can check its
(orange, on) Battery is charging. The indicator status by using the Test button on the battery itself. Push the button
goes off when the battery is fully and check the green charging level indicators to see how much
charged. charge is left (25%, 50%, 75% or 100%).

22
 23
Acquisition modules
You can use different types of acquisition modules with the monitor.
They provide connection to the patient, process patient data signals,
and send patient data signals to the monitor.
NOTE: See the “CARESCAPE Monitor B650 Supplemental Information
Manual” document for a complete list of compatible devices.
Hemodynamic multiparameter modules
Hemodynamic multi-parameter acquisition modules are the Patient
Side Modules (E-PSM, E-PSMP), hemodynamic E-modules (E-PRESTN,
E-RESTN, E-PRETN), and Patient Data Module (PDM).
Other hemodynamic modules
Other hemodynamic modules are the cardiac output and SvO2
E-modules and pressure E-modules . They provide measurements
for additional hemodynamic parameters. See the “E-module and
PDM parameters” tables for details.
E-modules offer a wide variety of parameter acquisition capability to
the patient monitoring system.
NOTE: E-modules are not suitable for use with neonatal patients.
Only PDM can be used with the NICU software package.
Gas acquisition modules
Gas acquisition modules are the E-CO, E-COV, E-COVX, E-CAiO,
E-CAiOV, E-CAiOVX, and E-miniC E-modules. They provide
measurements for gas parameters, anesthetic agents, Patient
Spirometry, gas exchange, and metabolics. See the “E-module and
PDM parameters” tables for details.
SpO2 E-modules
SpO2 E-modules are the E-MASIMO and E-NSATX.
Speciality modules
Speciality modules are the E-NMT, E-EEG, E-BIS, and E-ENTROPY
E-modules. They provide measurement for brain monitoring and
relaxation. See the “E-module and PDM parameters” tables for
details.
E-PSMP front view E-PRESTN front view

1 2 1 2 3 4

5
10 10
3
9
9
8

7 4
8 6
6

7
(1) Auto On/Off (for NIBP)
(2) Start Cancel (for NIBP) (1) Auto On/Off (for NIBP)
(3) Zero P2 (2) Start Cancel (for NIBP)
(4) Tab for removing the module (3) Zero P1
(5) ECG (Imp. Resp.) (4) Zero P2
(6) SpO2 (5) P1-P2
(7) T1-T2 (6) ECG (Imp. Resp.)
(8) P1-P2 (7) Module release latch
(9) NIBP (8) NIBP
(10) Zero P1 (9) SpO2
(10) T1-T2

24
 25

PDM front view PDM power indicator

(1)
ECG (Imp. Resp.) • The power indicator illuminates yellow during boot-up and turns
green after boot-up.
(2)
T1-T2/C.O.
• The power indicator illuminates green when the PDM module is
(3)
P1-P4
powered by the monitor.
(4)
SpO2 • The power indicator illuminates green when the PDM battery is
(5)
NIBP installed and power is applied to the PDM by pressing the Power
1 2 3
(6)
Communication On button.
4 5 6
indicator • The power indicator is not illuminated when no power is applied
7 (7) Power indicator to the PDM module.
(8) Dual function Power PDM communication indicator
On and Zero All
• The communication indicator illuminates yellow during boot-up
9 8 button and turns green after boot-up.
10 (9) Defib/Sync • The communication indicator flashes yellow if communication
(10) Tab for removing fails.
the module • The communication indicator is not illuminated when no power
is applied to the PDM module.
NOTE: The PDM module requires additional time to power up when
PDM battery information
used without the PDM battery. Do not interrupt the startup sequence
by unplugging the PDM module. This manual contains information about the PDM battery. See the
“Care and cleaning” chapter.
PDM safety precautions NOTE: When the monitor is being used on battery power, the PDM
PDM warnings battery is not being charged.
• PHYSICAL INJURY — Do not install the PDM above a patient.
Make sure the battery is completely inserted and the battery
door is completely closed. Falling batteries could seriously or
fatally injure neonatal or other vulnerable patients.
• PHYSICAL INJURY — Do not install the PDM above a patient.
Leaks from the battery cells can occur under extreme conditions.
The liquid is caustic to the eyes and skin. If the liquid comes in
contact with eyes or skin, flush with clean water and seek
medical attention.
E-module and PDM parameters
Most of the acquisition modules measure several parameters. The following tables show the measured parameters for each acquisition
module. The “X” indicates that the module measures the listed parameter. A number indicates that the module measures the listed parameter
and the number of sites that can be measured for that specific parameter.

E-modules ECG Invasive BP SpO2 # SpO2# Nellcor SpO2# Temp NIBP Imp Resp C.O. SvO2
and PDM GE Ohmeda (OxiMax) Masimo
E-PRESTN Up to 12 leads 2* X 2* X X

E-PRETN Up to 12 leads 2* 2* X X

E-RESTN Up to 12 leads X 2* X X

E-PSM Up to 12 leads X 2* X X
E-PSMP Up to 12 leads 2* X 2* X X

PDM (Masimo) Up to 12 leads 4* X 2* (or C.O.) X X X (or 2 Temp)

PDM (Nellcor) Up to 12 leads 4* X 2* (or C.O.) X X X (or 2 Temp)

E-P 1
E-PP 2

E-PT 1 2*

E-COP 1 X
+

E-COPSv 1 X
+ X

E-NSATX X

E-MASIMO X

+ The E-COP and E-COPSv modules also measure ventricular ejection fraction (REF).
*
A dual adapter cable is required to monitor two Invasive BP/Temp measurements on a single connector.
# Different SpO2 cables are required for each type of SpO2 processing. The cable connectors are not interchangeable.

26
 27

Specialty Level of Nerve EEG AEP Entropy BIS

E-modules relaxation stimulation
E-NMT X X

E-EEG X X

E-BIS X

E-ENTROPY X

Gas CO2 N2O O2 Anesthetic Agent Gas exchange Patient

E-modules agents identification Spirometry

E-miniC X +

E-CO X + X

E-COV X + X X

E-COVX X + X X X

E-CAiO X X X X X

E-CAiOV X X X X X X

E-CAiOVX X X X X X X X

+ The E-CO, E-COV, and E-COVX modules automatically compensate for N2O in realtime although N2O values are not displayed on screen. The E-miniC requires
manual selection from the monitor menu to compensate for N2O.
Letters on the airway modules stand for:
C = CO2 (and N2O)
O = Patient O2
V = Patient Spirometry
Ai = Anesthetic agents, anesthetic agent identification
X = Gas exchange
Barcode reader
The barcode reader can be used to scan a Technician ID and Patient
Information from barcodes when admitting patients.
NOTE: The barcode reader comes pre-configured and its
configuration must not be changed. If you change the barcode
reader it will not operate properly with the monitor.
Keyboard
A washable, antibacterial keyboard is specified for use with the
monitor. It may be connected to the monitor or secondary display
via one of the USB connectors on the back of the monitor or at the
bottom of the display. The keyboard allows you to enter data
without using the on-screen keyboard or a touchscreen display.
WARNING: Use only washable keyboards with at least
IPX1 protection against ingress of water.
28
Mouse
A standard mouse may be connected to the monitor or display via
one of the USB connectors on the back of the monitor or at the
bottom of the display. The mouse allows you to select any on-screen
items without a Trim Knob control or a touchscreen display.
Remote control
The remote control provides all patient monitor controls on a
portable component with a Trim Knob control. The remote control
is connected to the patient monitor via one of the USB connectors at
the back of the monitor or at the bottom of the display.
See the “Main menu buttons and control keys” section for a
description of the keys and controls located on the remote control
and keypad.
 29
Laser printers and the recorder option
The monitor can print to a configured network laser printer, or to the
optional recorder in the pivoting module frame, or to a remote
recorder in the network. See the “Printing” chapter for more details.
NOTE: You need the Unity IX Network or the S/5 Network for the
network printer.
Unity Network ID connectivity device
The Unity Network ID connectivity device acquires digital data from
eight individually isolated serial ports. The data is collected from up
to eight peripheral devices (not necessarily manufactured by GE),
then the device transmits the formatted data to the monitor.
For basic information about interfacing with other manufacturer’s
devices, see the “Interfacing with peripheral devices” chapter. For
more detailed information, see the Unity Network Interface Device
(ID) operator and service manuals.
CIC Pro central station iCentral

The CARESCAPE Network MC establishes communication and allows The S/5 Network (Ethernet) establishes communication and allows
patient data to be sent to an optional CIC Pro central station. See the patient data to be sent to an optional iCentral (central station). See
“CIC Pro Clinical Information Center Operator’s Manual” for the “iCentral and iCentral Client, User’s Reference Manual” for
operating instructions. operating instructions.

30
 31

Equipment symbols
NOTE: The following symbols appear on one or more of the devices.
Battery (monitor). The solid green symbol
indicates that the monitor is being used on
battery power.
Bell cancel. Audio off.
Battery (monitor): The battery slot cover is
open/closed.

Audio pause. Temporary audio off.

Battery (monitor): Test button on the battery to

check the battery charge level.


General alarm.
Battery (monitor).

Fuse. Replace with identical type and rating fuse.

Battery (PDM).

Do not reuse.  Communication.


Battery (monitor): The flashing orange symbol
indicates that there is a battery failure/missing Power indicator.
battery.

Battery (monitor): The solid orange symbol

indicates that the battery is being charged.

 Zero all.
 Defibrillator synchronization connector port Alternating current.
On the monitor front panel: the monitor is being
used on mains power.

Direct current.
DVI connector. Video output connector for digital
or analog source.
Equipotentiality. Connect device to a potential
equalization conductor.
USB connector port.

Protective earth ground. Connectors grounded to

the AC power source.
Ethernet connector port.

(WLAN) Class 2 Identifier

Gas inlet.

Date of manufacture. This symbol indicates the

date of manufacture of this device. The first four
Gas outlet.
digits identify the year and the last two digits

identify the month.
Manufacturer name and address.
Degree of ingress protection.

Batch or lot number.

Home. Return to the main display. /27

 lbl p/n Abbreviation for label part number.

32
 33
Catalogue or orderable part number.
Device serial number.
Stacking limit by number.
On/standby button.
Atmospheric pressure limitations.
Temperature limitations.
Humidity limitations.
Keep dry. Protect from rain.
Fragile. Handle with care.
This way up.
This symbol indicates that the waste of electrical
and electronic equipment must not be disposed
as unsorted municipal waste and must be
collected separately. Please contact an
authorized representative of the manufacturer for
information concerning the decommissioning of
your equipment.
Recycled materials or may be recycled.
Mercury. This product consists of devices that
may contain mercury, which must be recycled or
disposed of in accordance with local, state, or
country laws. (Within this system, the backlight
lamps in the monitor display contain mercury.)
 European authorized representative.
CMIIT ID
European Union Declaration of Conformity.
FCC. USA only. Complies with applicable US
government (Federal Communications
Commission) radio-frequency interference
regulations.
Prescriptive Device. USA only. For sale by or on
the order of a Physician.
China only. China Ministry of Industry and
Information Technology identification number for
Radio Transmission Equipment Type Approval.
Australia only. The product complies with the
applicable Australian standard and establishes a
traceable link between the equipment and the
manufacturer, importer or their agent responsible
for compliance.
Japan only. Approved under Japan TELEC
requirements.

Russia only. GOST-R mark.

Certification in Canada by the Canadian

Standards Association CAN/CSA-C22.2 No. 601-1
(1990).

Canada only. Industry Canada certification

IC number indicates that this product meets the
applicable Industry Canada technical
specifications.

34
 35

NOTE: The following symbols (required by China law only) are representative of what you may see on your equipment.
The number in the symbol indicates the EFUP period in years, as explained below. Check the symbol on your equipment
for its EFUP period.
This symbol indicates the product contains hazardous materials in excess of the limits established by the Chinese
standard SJ/T11363-2006 Requirements for Concentration Limits for Certain Hazardous Substances in Electronic
Information Products. The number in the symbol is the Environment-friendly User Period (EFUP), which indicates the
period during which the toxic or hazardous substances or elements contained in electronic information products will not
leak or mutate under normal operating conditions so that the use of such electronic information products will not result
in any severe environmental pollution, any bodily injury or damage to any assets. The unit of the period is “Year”.
In order to maintain the declared EFUP, the product shall be operated normally according to the instructions and
environmental conditions as defined in the product manual, and periodic maintenance schedules specified in Product
Maintenance Procedures shall be followed strictly.
Consumables or certain parts may have their own label with an EFUP value less than the product. Periodic replacement
of those consumables or parts to maintain the declared EFUP shall be done in accordance with the Product Maintenance
Procedures. This product must not be disposed of as unsorted municipal waste, and must be collected separately and
handled properly after decommissioning.
This symbol indicates that this electronic information product does not contain any toxic or hazardous substance or
elements above the maximum concentration value established by the Chinese standard SJ/T11363-2006, and can be
recycled after being discarded, and should not be casually discarded.
User interface symbols
NOTE: The following symbols appear in the software user interface.
Active audio alarms paused indicator. Indicates
an active audio alarm is temporarily paused. For
more information, refer to the “Alarms” chapter.
Pause audio alarms icon. Selecting this option
results in different silence alarm behaviors
depending whether alarms are active and/or
latched or not.

Alarm off indicator. Indicates the alarm is
disabled (turned off). NOTE: The symbol is not
displayed at the central station or on a remote
bedside monitor.
Alarm priority indicator: High (red). Indicates a
high priority alarm.
Reminder volume icon. Adjust the volume of the
tone that sounds every two minutes when audio
alarms are turned off.
Touch volume icon. Adjust the volume of the
tone that sounds when a user touches a
touchscreen display.

Alarm priority indicator: Medium (yellow). Home icon. Close all menus/applications
Indicates a medium priority alarm.
 displayed on the monitor.

Alarm priority indicator: Low (blue). Indicates a

Locking setting indicator. Indicates this setting is
low priority alarm.

Alarm volume icon. Adjust the minimum alarm

& locked and cannot be adjusted.

tone volume. Network connection indicator. Indicates the

monitor is connected to the Local Area Network
Audio alarms off indicator. Indicates the (LAN).
specified alarm group (ALL, APN, APN ECG or
ECG) audio alarms are turned off. Network connection indicator. Indicates the
monitor is connected to the Wireless Local Area
Audio alarms paused indicator. Indicates all Network (WLAN).
audio alarms are paused and the amount of
time remaining for the alarm pause period
displays as a countdown timer.

36
 37
Network (WLAN) signal strength. The number of
segments corresponds to the signal strength:
four segments indicate strong signal, one
segment weak signal. When connection to
access point is being searched the segments
scroll from zero to four and back.
Monitor battery charging indicator. Indicates the
battery is charging.
Monitory battery gauge indicator. Indicates the
Monitor charge level of the battery.
Monitory battery failure indicator. Indicates a
Monitor missing battery or a battery failure.
3'0
PDM battery charging indicator. Indicates the
battery is charging.
3'0
PDM battery gauge indicator. Indicates the
charge level of the battery.
PDM battery failure indicator. Indicates the
3'0 battery is not available for use.
Snapshot indicator. Indicates the event has an
associated snapshot.
Beat volume icon. Adjust the volume of the QRS
beep tone.
Respiration indicator. Indicates a breath is
detected by the impedance respiration
algorithm.
BIS and Entropy sensor impedance check
indicator. Displays for each sensor as the
impedance check is in progress.
BIS and Entropy sensor impedance check error
indicator. Indicates the specified sensor failed
the impedance check.
BIS and Entropy sensor impedance check
passed indicator. Indicates the specified sensor
passed the impedance check.
Completed NIBP volume icon. Adjust the volume
 of the tone that sounds when an NIBP
measurement result is available.
Manual NIBP icon. Start a manual NIBP
 measurement.
Nellcor OxiMax SatSeconds indicator. Indicates
the amount of time the SpO2 saturation is
outside the limits before alarms are generated.
SpO2 signal strength indicator. Indicates the
signal strength, with three asterisks indicating
the strongest signal.
NMT Stimulus beep volume icon. Adjust the
volume of the tone that sounds when a stimulus
pulse is generated.

Progress bar. Indicates the amount of time

remaining until the next automatic
measurement.

38
 39

For your notes

Monitoring basics
WARNING: Do not use identical measurement Connecting a PSM or PDM
1. Connect a module by aligning it with the insertion guides on the
modules or modules that map a measurement to the
pivoting module frame.
same channel or parameter window. If such modules 2. Push the module into the frame until it clicks and stops.
have been connected, remove the module that has
been most recently connected. You can also remove
both modules and re-connect the new module after
five seconds.

Identical modules
The following modules are considered identical and should not be
used simultaneously in the same monitoring system.

To monitor: Select one of these modules:

ECG, NIBP, SpO2, Temp, E-PRESTN, E-PRETN, E-RESTN,
Pressure, Resp E-PSM, E-PSMP, PDM

C.O., Pressure, SvO2 E-COP, E-COPSv NOTE: The PDM module requires additional time to power up when
used without the PDM battery. Do not interrupt the startup sequence
CO2, O2, N2O, Patient E-CO, E-COV, E-COVX, by unplugging the PDM module.
Spirometry, anesthetic E-CAiO, E-CAiOV, E-CAiOVX, E-miniC
agents and their Removing a PSM or PDM
identification, gas exchange 1. Pull the pull tab out and slide the module out of the guides.
Pressure E-P, E-PT 2. Hold onto the module to make sure it does not drop when it
comes out.
Separate SpO2 E-NSATX, E-MASIMO
measurement

Measurement channel mappings are defined in the “Pulse oximetry

(SpO2),” “Invasive blood pressures,” and “Temperature” chapters.

40
 41
Connecting other E-modules than PSM
1. With the module properly oriented (module release latch facing
down), align the insertion guide slot in the module with the
insertion guide in the module frame.
2. Push the module into the module frame until it clicks.
Removing other E-modules than PSM
1. Press the release latch on the bottom lefthand side of the
module.
2. Grasp the module firmly and pull out of the module frame.
 The Information area of the screen, when selected with the mouse,
Main screen layout
Trim Knob, or via the touchscreen display, opens the
The main screen displays alarms, information, trends, snapshots, Admit/Discharge window and provides access to the Patient, Load
waveforms, parameter windows, and the main menu in pre-defined Patient, Administr. Information and Standby tabs.
areas.
NOTE: If the OR or PACU software packages are used, a Case Setup
Alarm area Information area window opens and the Standby tab is not available.

In addition, the information area of the screen displays the following

information:
Split screen area Waveform area Upper • Patient name (if entered).
(option). You may parameter • Profile name that is being used for patient monitoring.
also select windows • PDM battery gauge and battery status icons if a PDM module is
Minitrend as connected to the monitor.
option for this • Monitor battery gauge and battery status icons if the optional
area. battery is inserted in the monitor.
• Bedname and care unit of the local monitor (if connected to the
CARESCAPE Network MC).
• Network symbol (if connected to the CARESCAPE Network MC or
Lower parameter windows (option) S/5 Network).
Main menu area • WLAN signal strength symbol (if connected to the wireless
network).
• Current time of day.

42
 43

Main menu buttons and control keys

The monitor’s main menu buttons, remote control (optional), and integrated keypad (optional) can be used to access various functions of the
monitor. A Trim Knob control is located on the remote control and integrated keypads. It is used for selecting menus and menu options. The
“X” indicates that the listed function is supported by the main menu or input device.

Non-touch display Touchscreen display

Main Remote
Key Function (monitor’s built-in (monitor’s built-in
menu control
and GE 15-inch) and GE 19-inch)

Home. Close all menus/applications displayed on the

 monitor.
X X X X

Pause audio alarm. Pause active audio alarms or pre-

X X X X
pause audio for incoming active alarms.

Alarm Setup Review alarm limits, alarm priorities, arrhythmia alarm

X X X
settings, and audible and visual alarm indicators.
Monitor Setup Select screen setup, parameter colors, sound volumes,
brightness settings, parameter settings, printing setup,
view optional monitor battery status, view PDM battery
status (when the PDM module is connected to the
X X X
monitor), and invasive blood pressure calibration. In
addition, the following password protected functions
are also displayed: Default setup, service calibrations,
service.
Procedures Select cardiac output, catheter insertion, wedge, 12
lead analysis, ST trends, and Patient Spirometry loops X X X
procedures. Select elapsed time or countdown timers.
 Non-touch display Touchscreen display
Main Remote
Key Function (monitor’s built-in (monitor’s built-in
menu control
and GE 15-inch) and GE 19-inch)
Data & Pages View drug calculator, laboratory data, calculations for
hemodynamic, oxygenation, and ventilation
measurement values, other patients on the network,
X X X
admit/discharge patient (ICU, ED, and NICU software
packages), start/end case (OR and PACU software
packages), and select predefined pages on screen.
Trends View or print graphic, numeric, snapshot, or ST-
X X X
snapshot trends. View or print event data.
Print Waveforms Print or stop printing the parameter waveforms. After
or Stop Printing selection, the button toggles to Stop Printing.
NOTE: To stop printing with the remote control and X X X
non-touch 15-inch display press Print Waveforms a
second time.
Freeze/Snapshot Freeze or unfreeze the scrolling waveforms. After
or Unfreeze selection, the button toggles to Unfreeze. Press the
button again to deactivate freezing. Or, freezing will
automatically end after 15 seconds.
X X X
A snapshot is taken every time this key is selected.
NOTE: To unfreeze the waveform with the remote
control and non-touch 15-inch display press Freeze/
Snapshot a second time.
NIBP Auto Start or Start or stop an automatic non-invasive blood
NIBP Auto Stop pressure measurements at timed intervals. After X
selection, the button toggles to NIBP Auto Stop.
NIBP Start or NIBP Start or stop a non-invasive blood pressure
Cancel measurement. After selection, the button label toggles X
to NIBP Cancel.

44
 45

Non-touch display Touchscreen display

Main Remote
Key Function (monitor’s built-in (monitor’s built-in
menu control
and GE 15-inch) and GE 19-inch)
NIBP Auto Start or stop automatic non-invasive blood pressure
X X
measurements at timed intervals.
NIBP Start/Stop Start or stop a non-invasive blood pressure
X X
measurement.
Parameters Select and review parameter settings. X X

Zero All Pressures Zero all invasive blood pressure channels. NOTE: This X X X
does not apply for ICP.
 Radio button menu options
Selecting menu options
Some menu options are radio buttons. A radio button is a graphical
In this manual, the term “select” means using the mouse, Trim
user interface element that allows you to choose one of the
Knob control, or touchscreen display to select an item on the
predefined sets of options:
display screen.
To select menu options with a mouse Selection is not active. Selection is active.
1. Move the mouse until the pointer (arrow) is on the menu option
you wish to select. Check box menu options
2. Click the left mouse button once. Some menu options are check boxes. A check box is a graphical user
interface element that allows you to choose one or more of the
To select menu options with a Trim Knob control predefined sets of options:
1. Rotate the Trim Knob control in either direction to move the
highlighted cursor from option to option on the display. Selection is not active. Selection is active.
2. Press the Trim Knob control once to select the highlighted
option. List selections
Similar to selecting menu options, you can use a mouse, Trim Knob
To select menu options with a touchscreen
control, or touchscreen to select items from a list.
Simply touch the menu option with your finger.

NOTE: Do not use pencils, pens, or other sharp objects to activate the List name
touchscreen. The touchscreen will not function properly if tape or
paper is stuck to the display surface. Option 1

Tab menu options Option 2 (now selected)

Some menu options are accessible from different tabs. A tab is a
navigational element for switching between sets of options. It is a Option 3
text label that appears at the top of the window. Activating a tab
makes its associated content visible.

Tab text 1 Tab text 2 Tab text 3

46
 47

Typing data into a data field Locked alarm and parameter settings
You can use the on-screen keyboard or a standard keyboard to type Some care unit and profile settings can be locked. These settings
data into a data field.
are indicated with a lock symbol: &
NOTE: You can select a data field with a mouse, Trim Knob control,
or touchscreen. Clinicians cannot adjust locked settings for the admitted patient.
The alarm and parameter settings that can be locked vary by
To type with a standard keyboard acquisition module and care unit settings. See the “CARESCAPE
To type data into a data field using a standard keyboard, do the Monitor B650 Supplemental Information Manual” for the factory
following: default settings.

1. Select the desired data field.

2. Type the desired text into the selected field with the keyboard.
To type with an on-screen keyboard
When data entry is required, the monitor automatically displays an
on-screen keyboard for you to use.
To type data into a data field when the on-screen keyboard is
available for use, do the following:
1. Select the desired field.
The selected field changes to the color yellow, indicating that
you may begin entering text.
2. Select the characters you wish to type with the mouse, Trim
Knob control, or touchscreen.
Putting the monitor into operation
Safety precautions
Site requirement warnings
• BEFORE INSTALLATION — Compatibility is critical to safe and
effective use of this device. Please contact your local sales or
service representative prior to installation to verify equipment
compatibility.
• LOSS OF MONITORING — Leave space for circulation of air to
prevent the monitor from overheating. The manufacturer is not
responsible for damage to equipment caused by improperly
vented cabinets, improper or faulty power, or insufficient wall
strength to support equipment mounted on such walls.
Site requirement caution
• PACKAGING DISPOSAL — Dispose of the packaging material,
observing the applicable waste control regulations.
Electrical warnings
• POWER SUPPLY — The device must be connected to a properly
installed power outlet with protective earth contacts only. If the
integrity of the protective earth conductor is in doubt, disconnect
the monitor from the power line and use it with the battery
option if available. If the installation does not provide for a
protective earth conductor, disconnect the monitor from the
power line. All devices of a system must be connected to the
same power supply circuit. Devices which are not connected to
the same circuit must be electrically isolated when operated.
• EXCESSIVE LEAKAGE CURRENT — Do not use a multiple socket
outlet or extension cord.
• INTERFACING OTHER EQUIPMENT — Devices may only be
interconnected with each other or to parts of the system when it
has been determined by qualified biomedical personnel that
48
there is no danger to the patient, the operator, or the
environment as a result. In those instances where there is any
element of doubt concerning the safety of the connected
devices, the user must contact the manufacturers concerned (or
other informed experts) for proper use. In all cases, safe and
proper operation should be verified with the applicable
manufacturer’s instructions for use, and system standards IEC
60601-1-1/EN 60601-1-1 must be complied with.
• EXCESSIVE LEAKAGE CURRENT — When interfacing the device
with other equipment, the devices may only be interconnected
with each other or to parts of the system when it has been
determined by qualified biomedical personnel that there is no
danger to the patient, the operator, or the environment as a
result.
Electrical caution
• POWER REQUIREMENTS — Before connecting the device to the
power line, check that the voltage and frequency ratings of the
power line are the same as those indicated on the device’s label.
If this is not the case, do not connect the system to the power
line until you adjust the device to match the power source. In
U.S.A., if the installation of this equipment will use 240V rather
than 120V, the source must be a center-tapped, 240V, single-
phase circuit. This equipment is suitable for connection to public
mains as defined in CISPR 11.
 49

Operation warnings • The environmental operating conditions specified in the

• After transferring or reinstalling the monitor, always check that it technical specifications must be ensured at all times.
is properly connected and all parts are securely attached. • The monitor is designed to comply with the requirements of IEC
• If you accidentally drop the monitor or modules, have them 60601-1/EN 60601-1.
checked by authorized service personnel prior to clinical use. • Using the power cord supplied with the monitor, connect it to the
• When detaching modules, be careful not to drop them. Always power line. Use only the original cord.
support with one hand while pulling out with the other. • For measurements in or near the heart, we recommend
• To prevent liquids from entering the display casing, do not tilt the connecting the monitor to the potential equalization system. Use
display more than +/- 15 degrees. the green and yellow potential equalization cable and connect it
• To prevent liquids from entering the monitor, do not tilt the to the pin labeled with the equipotential ( ) symbol.
monitor more than +/-15 degrees.
• ACCURACY — If the accuracy of any value displayed on the
Turning on the power to the monitor
monitor, central station, or printed on a graph strip is
questionable, determine the patient’s vital signs by alternative NOTE: The monitor is preset at the factory for a specific AC voltage.
means. Verify that all equipment is working correctly. Before applying power, be sure that the power requirements match
Operation caution your power supply. Refer to the label on the monitor back panel for
voltage and current requirements.
• The device/system should not be used adjacent to, or stacked
with, other equipment. Consult qualified personnel regarding 1. When all cables are properly connected, press the on/standby
device/system configuration. button located on the monitor front panel.
2. Turn on the power to the optional clone display screen. After
Monitor installation points to note approximately 10 seconds, a display will appear on the monitor.
• To avoid electrostatic charges building up, it is recommended to
store, maintain and use the equipment at a relative humidity of
30% or greater. Floors should be covered by ESD dissipative
carpets or similar ESC dissipative products. Non-synthetic
clothing should be used when working with the component.
• Choose a location that affords an unobstructed view of the
display and easy access to the operating controls at the monitor
or remotely via View on Alarm or central station monitoring.
• Set up the monitor in a location that affords sufficient ventilation.
The ventilation openings of the device must not be obstructed
(by equipment, walls, or blankets, for example).
Performance check
After turning on the monitor, and during operation, the monitor runs
automatic self-tests. If a malfunction is detected, the monitor
displays a message or an alarm, depending on the severity of the
malfunction.
Service PDM message
After connecting the PDM module, and during operation, the PDM
module runs automatic self-tests. If a malfunction is detected, the
monitor displays a ‘SERVICE PDM’ message. If this message displays,
do not use the module and contact your authorized service
personnel.
50
Pre-monitoring checklist
Before you start monitoring a patient check the following:
• Acquisition module is firmly in place.
• Accessories are intact and properly connected.
• Monitor is displaying the monitoring screen.
• No messages display indicating the monitor or acquisition
module is not functioning.
• Desired parameters are selected to view on the screen.
• Alarm signals are working and can be seen and heard in your
care environment.
• Required parameter calibrations are completed.
Supply main interruption
If the monitor is used without the optional battery and its AC power
is interrupted for less than 15 minutes, the monitor keeps the trend
data and the latest user-made settings. If not, contact authorized
service personnel. After 15 minutes, all patient information and trend
data is lost and the monitor returns to the user default settings
(start-up mode). For more information, see the technical manual.
NOTE: If there is a power failure and the monitor is used without the
optional battery, the monitor gives a medium priority alarm. This
alarm remains active for at least two minutes, or until it is silenced
from the Silence Alarms key, or until the power is reconnected.
 51
Interfacing with peripheral devices
Safety precautions
In addition, see the safety precautions for “Putting the monitor into
operation.”
NOTE: For a list of compatible peripheral devices, see the “Unity
Network Interface Device (ID) Operator’s Manual.”
Peripheral device warnings
• SINGLE PATIENT USE — All eight serial ports of the Unity Network
ID connectivity device must only be used on one patient.
• TREATMENT — Do not treat the patient based solely on the alarm
messages and/or numerics presented via the Unity Network ID
connectivity device. You must verify the accuracy of the alarm
message and/or numerics at the peripheral device itself before
initiating treatment, treatment should be based on the
information presented at the peripheral device.
Peripheral device cautions
• Always verify the compatibility of the software versions before
use; refer to the “Unity Network Interface Device (ID) Operator’s
Manual.”
• INSTALLATION — To avoid accidental ingress of liquids, always
mount the Unity Network ID connectivity device in a vertical
position with the connectors at the bottom.
• INSTALLATION — Qualified technical personnel must connect the
interface adapter to the peripheral device and make any
necessary adjustments to the peripheral device (baud rate,
parity, etc.) as described in the specific installation instructions
for the interface adapter. Insert cabling from the connectivity
device only into specified interface adapters and specified
peripheral devices. To avoid inadvertent disconnection, route all
cables in a way to prevent a stumbling hazard. Wrap and secure
excess cabling to reduce risk of entanglement by patients and
personnel. Do not install in a location where the device may drop
on a person.
Unity Network ID connectivity device
The monitor can interface with peripheral medical devices, such as
ventilators and gas delivery systems, to centralize patient data on
one device. A Unity Network ID connectivity device is used with the
monitor to communicate with peripheral devices.
NOTE: The monitor can only display information that the peripheral
device sends. The parameters sent vary with each peripheral device
and are subject to change.
In some cases, the peripheral device may impose alarm control
parameters that you may not be able to change or silence with the
monitor’s controls.
52
Unity Network ID interconnection
The Unity Network ID connectivity device connects to the monitor
via the Ethernet port labeled “ID” on the back of the monitor.
A factory-programmed adapter is required for each peripheral
device to communicate with the connectivity device. (Refer to the
instructions provided with the interface adapter for adapter setup
and installation instructions.)
CAUTION: The use of the wrong interface adapter may
cause improper operation of the supported peripheral
device.
(1) Interface adapters
Once the interface adapter is permanently connected to the
peripheral device, the cable can be plugged into any one of the eight
serial ports on the connectivity device.
 53

Unity Network ID serial port indicator lights

Each serial port on the connectivity device has an indicator light located directly above it. The light indicates the status of the serial port.

Green-colored indicator Yellow-colored indicator Serial port status Description

Off No connection Nothing is connected to the associated serial port
Off
or the interface connector is not operational.
Off On Communication pending Cable and interface adapter are connected, but
the supported device communication is not yet
established.
Off Slow blinking (once every 2 Communication error Connected, but communications error with
seconds) supported device.
Off Fast blinking (twice every Other errors Indicates:
second) - Too many supported devices of one type are
connected.
- Interface adapter is malfunctioning.
- Supported device software is not compatible
with the monitor software.
- Interface adapter is not supported by the
monitor software.
On Off Working Communication with the supported device is good.
Peripheral device parameter data
The data from a peripheral device that is displayed at the monitor varies with each device. The chart below gives some general information as
to what data is available to the monitoring system and how it is handled (trending, alarm broadcast, etc.). See the Unity Network Interface
Device (ID) operator and service manual for more detailed information regarding waveforms and alarms.

Peripheral device type Waveformsa, b Parameter Trends Alarm broadcastb Printouts Data to a central
windows stationc
Pulse oximeters No Yes Yes Yes Yes No
Transcutaneous No Yes Yes Yes Yes No
monitors
Ventilators Yes Yes Yes Yes Yes Limited
Gas analyzers No Yes Yes Yes Yes Yes
Continuous cardiac No Yes Yes Yes Yes No
output
Anesthesia machines Yes Yes Yes Yes Yes Yes
POC blood gas monitors No Nod Yes No No No

a. Unity Network ID connectivity device supports only digital waveforms.

b. See the Unity Network ID connectivity device operator and service manual for more details.
c. CIC version 1.0 and subsequent.
d. POC blood gas monitor data is displayed in Data & Pages > Laboratory Data window.

54
 55

Peripheral device alarm limits
The alarm limits are not adjustable when the measurement source is
from an external device connected to the Unity Network ID
connectivity device. Alarm limits can be turned on or turned off only.
Peripheral device parameter windows and menus
The data displayed in the parameter window may vary with each
device. Not all menu options are available with all devices.
Ventilators, gas analyzers, continuous cardiac output devices, and
anesthesia machines are capable of sending a number of
parameters to the monitor. In some cases, not all can be displayed
at one time.
Transcutaneous pO2/pCO2
The TC parameter window displays a pCO2 value, pO2 value, site
temperature value, and probe power value. The Ext indicates the
data is from an external source. There is no associated waveform or
parameter menu.
NOTE: Only one TC measurement from an external source can be
connected and active simultaneously.
Ventilators
The monitor displays Ppeak, Pplat, Pmean, PEEPtot, PEEPi, PEEP,
TVexp, TVinsp, MVexp, MVspont, Compl, Raw, I:E ratio, and static
Compl measurement data.

NOTE: See the “Unity Network Interface Device (ID) Operator’s
Manual” and the peripheral device manufacturer’s manuals for
more information.
Pulse oximeters
The SpO2 parameter window displays a saturation value and a pulse
rate. The Ext indicates the data is from an external source. There is
no associated waveform or parameter menu.
Anesthesia machines and gas analyzers
The monitor displays CO2, Resp Rate, O2, N2O, Halothane, Desflurane,
Enflurane, Isoflurane and Desflurane measurement data.
Laboratory data
The monitor provides a View and an Enter Data menu.

NOTE: Only one SpO2 measurement from an external source can be

actively displayed on the monitor.
SvO2
The SvO2 parameter window displays SvO2 index data and a signal
quality indicator (None, *, **, ***). For reliable saturation values, the
signal strength indicator should be higher than one asterisk. The
measurement range of SvO2 is from 0 to 100%. The Ext indicates the
data is from an external source. Guard limits do not affect alarms
from an external source.
Continuous cardiac output
Software compatibility
The interfaced continuous cardiac output measurement provides
See the Unity Network Interface Device (ID) manuals for software
C.O., Blood temperature, CCO, and SVR measurements depending on
compatibility information.
interfaced device. The Ext indicates the data is from an external
source.

The following conditions apply with the interfaced continuous

cardiac output measurement:
• The C.I. value for interfaced device is computed using the
following equation C.I. = C.O. / BSA.
• The C.I. value for interfaced device is invalid if BSA from the
monitor is not available.
• The CCI value for interfaced device is computed using the
following equation CCI = CCO / BSA.
• The CCI value for interfaced device is invalid if BSA from the
monitor is not available.
• The SVR value for the interfaced device shall be computed using
the following equation SVR = ((MAP - CVP) / CCO) * 79.9.
• The SVR value for the interfaced device shall be invalid if MAP,
CVP or CCO from the monitor are not available.
• The SVRI value for interfaced device shall be computed using the
following equation SVRI = ((MAP - CVP) / CCI) * 79.9.
• The SVRI value for the interfaced device shall be invalid if MAP,
CVP or CCI from the monitor are not available.
• The resolution of the C.O. values is 0.1l/min.
• TBlood value is the only temperature value displayed. The
Tblood-T1 temperature alarm limit is adjustable.

NOTE: The patient's BSA is available after patient’s height and weight
is entered in the monitor.

56
 57

For your notes

Setting up the monitor before use
This chapter introduces you to sound and brightness controls,
parameter areas, parameter windows, pages, and different
selections you can make to modify the screen according to your
needs. A graphic presentation of a generic layout can be found in
the “Monitoring basics” chapter.
Adjusting sound volumes
You can adjust various sound volumes according to your care
environment needs. While you are adjusting the volume, you will
hear a corresponding sound that will guide you in determining a
suitable level. All volumes other than Alarm Volume can be set to 0 if
required.
1. Select Monitor Setup > Sound Volumes.
2. Adjust the different sound volumes from the lists:
- Beat Volume
- Completed NIBP Volume
- Stimulus Beep Volume
- Alarm Volume. NOTE: For more information, see the “Alarms“
chapter.
- Touch Volume. This setting is not adjustable if the selection
has been locked. For more information, see the "CARESCAPE
Monitor B650 Supplemental Information Manual."
58
Adjusting the brightness settings
Using automatic brightness adjustment
With the automatic adjustment, the display brightness is
automatically set according to the ambient light. Also, the keypad
light comes on automatically when the brightness level of the
display stays below or above set default limits for more than 10
seconds.
1. Select Monitor Setup > Brightness.
2. Select the radio button for Automatic.
Using manual brightness adjustment
With the manual adjustment, you can set the display brightness
level and select the keypad light on or off according to your needs.
1. Select Monitor Setup > Brightness.
2. Select the radio button for Manual.
3. Select Display % and adjust the display brightness in the range
of 30% to 100%.
4. Select Keyboard and set the keyboard light On or Off.
Adjusting the alarm light brightness
The Brightness menu also includes the alarm light brightness
adjustment. For more information, see the “Alarms“ chapter.
1. Select Monitor Setup > Brightness.
2. Select the radio button for Manual.
3. Select Alarm Light % and adjust the brightness.
 59
Using pages
When monitoring begins, the main page appears automatically. This
preconfigured page is called the normal screen. Any changes you
make to the screen setup during monitoring are changes to this
normal screen. These changes are not permanent unless they are
saved to a profile. They are valid until the case is reset/the patient is
discharged from the monitor. They are also kept in the monitor
memory for 15 minutes after the power is turned off.
Pages are user-defined screen formats. The contents are
preconfigured but can be changed. Page configuration is password
protected, but once the pages are configured they can be selected
to screen by all users. There may be pages designed, for instance, for
physicians, surgeons, or nurses. For more information on page
configuration, see the “CARESCAPE Monitor B650 Supplemental
Information Manual.”
In addition to the normal screen, each profile can have up to five
additional pages and some of these may be preconfigured. These
additional pages are needed for instance when all the measured
parameters do not fit on the normal screen page. These pages can
also include information that is needed only during a specific phase
of care. The name of the page currently in use is always displayed in
the upper part of the screen.
Selecting the normal screen
By selecting this icon or key you can return to the normal
screen any time during monitoring. You can also return to the
normal screen through Data & Pages > Normal Screen.
Selecting other pages
To view information on other pages during monitoring:
1. Select Data & Pages.
2. Select the radio button of the page you want to see.
3. You can return to the normal screen (as you have configured it)
by selecting the home icon or home key, or through
Data & Pages > Normal Screen.
Modifying the screen setup
Selecting parameters to the screen
Most parameters appear on screen automatically when their
measurement starts. However, if you cannot see the parameter you
are measuring, select it to the screen:
1. Select Monitor Setup > Screen Setup.
2. Select the parameter to the upper or lower parameter area:
• Select Upper Parameter Area >Show Parameter.
• Select Lower Parameter Area and check the radio button for
this parameter.
Upper parameter area
NOTE: If the parameter is still not visible in the upper parameter area
after you have selected it to the screen, raise its priority with the
arrow keys in the Order column. Since only active parameters are
displayed on screen, ensure that the Active column has a check
mark for the parameters you want to see. If you want to hide the
waveform of a parameter, deselect Show with Waveform.
You can configure a maximum of eight individual waveforms and up
to 16 parameter windows in the Upper Parameter Area, provided
that the Lower Parameter Area is selected off. One parameter
window can show more than one parameter when parameter
combinations (such as SpO2 & SvO2) are used.
You can also combine invasive pressure waveforms. ECG or ST
monitoring reduces the number of upper parameter windows by
one, and monitoring both of them reduces the number by two.
Lower parameter area
NOTE: Any numeric parameter window in the lower parameter area
having an empty field (=OFF) above or below it is automatically
enlarged.
You can configure a maximum of eight lower parameter windows.
When the lower parameter windows are on, they reduce the space
used for waveforms and upper parameter windows: you can then
choose up to six waveforms and 12 parameter windows to display in
the upper parameter area of the screen.
60
Understanding parameter windows
The parameter windows show numeric or graphic presentation of
the measurement data. Each window can contain one or several
parameters according to what you have chosen.
The parameter windows can be of four different sizes according to
the number of selected and active parameters on screen. The sizes
can be described as big (full width, full height), small (half width, half
height), tall (half width, full height), and wide (full width, half height):
SMALL
WIDE
BIG TALL
Selecting the display mode for invasive blood pressure
waveforms
You can select the invasive blood pressure waveforms to be shown
as individual waveforms, or in a combined view.
1. Select Monitor Setup > Screen Setup.
2. Select Upper Parameter Area.
3. Select an option from the Invasive Pressure Waveforms list:
- To combine the currently displayed adjacent waveforms (2
to 4), select Combined. The new waveform field will use the
combined height of the original fields.
- To combine up to four waveforms in one field, select 4invP.
The new waveform field will use the height of two upper
parameter windows.
 61
Setting up a split screen
You can also split the waveform area into two parts. The split screen
option divides the screen so that you can view graphic and/or
numeric data of the chosen measurement on the left while still
having waveforms and parameter windows visible at the same time.
To set up a split screen:
1. Select Monitor Setup > Screen Setup.
2. Select Split Screen.
3. Check the radio button for the type of split screen you need:
- Off (no split screen)
- ST shows current and reference QRS complexes and ST
trends.
- Spiro 1 is a basic view of Patient Spirometry data
- Spiro 2 is an enhanced view of Patient Spirometry data
- EEG shows the EEG compressed spectral array (CSA)
- AEP shows the current auditory evoked potential waveforms
- Minitrend shows minitrends beside waveforms. For more
information on this licensed option, see the “Trends and
snapshots“ chapter.
Selecting colors
You can select display colors for the timer and all parameters
according to your needs. However, note that these settings are not
adjustable if the selection has been locked. For more information,
see the “CARESCAPE Monitor B650 Supplemental Information
Manual.”
Selecting colors for invasive blood pressure labels
1. Select Monitor Setup > Colors.
2. Select Invasive Pressures tab.
3. Select Labels and select the colors from the lists.
Selecting colors for invasive blood pressure channels without
label
1. Select Monitor Setup > Colors.
2. Select Invasive Pressures tab.
3. Select Channels and select the colors from the lists.
Selecting colors for other parameters and timer
1. Select Monitor Setup > Colors.
2. Select Other Parameters tab.
3. Select Common or Specific, and select the parameter colors
from the lists. You can select the color for the timer through
Specific > Timer.
Configuring parameters
Before monitoring a patient, always check the parameter setup
settings and alarm limit values. Parameter settings and alarm limit
values can be configured by selecting Monitor Setup > Parameter
Setup, then selecting a parameter. For more information on
parameter-specific setup options, see the relevant parameter
chapter.
Setting up printing options
You can check that the printing options for waveforms, reports and
devices are set according to your needs when you start monitoring a
patient.
1. Select Monitor Setup > Printing.
For more information on different options, see the “Printing” chapter.
Setting the touchscreen off
If you have a touchscreen display, you can set the touchscreen
feature off for 30 seconds at a time when you need to clean the
screen. The countdown timer appears on the screen.
To set the touchscreen off:
1. Select Monitor Setup > Touchscreen Off.
You can enable the touchscreen immediately by pressing any
monitor hardkey or the Trim Knob, or by selecting Cancel in the
Touchscreen Off display.
62
Checking the monitor battery status
This menu is only available when an optional monitor battery is
used. To check the battery status:
1. Select Monitor Setup > Battery Status.
2. Select the Monitor tab.
Battery status information is now available. For more information on
the optional monitor battery, see the “System introduction“ and
“Care and cleaning“ chapters.
Checking the PDM battery status
This menu is only available when a PDM is used. To check the battery
status:
1. Select Monitor Setup > Battery Status.
2. Select the PDM tab.
Battery status information is now available. For more information on
the PDM battery, see the “Care and cleaning“ chapters.
Making other setup changes
All other setup changes - like care unit settings and profile settings -
require a password. For more information, see the “CARESCAPE
Monitor B650 Supplemental Information Manual.”
 63

For your notes

Alarms
Safety precautions
Alarm warnings
• When the alarms are off or while alarm audio is paused either
temporarily or indefinitely, observe the patient frequently.
• Always make sure that the audio alarm volume level is adequate
in your care environment.
• Always make sure that necessary alarm limits are active and set
according to the patient's clinical condition when you start
monitoring a patient.
• Verify alarm processing is active and check the patient to ensure
no arrhythmias occurred during a power interruption.
• The secondary display does not sound audible alarms. Therefore,
always keep the patient under close surveillance.
• Alarms do not sound, alarm histories are not stored, alarm
graphs do not print, and alarms are not sent to the network
when the alarms are turned off.
• Alarms do not sound and alarms are not sent to the CARESCAPE
Network MC during Audio Pause.
• The peripheral device’s alarms must not be turned off or the
volume reduced in any way to diminish the importance of the
peripheral device as the primary alarm source for parameters
monitored by the peripheral device.
• The audible alarm signal may be paused temporarily from a
central station.
• A maximum of four beds can be displayed in the alarm area at
one time, five beds when no local alarms are present. Do not use
automatic view on alarm (AVOA) as a replacement for a primary
alarm source or as a central station.
64
• Only the most recent, highest priority alarm is sent to remote
devices on the CARESCAPE Network MC. Therefore, less recent
alarms of equal or lower priority may not be displayed or may
not be indicated with their associated priority remotely.
• Alarm messages may not be visible on the alarm display area
when one higher priority local alarm and four remote alarms are
active.
• Latched alarms are not retained through a monitor reset if the
alarm condition has been removed.
• The secondary alarm system shall not be relied upon for receipt
of alarm signals.
• Equipment malfunctions, network disconnection, and alarm
volume settings may result in missed alarms. Always keep the
patient under close surveillance.
• MIXED ENVIRONMENT— A hazard can exist when the same type
of monitors in the same care area are using different monitoring
profiles and default configuration settings.
• MISSED ALARM — Do not rely on receipt of the following alarm
conditions at a central station, remote bedside, or alarm
notification device when connected to the CARESCAPE Network
MC. Notification of any of these alarms will only be given when it
is the most recent, highest priority active alarm coming from the
bedside monitor.
This applies to the following limit alarms and technical alarms:
- ECG HR limit alarms (if Single HR mode and Primary HR is not
ECG)
- QT and QTc high limit
- CPP high/low limit
- Tblood-T1 Delta and Tblood-T3 Delta high limit
- RE and SE high/low limit
 65

- PEEPtot, PEEPe, PEEPi high/low limit Alarm conditions

- MVexp high limit • Physiological alarm conditions are triggered by a patient
- IP systolic & diastolic high/low limit for sites: P1-P8, ICP, CVP, measurement exceeding the parameter limits, or by an
RAP, RVP, LAP, UVC, FemV arrhythmia condition.
- ‘No Px transducer’ • Technical alarm conditions are triggered by an electrical,
- ‘SvO2 cable off’ mechanical, or other failure of the equipment, or by failure of a
- Measurement Removed for ECG, Pressure, NIBP, SpO2, SvO2, sensor or component. Technical alarm conditions may also be
CO, Temp, Gas caused when an algorithm cannot classify or interpret the
- Identical Modules for BIS, Entropy available data. The visual manifestation of a technical alarm is
- ‘Remove one ECG module’ active as long as the reason for that alarm exists.

Alarms overview Alarm priority levels

Physiological and technical alarms are categorized by priority level:
Alarm types • High priority alarms require an immediate response.
The monitor provides two types of alarm settings, system and • Medium priority alarms require a prompt response.
patient-specific. • Low priority alarms require you to be aware of this condition.
• Messages provide additional information.
System alarm settings are set globally across an entire unit. They are
configured at the time of installation and are password protected. Alarm priority escalation
Examples of configurable system alarm settings are: An escalating alarm starts at a designated priority level (low or
- Minimum alarm volume allowed medium) and will escalate to the next higher priority level of alarm
- Audio and alarm light off allowed (after a set number of seconds) if the alarm condition has not been
- Absolute (Guard) settings resolved. It is important to note that these escalate up to the next
level but will not reset until the condition has been resolved.
Patient-specific alarm settings are individualized, based on a
patient’s current condition. Examples of bedside alarm settings are: NOTE: Alarm priority escalation affects the currently ongoing alarm
condition, not any future alarms of the same type. Any new alarms
- Parameter alarm limits
will alarm at their designated priority level, not at the escalated level.
- Arrhythmia alarm priority settings
For more information about alarm priority escalation, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”
Physiological alarms’ activation criteria
Physiological alarms have individual activation criteria as shown in the table. Alarm annunciation does not depend on case activity.

Parameter Alarm activation criteria

ECG Active measurement for 30 seconds.
Impedance respiration Active measurement for 30 seconds.
SpO2 Active measurement for 60 seconds.

NIBP Manual, Automatic, or Stat mode started.

IBP Active measurement for 60 seconds from sites Art, ABP, Fem, or UAC.
Temperature Active as soon as measurement readings are available.
C.O. Active as soon as continuous measurement readings are available from the Unity Network ID connectivity
device.
SvO2 Active as soon as measurement readings are available.

Gases Active measurement for 60 seconds without apnea.

Patient Spirometry Active if the module is connected and communicating with the monitor.
Entropy Active as soon as measurement readings are available.
EEG When EEG is present and active for 15 seconds.
BIS Active measurement for 30 seconds.
TC Active measurement for 60 seconds.

NOTE: If the monitor is connected to the network, the alarms can be

heard and seen at the central station. See the central station’s user’s
manual for details.

66
 67

Alarm indications
Alarm icons display on the screen

Pause audio alarms indicator - Selectable from the monitor’s main menu.

Audio alarms paused indicator with countdown timer - Indicates all audio alarms are paused and the amount of time remaining
for the alarm pause period displays as a countdown timer. Displays in the upper left corner of the display screen.

Active audio alarms paused indicator. Indicates an active audio alarm is temporarily paused.

Audio alarms off indicator - Displays in the upper left corner of the alarms area of the display screen when physiological audible
alarms are turned off. See “Turning on/off audible alarms.”

Alarm off indicator - Displays in the upper right corner of the parameter window and in the Alarms Setup window when
physiological alarms for this parameter are turned off. NOTE: The symbol is not displayed at the central station or on a remote
bedside monitor.

Alarm priority indicator: High (red). Indicates a high priority alarm.

Alarm priority indicator: Medium (yellow). Indicates a medium priority alarm.

Alarm priority indicator: Low (blue). Indicates a low priority alarm.

Alarm volume indicator. Adjust the minimum alarm tone volume.

Alarm messages Audible alarm signals
Alarm messages can be displayed in three areas: When more than one alarm occurs at the same time, the monitor
• The parameter window will sound an alarm tone for the highest priority alarm. Any lower
• The waveform field priority audible alarm tones are suppressed by the higher priority
• Alarm area (title bar) alarm tone. The most recent of the alarms that has the highest
priority level at this moment is the alarm that is broadcasted on the
In the alarm area, up to five alarm or information messages may be network. For example, if there is one medium-priority alarm and a
displayed from left to right, from the newest highest priority alarm to low-priority alarm appears, the medium-priority alarm is
the oldest lowest priority alarm. Up to four newest highest priority broadcasted, not the most recent (low-priority) alarm.
remote alarm messages display first, followed by the newest highest If there is one medium-priority alarm and another medium-priority
priority local alarm messages. alarm appears, the alarm that just appeared is broadcasted.
Alarm and information messages are stored in the Clinical Log and Alarm tones
include: The alarm tones may be configured to sound in one of two different
• Time of occurrence. tone patterns: Legacy or IEC. IEC tones are 60601-1-8 compliant.
• Alarm or information message text. Legacy alarm tones match the tones used on some previous GE
• Current value and the associated alarm limit if a limit alarm. monitoring devices. For details about configuring alarm tones, see
the “CARESCAPE Monitor B650 Supplemental Information Manual.”
Alarm light
There is also an alarm light that indicates the highest priority alarm. AVOA alarm tones may differ from the local monitor alarm tones.
For details, see ”System introduction.” Both the highest priority local alarm tone and the highest AVOA
alarm tone will sound, but in a sequence containing one local alarm
Setting the alarm light brightness
tone pattern and one AVOA alarm tone pattern.
WARNING - Always make sure that the alarm light Adjusting the alarm volume
brightness is adequate in your care environment. NOTE: A minimum alarm volume level can be set in the care unit
defaults.
1. Select Alarm Setup from the monitor’s main menu. 1. Select Alarm Setup from the monitor’s main menu.
2. Select the Audible & Visual tab. 2. Select the Audible & Visual tab.
3. Select an Alarm Light value. 3. Select an Alarm Volume value.
The greater the value, the brighter the light. The lower the number, the quieter the alarm volume.

Depending on the Audio Alarm default settings configured during

installation, you can turn on or turn off audible alarms. See the
“Turning on/off audible alarms” section.

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Audible and visual alarm signals

Alarm signals indicate that an alarm condition is present. The alarm priority levels are indicated by visual and audible signals. The visual and
audible alarm signals assume that the patient monitor and the operator are within the patient environment (1.5 meters).

Alarm signal High priority level Medium priority level Low priority level Informational level
Parameter window White text flashes inside a red Black text flashes inside a Black text inside a cyan (blue) Not applicable.
physiological data values box. yellow box. box.

Alarm area White text inside a red box. Black text inside a yellow box. Black text inside a cyan (blue) Black text inside a grey box.
box.

Waveform field messages Text Text Text Text

Audible tone pattern

1 Repeats pattern of 2 * 5 beep Repeats pattern of 3-beep 1-beep tone None
(IEC 60601-1-8) tones tones

Audible tone pattern (legacy) Repeats pattern of 3-beep Repeats pattern of 2-beep 1- beep tone (advisory) None
tones (crisis) tone (warning)

Alarm light indicator

2 Flashes red Flashes yellow Solid blue Off

Automatic view on alarm User configurable

3
User configurable
3
User configurable
3 None
audible tone pattern

1 The IEC audible tone pattern is the factory default setting.

2
When the audible alarms are turned off or are paused, the alarm Audio pause/off area of the Alarm light is a solid blue color.
3
The AVOA audible alarm tone pattern may be configured to match the local monitor’s audible tone pattern, repeat a pattern of two beep tones, beep twice upon
activation by an alarm condition, or be turned off. For configuring the AVOA audible alarm tone pattern, see the “CARESCAPE Monitor B650 Supplemental
Information Manual.”

Auditory information signals

The monitor performs a self-diagnostic procedure at start-up and generates an auditory test signal. There are also other auditory information
signals indicating the status of some parameter measurements. For a detailed description of these signals, see the “CARESCAPE Monitor B650
Supplemental Information Manual.”
Turning on/off audible alarms
Depending on the Audio Alarm default settings configured during
installation, you can turn on or turn off audible alarms.
When audible alarms are turned off:
- All audible alarms are turned off except for any high priority
alarms configured to break through the Audio Off setting.
- The audio off bell icon displays in the upper left corner of the
display screen.
- The Alarm audio pause/off area of the Alarm light is solid blue
when audible alarms are paused or when Audio Off is selected
for an alarm group.
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To turn on/off the audible physiological alarm tones for an alarm
group or for all alarms:
1. Select Alarm Setup from the monitor’s main menu.
2. Select the Audible & Visual tab.
3. Select an alarm group.
Choices are:
- Apnea Audio Off: Turns off audible alarms for apnea, EtCO2,
FiCO2, respiration rate, Ppeak low, PEEPe, PEEPtot, PEEPi, and
MVexp limit alarms.
- ECG Audio Off: Turns off audible alarms for all HR and PR
source limit and arrhythmia alarms.
- Apnea & ECG Audio Off: Turns off audio alarms for all HR and
PR source limit, arrhythmia, apnea, EtCO2, FiCO2, respiration
rate, Ppeak low, PEEPe, PEEPtot, PEEPi, and MVexp limit
alarms.
- All Alarms Audio Off: Turns off all audible alarms except high
priority alarms defined as breakthrough alarms. See the
“Breakthrough alarms” section.
4. To turn on all audible alarms again, select Audio On.
NOTE: If alarms are turned off for any of the defined alarm groups
and an alarm occurs within the alarm group, a beep tone will sound
every 2 minutes as a reminder that alarms are turned off.
NOTE: France only: A reminder beep tone sounds every 2 minutes
when the Audible & Visual > Audio On setting is not selected.
 71

Pause Audio Alarm behaviors

Selecting consecutively results in different alarm behaviors depending whether alarms are active and/or latched or not.

Active and/or latched alarms No active and/or latched alarms Pause Audio Alarm behaviors
present present
See “Pause Audio Alarms Pause Audio Alarm behaviors 1:
Select once.
behaviors 2” for the alarm • Pauses the audio alarm tone of all active alarms for 2 minutes.
behaviors in this instance. • Marks the active alarm messages as paused with the active audio
alarms paused indicator .
• Removes all latched alarms from the alarm area.
• Removes information messages from the message area.
NOTE: When the monitor is on the network, alarms can be paused and
acknowledged at the central station.
Pause Audio Alarm behaviors 2:
Select twice, consecutively. Select once.
• Pauses the audio alarm tone of all active, latched, and new
incoming alarms (except breakthrough alarms1) for 2 or 5
minutes.2
• Hides active alarms from the alarm area.
• Displays a countdown timer indicating the time remaining for the
paused audio alarm period. The length of the paused audio alarm
time period depends on the alarms configuration.
• Displays a solid blue color in the alarm Audio pause/off area on
the alarm light because the audio alarms are turned off or paused.
Pause Audio Alarm behaviors 3:
Select three times, Select twice, consecutively.
• Ends the paused audio alarm period.
consecutively. • Restores all paused alarms if an alarm condition still exists.

1 See “Breakthrough alarms” section for a list of breakthrough alarms.

2 The Pause Audio Alarm duration of 2 or 5 minutes is a care unit default setting and is password protected.
Breakthrough alarms Latched alarms
The breakthrough alarms feature allows pre-defined and user- When alarms are latched, the audible alarm and visual message
selectable alarms to “break through” (interrupt) an All Alarms Audio remains after the alarm condition no longer exists. Selecting
Off or a 2 or 5 minute audible alarm pause condition.
pauses the audible alarm.
The FiO2 low, EtO2 low, and Ppeak high alarms will always break
Alarms can be configured to latch for all high priority alarms only, all
through when escalated to or activated at high priority alarm
alarm priorities, or none. For configuring latched alarms, see the
condition regardless of the All Alarms Audio Off selection.
“CARESCAPE Monitor B650 Supplemental Information Manual.”
The FiN2O high alarm will break through when activated at high
The Latching Alarms setting is configured in the Care Unit Settings
priority alarm condition regardless of the All Alarms Audio Off
and is password protected. Setting choices are High, All, or None.
selection.

The following alarms will break through when activated at high

priority alarm condition regardless of the 2 to 5 minute audible
alarm pause: FiO2 low, EtO2 low, Ppeak high, FiN2O high, Asystole, V
Fib, V Fib/V Tach, V Tach, and Brady (in NICU software package only).

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Setting parameter alarm limits
Parameter alarm limits may be set from the Alarm Setup option via
the main menu or from the Alarms tab via the parameter window.
See the appropriate parameter chapter to set the parameter alarm
limits.
NOTE: Alarm limits should not be set beyond reasonable
physiological boundaries in order to maintain patient safety. Setting
outside of reasonable boundaries would cause the alarms to be
ineffective.
To set the alarm limit values:
1. Select Alarm Setup from the monitor’s main menu.
2. Select the Alarm Limits tab.
3. Select the parameter label.
NOTE: If you are unable to find a specific parameter, select the
right arrow to display additional parameter labels.
NOTE: If the parameter limit has been turned off, the alarm limit
will be greyed out.
4. Select Alarm On to set the alarms.
5. Set the alarms. NOTE: The parameter alarm limit window shows
the current upper and lower alarm limits and a 5 minute trend of
the parameter value in the middle.
Alarm locks
Alarm locks prevent parameter alarm limits from being turned off.
When locked, a lock icon appears next to the Alarm On/Alarm Off
setting. Parameter alarm locks are password protected. See the
“CARESCAPE Monitor B650 Supplemental Information Manual” for
details.
Selecting parameter alarm priority levels
1. Select Alarm Setup from the monitor’s main menu.
2. Select the Alarm Priorities tab.
3. Select an alarm priority from Alarm Priority list. Parameter
choices are:
- HR/PR
- ST Segment
- Frequent PVCs
- Noisy ECG
- Arrhythmia paused
- SpO2
- Art, ABP, Fem, UAC, PA, CVP, RAP RVP, LAP, ICP, P1-P8
- TcCO2/O2
NOTE: Escalating an alarm priority increases the priority of the alarm
condition or increases the sense of urgency of an alarm signal. The
alarm priority is based on clinical considerations.
Setting arrhythmia alarms
You can set the lethal, ventricular, and atrial alarm conditions. See
the “ECG” chapter for details.
Setting alarm limits automatically
When selected, the Auto Limits feature automatically sets new high
limit and low limit values, based upon the current physiological
value. NOTE: The Auto Limits should only be used for patients whose
currently measured values are considered safe.
To set high limit and low limit values based upon the current
physiological measurement readings automatically:
1. Select Alarm Setup from the monitor’s main menu.
2. Select the Alarm Limits tab > Auto Limits.
3. To undo these changes and return to your previous alarm limit
settings, select Undo Settings before you close this window.
The following table lists the available default Auto Limits.

Parameter High limit Low limit Parameter High limit Low limit

NIBP Sys/Dia/Mean: Sys/Dia/Mean: SvO2 SvO2*1.05 SvO2*0.95

NIBP*1.25+10 NIBP*0.75-10
Temperature, Tx+1°C Tx-1°C
All HR/PR All HR*1.25 of the current All HR*0.75 of the current TBlood Tx+1.8°F Tx-1.8°F
parameters HR value (averaged over HR value(averaged over
Tx-Ty Tx-Ty+1°C Tx-Ty-1°C
(ECG, SpO2, last 10 s) last 10 s)
(e.g., T2-T1) Tx-Ty+1.8°F Tx-Ty-1.8°F
UAC, Art,
ABP, Fem) Ppeak Ppeak+10 cmH2O Ppeak-10cmH2O

ST group Greatest value in group: Smallest value in group: PEEPtot PEEPtot+5cmH2O PEEPtot-5cmH2O
+1 if group is enabled, -1 if group enabled,
otherwise limit is +2 otherwise limit is -2 PEEPe PEEPe+5cmH2O PEEPe-5cmH2O

ST individual ST+1 if enabled, ST-1 if enabled, MVexp MVexp+2 MVexp-2

otherwise limit is +2 otherwise limit is -2 RR RR*1.25+2 RR*0.75-2
PVC PVC+10 Not applicable
Returning alarm limits to their default settings
EtCO2 EtCO2*1.01 EtCO2*0.99
1. Select Alarm Setup from the monitor’s main menu.
SpO2 SpO2*1.05 SpO2*0.95 2. Select the Alarm Limits tab.
3. Select Default Limits.
Art, ABP, Sys/Dia/Mean: Sys/Dia/Mean: 4. To undo these changes and return to your previous alarm limit
Fem, P1 • Value*1.25+10mmHg • Value*0.75-10mmHg settings, select Undo Settings before you close this window.
• Value*1.25+1.3kPa • Value*0.75-1.3kPa
FemV, CVP, Sys/Dia/Mean: Sys/Dia/Mean:
PA, RAP, RVP, • Value*1.25+5mmHg • Value*0.75-5mmHg
LAP, ICP, • Value*1.25+0.67kPa • Value*0.75-0.67kPa
CPP, P2-8
UAC/UVC Sys/Dia/Mean: Sys/Dia/Mean:
• Value*1.25+5mmHg • Value*0.75-5mmHg
• Value*1.25+0.67kPa • Value*0.75-0.67kPa

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Turning off all local alarm indicators (sleep mode)
You can turn off the monitor’s display and turn off all audible, visual,
and alarm light alarm indicators until you turn them back on again.
Patient monitoring is occurring; however, the monitor is not
displaying patient data or indicating patient alarms locally. Alarms
are logged and trended.
NOTE: If the monitor is connected to the network, alarms and alarm
printouts, and parameter data signals will continue to be sent over
the network during sleep mode.
To enable or disable this Audio/Display feature, see the “CARESCAPE
Monitor B650 Supplemental Information Manual.”
1. Select Alarm Setup from the monitor’s main menu.
2. Select the Audible & Visual tab.
3. Select Off from the Audio/Display list.
A screen saver replaces the display of patient data.
4. To reactivate alarms and the display screen, press any keyboard
key, touch the touchscreen display, click the left mouse button,
or turn or press the Trim Knob control.
Managing alarms from a remote location
The remote alarm settings are defined in the care unit alarm
defaults and allows you to define the following:
- Allow a Remote Audio Pause from a central station or from a
remote monitor.
- Show the remote patient name.
- Turn a remote monitor’s alarm light on/off.
- Choose the remote alarm notification tone.
See the “CARESCAPE Monitor B650 Supplemental Information
Manual” for details.
Reviewing alarm events
To review stored alarm event trends and snapshots, see the “Trends
and snapshotsTrends and snapshotsTrends and snapshots” chapter.
Alarm settings after a power loss
If the monitor loses power, the amount of time without power affects
whether or not you need to reset the alarm settings.
Power loss duration Alarm setting status after a power loss
Up to 15 minutes • The alarm settings that are in effect
before the power loss are restored
automatically.
Greater than 15 • The alarm settings revert back to the
minutes user default settings (start-up mode).
You must reset any patient-specific
alarm settings.
Alarm data stored in Clinical logs
NOTE: Access to the Clinical logs is a service-level function and is
password protected.
The monitor stores a record of patient-related local and remote
alarms and information messages in Clinical logs. Local alarms are
logged as alarms and remote alarms and information messages are
logged as information messages.
Stored alarm data during a power cycle or power loss
If the monitor goes through a power cycle or a loss of power, the
stored alarm data is not affected. The alarm data remains stored in
the Clinical log until the monitor automatically clears the oldest
stored data to allow new data to be stored.
Starting and ending monitoring
Note that the terminology used in this chapter reflects that used in
Residual physiological data
different software packages: in OR and PACU, you start or reset a
To ensure that no physiological data remains in the acquisition
case, and in other software packages you admit or discharge a
module or in the bedside monitor after resetting a case/discharging
patient. In addition, some other menu selections may also differ
the patient, do the following:
according to the licenses in use. Please read the following
• PDM: Do not disconnect the acquisition module from the bedside
instructions carefully.
monitor before ending a case or discharging a patient. You must
Also note that user default settings are those settings (start-up mode, also disconnect all the patient cables from the patient. The PDM
profile etc) that the user has saved into the monitor to replace the can continue to measure patient data from battery power even
factory default settings. The monitor uses these settings when it is when the module is not connected to the patient monitor.
turned on and after a power off situation that lasts more than 15 • Bedside monitor: Remove the acquisition modules from the
minutes. If user default settings are not available, factory default monitor or disconnect all the patient cables from the patient.
settings are used instead. For more information, see the “CARESCAPE
Monitor B650 Supplemental Information Manual.”

Always observe the monitor and the patient carefully during start-up
periods and when inserting acquisition modules.

CAUTION: - Discharge to clear patient data - When

admitting a new patient/starting a new case, you must
clear all previous patient data from the system. To
accomplish this, be sure the acquisition module is
securely mounted, disconnect the patient cables, then
discharge the previous patient/end the case.
NOTE: If the monitor is connected to the S/5 Network, patient and
trend data can later be reloaded to the monitor from iCentral. No
trend data can be loaded from the CARESCAPE Network MC.

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Starting monitoring
1. Connect the patient to the monitor according to the setup
illustrations in the measurement chapters. The alarms and
parameter settings become active.
2. If the startup profile is not suitable, select another profile - see
the “Selecting a profile” section.
3. Enter patient demographics, or load/merge the data, according
to the instructions given later in this chapter.
4. Start the measurement according to the instructions given in the
measurement chapter.
5. Zero invasive pressure lines.
6. If necessary, change the parameter windows on screen. For
more information, see the “Setting up the monitor before use“
chapter.
7. Check alarm limits and adjust if necessary.
A case automatically starts/a patient is admitted when the monitor
detects any of the following vital signs: ECG/ImpResp, Art, ABP, Fem,
UAC, NIBP, SpO2, CO2, EEG, BIS or Entropy. Each vital sign has
activation criteria that must be met before the vital sign is
considered active. For more information, see the “Alarms“ chapter.
When a case is started/a patient is admitted at the bedside monitor
and the monitor is connected to the network, patient data will
display at the central station.
A case manually starts/a patient is admitted when any patient data
is entered or loaded. Patient data can be entered locally using the
monitor, loaded from an Admit-Discharge-Transfer (ADT) server over
the CARESCAPE Network, or entered remotely using a CARESCAPE
CIC Pro clinical information center or the iCentral. For more
information on entering patient data remotely, see the CARESCAPE
CIC Pro operator’s manual, or the iCentral and iCentral Client User’s
Reference Manual.
Entering patient data using the monitor
1. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
2. Select the Patient tab.
3. Edit or enter the patient data:
- Edit Name & MRN: Select the field to be edited and enter the
data.. Entering the Second ID in addition to the MRN allows a
flexible use of local patient identification methods, like the
use of BSN in the Netherlands. NOTE: The Second ID has no
network support, so only the MRN can be used for searching
and retrieving patient data from the network. Both MRN and
Second ID will appear in the printouts.
- Edit All Demographics: Select values from the lists.
NOTE: You can also edit the Height and Weight from the
corresponding lists on the Patient tab.
NOTE: If 12SL ECG with ACI-TIPI or 12RL 12 lead ECG is
licensed, you can also select the patient’s Ethnicity.
Entering patient data using a barcode reader
You can scan patient data from barcodes if this function has been
enabled during configuration:
1. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
2. Select the Patient tab > Scan from Barcode.
• Note that any information (including empty fields) scanned
from the barcodes replaces the corresponding information
previously entered from the monitor.
• To cancel the scanning, select Cancel Scan.
For more information on the barcode reader configuration and
supported barcode parser types, see the “CARESCAPE Monitor B650
Technical Manual.”
Selecting a profile
When you start monitoring a patient, use the startup profile or select
another profile. According to the configuration, your monitor
software may have up to eight profiles to choose from.
NOTE: Profiles control many settings, including parameter defaults,
alarm detection limits and alarm functionality. Perfusion profile in
the OR software package will enable the Apnea & ECG Audio Off
feature. Alarm configuration will change extensively: many alarms
are configured to off or to a low priority. ‘Leads off’ alarm is
prevented, and the ‘Leads off‘ information appears in the waveform
area only. Also the ‘SpO2 probe off‘, ‘No probe‘ and ‘No pulse‘ alarms
are prevented and the information appears in the parameter
window only. For more information on the profiles and their use, see
the "CARESCAPE Monitor B650 Supplemental Information Manual."
To select a profile:
1. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
2. Select the Patient tab.
3. Select a profile from the Profile list.
Loading patient data from an ADT Server
1. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
2. Select the Load Patient tab.
3. Select Find Patients.
4. Select a field (Medical Record Number, Last Name) and enter
the information you have available. You can also add the First
Name information if you wish. However, note that the search
does not function with First Name information only.
5. Select Find.
6. When a patient list appears, select the patient.
7. Select Load Patient Information to load the patient data from
the ADT Server.
NOTE: You cannot merge data between the monitor and the ADT
Server.
NOTE: In the CARESCAPE Network environment the MRN information
is limited to 13 characters.

To return to the previous profile:

1. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
2. Select the Patient tab > Return to Previous Profile.

NOTE: If you make changes to a profile while using it, you can only
return to its previously saved settings by selecting another profile,
and then reselecting the first one.
NOTE: If you choose another profile while monitoring a patient, you
will not lose any patient data.

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Loading patient data and trend data from the S/5 Network Entering administrative information
1. Select the patient data field. To enter relevant administrative information:
2. Select the Load Patient tab. 1. Select the patient information area on screen, or select
3. Select a network from the Central list. A patient table appears, Data & Pages > Admit/Discharge or Start / End Case.
showing all the patients connected to the chosen network. 2. Select the Administr. Information tab > Edit.
4. Select a patient from the table. 3. Select the field to be edited and enter the data.
5. One of the following selections is available:
- Start New when there is no active patient case/admitted
patient on the monitor. Select this to load patient data from
the network.
- Reset Current or Discharge Current when there is an active
case/admitted patient on the monitor. Select this to end the
case/discharge the patient. The Start New selection will then
appear.
- Merge to Current when there is an active patient case/
admitted patient on the monitor and the same patient can
be found at the central station. Select this to merge their
patient data. The message ‘Loading from network’ is
displayed until all data has been loaded.

The monitor will send all updated patient data except trends to the
connected acquisition modules.

Using standby
NOTE: Not available in OR and PACU software packages.
When you remove the patient temporarily from the monitor, you can
use the standby option. Standby locations are defined during
configuration. For more information, see the "CARESCAPE Monitor
B650 Supplemental Information Manual."
Starting standby
1. Disconnect patient cables or acquisition modules from the
monitor and ensure that the monitor receives no vital signs.
Standby is not selectable unless the cables or the modules are
disconnected.
2. Check that the NIBP Auto is turned off.
3. Select the patient information area on screen, or select
Data & Pages > Admit/Discharge or Start / End Case.
4. Select the Standby tab.
5. Select the radio button of the standby location.
6. Select Standby. The screen goes blank and the GE logo with the
text ‘Patient temporarily in MRI’ (location according to your
selection) appears.
Ending standby
The monitor ends the standby automatically when any of the
following conditions occur:
• Any of the following patient’s vital signs are detected as
active: ECG/ImpResp, Art, ABP, Fem, UAC, NIBP, SpO2, CO2,
EEG, BIS or Entropy
• Any user input is received (e.g. a keyboard key is pressed,
Trim Knob is pressed or rotated, primary mouse button is
pressed, touchscreen is pressed)
• A PDM is connected.
80
To return to normal monitoring, select how you want the patient
data between the acquisition module and the monitor handled. For
more information, see the “Continuing monitoring“ section.
Resetting a case/discharging a patient
NOTE: Resetting a case/discharging a patient deletes all patient
information from an attached PDM. If this is not desired, disconnect
the PDM from the monitor before resetting a case/discharging the
patient.
1. Disconnect patient cables.
2. Print necessary data and wait until the printing is completed.
3. Select the patient information field, or select Data & Pages >
Start / End Case or Admit/Discharge.
4. Select the Patient tab > Reset Case or Discharge Patient.
Monitor settings, including alarm limits, return to their default
settings. All patient data and trend data is removed from both the
monitor and PDM, if connected.
NOTE: The monitor may be configured with an automatic case reset/
patient discharge timer. If this is configured and vital signs are no
longer detected, monitoring will end automatically after the
configured time has elapsed. For more information, see the
"CARESCAPE Monitor B650 Supplemental Information Manual."
NOTE: The patient can be discharged remotely using a CARESCAPE
CIC Pro clinical information center provided that this option has been
enabled. This option is not available in OR and PACU software
packages. For more information, see the “CARESCAPE Monitor B650
Supplemental Information Manual” and the CARESCAPE CIC Pro
operator’s manual.
 81
Continuing monitoring
Patient information and data is stored in the PDM. The ‘Connecting
Measurement’ message appears on the monitor when the PDM is
first connected. Vital sign monitoring is not available during this
initialization time. At the conclusion of the initialization, the stored
patient information and data can be transferred to the monitor from
the acquisition module. While patient information and data is being
transferred, the ‘Loading from PDM’ message appears on the
monitor. The type of patient information and data that can be
transferred includes the following:
- Patient demographic data
- Patient trends and alarm histories (NOTE: Alarm histories are
converted to snapshots during the transfer)
- All invasive pressure site labels
- All invasive pressure transducer zero values for channels 1
through 4
- Latest values and timestamps for C.O., PCWP and NIBP
measurements
- NIBP cuff size
- NIBP auto cycle on/off information
- NIBP cycle time information if the NIBP auto cycle is on.
The actions taken by the monitor and the menus that appear
depend on whether the monitor has an active patient case/admitted
patient.
Continuing monitoring when a case is not active/patient is
discharged
When you connect a PDM that is actively measuring vital signs from
ECG, invasive pressures or SpO2, the patient information and data is
automatically loaded from the PDM to the monitor and a case is
automatically started/patient is admitted.
When you connect a PDM that is not actively measuring vital signs
from ECG, invasive pressure or SpO2 but it contains patient
information, the Continue menu appears. The Continue menu has
two informative fields on the top: the Patient in the monitor and the
Patient in the PDM. These fields show the text ‘No patient data
available’ if there is no active case/admitted patient. Select one of
the following to continue monitoring:
- Load PDM Data: This selection loads patient information and
data from the module.
- Erase PDM Data: This selection erases the patient
information and data from the module.
Continuing monitoring when a case is active/patient is
admitted
When you connect a PDM that contains the MRN that matches the
MRN entered on the monitor, the patient information and data is
automatically loaded from the PDM to the monitor and a case is
automatically started/patient is admitted.
When you connect a PDM that contains patient information but the
MRN does not match the MRN entered on the monitor, the Continue
menu appears. The Continue menu has two informative fields on the
top: the Patient in the monitor and the Patient in the PDM. These
fields show the MRN and the Name of the Patient if there is an
active case/admitted patient.
Select one of the following to continue monitoring:
- Load PDM Data: This selection erases the patient data from
the monitor and loads the data from the module.
- Continue Current: Monitoring will continue with the patient
data from the monitor. If the patient identification is not the
same on the acquisition module and the monitor, this
selection erases the patient data from the module and
continues with the patient currently on the monitor.
- Erase PDM Data: This selection erases the patient data from
the module.
82
- Merge Anyway: This selection merges the patient data from
the module with that of the monitor even if the patient
identification is different or when it has not been entered.
Use this selection if no MRN has been entered or you know
for certain that you will continue monitoring the same
patient. This selection may also be useful if there has been a
typing mistake or some other minor error when entering the
patient identification. Any information available in one device
and not in the other will overwrite the missing information
during merging. If the information is available in both
devices, the monitor data will overwrite the module data.
NOTE: Be careful when using this selection. If you are not
absolutely certain that it is the same patient on the monitor
and module, do not merge the data.
- Discharge: This selection deletes the patient data from the
module and from the monitor.
NOTE: When you connect a PDM module and there is no patient
information or data in the module or in the monitor, the monitoring
does not start and the Continue menu does not appear.
NOTE: When you select to erase data or discharge a patient in the
Continue menu, the patient’s vital signs cannot be observed during
the erase/discharge cycle time.
NOTE: When you connect a PDM, its battery status indication
appears on display. For more information, see the “Setting up the
monitor before use“ chapter.
 83

For your notes

Trends and snapshots
CAUTION: MEASURING DATA STORED IN ALARM HISTORY
Waveform data is stored in the alarm history using
compression technology that may not allow perfect
reconstruction of the waveform data when
subsequently viewed. Although differences occur
relatively frequently and are usually very minor, users
are urged to verify diagnostic waveform measurements
with the waveform data from realtime graph strips.
NOTE: The numeric trends include a predefined set of parameters.
The graphic trend selections include all parameters that can be used
with the CARESCAPE Monitor B650. If you are viewing trends for
parameters for which you do not have a license, trend labels are
shown, but no new data is collected. Therefore, no data is shown in
the Trend view or printouts. Data loaded from previous cases where
the parameters were available, can be viewed.
Symbols
In printouts, the graphic presentation formats are replaced by
symbols. Examples of these are shown below.

Trend views CO2

The Trend views provide means to display five types of trend data,
graphic, numeric, event, snapshot and ST snapshot data. Each of
these is covered in more detail in the following sections. All views SpO2
have default parameter content. You can make configuration
changes for the graphic trend and snapshot views.

When entering the Trends menu after ending a case/discharging Art (sys/dia/mean):
the patient or when the monitor has been powered down for longer the gap shows the blood pressure mean value
than 15 minutes, the displayed menu and the corresponding trend
view are either the configured graphic or numeric ones. For details
about configurations, see the “CARESCAPE Monitor B650
NIBP (sys/dia/mean):
Supplemental Information Manual.”
the gap shows the blood pressure mean value
The trend data and views are updated, if there is an active case on
the monitor or at least one vital sign parameter is connected. This
applies to all trend, event and snapshot views.

You can split the normal screen page so that the lefthand side of the
screen continuously shows graphic minitrends beside waveforms.
For details about minitrends, see the “Minitrend split screen” section.

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Graphic trends
Viewing graphic trends
Graphic trends contain 24 or 72 hours of trend data depending on
the trend license. Graphic trends contain four trend pages, each
having up to six fields, with different parameters already
preconfigured in the defaults. Five fields can be displayed and six
fields printed. The top of each page can be configured to show the
highest priority realtime waveform. For details about configuration,
see the “CARESCAPE Monitor B650 Supplemental Information
Manual.”
To view graphic trends:
1. Select Trends.
2. Select Graphic from the View list.
• To see more parameters, select tabs 1-4.
• To view numeric measurement values of a certain time,
move the cursor to that time. The numeric values are
displayed next to the cursor.
Changing time scale
To change the time scale of graphic trends:
1. Select Trends.
2. Select Graphic from the View list.
3. Select a time value from the Time Scale list.
Points to note
The time scale available depends on the license in use:
• the basic settings for all software packages are 20 min, 1 h,
2 h, 4 h, 6 h, 8 h, 10 h, 12 h and 24 h.
• the 72 h license provides the basic settings and additionally
settings for 36 h, 48 h and 72 h.
• high-resolution trends license provides basic settings and
additionally settings for 2 min and 4 min selections.
NOTE: The time scale setting is dependent on the cursor time. When
the cursor position is more than 30 minutes from the current time,
the Time Scale list does not show the 20 min option. With the high-
resolution trends license enabled, the 20 min option is visible even if
the cursor is as far as 1 hour from the current time. For details about
the high-resolution trends, see the ”Resolution” section.
NOTE: High-resolution trends contain 24 hours of trend data. This
means that when the cursor position is more than 24 hours from the
current time, the Time Scale list does not show the 2 min, 4 min and
20 min options.
Resolution
The graphic trend resolution depends on the time scale of the trend.
Graphic trends are updated once a minute, when the time scale is
1 hour and greater. For the 20 minute scale, the update rate is
10 seconds.
High-resolution trends is a licensed graphic trend option that
provides an increased update rate of 2 seconds for the 2, 4, and
20 minute scales. This trend also contains compressed CO2 and
impedance respiration waveforms (10 Hz) as well as beat-to-beat
ECG heart rate and mean arterial pressure MAP (6 Hz). For details
about resolution and high-resolution trend, see the “CARESCAPE
Monitor B650 Supplemental Information Manual.”
NOTE: High-resolution trend data is not saved over power down
situations. This means that data in the 2, 4 and 20 minute time
scales is erased.
NOTE: High-resolution trend data is neither sent nor loaded to/from
the network (central station) or acquisition modules (PDM, PSM).
Changing trend scales
Numeric trends
To change the trend scales of a parameter:
1. Select Trends. Viewing numeric trends
2. Select Graphic from the View list. Numeric trends contain nine pages with 24 or 72 hours of trend data
3. Select Trend Scales. depending on the trend license. The top of the view shows the
4. Select the General, IP/NIBP or Temp/C.O. tab. highest priority realtime waveform.
5. Set the trend scales of appropriate parameters.
NOTE: You cannot configure the layout of the Numeric Trend view.
Printing graphic trends
To print the currently viewed trend data: To view numeric trends:
1. Select Trends. 1. Select Trends.
2. Select Graphic from the View list. 2. Select Numeric from the View list.
3. Select Print Page. • To see more parameters, select appropriate tabs from the
4. To stop printing, select Cancel Printing. Numeric Trend view.
• To see more numeric trend data, use the cursor to scroll data
To print all the graphic trend data: in horizontal direction.
1. Select Monitor Setup > Printing. Points to note
2. Select Reports. The lowest row on each page, named Mark, shows snapshot event
3. Select Trends. numbers. If more than one snapshot has been created in a one-
4. Select Print. minute period, only the last snapshot event number is shown in the
5. To stop printing, select Cancel Printing. Mark row.
For details about printing graphic trends, see the “Printing” chapter. Changing the time interval of numeric trend
NOTE: Numeric trend displays values according to the selected time
interval. Numeric trends are updated with averaged measurement
data once a minute independent of the selected time scale.

To change the time interval of a numeric trend:

1. Select Trends.
2. Select Numeric from the View list.
3. Select a value from the Time Interval list.

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Printing numeric trends

Event trends
To print the currently viewed numeric trend page:
An event is created automatically upon an alarm. An event records
1. Select Trends.
the time of the event creation and the reason for it. Some events
2. Select Numeric from the View list.
may also record a snapshot. For details, see the “Automatic
3. Select Print Page.
snapshots” section.
4. To stop printing, select Stop Printing or Cancel Printing.
Manually created events contain only the time and a manually
For details about printing numeric trends, see the “Printing” chapter.
added reason for the event. For details, see the “Creating events
manually” section.
Invasive pressure trends
The following invasive pressure trend data is collected: NOTE: You cannot configure the Event Trend pages.
• PDM:
Automatic events
- Systolic, diastolic and mean pressure data for Art, ABP, Fem,
An event is created automatically
PA and UAC.
• from a medium and high priority physiological alarm.
- Mean pressure data for FemV, CVP, LAP, RAP, ICP, P1 to P8,
• from a medium and high priority technical alarm.
RVP and UVC.
• from a low priority alarm, if a snapshot is attached to that
• E-modules:
alarm.
- Systolic, diastolic and mean pressure data for all labels
• from a manually created snapshot or an ST snapshot.
except UAC and UVC.
• when alarm history is transferred from PDM to the monitor
NOTE: The invasive pressure trends will only be stored for those and corresponding snapshots are created at the monitor.
channels that have been zeroed.

Heart rate (HR) trends

Only the measured values from the primary heart (ECG) or pulse rate
source are trended to the HR graphical and numeric trends. Pulse
rate sources that can be selected are the monitored and zeroed
invasive pressure (IP) channels labeled with Art, ABP, Fem and UAC
(NICU only) and the SpO2 parameter.
Viewing event trends
1. Select Trends.
2. Select Event from the View list.
The Event Trend view shows event data on horizontal axis and time
on vertical axis in the Time column.
The top of the view shows the highest priority realtime waveform.
The bottom of the view shows a sample waveform, if an event has a
snapshot.
The Priority column
• shows an alarm priority symbol, if the event is created
automatically from an alarm. The alarm priority levels are:
High (red), Medium (yellow) and Low (blue). For details about
the symbol, see the “System introduction” chapter. For
details about the priority levels, see the “Alarms” chapter.
• shows no symbol, if the event is created manually.
The Event column
• shows the reason for event creation.
If the event is created:
• automatically, an alarm message is shown. For example:
’Tachy‘, ‘SpO2 probe off’.
• manually, a possible manually added text string is shown.
• automatically or manually and a manual annotation is
added to the event, the annotation text is shown in quotation
marks starting with prefix “NOTE -”.
• from a manual snapshot, a ‘Mark xxx’ message is shown,
where ‘xxx’ refers to the sequence number of the snapshot.
The Snapshot column
• shows a snapshot symbol if a snapshot is attached
to the corresponding event.
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Sorting events
To list events according to the Sort by setting:
1. Select Trends.
2. Select Event from the View list.
3. Select Time or Priority from the Sort by list.
• Time lists the events with the newest event at the top of the
list.
• Priority lists the events in chronological order with the
highest priority event at the top of the list. Manually created
events and snapshots have the lowest priority.
Creating events manually
The manual creation of an event enables you to add a special
situation event to the Event Trend view and to describe the reason
for the event in the desired way.
To create an event manually:
1. Select Trends.
2. Select Event from the View list.
3. Select Create Event.
4. Type the text for the event in the Event field by using the
software keyboard. Use a maximum of 50 characters.
5. Select Add to add the event to the event list.
6. Select Previous Menu to return to the Event Trend view.
NOTE: The time stamp of a manually added event is the time when
the Add button is selected.
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Annotating events
Snapshots
You can add an annotation to a manually or automatically created ,
A snapshot is a set of measured data saved from a certain moment
already existing event. This function enables you to add further
of time. Snapshots can contain waveform clips and graphic trends.
information to the event.
For configuration of snapshots (Print Loop, Create on Alarms and
To annotate an event: Automatic Printing), see the “CARESCAPE Monitor B650
Supplemental Information Manual.”
1. Select Trends.
2. Select Event from the View list. Creating snapshots manually
3. Select the desired event from the Event Trend view. To create a snapshot:
4. Select Annotate Event. • Select Freeze/Snapshot.
5. Type the text in the Annotation field by using the software
keyboard. Use a maximum of 50 characters. The monitor saves an image of preconfigured waveforms or trends.
6. Select Add to accept the annotation text. You can take up to 400 snapshots depending on the data load.
7. Select Previous Menu to return to the Event Trend view.
NOTE: When a snapshot is taken manually, it is automatically
NOTE: A manually added annotation is shown in the Event column in numbered. A ‘Mark xxx’ message is shown in the message field,
quotation marks starting with prefix “NOTE - ”. where ‘xxx’ refers to the sequence number of the snapshot. This
number appears also in the Mark row of the Numeric Trend view.
Printing events
It is possible to print alarms and user events in event history reports. Automatic snapshots
Depending on the amount of saved events, one or more pages are Automatic snapshot creation can be defined separately for each
printed. arrhythmia alarm. For details, see the ”Arrhythmia detection”
chapter.
To print the event history report: If automatic snapshot creation is enabled, snapshots are taken
1. Select Trends. automatically also on:
2. Select Event from the View list. • HR high/HR low, Art/ABP/Fem/UAC Sys/Dia/Mean high/low,
3. Select Print Page. SpO2 high/SpO2 low and ST high/low alarms, if their alarm
4. To stop printing, select Cancel Printing. priority is high.
NOTE: UAC is only available in the NICU software package.

For details on enabling automatic snapshots, see the “CARESCAPE

Monitor B650 Supplemental Information Manual.”
For details on printing automatic snapshots, see the “Printing
snapshots” section.
Viewing snapshots You can select snapshots either by using the arrows in the scroll bar
For configuration of the Snapshot view, see the “CARESCAPE Monitor or with the Trim Knob by selecting the scroll bar and then turning
B650 Supplemental Information Manual.” The top of the view can be the Trim Knob clockwise or counter-clockwise. When the cursor is
configured to show the highest priority realtime waveform. scrolled in the event time scale and indication box of the Snapshot
view, it moves between the snapshot indicators only and skips the
NOTE: The sweep speed for hemodynamic parameters and EEG on ST snapshot indicators.
the snapshot page is always 12.5 mm/s independent of the user
selection on the normal screen. NOTE: When you select the Snapshot view from the Trends menu
NOTE: The duration of the stored snapshot may not contain the and there are snapshots, the snapshot closest to the graphic or
entire duration of the physiological event that triggered it. If the numeric trend cursor's time is displayed. The snapshot cursor’s time
snapshot was triggered by the monitor, there will be about 11.5 is set to the time of that snapshot.
seconds of waveform data displayed in the waveform box. If the Changing snapshot time scale
snapshot was converted from a PDM Alarm History, there will be 10
1. Select Trends.
seconds of waveform data displayed.
2. Select Snapshot from the View list.
To view snapshots: 3. Select a time value from the Time Scale list.
1. Select Trends. Changing snapshot trend scales
2. Select Snapshot from the View list. 1. Select Trends.
2. Select Snapshot from the View list.
In the upper righthand corner of the Snapshot view, you can see the
3. Select Trend Scales.
time the snapshot was created. Five fields can be displayed on the
4. Select the General, IP/NIBP or Temp/C.O. tab.
snapshot page, and six fields can be printed.
5. Set the trend scales of appropriate parameters.
The lowest field in the Snapshot view shows the event time scale
and indication box. The snapshots are shown with color coded Printing snapshots
vertical lines. A yellow line indicates the chosen snapshot and its 1. Select Trends.
exact time is shown in digits. 2. Select Snapshot from the View list.
Event indicators are drawn in the time indication box as vertical lines 3. Select Print Page.
according to the time of the event and shown in the following colors: 4. To stop printing, select Cancel Printing.
• white: a snapshot event NOTE: You can print a snapshot that was created in the past by
• red: high priority alarm event displaying it on the screen using the trend cursor and by selecting
• yellow: medium priority alarm event Print Page.
• blue: low priority alarm event You can select automatic snapshots to be printed automatically by
• blue-gray: standby period an alarm. For configuration of automatic snapshot printing, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”

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Erasing trends and snapshots

ST snapshots
Trends and snapshots are erased:
• when you end a case/discharge the patient. Creating ST snapshots manually
• when the monitor has been off for longer than 15 minutes. An ST snapshot is a snapshot that displays QRS complexes. For
• automatically after 24 or 72 hours depending on the license. configuration of ST snapshots, see the “CARESCAPE Monitor B650
Points to note Supplemental Information Manual.”
• Erased snapshots cannot be recovered.
To create an ST snapshot:
• If the monitor has been off for less than 15 minutes,
snapshots are stored and remain unchanged. 1. Select Monitor Setup > Parameter Setup.
• The memory is automatically checked every time a snapshot 2. Select ECG.
is created. When the memory is too full, the message 3. Select ST.
‘Snapshot memory full. Oldest snapshot erased.’ is 4. Select Realtime View.
displayed in the message field for five seconds. If the 5. Select Save Reference.
contents of the snapshot have been changed, a new
The monitor saves an image of preconfigured waveforms or trends.
snapshot may need more memory than the previous ones.
You can take up to 10 ST snapshots depending on the data load.
Therefore, more than one snapshot may have to be erased.
NOTE: If there is not enough free memory in the database to create
To erase snapshots and trends:
the next ST snapshot without deleting old ST snapshots, the
1. Select Data & Pages. message ‘ST snapshot memory full. Oldest ST snapshot erased.’ is
2. Select Start / End Case (when OR or PACU software package is in displayed in the message field for 5 seconds.
use) or Admit/Discharge (with other software packages).
3. Select Patient.
4. Select Discharge Patient.
5. Select YES.
Transferring snapshots to PDM
The monitor transfers to PDM (in order to store) alarm histories only
from those snapshots that were triggered by arrhythmia alarms.

NOTE: Snapshots that are triggered manually or by HR high/HR low,

SpO2 high/SpO2 low or arterial label Art, ABP, Fem or UAC high/low
alarms are not stored to PDM.
Automatic ST snapshots
For details about automatic ST snapshot creation, see the ”ST
detection” chapter.
If automatic ST snapshot creation is enabled, ST snapshots are taken
automatically on:
• ST Ant high, ST Inf high, ST Lat high, ST Ant low, ST Inf low, ST Lat
low, ST XXX high and ST XXX low alarms (where XXX refers to a
lead).
NOTE: Only the first limit alarm triggers an ST snapshot when there
are subsequent limit alarms in the same group (anterior, inferior,
lateral).
Printing ST snapshots
1. Select Trends.
2. Select ST-Snapshot from the View list.
3. Select Print Page.
4. To stop printing, select Cancel Printing.
You can select automatic ST snapshots to be printed automatically
by an alarm in the same way as automatic snapshot printouts. For
configuration of automatic ST snapshot printing, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”
Erasing ST snapshots
NOTE: It is not possible to erase the initial reference complex.

Viewing ST snapshots To erase an ST snapshot:

1. Select Trends.
2. Select ST-Snapshot from the View list.
In the upper righthand corner of the ST-Snapshot view, you can see
the time the ST snapshot was created. The ST-Snapshot view
displays 11 QRS complex windows.
1. Select the ST parameter window.
2. Select the reference to be erased from the Erase Reference list.
Transferring ST snapshots to PDM
The monitor transfers all triggered ST snapshots to PDM.

The lowest field in the ST-Snapshot view shows the event time scale
and indication box in the same way as in the Snapshot view. For
details, see the “Trends and snapshotsViewing snapshots” section.

You can select snapshots either by using the arrows in the scroll bar
or with the Trim Knob by selecting the scroll bar and then turning
the Trim Knob clockwise or counter-clockwise. When the cursor is
scrolled in the event time scale and indication box of the ST-
Snapshot view, it moves between the ST snapshot indicators only
and skips the snapshot indicators.

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Minitrend split screen

You can split the normal screen page so that the lefthand side of the
screen continuously shows graphic minitrends beside waveforms.
i
11 min
min
NOTE: Minitrend is a license providing components for Minitrend and
Minitrend Length. The high-resolution license provides additionally
CO2 Minitrend and Impedance Respiration Minitrend.

To select a minitrend split screen view:

1. Select Monitor Setup > Screen Setup.
2. Select Split Screen.
3. Select Minitrend.
To have minitrends on other pages, see the “CARESCAPE Monitor
B650 Supplemental Information Manual” for details.

NOTE: Minitrends follow graphic trend scale settings. Use the same
scale for waveforms and trends. IP is an exception. IP minitrends
follow the IP waveform scales and not the IP trend scales.

For details on graphic trend scale settings, see the ”Changing trend
scales” section. For details on IP waveform scales, see the “Invasive
blood pressures” chapter.

(1) Indication of the selected minitrend length (e.g. 1 minute)

(2) Trend scales
(3) Graphic minitrend; appearance according to the parameter
(4) Compressed waveform
Modifying minitrend length
You can choose to view minitrend data from the last 1, 2, 5, 10, 30,
60 or 120 minute period.
• The 1 and 2 minute minitrends are updated every 2 seconds.
• The 5 and 10 minute minitrends are updated every 10
seconds.
• The minitrend for other time scales is updated once every
minute.
To modify the minitrend length:
1. Select Monitor Setup > Screen Setup.
2. Select Split Screen.
3. Select a value from the Minitrend Length list.
NOTE: You can select the minitrend length from a selection varying
from 1 minute to 120 minutes. The 1 and 2 minute selections are
available only when the high-resolution license is available. For
details about available time scale and high-resolution licenses, see
the “CARESCAPE Monitor B650 Supplemental Information Manual.”
To modify the minitrend length on other pages, see the “CARESCAPE
Monitor B650 Supplemental Information Manual” for details.
94
High-resolution CO2 and Impedance Respiration Minitrends
If the high-resolution license is enabled and the Minitrend Length is
1 minute normal or 2 minutes wide, it is possible to configure CO2
and Impedance Respiration (10Hz) compressed waveform
Minitrends or Respiration Rate Minitrends.
1. Select Monitor Setup > Screen Setup.
2. Select Split Screen > Minitrend.
3. Select Resp Rate or Compressed Waveform from the CO2
Minitrend or Imp. Resp Minitrend list.
Removing minitrend
To remove the minitrend from the screen:
1. Select Monitor Setup > Screen Setup.
2. Select Split Screen.
3. Select Off.
To remove the minitrend from other pages, see the “CARESCAPE
Monitor B650 Supplemental Information Manual” for details.
 95

For example, if the time is adjusted

Time change during a patient case
CAUTION: System time changes will result in time
differences between stored and realtime data.
Time adjustment is allowed during a patient case, if the monitor is
configured to the CARESCAPE Network MC.
When the time is adjusted, the monitor shifts the timestamps of
continuous trend data, but not the timestamps of other (discrete)
data.
Discrete data:
• NIBP, C.O., Wedge and NMT measurements.
• All data outside the trends, e.g., snapshots, calculations and
events.
Continuous data:
• All other data stored in the trends.
• one hour forward, the timestamps of all previously trended
continuous data are shifted one hour forward, whereas the
timestamps of discrete data are not changed.
• backwards, data that remains in the future is not displayed, but it
will be displayed again when it is not in the future anymore. This
concerns alarms, snapshots, calculations, clinical log as well as
NIBP, C.O., Wedge and NMT measurements.
• backwards and then a new discrete measurement is stored to
the same minute with the old measurement, the timestamp of
the new measurement is set to the next minute.
- If there is no “free” next minute for the new measurement,
the new measurement is stored as is to the original
measurement minute.

NOTE: If the Continue menu is open when the request for time
adjustment is received, time adjustment is delayed until the menu is
closed and the data is loaded.

NOTE: If a PDM is connected to the monitor when the time is

adjusted, the monitor sends the new time to the module.

NOTE: After time adjustment, continuous and discrete data cannot

be compared to each other, because their timestamps do not match
anymore. This applies, for instance, to snapshots including trends.
Viewing other monitored patients
When the monitor is on the network, you can open a bed-to-bed
view of other remote patient beds that are on the same network.
Viewing remote patient beds in alarm automatically
You can choose to view a remote patient bed under an alarm You can set the monitor to automatically notify you with an alarm
condition, or simply view any available bed on your network. message or with a bed-to-bed window, when selected remote
patient beds go into an alarm condition. All automatically viewable
The numeric values, up to six waveforms, alarms, and location alarming beds display in order from the highest to lowest alarm
information are displayed inside a separate bed-to-bed window. The priority and from the newest to oldest alarms.
bed-to-bed window is located on the left side of the display screen.
View on alarm notification settings
Function Network features You can determine how the monitor notifies you of a remote patient
bed alarm condition. Choices are:
View on alarm notification CARESCAPE Network MC and S/5 • Off: Remote alarm notification is turned off.
Network: Monitor alarms for up to 40 • Message: Remote alarm messages display in the alarm area. At
beds. any time, you can select a remote alarm message to open a bed-
View remote beds CARESCAPE Network MC: View one to-bed window and view the remote patient’s data.
bed from up to 2048 beds. • Auto View: Bed-to-bed window opens immediately if no other
S/5 Network: View one bed from up procedure or setup window is currently open. Otherwise, a
to 128 beds. remote alarm message displays in the alarm message area. To
open the bed-to-bed window and view the remote patient’s
See the “CARESCAPE Monitor B650 Supplemental Information data, select the remote alarm message.
Manual” to configure the following remote alarm configuration • Auto View Always: Immediately closes any open procedure or
settings: setup windows and opens a bed-to-bed window with the remote
• Alarm priority for an allowed remote audio pause. patient’s data.
Choices are: Not Allowed; Low; Medium, Low; and High, Med,
Low.
• Display of the remote patient name.
• Use of the alarm light for a remote alarm.
• Remote alarm tone selection.

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Setting the view on alarm notification Changing all patient beds to one view on alarm notification
To set how you want to be notified during a remote patient bed setting and/or alarm priority setting
alarm condition: You can select a care unit and change all of the listed remote patient
1. Select Data & Pages from the monitor’s main menu. beds to a single notification setting and/or a single alarm priority
2. Select Other Patients > Receive Alarms setting.
3. Select a care unit from the Unit list. 1. Select Data & Pages from the monitor’s main menu.
4. Select a patient bed from the displayed list. 2. Select Other Patients > Receive Alarms
5. Select the type of alarm notification desired from the Alarm 3. Select a care unit from the Unit list.
Notification list. 4. To change the alarm notification settings, choose a setting from
See “View on alarm notification settings” section for notification the Change All Notifications list.
choices. See “View on alarm priority settings” section for alarm priority
choices.
View on alarm priority settings
5. To change the alarm priority settings, choose a setting from the
You can determine the remote patient alarm priority levels you want
Change All Priorities list.
notification of. Choices are:
See “View on alarm notification settings” section for notification
- High: Opens a bed-to-bed window for remote patients in a
choices.
high alarm priority condition.
- High, Med: Opens a bed-to-bed window for remote patients
Viewing the next alarming remote patient bed
in a high or medium alarm priority condition.
- High, Med, Low: Opens a bed-to-bed window for remote If you have a bed-to-bed window open and another Auto View or
patients in a high, medium, or low alarm priority condition. Auto View Always bed goes into alarm, select View Next Patient to
open the bed-to-bed window to view the next highest and newest
Setting the view on alarm priority alarming patient bed.
To set the alarm priority level you want to be notified of during a
remote patient bed alarm condition:
1. Select Data & Pages from the monitor’s main menu.
2. Select Other Patients > Receive Alarms.
3. Select a care unit from the Unit list.
4. Select a patient bed from the displayed list.
5. Select the alarm priority level from the Alarm Priorities list.
See “View on alarm priority settings” section for alarm priority
choices.
Viewing remote patient beds Printing remote patient bed waveforms manually
You can select and view a networked alarming or non-alarming NOTE: Printing remote patient bed waveforms is supported by the
remote patient bed. CARESCAPE Network MC only.

To select a remote patient bed to view:
1. Select Data & Pages from the monitor’s main menu.
2. Select Other Patients > View Patients.
3. Select the care unit from the Unit list.
A list of remote patient beds display for the selected care unit.
4. Choose whether you want to see a list of all patient beds in the
care unit or the list of remote patient beds configured for alarm
notification:
• To show a list of all the remote patients in the care unit,
select All Patients from the Show list.
• To show the list of remote patients configured for alarm
notification, select Notification Patients Only from the Show
list.
See the “View on alarm priority settings” section for alarm
priority choices.
5. Select a patient’s bed from the displayed list.
6. Select View.
30 seconds of waveform data can be manually printed from a
remote monitor. The waveforms that appear on the printout are
determined by the remote monitor’s print configuration
To manually print waveforms for the remote patient bed viewed
from the bed-to-bed window:
• Select Print from the bed-to-bed window.
The print location is determined by the local monitor’s print
configuration.
Stop viewing a patient bed
To stop viewing this patient bed and to close the bed-to-bed
window, select Close View.
NOTE: Selecting will not close any open bed-to-bed views
of an alarming or non-alarming patient bed.

Pausing remote patient bed audible alarms

NOTE: The monitors must be on the network. The remote monitor
must be configured to allow a Remote Audio Pause to occur.

To pause the active alarms for the remote patient bed viewed from
the bed-to-bed window, select Remote audio alarm pause.

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For your notes

Checking alarm function
1. Set a parameter alarm limit outside of the current measured
patient values.
For example, connect the SpO2 sensor and adjust the SpO2 High
limit under the measured SpO2values.
2. Confirm that the following alarm notification events occur:
NOTE: See the “Audible alarm signals” table in the “Alarms”
chapter for alarm behavior descriptions.
- The audible alarm sounds the correct tone.
- The alarm light illuminates.
- The SpO2 numeric value flashes in the parameter window
with the correct color.
- An alarm printout (if enabled).
3. Audio pause the alarms and confirm that the alarms are paused
and that the left side of the alarm indicator light is a solid blue
color.
4. Return the parameter alarm limit to the original value.

100
 101

System messages
For a graphic presentation of a generic layout, see the “Monitoring basics” chapter. This will help you identify where on screen the following
messages appear. The table below lists the messages in alphabetical order according to the message in the alarm area. If there is also a
simultaneous message in parameter windows or in the waveform area, these are listed with the alarm area message. In this table, the message
location is indicated with the following: al. area = alarm area; param. = parameter window; wavef. = waveform area. Modules connected using
the Unity Network Interface Device are referred to as UNID. For information regarding alarm priorities and escalation times, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”

MESSAGE LOCATION EXPLANATION WHAT TO DO

• A Fib
• Accel. Ventric.
• ABP high / ABP low
• ADT server
communication failure
• Agent mixture
• Alarm setup changed
from central
• Alarm volume changed
• Alarms acknowledged
from central
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area An error occurred when trying to search for • Check the network connectivity.
patient on the ADT server. • Retry loading from the network.
• If the problem persists, contact
authorized service personnel.
• al. area, param. Compact airway modules: Mixture of halogenated • Check the ventilator and agent
agents is detected. vaporizer settings.
• al. area The alarm setup has been changed from the • Check the alarm settings and
Central. adjust if necessary.
• al. area The network connection is lost, and the local alarm • Readjust volume if desired.
volume is increased.
• al. area The alarms have been acknowledged from the • No action required but you may
Central. wish to confirm in alarm history
which alarm has been
acknowledged.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• All monitors • al. area Host monitor is disconnected from the network. • Re-establish connection.
disconnected • If the problem persists, contact
authorized service personnel.
• Apnea • al. area, wavef. Airway gases, impedance respiration: No • Check the patient status.
• APN • param. breathing detected. • Check the ventilator and
breathing status.
• Application error: iPanel • alarm Connection to iPanel was lost. • Re-establish the connection.
• If the problem persists, contact
authorized service personnel.
• Application error: pdf • al. area MUSE 12 SL: PDF viewer closes unexpectedly. • Try to open the MUSE 12SL report
again.
• If the problem persists, contact
authorized service personnel.
• Application error: • al. area Webmin application closes unexpectedly. • Try to open Webmin again.
Webmin • If the problem persists, contact
authorized service personnel.
• Arrhythmia paused • al. area Arrhythmia processing/detection is paused due to • Check the patient status.
excessive artifact. • Check electrode placement.
• Prep the patient’s skin at
electrode sites.
• Change or move electrodes.
• Art disconnect • al. area Invasive pressure line is disconnected. • Check connections.
• Disconnected • param.
• Art high / Art low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• Asystole • al. area, ECG: Physiological alarm. • Check the patient status.
param., wavef.

102
 103

MESSAGE LOCATION EXPLANATION WHAT TO DO

• Barcode scanned • al. area All data has been successfully stored to the • No action required.
monitor.
• Barcode too long • al. area The maximum length of the barcode has been • Verify the information read by the
exceeded. barcode reader and edit if
necessary.
• Battery Failure • al. area The monitor battery is faulty. • Replace the battery if necessary.
• Battery Temperature • al. area The battery’s temperature is too high. • Replace the battery.
High • If the problem persists, contact
authorized service personnel.
• Bigeminy • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• BIS cable off • al. area BIS: Cable is disconnected from the module. • Connect the cable.
• Cable off • param., wavef.
• BIS DSC error • al. area BIS: The digital signal converter is not • Test the DSC.
• DSC error • param., wavef. communicating or operating properly. • If the problem persists, contact
authorized service personnel.
• BIS high / BIS low • al. area BIS: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
• BIS measurement • al. area BIS: The module is disconnected. • Connect the module to start the
removed measurement.
• BIS module error • al. area BIS: The module is not working properly. • Check cable and connections.
• Module error • param., wavef. • Replace digital signal converter
(DSC).
• If the problem persists, contact
authorized service personnel.
MESSAGE
• BIS sensor check failed
• Sensor check failed
• BIS sensor expired
• Replace sensor
• Block recovery
• Brady
• Call Service: Text(s)
missing
• Cardiac artifact
• Artifact
• Case ended
• Case started
• CCI high / CCI low
• CCO high / CCO low
LOCATION EXPLANATION WHAT TO DO
• al. area BIS: The sensor has not passed the impedance • Check sensor placement and
• param., wavef. check. attachment.
• Press each electrode in the
sensor.
• Replace the sensor.
• al. area BIS: The sensor is too old or it has been used for • Replace the sensor.
• param., wavef. more than 24 hours.
• al. area NMT: Count number has reached the value you • Check the patient status.
have selected for the recovery note function.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area The software text is missing in this languaage; the • Contact authorized service
text file may be corrupted. personnel.
• al. area Impedance respiration with PDM: Cardiac artifact • Check the patient status.
• param., wavef. has been detected. • Select alternate leads to monitor.
• Increase sensitivity settings.
• Select alternate lead placement.
• Relearn respiration.
• al. area OR and PACU software packages: The current case • No action required.
has just been ended.
• al. area OR and PACU software packages: A new case has • No action required.
just been started.
• al. area CCI: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
• al. area CCO: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
104
 105

MESSAGE LOCATION EXPLANATION WHAT TO DO

• Check PDM battery • al. area PDM: The module is connected but the battery • Change the battery.
quality is not acceptable. • If the problem persists, contact
authorized service personnel.
• Check NIBP • al. area NIBP: Systolic and/or diastolic results missing. • Check the patient status.
• Check NIBP cuff and hoses.
• Repeat the measurement.
• Check sample gas out • al. area Gases: The water trap is not connected, the • Check water trap connection.
• Sample gas out • param. sample gas outflow is blocked, or there is a leak • Remove the blockage from the
• Check water trap and • wavef. inside the module. sample gas outlet.
sample gas out. Wait 30 • Change module if needed.
sec. And press Normal
Screen to continue.
• Check SpO2 probe / • al. area SpO2 with E-modules: There is no detectable SpO2 • Check the sensor and
Check SpO2(2) probe signal, the sensor is faulty or is detached from the connections.
• Check probe • param. patient.
• Check Water Trap • al. area, param. Gases: Water trap connection is not correct, or • Check the patient status.
• Check water trap and • wavef. there is a leak in the sampling line inside the • Check the water trap and its
sample gas out. Wait 30 module. connection.
sec. And press Normal
Screen to continue.
• CO measurement • al. area C.O.: Acquisition module has been removed. • Connect the module if you want
removed to restart the measurement.
• Condition monitor • al. area Battery is not working properly. • Replace or remove the battery.
battery
• Configuration change(s) • al. area The loaded configuration has changed from the • No action required, but you may
previous one. wish to check the settings.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• Configuration changes. • al. area The configuration has changed. • Restart the monitor.
Restart required
• Configuration error(s) • al. area One or more errors have been detected in the • Contact authorized service
configuration. personnel.
• Connecting • al. area An acquisition module has been connected. • No action required.
Measurement
• Countdown timer • al. area User set countdown timer has expired. • Reset the timer if required.
expired
• Couplet • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• CPP high / CPP low • alarm IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• CVP high / CVP low • alarm IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• ECG error • al. area ECG: The module has a communication error. • Check the module.
• Replace the module if necessary.
• ECG measurements • al. area ECG: Acquisition module has been removed. • Connect the module if you want
removed to restart the measurement.
• EEG leads off • al. area EEG: Leads are not connected. • Reconnect the disconnected
• Leads off • param. headbox leads.
• EEG measurement • al. area EEG: Acquisition module has been removed. • Connect the module if you want
removed to restart the measurement.
• End of 20 min trend data • al. area There is more trend data available but not with this • Change the time resolution in
resolution. graphic trends to be more than
20 minutes (e.g., 1 hour, 2 hours).
• Scroll the trends to see past data.

106

MESSAGE
• Entropy cable off
• Cable off
• Entropy measurement
removed
• Entropy RE high /
Entropy RE low
• Entropy SE high /
Entropy SE low
• Entropy sensor check
failed
• Sensor check failed
• Entropy sensor off
• Sensor off
• EtAA high / EtAA low
where AA = Hal, Enf, Iso, Sev or
Des
• EtCO2 high / EtCO2 low
• EtO2 high / EtO2 low
107
LOCATION EXPLANATION WHAT TO DO
• al. area Entropy: The Entropy sensor cable is not • Connect the Entropy cable to the
• param. connected to the Entropy module. Entropy module.
• al. area Entropy: Acquisition module has been removed. • Connect the module if you want
to restart the measurement.
• al. area Entropy: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Entropy: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Entropy: The sensor has not passed the • Check sensor placement and
impedance check. attachment.
• param. • Press each electrode in the
sensor.
• Replace the sensor.
• al. area Entropy: The sensor is connected to the cable but • Check that the sensor is properly
• param. not attached to the patient. attached to the patient.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
MESSAGE
• Ext:Apnea
• Ext: Hardware error
• Hardware Error
• Faulty cable
• Faulty ECG cable
• Fem high / Fem low
• FemV high / FemV low
• FiAA high / FiAA low
where AA = Hal, Enf, Iso, Sev or
Des
• FiCO2 high / FiCO2 low
• FiN2O high
• FiO2 high / FiO2 low
• Frequent PVCs
LOCATION EXPLANATION WHAT TO DO
• al. area Gases with UNID: No breathing detected. • Check the patient status.
• Check the ventilator and the
breathing status.
• Check the interfaced device.
• al. area Gases with UNID: There is a problem with the • Check the interfaced device.
• param. interfaced device. • If the problem persists, contact
authorized service personnel.
• wavef. ECG: The cable is faulty. • Replace the cable.
• al. area
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area Gases: Measurement value is equal to or outside • Check the patient status.
the alarm limits. • Adjust the alarm limit if
necessary.
• al. area Gases: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust the alarm limits if
necessary.
• al. area ECG: Physiological alarm. • Check the patient status.
108
 109

MESSAGE LOCATION EXPLANATION WHAT TO DO

• Gas measurements • al. area Gases: Acquisition module has been removed. • Connect the module if you want
removed to restart the measurement.
• High BIS impedance • al. area BIS: Electrode impedance is too high. • Check electrode connections.
• HR(ECG) high / • al. area HR (ECG)/PR (ABP, ART, Fem, UAC, SpO2): • Check the patient status.
HR(ECG) low Measurement values are equal to or outside the • Adjust the alarm limits if
• PR(ABP) high / alarm limits. necessary.
PR(ABP) low
• PR(Art) high /
PR(Art) low
• PR(Fem) high /
PR(Fem) low
• PR(UAC) high /
PR(UAC) low
• PR(SpO2) high /
PR(SpO2) low
• HR high / HR low • al. area ECG: Measurement values are outside the alarm • Check the patient status.
limits. • Adjust the alarm limits if
necessary.
• ICP high / ICP low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• Identical BIS modules • al. area BIS: There are two BIS modules in the system. • Remove one BIS module.
• Identical Entropy • al. area Entropy: There are two Entropy modules in the • Remove one Entropy module.
modules system.
• Identical IP address • al. area Two or more monitors have the same IP address. • Contact authorized service
noticed personnel.
• Identical unit & bed • al. area Two or more monitors have the same unit and bed • Contact authorized service
name noticed name. personnel.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• Incompatible gas • al. area Gases: The module is not compatible. • Replace with compatible gas
module module. See the “CARESCAPE
Monitor B650 Supplemental
Information Manual.”
• If the problem persists, contact
authorized service personnel.
• Incompatible Module • al. area The module is not compatible. • Replace with compatible module.
See the “CARESCAPE Monitor
B650 Supplemental Information
Manual.”
• If the problem persists, contact
authorized service personnel.
• Incompatible SpO2 • al. area SpO2 with PDM, E-PRESTN, E-RESTN, PSM, E- • Replace the sensor. See the
probe / Incompatible MASIMO: The sensor is not compatible. “CARESCAPE Monitor B650
SpO2(2) probe Supplemental Information
• Incompatible probe • param. Manual.”
• If the problem persists, contact
authorized service personnel.
• Incorrect barcode value • al. area The barcode string differs from the defined values. • Contact authorized service
personnel.
• Invalid barcode • al. area The barcode configuration is not correct. • Contact authorized service
configuration personnel.
• IP's not zeroed • al. area, param. The invasive pressure lines have not been zeroed. • Perform zeroing, see the “Invasive
blood pressures“ chapter.
• Irregular • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• Lab data available • al. area UNID: Interfaced device has sent a new set of • Save the new data; see the
laboratory data to the monitor. “Laboratory data“ chapter.

110
 111

MESSAGE LOCATION EXPLANATION WHAT TO DO

• Lab data interface • al. area UNID: There is a communication failure or error • Check the interfaced device.
failed between the UNID and the interfaced device. • If the problem persists, contact
authorized service personnel.
• LAP high / LAP low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• Leads off • al. area, wavef. ECG: ECG cable is disconnected. • ECG: Check the ECG cable and
connections.
• License(s) expired • al. area One or more trial licenses have expired. • Contact authorized service
personnel.
• Loading failed • al. area Loading a case/patient from an acquisition • Check device or network cable
module or network has been interrupted. connections.
• For more information, see the
“Starting and ending monitoring“
chapter.
• Loading from network • al. area Patient data is being loaded from the network. • No action required.
• Loading from PDM • al. area Patient data is being loaded from an acquisition • For more information, see the
module. “Starting and ending monitoring“
chapter.
• Low gas sample flow • al. area Gases: Sample flow is less than 80% of the • Check the sample line.
module’s nominal flow value. This can happen if • If the problem persists, contact
nebulized medications are given without authorized service personnel.
disconnecting the sample line.
• Missing beat • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• Module voltage low • al.area E-modules only. Parameters may not be working • Check the patient status.
properly due to a technical fault in the monitor. • Contact authorized service
personnel.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• Monitor battery empty! • al. area The monitor is used on battery power, and there is • Charge the battery by using the
less than 5 minutes of charge left. monitor on mains power.
• Monitor battery low • al. area The monitor is used on battery power, and there is • Charge the battery by using the
less than 20 minutes of charge left. monitor on mains power.
• Monitor disconnected • alarm The alarming monitor is disconnected from the • Re-establish the connection.
network.
• Monitor powering down! • al. area The monitor is used on battery power and there is • Charge the battery by using the
less than 10 seconds of charge left. monitor on mains power.
• Multifocal PVCs • alarm, wavef. ECG: Physiological alarm. • Check the patient status.
• MVexp high / MVexp low • alarm Patient Spirometry: Measurement values are equal • Check the patient status.
to or outside the alarm limits. • Adjust the alarm limits if
necessary.
• Network down • al. area Network connection has failed. • Try to re-establish the
If the monitor is used with WLAN option, it is is connection.
shadow region and not connected to the network. • Contact authorized service
personnel.
• NIBP air leakage / • al. area NIBP with E-modules only. • Check the cuff and cuff hose.
NIBP manual Loose cuff or cuff hose.
• Air leakage • param.
• NIBP cuff occlusion • al. area NIBP: Occlusion during measurement or • Check the cuff.
• Cuff occlusion • param. overpressured cuff.
• NIBP cuff loose / • al. area NIBP: Loose cuff or cuff hose. • Check the cuff and cuff hose.
NIBP manual
• Cuff loose • param.
• NIBP high / NIBP low • al. area NIBP: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.

112
 113

MESSAGE LOCATION EXPLANATION WHAT TO DO

• NIBP measurement
removed
• NMT cable removed
• Cable off
• NMT measurement
removed
• No battery backup in
monitor
• No BIS sensor
• No sensor
• No Entropy sensor
• No sensor
• No patients found
• No printer selected
• No Px Transducer
where x = 1, 2, 3, 4, 5, 6, 7, 8
• al. area NIBP: Acquisition module has been removed. • Connect the module if you want
to restart the measurement.
• al. area NMT: The cable has been disconnected from the • Reconnect the cable if you want
• param. module. to restart the measurement.
• al. area NMT: Acquisition module has been removed. • Connect the module if you want
to restart the measurement.
• al. area The monitor has the battery option but there is no • Insert a battery.
battery inserted.
• al. area BIS: The sensor is not connected to the digital • Check the connection between
• param., wavef. signal converter. sensor and DSC, and sensor and
PIC.
• al. area Entropy: The sensor is not connected to the cable. • Check connection between
Entropy sensor and cable.
• al. area No patients were found when searching the ADT • Verify or change search criteria.
server. • Manually enter demographic
information.
• al. area There is no printer selected on the monitor. • Select a printer, see the “Printing“
chapter.
• al. area IP: No transducer connected. • Connect a transducer.

• No SpO2 pulse / • al. area SpO2 with E-modules: Pulse signal is poor. • Try other measurement sites.
No SpO2(2) pulse
• No pulse • param.
• No SpO2 probe / • al. area SpO2 with all modules except UNID: Sensor is not • Check connection between the
No SpO2(2) probe connected to the acquisition module. sensor and the acquisition
• No probe • param. module.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• Noisy ECG • al. area ECG: Excessive noise which compromises the • Check and remove sources of
accuracy of detecting events. excessive noise.
• Not an Entropy sensor • al. area Entropy: The sensor used is not an Entropy sensor. • Make sure that you are using an
• Not Entropy sensor • param. Entropy sensor by GE.
• Over range • al. area, param. IP: The measurement value is over range. • Check the patient status.
• P7 connected • al. area IP: The channel has been connected. • No action required.
P8 connected
• PA high / PA low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• Patient admitted • al. area ICU, NICU and ED software packages: The current • For more information, see the
patient has just been admitted. “Starting and ending monitoring“
chapter.
• Patient discharged • al. area ICU, NICU and ED software packages: The patient • For more information, see the
has just been discharged. “Starting and ending monitoring“
chapter.
• Pause • al. area, wavef. ECG • Check the patient status.
• PDM battery low • al. area PDM: The PDM battery cannot be charged due to a • Allow PDM battery to charge.
power fault. • If message persists, change
battery.
• If message still persists, contact
authorized service personnel.
• PDM charging is denied • al. area The PDM battery cannot be charged because the • Contact authorized service
internal temperature of the monitor is too high. personnel.
• PEEPe high / PEEPe low • al. area Patient Spirometry with ICU and ED software • Check the patient status.
packages: Measurement values are equal to or • Adjust alarm limits if necessary.
outside the alarm limits.

114

MESSAGE
• PEEPi high / PEEPi low
• PEEPtot high /
PEEPtot low
• Ppeak high / Ppeak low
• Pressure measurement
removed
• Printer error
• Printing Alarm
• Printing ready
• Printing...
• Px high / Px low
where x = 1, 2, 3, 4, 5, 6, 7, 8
• QT high
• QTc high
115
LOCATION EXPLANATION WHAT TO DO
• al. area Patient Spirometry with ICU and ED software • Check the patient status.
packages: Measurement values are equal to or • Adjust alarm limits if necessary.
outside the alarm limits.
• al. area Patient Spirometry with OR and PACU software • Check the patient status.
packages: Measurement values are equal to or • Adjust alarm limits if necessary.
outside the alarm limits.
• al. area Patient Spirometry: Measurement values are equal • Check the patient status.
to or outside the alarm limits. • Adjust alarm limits if necessary.
• al. area IP: The acquisition module has been removed. • Reconnect if necessary.
• al. area Printer: A printer is not present or the printer needs • Select Monitor Setup > Printing
paper. to choose a different printer.
• Add paper to the printer.
• al. area Recorder: An alarm has triggered printing. • Wait for the printing to finish.
• al. area Your printing request has been forwarded to the • No action required. The message
printer. will disappear automatically.
• al. area Printer: Printing is occurring. • Wait for the printing to finish.
Recorder: Manual printing is initiated for Print
Waveforms, ALL ECG, PA Waveform, or Catheter
Insertion.
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
MESSAGE LOCATION EXPLANATION WHAT TO DO
• RAP high / RAP low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• RVP high / RVP low • al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• Rapid VT • al. area ECG: Physiological alarm. • Check the patient status.
• R on T • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• Re-calibrate SvO2 • al. area, param. SvO2: The calibration is over 24 hours old. • Perform In Vivo calibration.

• Recorder cover open • al. area The recorder cover is open. • Close the recorder cover.
• Recorder input voltage • al. area There are problems with the recorder input • Contact authorized service
high / Recorder input voltage. personnel.
voltage low
• Recorder out of paper • al. area The recorder is out of paper. • Add paper.
• Recorder system error • al. area The local recorder is not working. • Reset the local recorder by
turning its power off and on
again. If this does not help,
contact authorized service
personnel.
• Recorder thermal array • al. area There are problems with the recorder • Contact authorized service
overheat temperature. personnel.
• Remove one ECG • al. area ECG, impedance respiration, SpO2: There are two • Remove one ECG module.
module ECG modules in the system.
• Replace Entropy sensor • al. area Entropy: The sensor is too old. • Replace the sensor with a new
• Sensor expired • param. one.
• Replace Monitor battery • al. area Monitor battery is not working properly. • Replace the battery.

116

MESSAGE
• Replace Water Trap
• Resp high / Resp low
• Sample line blocked
• Continuous blockage.
Check sample line and
water trap.
• Saving
• Saving Loop...
• Select cuff size
• Select inflation limits
• Sensor
• Service Monitor -
and specific error indication
• Service the PDM -
and specific error indication
• Single PVC
• Snapshot created
117
LOCATION EXPLANATION WHAT TO DO
• al. area, param. Gases: Water trap is partially blocked. • Replace the water trap.
• al. area Impedance respiration: Measurement values are • Check the patient status.
equal to or outside the alarm limits. • Adjust alarm limits if necessary.
• al. area Gases: The gas sampling line is blocked or the • Change sampling line and water
• wavef. water trap is occluded. trap.
• al. area The recorder is unavailable while printing manual • Check the recorder.
or alarm waveform recording, and the recording is
saved for later printing.
No recording location has been selected. • Select a recording location.
• al. area Patient Spirometry: A loop is being saved. • Wait until the message
disappears.
• al. area, param. NIBP: Cuff does not have an automatically • Select a cuff size from the NIBP
detectable cuff ID. setup menu.
• al. area, param. NIBP: Cuff does not have an automatically • Select an inflation limit from the
detectable cuff ID. NIBP setup menu.
• al. area, param. IP: Faulty sensor. • Check the cable and connections.
• Replace the transducer.
• al. area Technical fault in the monitor. • Contact authorized service
personnel.
• al. area Technical fault in the PDM. • Contact authorized service
personnel.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area A snapshot has been created. • No action required.
MESSAGE
• Snapshot memory full. •
Oldest snapshot erased.
• SpO2 faulty probe /
SpO2(2) faulty probe
• Faulty probe
• SpO2 high / SpO2 low
• SpO2(2) high / SpO2(2)
low
• SpO2 measurement
removed
• SpO2 probe off /
SpO2(2) probe off
• Probe off
• ST snapshot created
• ST snapshot memory
full. Oldest ST snapshot
erased.
• ST x high / ST x low
where x = Ant., Inf., Lat.
• ST XXX high / ST XXX low •
where XXX = ECG lead label
LOCATION EXPLANATION WHAT TO DO
al. area You are trying to save a snapshot but the memory • Choose whether or not you wish
capacity is full. to save the new snapshot and
erase the oldest one. For more
information, see the “Trends and
snapshots“ chapter.
• al. area SpO2: The sensor has failed. • Replace the sensor.
• param.
• al. area SpO2: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
• al. area SpO2: Acquisition module has been removed. • Connect the module if you want
to restart the measurement.
• al. area SpO2 with all modules except E-NSATX: The finger • Check the patient status.
or earlobe may be too thin or the sensor is off the • Reposition the SpO2 sensor.
• param. patient. • Replace the SpO2 sensor.
The sensor may be defective.
• al. area ST snapshot created. • No action required.
• al. area You are trying to save an ST snapshot but the • Choose whether or not you wish
memory capacity is full. to save the new ST snapshot and
erase the oldest one. For more
information, see the “Trends and
snapshots“ chapter.
• al. area, param. ECG: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
al. area ECG: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
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MESSAGE LOCATION EXPLANATION WHAT TO DO

• SvO2 cable off • al. area SvO2: The cable is disconnected from the module. • Re-connect the cable to the
module.
• SvO2 faulty cable • al. area, param. SvO2: The optical module has failed. • Check the optical module and
connections.
• Replace the optical module.
• SvO2 high / SvO2 low • al. area SvO2: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.

• SvO2 measurement • al. area SvO2: Acquisition module has been removed. • Connect the module if you want
removed to restart the measurement.
• SvO2 not calibrated • al. area, param. SvO2: The optical module is connected to the • Perform In Vivo calibration.
monitor and the catheter has not been calibrated.
• SvO2 signal poor • al. area, param. SvO2: There is signal pulsation, the catheter is • Flush the catheter.
touching the wall, or there is an intensity shift in • Check the optical module and
signal quality level. connections.
• Check the catheter placement via
x-ray.
• SvO2 temp error • al. area SvO2: The temperature of the optical module is out • Check the optical module and
of range for more than 10 minutes. connections.
• Replace the optical module.
• Contact authorized service
personnel.
• Tachy • al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• TC measurement • al. area TC: Interfaced module has been removed. • Connect the module if you want
removed to restart the measurement.
• TC pCO2 high / • al. area TC: Measurement values are equal to or outside • Check the patient status.
TC pCO2 low the alarm limits. • Adjust alarm limits if necessary.
MESSAGE
• TC pO2 high /
TC pO2 low
• TC timer expired
• TC Tsensor high
• Tsensor high
• Temp measurement
removed
• Trigeminy
• TVexp low
• Tx Calibration fail
where x = 1, 2, Tblood
• Calibration fail
• Tx high / Tx low
where x = 1, 2, 3, 4, Tblood
• Tx temperature error
where x = 1, 2, 3, 4
• Temperature error
• T2-T1 high
• T4-T3 high
• Tblood-T1 high
• Tblood-T3 high
LOCATION EXPLANATION WHAT TO DO
• al. area TC: Measurement values are equal to or outside • Check the patient status.
the alarm limits. • Adjust alarm limits if necessary.
• al. area TC: The time set on the interfaced device after a • Change the sensor site and reset
successful calibration has now expired. the timer.
• al. area TC: Limit is set on the interfaced device. • Check the interfaced device.
• param. • If the problem persists, contact
authorized service personnel.
• al. area Temperature: Acquisition module has been • Connect the module if you want
removed. to restart the measurement.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area Patient Spirometry: Measured value is outside or • Check the patient status.
equal to the alarm limit. • Adjust alarm limit if necessary.
• al. area Temperature with PDM: Calibration on the • Check the connections.
indicated channel failed. • Replace the transducer.
• param. • If the problem persists, contact
authorized service personnel.
• al. area Temperature: Measurement values are equal to or • Check the patient status.
outside the alarm limits. • Adjust alarm limits if necessary.
• al. area Temperature with E-PSM, E-PSMP, E-PRESTN, • Change the cable.
E-RESTN, E-PRETN, E-COP, E-COPSv, E-PT: • Change the module.
• param. Hardware or calibration test failure in the • If the problem persists, contact
measurement device. authorized service personnel.
• al. area Temperature: Measured delta value is equal to or • Check the patient status.
outside the alarm limits. • Adjust alarm limits if necessary.
120

MESSAGE
• UAC high / UAC low
• Unable to read licenses
• Under range
• UVC high / UVC low
• V Brady
• V Fib
• V Fib/V Tach
• V Tach
• Vent: Apnea
• Vent: Check ventilator
• Vent: Connecting
• Connecting
121
LOCATION EXPLANATION WHAT TO DO
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area The system cannot use the correct license file. • Contact authorized service
personnel.
• al. area, param. IP: The measurement value is under the range. • Check the patient status.
• Check the cables.
• Rezero the transducer.
• Change the module.
• If the problem persists, contact
authorized service personnel.
• al. area IP: Measurement values are equal to or outside the • Check the patient status.
alarm limits. • Adjust alarm limits if necessary.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area, ECG: Physiological alarm. • Check the patient status.
param., wavef.
• al. area, ECG with PDM: Physiological alarm. • Check the patient status.
param., wavef.
• al. area, ECG: Physiological alarm. • Check the patient status.
param., wavef.
• al. area Spirometry with UNID: No breathing detected. • Check the patient status.
• Check the interfaced device.
• al. area Spirometry with UNID: The interfaced device needs • Check the interfaced device.
to be checked. • If the problem persists, contact
authorized service personnel.
• al. area Spirometry with UNID: Interfaced device is being • No action required.
• param. connected to the monitor through UNID.
MESSAGE
• Vent: Disconnect
• Vent: Ext not supported
• Ext not supported
• Vent: In Alarm
• Vent: Low battery
• Vent: No ext device
• No ext device
• Ventilator interface
removed
• VT>2
• Wrong cable. Use
Masimo Set
• Wrong cable
LOCATION EXPLANATION WHAT TO DO
• al. area Spirometry with UNID: Interfaced device needs to • Check the patient status.
be checked. • Check the ventilator tubing and
patient connection.
• Check the interfaced device.
• If the problem persists, contact
authorized service personnel.
• al. area Spirometry with UNID: Interfaced device is not • See the “Unity Network Interface
• param. supported. Device (ID) Operator’s Manual” for
supported devices.
• If the problem persists, contact
authorized service personnel.
• al. area Spirometry with UNID: Interfaced device needs to • Check the patient status.
be checked. • Check the ventilator tubing and
patient connection.
• Check the interfaced device.
• al. area Spirometry with UNID: Interfaced device needs to • Check the interfaced device.
be checked. • If the problem persists, contact
authorized service personnel.
• al. area Spirometry with UNID: Interfaced device is not • Check the interfaced device.
• param. detected by UNID. • If the problem persists, contact
authorized service personnel.
• al. area Spirometry with UNID: The cable between the • Reconnect the cable if you want
UNID and the interfaced device has been removed. to restart the interface.
• al. area, wavef. ECG: Physiological alarm. • Check the patient status.
• al. area, param. SpO2: You have connected a Nellcor OxiMax cable • Use a MasimoSet cable.
to the PDM Masimo.
• param.
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MESSAGE LOCATION EXPLANATION WHAT TO DO

• Wrong cable. Use
Nellcor OxiMax
• Wrong cable
• Zero ICP separately
• alarm, param. SpO2: You have connected a MasimoSet cable to • Use a Nellcor OxiMax cable.
the PDM Nellcor.
• param.
• alarm IP: The ICP channel must be zeroed separately • Zero the channel using the Zero
from all other invasive pressures. option found under the ICP
channel setup menu.

Information messages in parameter windows and waveform area only

In this table, the message location is indicated with the following: report = report view; param. = parameter window; wavef. = waveform area,
and modules connected using the Unity Network Interface Device are referred to as UNID.

MESSAGE LOCATION EXPLANATION WHAT TO DO

> 320 mmHg param. IP: Measurement is over range. • Check the patient’s pressure by
> 43 kPa NOTE: There is also the ‘Over range’ message in alternative means.
the alarm area. • Check the cable and connections.
• Rezero the transducer.
• Replace the module.
• If the problem persists, contact authorized
service personnel.
< -40 mmHg param. IP: Measurement is under range. • Check the patient’s pressure by
< -5 kPa NOTE: There is also the ‘Under range’ message alternative means.
in the alarm area. • Check the cable and connections.
• Rezero the transducer.
• Replace the module.
• If the problem persists, contact authorized
service personnel.
12 diagnostic leads report ECG: Some of the ECG leads are disconnected. • Check that all ECG leads are connected to
needed the patient.
MESSAGE LOCATION EXPLANATION WHAT TO DO
12RL can't be used with report ECG: 12RL is not available in the NICU software • Use another software package to create
neonates package. 12RL/12SL reports.
ACI-TIPI on but age less report ECG: The setting is ON but the patient is under • Set the ACI-TIPI to OFF to create 12SL
than 16 16 years old. reports.
• Adjust the patient age on the monitor if it
is not correct.
ACI-TIPI on but chest or report ECG: The setting is ON but chest or left arm pain • Set the ACI-TIPI to off.
left arm pain not entered information has not been entered. • Enter chest or left arm pain information.
AEP stimulation on param. AEP: The measurement is being performed and • Wait until the stimulation is completed.
clicks are being delivered to the headphones.
Apnea deactivated param. Gases: A new case has just been started/a new • Wait. The message disappears after the
patient admitted, or the measurement has just monitor detects 3 breaths during the last
been started and the apnea alarm is not active minute.
yet.
Impedance respiration: The case has just been • Wait. The message disappears after the
started/patient admitted on the monitor, or the monitor detects 5 breaths.
measurement has just been started.
Apply sensor param. BIS: Loose electrode connection. • Connect the electrodes properly to the
patient and check connections.
Arrh off param. ECG: The arrhythmia detection level is set to Off. • If arrhythmia detection is needed, set the
detection level to Full or Lethal
Arrh paused wavef. ECG • Check the patient status.

124
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MESSAGE LOCATION EXPLANATION WHAT TO DO

Artifact param. Gas exchange: The sample line length is not • Check that the sample line length is 2
correct. meters.
• Change sample line if necessary.
param., wavef. BIS, Entropy: Signals contain noise or artifact. • Check sensor contact.
• Remove sources of excessive noise.
wavef. ECG: Muscle artifact. • Check electrode contact.
• Check lead placement.
• Perform skin preparation.
• Reposition/replace electrodes.
• Request for the patient to remain still.
param. SpO2: • Check sensor contact.
• Reposition/replace sensor.
• Request for the patient to remain still.
param. IP: Measurement is disturbed by artifact. • Check the patient status.
• Check cable contact.
• Minimize tubing length.
• Rezero the transducer.
Artifacts param. EEG: Electrodes are poorly connected, or • Check the electrodes and their
electrical interference is coupling to electrode impedances.
cables. • Remove the sources of noise, if necessary.
NIBP with E-modules: Measurement is disturbed • Calm the patient and retry.
by artifact (e.g. patient movement, shivering,
deep breathing, marked arrhythmia or irregular
beats).
Automatic check off param. BIS, Entropy: Automatic sensor check has been • If required, activate the automatic check.
turned off.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Big contact difference param. EEG: The electrode impedance check fails. • Check the contact quality from the active
and baseline (+ and -) electrodes
establishment to ensure measurement
from the same noise signal.
• Perform a new electrode impedance
check.
Bypass flow high param. Gas exchange: The module is unable to • Add a 5 ml spacer to the patient circuit
synchronize flow and CO2 due to bypass flow. between the Y-piece and D-lite.
• Shorten the expiration time to avoid
expiratory flow pause.
Cable off param. ECG cable is off. • Connect the cable.
Calibrate system param. Gases with UNID: Interfaced device should be • Check the interfaced device.
calibrated. • If the problem persists, contact authorized
service personnel.
Calibrated param. NIBP: Channel calibrated successfully. • Wait until the message disappears before
starting a measurement.
Calibrating param. TC, gases, C.O.: Calibration is in progress. • No action required.
SvO2: Calibration factors are being calculated • No action required.
and stored to the module.
NIBP, IP: Calibration of a channel is in progress. • No action required.
Calibrating gas sensor wavef. Gases: The measurement has been started and • Wait until the calibration is completed and
calibration is in progress. the message disappears.
Calibration error param. Gases, NIBP, TC: Unsuccessful calibration. • Authorized service personnel should
repeat the calibration procedure.
Calibration fail param. C.O.: Unsuccessful calibration. • Authorized service personnel should
repeat the calibration procedure.

126
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MESSAGE LOCATION EXPLANATION WHAT TO DO

Calibration failed param. IP: Unsuccessful calibration. • Check the connections and recalibrate.
Calibration switch ON param. NIBP: The calibration switch is on. • Contact authorized service personnel.
Call service param. NIBP: Technical fault. • Contact authorized service personnel.
Call service: Error x param. NIBP: • Contact authorized service personnel.
where x = 0 - 99 0 = RAM failure; 1 = ROM checksum failure
2 = +15V failure; 3 = -15V failure
6 = ADC error; 7 = Watchdog time too short
8 = Watchdog time too long; 9 = Watchdog activated
10 = EEPROM checksum error; 11 = Autozero range
exceeded; 12 = Communication watchdog activated;
13 = Not in use; 14 = Too early autocycle start

Check cath. position param. SvO2: Low signal quality. • Check the connections and catheter.

Check device param. SpO2: The acquisition module has failed. • Replace the acquisition module.

Check electrodes param. NMT: Adjusted stimulus current could not be • Check the white and brown stimulating
delivered properly due to a broken connection electrodes and their connections.
of the stimulating electrode or cable. • Check the cable.
• Change the cable if necessary.
Check ext device / Check param. Gases, C.O., SpO2, SvO2 with UNID: Interfaced • Check the interfaced device.
Ext device /Check Ext device should be checked. • If the problem persists, contact authorized
Device service personnel.
Check GND electrode param. EEG: The ground electrode impedance is over 5 • Check the contact quality from the ground
kOhm. electrode establishment.
• If necessary, change the electrode.
• Perform a new electrode impedance
check.
Checking electrodes param. EEG: Electrode impedance is being measured • Wait until the electrode impedance check
and EEG analysis is stopped for a few seconds. is completed.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Checking sensor param., wavef. BIS, Entropy: Sensor check is in progress. • Wait until the check is over. Check results
are displayed.
Connecting param. TC, SvO2, SpO2, Spirometry with UNID: • No action required.
Connection to the interfaced device is being
established.
Control measurement param. NIBP: Pressure alarm limit exceeded. • Allow measurement to complete.
• Check the patient status.
Cuff overpressure param. NIBP cuff is squeezed during measurement. • Check NIBP cuff and hoses.
• Repeat the measurement.
Damped Intensity param. SvO2 with UNID • Check the catheter.
• Check the cable and connections.
• Recalibrate in vivo.
• If the problem persists, contact authorized
service personnel.
Disconnected param. IP: Pressure is below physiological detection • Check the patient status.
threshold. • Check the cable and connections.
Draw blood param. SvO2: An advisory prompt. • Draw blood as indicated on screen.

EEG measurement off param. EEG: The measurement has been stopped. • Restart the measurement if required.
Electrodes OK param. EEG: Electrode impedance is below 5 kOhm. • You can continue the measurement.
EMG electrodes off param. NMT: The EMG recording electrodes are off. • Attach the electrodes to continue or start
the measurement.
Enter lab results param. SvO2 : Laboratory values are available. • Enter laboratory results as indicated on
screen.

128
 129

MESSAGE LOCATION EXPLANATION WHAT TO DO

Ext device error param. TC: Interfaced device should be checked. • Check the interfaced device.
• If the problem persists, contact authorized
service personnel.
Failure in Agent ID param. Gases with compact airway modules: An • Flush the breathing circuit with O2 flush
unknown agent or three or more agents (O2+, 100% O2).
detected.
Vaporizer may contain a mixture of agents. • Empty the vaporizer and refill from an
unopened container.
Gas liquified param. Gases with UNID: Interfaced device should be • Check the interfaced device.
checked. • If the problem persists, contact authorized
service personnel.
Gender is not defined report ECG: Patient’s gender has not been entered. • Enter the patient’s gender.
Headbox off param. EEG: Headbox is not connected. • Connect the headbox.
High EMG param. EEG: High frontal muscle activity may disturb • Calm the patient.
the EEG measurement.
High Intensity param. SvO2 with UNID: Catheter floated or up against • Check the optical module and
vessel wall. connections.
• Check the catheter placement via x-ray.
• Only authorized medical personnel should
adjust catheter placement.
In vitro calibrating param. SvO2: In vitro calibration is in process. • Wait until the message disappears.

In vitro failed param. SvO2: Unsuccessful calibration. • Check connections and catheter.
• Change optical module and recalibrate.
• If the problem persists, the catheter could
be faulty; replace the catheter.
In vivo calibrating param. SvO2: In vivo calibration is in process. • Wait until the message disappears.
MESSAGE LOCATION EXPLANATION WHAT TO DO
In vivo poor signal param. SvO2: The measurement cannot be performed • Check connections and catheter.
because the signal is too weak. • Change optical module and recalibrate.
• If the problem persists, the catheter could
be faulty; replace the catheter.
Incompatible DSC param. BIS: The hardware/software is not compatible • Check and change the digital signal
with the digital signal converter type used. converter.
Incompatible sensor param., wavef. BIS: The sensor used is not a BIS sensor. • Make sure that you are using an Aspect
BIS sensor.
Incorrect infl. limits param. NIBP: Adult or child cuff is used, but the • Adjust NIBP setup.
selected infant mode restricts the inflation
pressure too low to be able to measure the
blood pressure.
Insufficient signal param. SvO2: The measurement cannot be performed • Check the patient status.
because the signal is too weak. • Check connections and catheter.
• If the problem persists, contact authorized
service personnel.
Intensity shift param. SvO2: The measurement cannot be performed • Check the patient status.
because the signal intensity changed. • Check connections and catheter.
• If the problem persists, contact authorized
service personnel.
Interface Failed param. Gases with UNID: Interfaced device and UNID • Check the interfaced device.
should be checked. • If the problem persists, contact authorized
service personnel.
Interference param. SpO2: The measurement is disturbed. • Check the sensor.

Isoelectric EEG param., wavef. Entropy: Isoelectric (flatline) EEG detected in • Check the patient status. The patient’s
Entropy measurement. anesthetic status may be unnecessarily
deep.

130
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MESSAGE LOCATION EXPLANATION WHAT TO DO

Lead changed wavef. ECG: The monitor automatically switches the • Note that the ECG waveform changes
ECG1 waveform selection to a measurable ECG according to the lead it is measured from.
Lead (I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5 or Check the lead.
V6) if the current ECG1 waveform is not
measurable.
Lead I failed param., wavef. Impedance respiration with PDM: One of the • Check the electrodes and their
Lead II failed electrodes is off. connections.
Lead RL-LL failed param., wavef. Impedance respiration with PDM: One of the • Check the electrodes and their
electrodes is off. connections.
Learning wavef. ECG: ST algorithm is in learning phase, message • No action required.
shown e.g. when ECG measurement is started.
param. SpO2 with UNID: SpO2 algorithm is in learning • No action required.
phase.
Long meas. time param. NIBP: The measurement time is long. The • Check the patient status.
triggering values vary according to the module • Check the cuff and hose connections.
and inflation limits in use: • Restart the measurement.
- PSM, hemodyn. E-modules: >2 min for adult / • If the problem persists, contact authorized
child, 75 s to 80 s for infant service personnel.
- PDM: >2 min for adult /child, 80 s for infant

Low battery param. SpO2 with UNID • Check the interfaced device.
• If the problem persists, contact authorized
service personnel.
Spirometry with UNID • Check the interfaced device.
• If the problem persists, contact authorized
service personnel.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Low Intensity param. SvO2 with UNID: Catheter floated or up against • Check the optical module and
vessel wall. connections.
• Check the catheter placement via x-ray.
• Only authorized medical personnel should
adjust catheter placement.
Low Light param. SvO2 with UNID: Catheter floated or up against • Check the optical module and
vessel wall. connections.
• Check the catheter placement via x-ray.
• Repeat in-vivo calibration.
Low perfusion param. SpO2: Low perfusion at the measurement point. • Check the sensor and sensor positioning.
• Relocate the sensor to a better
measurement site, if possible.
• Make sure the patient is not shivering.
Low signal param. Entropy: Measured EEG signal is too low for • Check sensor placement.
reliable Entropy calculation. • The patient may be in total suppression;
check the patient status.
SpO2: The quality of the signal is questionable. • Check the sensor placement and the
patient status.
Low signal quality param. SpO2: The quality of the signal is questionable. • Check the sensor and sensor positioning.
• Relocate the sensor to a better
measurement site, if possible.
• Make sure the patient is not shivering.
Low volumes param. Patient Spirometry: The water trap may not be • Check the patient status.
properly connected, or there may be a leak in • Check the water trap and its connection.
the breathing circuit. • Check the breathing circuit for leaks.
Tidal volumes detected are so small that • Check the loops on screen to locate the
inspiration and expiration cannot be problem.
distinguished from each other.

132
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MESSAGE LOCATION EXPLANATION WHAT TO DO

Measurement off param. NMT: The measurement has been stopped. • Restart the measurement if required.
param., wavef. Imp. resp.: ECG leads not connected to the • Connect the ECG leads to the patient to
patient. start the impedance respiration
measurement.
Motion detected param. SpO2: Patient movement detected. • Reposition sensor.

MVexp << MVinsp param. Patient Spirometry: Exhaled volume is markedly • Check the patient status.
smaller than inhaled. • Check the ventilatory system for leaks.
• If the problem persists, contact authorized
service personnel.
No 10 or 6 lead cable report ECG: No 6- or 10-lead ECG cable is attached. • Connect a 6- or 10-lead cable.
No 12RL license report ECG: No 12 RL 12-lead ECG license. • Contact your GE representative to
purchase this feature.
No 12SL license report ECG: No 12 SL ECG with ACI-TIPI license. • Contact your GE representative to
purchase this feature.
No ext device /No Ext param. TC, SvO2, SpO2, Patient Spirometry, gases, C.O. • Check the interfaced device.
Device / No ext device with UNID: Interfaced device should be checked. • If the problem persists, contact authorized
service personnel.
No HR for REF param., wavef. C.O. with E-modules: REF measurement cannot • Check that the patient’s heart rate is being
be done. monitored.
• Add HR measurement if needed.
No Light param. SvO2 with UNID: Interfaced device should be • Check the interfaced device.
checked. • If the problem persists, contact authorized
service personnel.
No sensor detected param. Temperature: No sensor detected. • Check the sensor and connections.
MESSAGE LOCATION EXPLANATION WHAT TO DO
No VO2, FiN2O high param. Gas exchange: Module has detected N2O. • Gas exchange cannot be measured if N2O
is used. If you wish to measure gas
exchange, use another anesthetic. If the
measurement is not used, you may
consider removing gas exchange
numbers from the screen.
No VO2, FiO2 >85% param. Gas exchange: Measured FiO2 is more than • Gas exchange cannot be measured if FiO2
85%. is more than 85%. If the patient’s oxygen
values are consistently high, you may
consider removing gas exchange
numbers from the screen.
Noise wavef. ECG: Unreliable ECG calculation or distorted • Remove the source of noise if possible.
ECG waveform may appear during
electrosurgery or other high frequency noise.
Entropy: Unreliable Entropy calculation or • Interpret Entropy values with caution.
distorted EEG waveform may appear during
electrosurgery or other high frequency noise.
Noisy baseline wavef. C.O.: Changes in patient’s blood temperature • Check the patient status.
affect C.O. measuring. • Check the blood temperature connector.
Not calibrated param. TC • Perform calibration.
Not zeroed param. IP: Initial zeroing not executed. • Zero IP channel.

134

MESSAGE LOCATION EXPLANATION
Out of range
Over range
Over scale
Performing temp test
Please wait - collecting
waveform
Poor electr. contact
Poor signal param., wavef. BIS: The BIS cannot be calculated because the
Press electrodes
Press electrode x
where x = 1, 2 or 3
Pressure Sensed
Protect calibration
135
WHAT TO DO
param. Gas exchange: VO2 or VCO2 is below 0 ml/min or • Check that the gas sampling line and
above 999 ml/min. spirometry lines are correctly connected
to the patient airway and to the gas
module.
• Check that the correct sensor type (D-lite/
Pedi Lite) has been selected from the
monitor menu.
param. Gases: Measured FiO2 is more than 103%. • Calibrate airway gases, see the “Airway
gases with E-modules“ chapter.
wavef. Gases, Patient Spirometry: Gas signal exceeds • Check the patient status.
the maximum waveform area. • Select a larger scale for waveform.
param. Temperature: Module is calibrating. • No action required.
param. ECG: There is enough ECG sample data to run • Wait for about 10 seconds.
the algorithm.
param. EEG: Electrode impedance is over 5 kOhm. • Press the electrode to improve
connection.
• Change the electrode.
• Check the impedance.
• Check electrode connections.
SQI is below 50.
param. Entropy: More than one of the sensor electrodes • Press all sensor electrodes to ensure
have poor contact. proper contact.
param. Entropy: One of the sensor electrodes has poor • Press sensor electrode 1, 2 or 3 as
contact. indicated in the message.
param. IP: Pressure has been sensed. • No action required.
param. NIBP with PSM and hemodyn. E-modules • Contact authorized service personnel.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Pulse search param. SpO2: Defective or damaged sensor or cable. • Check the sensor and cable.
Sensor is off of the patient. Detection of a • Reposition or replace sensor.
repeatable pulse has stopped.
Purging param. Gases with UNID: Interfaced device should be • Check the interfaced device.
checked. • If the problem persists, contact authorized
service personnel.
RA/R lead off param., wavef. Impedance respiration: One of the electrodes is • Check the electrodes and their
LA/L lead off off. connections.
LL/F lead off
Ready param. TC • No action required.
REF out of range param., wavef. C.O.: The result of the REF measurement is • Check cables and connections.
invalid. • Perform a new measurement.
• If the problem persists, contact authorized
service personnel.
Reference not stable param. NMT: The deviation between the four calibration • Stop measurement, reposition electrodes
twitches is too big. and restart the measurement.
Regional Block param. NMT: Regional block stimulation is in progress. • Wait until the stimulation is completed.
Relearning param., wavef. Impedance respiration with PDM: The patient’s • Wait until the message disappears.
breathing pattern is being relearned or a lead
has been changed.
Response too weak param. NMT: The measurement cannot be performed • Check electrode placement and
because the response is too weak. connections.
• Replace dry electrodes.
• Check that the stimulus current is not too
weak.

136
 137

MESSAGE LOCATION EXPLANATION WHAT TO DO

RL/N lead off wavef. ECG: An electrode is disconnected. • Check the electrodes.
LL/F lead off NOTE: There is also the ‘Leads off’ message in
LA/L lead off the alarm area.
RA/R lead off
V/C lead off
Va/Ca lead off
Vb/Cb lead off
V2/C2 lead off
V3/C3 lead off
V4/C4 lead off
V5/C5 lead off
V6/C6 lead off
Scale changed wavef. Patient Spirometry: The Auto scaling mode has • Wait until the message disappears.
changed the Flow, Paw or Vol scale.
Sensor INOP wavef. Gases, Patient Spirometry, gas exchange: The • Contact authorized service personnel.
measuring sensor is inoperative or the
temperature in the module has increased.
Service ext device param. Gases with UNID: Interfaced device should be • Contact authorized service personnel.
checked.
Service Mode param. Gases with UNID: Interfaced device should be • Contact authorized service personnel.
checked.
Setting reference param. NMT: Calibration is in progress. • Wait until the calibration is completed.
Signal Adapting param. C.O.: Interfaced device signal is being • Wait until the message disappears.
processed.
Small resp curve param. Impedance respiration: Signal amplitude < 0.4 • Check the patient status.
ohm. • Check electrode placement.
• Change or move electrodes.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Start SvO2 param. SvO2: Displays when the catheter has been • Select the Start SvO2 option found in the
inserted into the patient after in-vitro SvO2 parameter window.
calibration.
Starting up param. Entropy: The monitor is collecting data to start • Wait for about one minute. Entropy values
the measurement. appear automatically.
Supramax not found param. NMT: Supramaximal stimulus current was not • Stop measurement, reposition the
found. 70 mA is used as stimulus current. stimulating or recording electrodes and
restart the measurement.
Supramax search param. NMT: Search is in progress. • Wait until the search is completed.
SvO2 out of range param. SvO2: Values are above or below the range the • Check cables and connections.
monitor can process. • Repeat in-vivo calibration.
• Change the optical module.
• If the problem persists, the catheter could
be faulty; contact authorized service
personnel.
Testing DSC param., wavef. BIS: The digital signal converter test has been • Wait until the check is completed.
activated.
TETANIC param. NMT: Tetanic stimulation is in progress. • Wait until the stimulation is completed.
Unable to meas. Dia param. NIBP: Accurate diastolic pressure is difficult to • Assess the patient and check inflation
measure because of artifacts, weak pulsation limits.
etc. • Perform a new measurement.
Unable to meas. Sys param. NIBP: Systolic pressure probably higher than • Assess the patient and check the cuff
maximum inflation pressure or artifacts placement.
interfere in the systolic area. • Perform a new measurement.

138
 139

MESSAGE LOCATION EXPLANATION WHAT TO DO

Unstable Tblood param., wavef. C.O.: Software in auto mode detects the • Check the patient status.
unstable baseline patient temperature. • Change C.O. software to manual mode
and repeat the measurement.
Unstable zero press. param. NIBP: Pressure is unstable at start of the NIBP • Check the patient status.
measurement. • Check hose and cuff position.
• Repeat the measurement.
• If the problem persists, contact authorized
service personnel.
V lead A is not V1 or V param. ECG: Va lead is not V1 and/or Vb lead is not V5. • Check the settings and correct if
lead B is not V5 necessary.
V leads off param. ECG, 12 SL: All V leads are off. • Connect the V leads to the patient.
Wait, initializing param. SvO2: Optical module signal is being processed. • Wait until the message disappears.

Warming up param. SvO2: The optical module is warming up. • Wait until the module has warmed up and
the message disappears.
Waveform available only wavef. High Resolution trends license is configured for • Change trend resolution to 2 minute or 4
for 2min and 4min time HR, Resp, SpO2, CO2 and MAP. minute time scale for the affected
scales parameter.
Weak pulsation param. NIBP: Weak or unstable oscillation signal. • Check the patient status.
• Reposition the cuff.
• Repeat the measurement.
Zero adj >100 mmHg param. IP with E-modules: IP channel zeroed to over • Check connectors and cables to ensure
100 mmHg pressure, no values will be shown. that all is as it should be for zeroing.
• Repeat the zeroing.
Zeroed param. IP: Zeroing was successful. • No action required.
Zero error param. Gases, Patient Spirometry: Zeroing has failed. • Repeat the zeroing.
MESSAGE LOCATION EXPLANATION WHAT TO DO
Zero failure param. NIBP: Zeroing has failed. • Check the patient’s pressure by
alternative means.
• Replace the module.
• If the problem persists, contact authorized
service personnel.
Zeroing param. Gases, Patient Spirometry, NIBP, IP: Zeroing is in • Wait until the zeroing is completed.
progress.
Zeroing failed param. IP: All channels have not been zeroed • Repeat the zeroing.
successfully.
Zero OK param. NIBP: Zeroing was successful. • No action required.

140
 141

For your notes

Care and cleaning
Safety precautions
Care and cleaning warnings
• Before cleaning or disinfecting, disconnect the monitor from the
power supply.
• Regular preventive maintenance should be carried out annually.
Failure to implement the recommended maintenance schedule
may cause equipment failure and possible health hazards.
• The user may only perform maintenance procedures specifically
described in this manual.
• Non-medical equipment does not provide the same level of
protection against electrical shock. Do not touch the patient and
any part of non-medical equipment at the same time. Some
examples of non-medical equipment are laser printers and non-
medical computers.
• Since calibration gas contains anesthetic agents, always ensure
sufficient ventilation of the room during calibration.
• Avoid use of cleaners, materials or chemicals that may damage
device surfaces, labels, or cause equipment failures.
• To prevent liquids from entering the monitor, do not tilt the
monitor more than +/-15 degrees.
• To prevent liquids from entering the display casing, do not tilt the
display more than +/-15 degrees.
• If liquid has accidentally entered the system or its parts,
disconnect the power cord from the power supply and have the
equipment serviced by authorized service personnel.
• Use only washable keyboard with at least IPX1 protection
against ingress of water.
• Cleanup and disposal of broken display monitors must be in
compliance with the safety and waste control guidelines
regulating this product.
142
• Never immerse any part of the device, cables, or leadwires in
liquids or allow liquid to enter the interior.
• Do not autoclave any part of the system with steam (including
cables or leadwires) or sterilize with ethylene oxide.
• Do not pour or spray any liquid directly on cables or leadwires or
permit fluid to seep into connections or openings.
• Never use conductive solutions, solutions that contain chlorides,
wax, or wax compounds to clean devices, cables or leadwires.
Care and cleaning caution
• Do not apply pressurized air to any outlet or tubing connected to
the monitor. Pressure may destroy sensitive elements.
Disposal warnings
• Do not incinerate a battery or store at high temperatures.
Serious injury or death could result.
• DISPOSAL — At the end of its service life, the product described in
this manual, as well as its accessories, must be disposed of in
compliance with the guidelines regulating the disposal of each
product. If you have any questions concerning disposal of a
product, please contact GE or its representatives.
Disposal caution
• PACKAGING DISPOSAL — Dispose of the packaging material,
observing the applicable waste control regulations.
Storage and use caution
• Do not use or store equipment outside the specified
temperature, humidity, or altitude ranges.
 143

Cleaning schedules Cleaning precautions

• Do not let liquid “pool” around connection pins. If this should
NOTE: See the technical manual for more comprehensive checks.
happen, blot dry with a soft, lint-free cloth.
NOTE: For details about cleaning, disinfecting and sterilizing the • Do not use excessive drying techniques, such as oven, forced
accessories, see the instructions for use in the accessory package. heat, or sun drying.
• Do not spray cleaner directly on the display screen.
NOTE: Do not reuse single-use disposable accessories.
• Never connect any device or applied part to a patient until it is
Daily and between patient cleaning schedule thoroughly dry.
• Clean the monitor, modules, displays and other non-applied
Permitted detergents
parts, see the “General cleaning instructions” section.
• Water
• Clean applied parts, see the “Applied part cleaning instructions”
• Mild soap
section.
• Empty the water trap, see the “Water trap cleaning instructions” Permitted disinfectants
section. • Ethanol (max. 99.7% by volume)
• Change or sterilize all airway and invasive patient accessories. • Isopropyl alcohol (max. 60% by weight)
• Clean, disinfect, or sterilize reusable temperature probes. • Chloramine (max. 5% by volume)
• Use a new BIS sensor for each patient. • Glutaraldehyde (max. 2% by volume)
• Use a new Entropy sensor for each patient. • Phenol (max. 2% by volume)
• Check that the accessories, cables, cable connectors, monitor,
modules, and display parts are clean and intact.
• Check the monitor battery charge, see the “System introduction“
chapter.
Monthly cleaning schedule
• Perform gas calibration for gas exchange, see the “Calibrating
gas exchange” section.
• Change the water trap every two months and when the ‘Replace
Water Trap’ message displays on the display screen.
Semi-annual cleaning schedule
• Perform gas calibration for airway gas monitoring, see the
“Calibrating airway gases” section.
Impacts/results of improper cleaning
General cleaning instructions
Use of cleaning agents other than those listed above is considered
To clean the monitor, modules, display screen surfaces, EEG
improper cleaning and could lead to the following:
headbox and other non-applied parts:
• Product discoloration.
1. Turn off the power to the equipment.
• Metal part corrosion.
• Brittle wires. 2. Disconnect the equipment from the power supply.
• Brittle and breaking connectors. 3. Remove all cables and batteries (if applicable) and close battery
• Reduced cable and leadwire life. door(s).
• Appearance of waveforms when the device is not connected to a 4. Dampen a soft lint-free cloth with one of the permitted
patient, causing false alarms instead of a leads fail alarm and detergents or disinfectants.
possibly not providing a visual or audible leads fail alarm. 5. Wring excess liquid from the cloth and wipe the exterior surface.
• Brittle and breaking device case. NOTE: Any contact of disinfectant solutions with metal parts may
• Overall system performance degradation. cause corrosion.
• Melting, dulling, or distorting the case. NOTE: Do not damage or bend connector pins when cleaning or
• Total medical device failure requiring replacement. drying.
• Unit malfunction. 6. Allow solution to remain on device for a minimum of one minute
• Void warranty. or per hospital guidelines.
NOTE: Do not let fluid “pool” around connection pins. If this
happens, blot dry with a cotton swab or soft cloth.
7. Wipe off the cleaning solutions with a clean, lightly moistened
cloth.
8. Dry thoroughly with a dry, lint-free cloth and let air dry for at
least 30 minutes.
NOTE: Drying times may vary based on the environmental
conditions.
9. Reconnect the equipment to the power supply.
10. Turn on the power to the equipment.

144
 145
Barcode reader cleaning instructions
Do not submerge the barcode reader in water. Do not use abrasive
wipes or tissues on the barcode reader’s window – abrasive wipes
may scratch the window. Never use solvents (e.g., acetone, benzene,
ether, or phenol-based agents) on the housing or window as
solvents may damage the finish or the window.
Reading performance may degrade if the reader’s window is not
clean. If the window is visibly dirty, or if the reader isn’t operating
well, clean the window with a soft cloth or lens tissue dampened
with water (or a mild detergent- water solution). If a detergent
solution is used, rinse with a clean lens tissue dampened with water
only.
The reader’s housing may also be cleaned the same way.
Keyboard and mouse cleaning instructions
Refer to the user documentation provided with the keyboard and
mouse for instructions on how to clean them. Always consider your
hospital guidelines as well.
Applied part cleaning instructions
Cables and leadwires can be cleaned with a warm, damp cloth and
mild soap. Consult manufacturer instructions for cleaning methods
and products. For more intensive disinfecting (near sterile) Ethylene
Oxide (ETO) is acceptable but will reduce the useful lifetime of the
cable or leadwire.
For other applied parts such as temperature sensors, catheters,
pulse oximetry probes, and other reusable accessory parts, consult
the manufacturer instructions for cleaning, sterilization, or
disinfecting methods.
To clean ECG trunk cables, NIBP cuff and cables, reusable sensors:
1. Remove cables and leadwires from the handheld device or
system before cleaning.
2. Use care in cleaning leadwires to prevent pulling the long wires
from the connector ends. Metal connections can be pulled away
from the connectors.
3. For general cleaning of cables and leadwires, wipe using a lightly
moistened cloth with a mild soap and water solution.
4. For disinfecting the cables and leadwires, wipe exterior with a
soft lint-free cloth, using a diluted sodium hypochlorite solution.
NOTE: Wring excess disinfectant from wipe before using.
NOTE: Any contact of disinfectant solutions with metal parts may
cause corrosion.
NOTE: Do not immerse either end of a cable or leadwire
connector. Immersing or soaking the connector ends may
corrode metal contact ends and affect signal quality.
5. Wipe off cleaning solutions with a clean, lightly moistened cloth.
6. Dry thoroughly with a dry, lint-free cloth and let air dry for at
least 30 minutes. Do not apply heat.
NOTE: Drying times may vary based on the environmental
conditions.
Sterilizing applied parts
WARNING: Autoclaving a cable or leadwire will
adversely affect the integrity. Autoclaving is not
required.
NOTE: Ethylene oxide gas (EtO) sterilization is not recommended.
Frequent sterilization will reduce the useful life of cables and
leadwires.
Water trap cleaning instructions
• Empty the container whenever half full.
• Change the water trap every two months and when ‘Replace
Water Trap’ appears.
• The water trap cartridge is disposable. Do not wash or reuse the
cartridge.
• Change the green D-fend+ water trap every 24 hours and when
‘Replace Water Trap’ appears.
Reusable D-lite and Pedi-lite Patient Spirometry sensor
cleaning instructions
The reusable Patient Spirometry sensors can be washed and steam
autoclaved. Make sure that the sensor is dry and the connectors are
not damaged. A tight connection is essential for correct
measurement.
Storing handheld devices
To store the PSM or PDM:
• Remove PDM batteries when the device is not in use, even for
short periods of time.
• Store in a dry well-ventilated area.
• Hang the device using a holder if available.
• If leadwires or cables are attached, hang them straight.
• Do not coil leadwires or cables tightly around the device.

146
 147
PDM battery care
The PDM uses one rechargeable lithium-ion battery. For more
information, see the technical manual.
Charging the PDM battery while connected to the monitor
The PDM battery is charged whenever the PDM, with its battery
installed, is connected to a monitor that is connected to an AC-
derived power source. The battery capacity gauge (labeled with a
PDM) indicates the battery’s charge level.
NOTE: A ‘PDM battery low’ message displays on the monitor if a
power fault prevents the PDM’s battery from charging when the
PDM is connected to the monitor. If this occurs, request authorized
service personnel to check the system.
Charging the PDM battery with a Cadex SMart Two+ Charger
1. Insert the battery into the battery charger. The RUN LED
illuminates.
2. Leave the battery in the battery charger until the READY LED
illuminates.
NOTE: If the FAIL LED illuminates, remove the battery from the
battery charger and reinsert it. This will correct any battery charger
time-out errors.
NOTE: LEDs on the battery indicate the approximate percentage of
remaining charge in 25% increments.
Replacing the PDM battery
WARNING - EXPLOSION OR FIRE — Using non-
recommended batteries could result in injury/burns
to the patients or users. Only use batteries
recommended or manufactured by GE. The warranty
can be voided if non-recommended batteries are
used.
WARNING: PHYSICAL INJURY — Do not install the PDM
above a patient. Make sure the battery is completely
inserted and the battery door is completely closed.
Falling batteries could seriously or fatally injure
neonatal or other vulnerable patients.
WARNING - PHYSICAL INJURY — Do not install the
PDM above a patient. Leaks from the battery cells can
occur under extreme conditions. The liquid is caustic
to the eyes and skin. If the liquid comes in contact
with eyes or skin, flush with clean water and seek
medical attention.
1. Open the battery door by gently pulling on the battery door pull
tab.
2. Pull the battery tray out of the PDM using the battery tray strap
and remove the battery from the battery tray.
3. Insert the new battery with the test button facing up and the
arrow pointing into the PDM.
4. Press the battery door closed until it seals the battery
compartment.
5. Connect the PDM to the monitor.
6. Confirm the P battery capacity gauge displays on the monitor.
Recycling the PDM battery
When the battery no longer holds a charge, it should be replaced.
Remove the old battery and follow your local recycling guidelines.
148
Monitor battery care
Replacing the monitor battery
WARNING - EXPLOSION OR FIRE — Using non-
recommended batteries could result in injury/burns
to the patients or users. Only use batteries
recommended or manufactured by GE. The warranty
can be voided if non-recommended batteries are
used.
WARNING: PHYSICAL INJURY — Make sure the battery
is completely inserted and the battery door is
completely closed. Falling batteries could seriously or
fatally injure neonatal or other vulnerable patients.
1. Open the battery slot by gently turning the lock counter-
clockwise.
2. Pull the battery out using the battery strap.
3. Insert the new battery all the way with the test button facing up.
4. Close the battery slot by turning the lock clockwise.
Recycling the monitor battery
When the battery no longer holds a charge, it should be replaced.
Remove the old battery and follow your local recycling guidelines.
 149

Calibration check of temperature, NIBP and invasive blood

Calibration
pressures
The following parameters require calibration at regular intervals, in
A calibration check of temperature, NIBP and invasive blood
addition to the calibration performed while monitoring patients. For
pressures should be performed at least once a year to ensure that
monitoring calibration instructions, see the appropriate parameter
the measurement accuracy remains within specifications. For
chapter in this manual.
temperature, NIBP and invasive blood pressure calibration
Calibrating airway gases instructions, see the “Module Frames and Modules Technical
The recommended calibration interval for airway gas Manual.”
measurements is every six months in normal use and every two
Calibrating invasive blood pressure transducers
months in continuous use, to ensure that the measurement
The recommended transducer calibration should be performed
accuracy remains within specifications. For calibration instructions,
when a transducer error occurs. A transducer error is determined
see the “Airway gases with E-modules” chapter.
when pressure calibration is measured with another instrument
Calibrating Patient Spirometry such as a mercury manometer.
The recommended flow calibration interval for Patient Spirometry is
To calibrate an invasive blood pressure transducer:
once a year or when the difference between the inspiratory and
expiratory volumes is permanent to ensure that the measurement 1. Select Monitor Setup > IP Calibration.
accuracy remains within specifications. For calibration instructions, 2. Create a 100 mmHg pressure to calibrate the transducer.
see the ”Module Frames and Modules Technical Manual.” 3. Adjust to the displayed pressure or to the known calibration
factor.
Calibrating gas exchange 4. Select Confirm.
The recommended gas exchange calibration interval is once a
month to ensure that the measurement accuracy remains within
specifications. For calibration instructions, see the ”Module Frames
and Modules Technical Manual.”
ECG
NOTE: For a comprehensive list of compatible supplies and
ECG equipment to patient connection accessories, see the supplies and accessories document delivered
(1) Module with ECG measurement capability with the monitor.
(2) AAMI/AHA or IEC Multi-Link 3/5-lead, 6-lead, or 12SL ECG cable
(3) AAMI/AHA or IEC 3-leadwire, 5-leadwire, or 6-leadwire set NOTE: This illustration is an example of an equipment to patient
(4) AAMI/AHA or IEC precordial leads leadwire set connection.

R=RED (IEC) L=YELLOW (IEC

) R=RED (IEC) L=YELLOW (IEC
)
RA=WHITE (AAMI
) LA=BLACK (AAMI) RA=WHITE (AAMI
) LA=BLACK (AAMI)

LEAD I R/RA L/LA

R/RA L/LA
V1 V2 V6
V3 V5
V4

LEAD III
1 LE 1 2
3 6
AD
II 4 5
F/LL

N/RL F/LL
F=GREEN (IEC) N=BLACK (IEC
) F=GREEN (IEC)
LL=RED (AAMI) RL=GREEN (AAMI) LL=RED (AAMI)

RL/N
RA/R
RL LA/L
RA

R A L A
LA
LL
V
3 LL/F
V1/C1
1 2
34 V1
56
V2/C2
V2
V3/C3
4
V3
V4
V4/C4
2 RL L L
V5
V6
V5/C5
V6/C6

3
2

150
 151

ECG module keys 3-lead or 5-lead ECG electrode placement

There are no ECG related keys on the modules.

Preparing the patient’s electrode sites

55$ //$
Excessive body hair or skin oil reduces electrode contact with the
skin and decreases the quality of electrode signal.

When preparing the electrode sites, avoid bones close to skin, 

obvious layers of fat and major muscles.
1. Shave any hair from the electrode site.
2. Gently rub the surface of the skin to increase capillary blood
flow.
3. Clean the skin with alcohol or a mild soap and water solution to
remove skin oil and dead or abraded skin cells. 15/ )//
4. Dry the skin completely before applying the electrodes.
IEC AAMI/AHA Electrode placement
Applying the electrodes to the patient
1. Place the electrodes on the prepared sites. R (red) RA (white) Just below the right clavicle.
2. Stabilize the electrode and leadwire with a leadwire stress loop L (yellow) LA (black) Just below the left clavicle.
near the electrode.
3. Tape the stress loop to the patient (excluding neonates). User defined User defined For the 5-lead placement, place the
precordial electrode according to the
physician's preference.
N (black) RL (green) Lower right edge of the rib cage.

F (green) LL (red) Lower left edge of the rib cage.

NOTE: For a 3-leadwire electrode placement, the R/RA, L/LA, and

A secured stress loop prevents leadwire rotation about the F/LL electrodes should be used.
electrode snap, leadwire tugging at the electrode, and ECG
artifact.
6-lead ECG electrode placement Cardiac monitoring 10-lead ECG electrode placement
NOTE: For 12RL monitoring, a 12RL 12 lead ECG license is required.
NOTE: A 6- or 10-leadwire cable may be used. However, when using
a 10-leadwire cable, do not prepare or connect precordial leads 2, 3, //$
55$
4, or 6. Position the Ca/Va electrode in the C1/V1 position and place
the Cb/Vb electrode in the C5/V5 position. The leadwire label for the
Ca/Va and Cb/Vb leads are white (IEC) or brown (AAMI/AHA).  

  

55$ //$

15/ )//

IEC AAMI/AHA Electrode placement

R (red) RA (white) Just below the right clavicle.

L (yellow) LA (black) Just below the left clavicle.

N (black) RL (green) Lower right edge of the rib cage.

15/ )//
F (green) LL (red) Lower left edge of the rib cage.
IEC AAMI/AHA Electrode placement
C/C1 (white) V/V1 (brown) 4th intercostal space, right sternal
R (red) RA (white) Just below the right clavicle. border.

L (yellow) LA (black) Just below the left clavicle. C2 (white/yellow) V2 (brown/yellow) 4th intercostal space, left sternal
border.
Ca/C1 (white) Va/V1 (brown) 4th intercostal space, right sternal border.
C3 (white/green) V3 (brown/green) Midway between C2/V2 and C4/V4.
Cb/C5 (white) Vb/V5 (brown) Left anterior axillary line at C4/V4 level.
C4 (white/brown) V4 (brown/blue) 5th intercostal space, mid-
N (black) RL (green) Lower right edge of the rib cage. clavicular line.
F (green) LL (red) Lower left edge of the rib cage. C5 (white/black) V5 (brown/orange) Left anterior axillary line at C4/V4
level.

C6 (white/purple) V6 (brown/purple) Mid-axillary line at C4/V4 and

C5/V5 levels.

152
 153

Standard resting 10-lead ECG electrode placement ECG analog output signal
The frequency response of the analog output hardware is DC to
100 Hz. The gain is 1 V/mV. The propagation delay time from ECG
input to analog output is 35 ms (PDM) or 15 ms (E-modules)
maximum. A pace pulse is included when appropriate and is
55$ //$ summed with the ECG waveform.
 
 ECG module Analog output signal
  
E-modules ECG 1 Lead (top waveform position).
If ECG 1 Lead is any of the derived leads related to the
12RL 12 lead, then the analog output will use lead II.
15/ )//
PDM ECG 1 Lead (top waveform position).

IEC AAMI/AHA Electrode placement

R (red) RA (white) Right deltoid or wrist.

L (yellow) LA (black) Left deltoid or wrist.

N (black) RL (green) Right thigh or ankle.

F (green) LL (red) Left thigh or ankle.

C/C1 (white) V/V1 (brown) 4th intercostal space, right border

of the sternum.
C2 (white/yellow) V2 (brown/yellow) 4th intercostal space, left border of
the sternum.

C3 (white/green) V3 (brown/green) Midway between C2/V2 and C4/V4.

C4 (white/brown) V4 (brown/blue) 5th intercostal space, mid-

clavicular line.

C5 (white/black) V5 (brown/orange) Left anterior axillary line at C4/V4

level.

C6 (white/purple) V6 (brown/purple) Mid-axillary line at C4/V4 and

C5/V5 levels.
ECG points to note
• Pre-gelled ECG electrodes are recommended. Check the
expiration date.
• Make sure the electrode gel is moist.
• Make sure the electrodes have good skin contact.
• Replace all electrodes at least every 24 to 48 hours.
• Use the Multi-Link electrosurgical unit (ESU) ECG patient cable
when using the monitor in the presence of an electrosurgical
unit. This cable, with a built-in ESU filter, helps reduce
electrosurgical noise detected on the ECG signal.
• E-modules: Whenever a cable, electrode or V-lead is changed,
the monitor automatically relearns.
• Depending on the ECG module used, not all ECG measurements
and settings are available to view or change.
• Select the Update Lead Set option to remove a ‘Leads off’
message from the display when a cable is off.
• For a list of acquisition modules capable of measuring this
parameter, see the “System introduction” chapter.
ECG measurement limitations
• E-modules are not suitable for use with neonatal patients.
• The monitor will display a ‘Leads off’ message in an input
overload condition, or upon disconnection of electrode
leadwires.
ECG measurement checks
• Check that the waveforms and parameter values are displayed
when the cable is connected to the patient.
154
Safety precautions
ECG warnings
• Make sure that the leadwire set clips or snaps do not touch any
electrically conductive material including earth.
• The Maximum filter may alter the displayed ECG morphology. Do
not make measurements from the displayed or printed ECG
when this filter is selected. Displayed ST values are calculated
before applying the Maximum filtering and may differ from
values measured from the displayed or printed ECG.
• This device uses a computerized 12-lead ECG analysis program,
which can be used as a tool in generating ECG records that
provide ECG measurements and interpretative statements from
the ECG recordings. The interpretive statements are only
significant when used in conjunction with clinical findings. All
ECG records should be overread by a qualified physician. To
ensure accuracy, use only the ECG records for physician
interpretation.
• When transitioning from a 10-lead cable to a 5-lead cable with
the PDM, select the Update Lead Set option to clear the ‘Leads
off’ message from the display.
• CONDUCTIVE CONNECTIONS — Extreme care must be exercised
when applying medical electrical equipment. Many parts of the
human/machine circuit are conductive, such as the patient,
connectors, electrodes, transducers. It is very important that
these conductive parts do not come into contact with other
grounded, conductive parts when connected to the isolated
patient input of the device. Such contact would bridge the
patient’s isolation and cancel the protection provided by the
isolated input.
 155
• DELAYED ASYSTOLE ALARM - PDM — The pulsatile heart rate may
have a slower response time than the electrical heart rate where
there is a low perfusion patient condition. When using the
IntelliRate feature in this situation, the monitor may delay calling
an ASYSTOLE patient alarm. The user may elect to turn the
IntelliRate feature off for patients at risk of these events,
otherwise patient treatment may be delayed. Such patients
should always be kept under close observation.
• INACCURATE HEART RATE INDICATION - PDM — The electrical
and pulsatile heart rate values provided by the various
monitored parameters (ECG, SpO2, blood pressures) may differ
markedly. These differences may be due to underlying
physiologic conditions (e.g., electromechanical dissociation,
pulseless electrical activity, non-perfusing rhythms) or to
inaccuracies in the heart rate values caused by artifact or poor
signal quality. The user may elect to turn the IntelliRate feature
off for patients at risk of these events, otherwise patient
treatment may be delayed. Such patients should always be kept
under close observation.
• ELECTRODES — Whenever patient defibrillation is a possibility,
use non-polarizing (silver/silver chloride construction) electrodes
for ECG monitoring. Polarizing electrodes (stainless steel or silver
constructed) may cause the electrodes to retain a residual
charge after defibrillation. A residual charge will block
acquisition of the ECG signal.
• DEFIBRILLATOR PRECAUTIONS — Patient signal inputs labeled
with the CF and BF symbols with paddles are protected against
damage resulting from defibrillation voltages. To ensure proper
defibrillator protection, use only the recommended cables and
leadwires.
• HEART RATE ALARM INTERFERENCE — Poor cable positioning or
improper electrode preparation may cause line isolation monitor
transients to resemble actual cardiac waveforms and thus
inhibit heart rate alarms. To minimize this problem, follow proper
electrode placement and cable positioning guidelines provided
with this product.
ECG cautions
• The patient's skin may become irritated after prolonged contact
with electrode gel or adhesive.
• To assure accurate 12 lead analysis when using a 10-leadwire
patient cable, you must verify that the correct leadwire block is
plugged into the appropriate side of the cable. The V2 through
V6 leadwire block is color-coded brown (AHA) or white (IEC).
• When using an electrosurgery unit, ensure proper contact of the
electrosurgical cautery unit’s (ESU) return electrode to the
patient to avoid burns at the monitor measurement sites.
 Selecting the third displayed lead
Selecting the first three displayed ECG waveforms
The ECG 3 Lead is the ECG lead displayed after the ECG 2 Lead in the
You can choose the order of the ECG waveforms displayed in the
ECG waveform area.
ECG waveform area.
1. Select the HR parameter window.
NOTE: Lead selection depends on the type of ECG cable used. 2. Select a lead from the ECG 3 Lead list.
If your selection is Cascade, the displayed ECG 2 Lead waveform
NOTE: When ECG 1 Lead, ECG 2 Lead, and or ECG 3 Lead are continues into the ECG 3 Lead waveform area.
changed manually and the lead becomes inactive due to a
disconnection, the monitor looks to the ECG lead saved in the patient Selecting the Va ECG lead
profile. If ECG 1 Lead is not available, the monitor looks for lead II, NOTE: The Va Lead Position selection affects ST numeric trends.
then lead I, and lastly lead III. Later, if the manually selected lead
becomes available again later, the monitor will change back to this NOTE: 12RL monitoring - The Va lead is the first V-lead label used
lead. with a 6-leadwire ECG cable for 12RL monitoring.
Selecting the first displayed lead When using a 6-leadwire ECG cable, the factory default for the Va
The ECG 1 Lead is the first ECG lead displayed in the ECG waveform lead is V1, however you may choose a different lead.
area. NOTE: The Va lead is the only V-lead used with a 5-leadwire ECG
NOTE: The monitor uses the ECG 1 Lead for single-lead analysis. cable.
1. Select the HR parameter window.
2. Select a lead from the ECG 1 Lead list. The Va lead is the V-lead data that is sent to all remote network
devices such as the CIC Pro clinical information center.
Selecting the second displayed lead
1. Select the HR parameter window.
The ECG 2 Lead is the ECG lead displayed after the ECG 1 Lead in the
2. Select a lead from the Va Lead Position list.
ECG waveform area.
1. Select the HR parameter window.
2. Select a lead from the ECG 2 Lead list.
If your selection is Cascade, the displayed ECG 1 Lead waveform
continues into the ECG 2 Lead waveform area.

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Selecting the Vb ECG lead Selecting the ECG waveform size

1. Select the HR parameter window.
NOTE: 12RL monitoring - The Vb lead is the second V-lead label used
2. Select a value from the Size list.
with a 6-leadwire ECG cable and must be set to V5.
NOTE: PDM only - The ECG size setting affects arrhythmia detection
When using a 6-leadwire ECG cable, the factory default for the Vb and heart rate calculation sensitivity. Normal waveform size/QRS
lead is V5, however you may choose a different lead. detection sensitivity is 1x. Size 2x and greater increases the QRS
detection sensitivity. This may be helpful for low amplitude QRS
1. Select the HR parameter window.
waveforms. Use with caution since baseline artifact may be
2. Select a lead from the Vb Lead Position list.
detected as a QRS complex.
Changing to an ECG cable with fewer leadwires
Selecting the ECG hemodynamic sweep speed
To change from using a 10-leadwire cable to a 6-, 5-, or 3-leadwire
NOTE: This setting adjusts the waveform speed for all ECG, SpO2, and
ECG cable:
1. Select the HR parameter window. invasive blood pressure parameters.
2. Select Update Lead Set. 1. Select the HR parameter window.
2. Select a value from the Hemodynamic Sweep Speed list.
Setting the ECG QRS beep tone volume The smaller the value, the slower the sweep speed.
1. Select the HR parameter window.
Viewing and printing all ECG waveforms
2. Set the beat volume with the Beat Volume arrows.
To print all of the ECG waveforms:
Setting a beep tone during bradycardia 1. Select the HR parameter window.
2. Select All ECG Waveforms.
NOTE: PDM modules and NICU software package only.
3. Select Print Page.
NOTE: Bradycardia beep tones can only be enabled if the QRS beep 4. To stop printing, select Stop Printing or Cancel Printing.
tone volume is set to zero. If the bradycardia beep tone is enabled, a
beep will be heard at a rate equal to the heart rate when a
Bradycardia alarm occurs.
1. Select the HR parameter window.
2. Select Beat Tone on Brady Only.
Setting the ECG waveform filter Setting the ECG QRS width
To set how the waveform appears on the display and on the printed NOTE: PDM only - The ECG QRS width setting affects arrhythmia
strip: detection sensitivity.
1. Select the HR parameter window.
2. Select the Advanced button. NOTE: If the QRS Width setting is locked in the care unit settings, this
3. Select a filter setting from the Waveform Filter list. setting is not selectable.
Display bandwidths apply to all modules unless otherwise The default QRS Width for the Adult profile is Normal. The default
indicated. Choices are: setting for QRS Width for the Infant profile is Narrow.
- Diagnostic:
To change the QRS detection sensitivity:
0.05-100 Hz = PDM
1. Select the HR parameter window.
0.05-150 Hz = E-modules
2. Select the Advanced button.
- Monitoring:
3. Select a setting from the QRS Width list.
0.05 to 32 Hz (with 50 Hz powerline frequency)
Choices are:
0.05 to 40 Hz (with 60 Hz powerline frequency)
- Narrow: Intended for use with all neonates and the pediatric
- Moderate: 0.05-25 Hz
patient with a QRS complex width of 100 ms or less.
- Maximum: 5-25 Hz.
- Normal: Intended for ECG rhythms that have QRS complex
widths of approximately 70 ms or wider (for example, almost
Setting the ECG HR averaging
all adult patients and any patient with electronic ventricular
NOTE: PDM only. If the Heart Rate Averaging setting is locked in the pacing).
care unit settings, this option is not selectable.

To set the number of heart beats used to calculate the HR value:

1. Select the HR parameter window.
2. Select the Advanced button.
3. Select a setting from the Heart Rate Averaging list.

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Selecting the leads used for ECG analysis
For PDM, you can choose whether the monitor performs an ECG
analysis using single lead ECG data or data from multiple ECG leads.
Multiple ECG leads may help reduce false alarms.
NOTE: When a 3-leadwire cable is used, your selection is Single lead
only.
NOTE: When selecting Single lead, ST values are calculated for the
single lead.
NOTE: When Single lead is selected, the EK-Pro algorithm uses ECG 1
Lead if that lead is lead I, II, III or Va. If lead I, II, III, or Va is not
selected, then the default lead for single lead monitoring is lead II.
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select a setting from the Lead Analysis list.
Relearn the patient’s QRS pattern
During ECG monitoring, you may need to use the Relearn QRS
feature when a dramatic change in the patient’s ECG pattern has
occurred. Allowing the monitor to learn the new ECG pattern
corrects false arrhythmia alarms. The message ‘Learning’ displays
while the monitor relearns the QRS pattern. During this time,
arrhythmia detection may not be available.
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select Relearn QRS.
Setting the primary HR source
WARNING: FAILURE TO DETECT LETHAL ARRHYTHMIA
- The SpO2 parameter pulsatile heart rate
measurement is based on the optical detection of a
peripheral flow pulse and therefore may not detect
certain arrhythmias. The pulse oximetry parameter
should not be used as a replacement or substitute for
ECG based arrhythmia analysis.
Heart rate can be calculated from several parameters (e.g., ECG,
SpO2, Art, Fem, ABP, UAC).
If the primary HR source for E-modules is ECG or Auto (ECG), the
secondary HR source is displayed in this order: Art, ABP, Fem, SpO2.
If the primary HR source for PDM is ECG or IntelliRate (ECG), the
secondary HR source displayed in this order: UAC, Art, ABP, Fem,
SpO2. NOTE: UAC available with the NICU software package only.
If the primary HR source is anything else than mentioned above, the
secondary HR source is always ECG.
NOTE: This setting adjusts the primary heart rate source for all of the
hemodynamic parameters.
To set the heart rate source displayed in the HR parameter window:
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select a parameter from the Primary HR Source list.
Choices are module dependent:
- PDM (Single HR): IntelliRate, ECG, Art, ABP, Fem, UAC*, Pleth.
- PDM (Multiple HR): IntelliRate, ECG.
- E-modules (Single HR): Auto, ECG, Art, ABP, Fem, Pleth.
- E-modules: (Multiple HR): Auto, ECG.
*NOTE: UAC available with NICU software package only.
Showing the PVC value in the HR parameter window
NOTE: Full Arrhythmia license with the arrhythmia category set to
Full only.
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select Show PVC.
Showing the QT value in the HR parameter window
NOTE: Multi-lead QT/QTc Analysis license only.

NOTE: QT/QTc values are calculated with 5-leadwire, 6-leadwire, or

Setting the HR alarm range
10-leadwire ECG cables.
1. Select the HR parameter window.
2. Select the HR/PR Alarms button. 1. Select the HR parameter window.
3. Select a value from the HR Alarm Range list. 2. Select the Advanced button.
3. Select Show QT.
Showing a second HR value in the HR parameter window
Displaying a reference grid in the ECG waveform areas
For E-modules you can display a second heart rate source in the HR
parameter window. To display a grid in ECG1, ECG2, and ECG3 with grid points at 200 ms
horizontally and grid points at 0.5 mV vertically:
NOTE: UAC is for use with the NICU software package only. 1. Select the HR parameter window.
1. Select the HR parameter window. 2. Select the Advanced button.
2. Select the Advanced button > Show 2nd HR Source. 3. Select ECG Grid.

Showing the ST value in the HR parameter window

NOTE: Multi-lead ST Analysis license only.
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select Show ST.

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ECG alarm limits Setting HR/PR alarm limits for multiple HR sources
NOTE: If the HR Alarms default setting is set to Single and you turn NOTE: The HR/PR Alarms setting is only available when the care unit
off the SpO2 HR alarm limits, the Primary HR alarm is also turned off. default Parameters > ECG > HR Alarms setting is set to Multiple.
Similarily, if you adjust the SpO2 HR limit values, the Primary HR limit This setting is password protected.
value is also adjusted.
To set the primary heart rate and individual pulse rate alarm limits:
If the HR Alarms default setting is set to Multiple and you turn off
the SpO2 HR alarm limits, the Primary HR alarm is not turned off. The 1. Select the HR parameter window.
2. Select the HR/PR Alarms tab.
Single heart rate setting allows you to set one common HR limit for
3. Select a heart rate source from the list.
multiple sources (e.g., ECG, SpO2, ART) and the PVC alarm limits for
NOTE: If the feature is not active, the alarm limits are greyed out.
ECG from the Alarms tab.
Select Alarm on to set the alarms.
The Multiple heart rate setting allows you to set a primary heart 4. Set the alarm limits
rate/pulse rate source and up to six individual heart rate/pulse rate Setting the PVC alarm limits
alarms and limits from the HR/PR Alarms tab. It also allows you to
NOTE: Full Arrhythmia license only.
set PVC alarm limits for ECG from the PVC Alarm tab.
1. Select the HR parameter window.
Setting HR alarm limits for a single HR source 2. Select the PVC Alarm tab or Alarms tab.
NOTE: The Alarms setting is only available when the care unit default 3. Check that the alarm is turned on.
Parameters > ECG > HR Alarms setting is set to Single. This setting is 4. Set the high and/or low limit values.
password protected.
ECG on the monitor screen
To set the heart rate and PVC alarm limits:
1. Select the HR parameter window. - Primary HR source indicator: Displays next to the primary
2. Select the Alarms tab. HR value.
3. Check that the required alarm is turned on (HR or PVC).
NOTE: If a feature is not active, the alarm limits are greyed out.
Select Alarm on to set the alarms.
4. Set the alarms.
Troubleshooting the ECG measurement
NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”
3

PROBLEM WHAT TO DO
ECG signal is • Ensure that the patient is not shivering.
noisy or no • Select the correct filter by selecting the HR
QRS is parameter window > Advanced > Waveform
detected Filter.
• Check the electrode quality and positioning. Do
not place electrodes on body hair, bones close
to skin, layers of fat and major muscles. Pre-
gelled electrodes are recommended.
• Change the lead.
• Remove the ECG cable from the module and
reinsert it.

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12 lead ECG analysis
12 lead ECG analysis points to note
• For a 12 lead ECG analysis, a 12SL ECG with ACI-TIPI license, 10-
leadwire cable, and 10-lead electrode placement are required.
• To obtain the most accurate 12 lead ECG analysis, you should
enter accurate patient demographics. This is especially
important when storing and comparing 12 lead reports in the
MUSE database.
• For a 12 lead ECG analysis with the 12RL feature, a 12RL 12 lead
ECG license and a 6-leadwire cable (or a 10-leadwire cable with
the C2/V2, C3/V3, C4/V4, and C6/V6 leads disconnected) is
required.
• For a 12 lead ECG analysis with the 12RL feature, confirm that
the Va and Vb lead positions are set correctly for a 12RL
measurement.
• For the most accurate serial comparisons, use the same
electrode configuration as used on the prior analysis for the
patient.
Selecting 12 lead ECG analysis settings
Entering required data for a 12 lead ECG analysis
NOTE: When the care unit default setting for Technician ID is set to
“mandatory,” you must enter a Technician ID before you can
confirm the 12 Lead settings. For details about changing the
password protected Technician ID care unit setting, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”
NOTE: For details about adding your own password protected list of
pre-defined reasons for recording a 12 lead ECG, see the
“CARESCAPE Monitor B650 Supplemental Information Manual.”
You can enter data into the data fields with the on-screen keyboard,
barcode reader, or a standard keyboard.
1. Select the HR parameter window.
2. Select 12 Lead Analysis > Settings.
3. Enter the Technician ID if required.
4. Enter the Order Number.
5. Select the reason for taking the 12 lead ECG from the Reason for
12 Lead list.
6. Select Cancel or Confirm.
- To close the settings window without saving your changes,
select Cancel.
- To save the data displayed in the settings window and close
the window, select Confirm.
Entering required data for an ACI-TIPI 12 lead ECG analysis Setting the 12 lead ECG analysis display format
To change the 12 lead ECG waveform display format and the printed
NOTE: If the patient’s age is not already entered, you must enter it.
12 lead ECG report waveform format:
See the “Starting and ending monitoring” chapter.
1. Select the HR parameter window.
NOTE: A patient must be at least 16 years old in order to perform an 2. Select 12 Lead Analysis > Settings.
ACI-TIPI 12 lead ECG analysis. 3. Select a format from the Display Format list.
4. Select Cancel or Confirm.
1. Select the HR parameter window.
- To close the settings window without saving your changes,
2. Select 12 Lead Analysis > Settings.
select Cancel.
3. Select On from the ACI - TIPI list.
- To save the data displayed in the settings window and close
4. Select the patient’s gender from the Gender list.
the window, select Confirm.
5. Select the symptoms present from the Chest or Left Arm Pain
list. Generating a 12 lead ECG analysis report during an ST
6. Select Cancel or Confirm. alarm condition
- To close the settings window without saving your changes, You can have a 12 lead ECG report automatically generated when
select Cancel. an ST alarm condition occurs. Automatically generated reports are
- To save the data displayed in the settings window and close viewable from the 12 Lead Analysis > Saved Reports window.
the window, select Confirm. 1. Select the HR parameter window.
NOTE: Selecting Confirm is required before you can complete an 2. Select 12 Lead Analysis > Settings.
ACI-TIPI 12 lead ECG analysis. 3. Select On from the 12 Lead on ST Alarm list.
4. Select Cancel or Confirm.
Setting automatic 12 lead ECG analysis measurements - To close the settings window without saving your changes,
1. Select the HR parameter window. select Cancel.
2. Select 12 Lead Analysis > Settings. - To save the data displayed in the settings window and close
3. Select a time interval from the Auto Interval list. the window, select Confirm.
4. Select Cancel or Confirm.
- To close the settings window without saving your changes,
select Cancel.
- To save the data displayed in the settings window and close
the window, select Confirm.

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Closing the 12 lead ECG analysis settings window
Choose one of the following:
• To close the settings window without saving your changes,
select Cancel.
• To save the data displayed in the settings window and close the
window, select Confirm.
NOTE: Selecting Confirm is required before you can complete an
ACI-TIPI 12 lead ECG analysis.
Performing a 12 lead ECG analysis
1. Select the HR parameter window.
2. Select 12 Lead Analysis.
3. Select 12 Lead Now.
All the waveforms in the 12 Lead Analysis window freeze during
the analysis except for the ECG 1 waveform. Analysis takes less
than one second to complete. At that time, the monitor
generates a 12 lead report, saves the report locally, and displays
the report on the display screen. The monitor can store up to 15
12 lead reports locally.
The 12 lead ECG report
After the monitor generates the 12 lead report, you can send it to the
optional MUSE database for further analysis or storage, print the
report, or delete the report.
NOTE: The Send to MUSE or MUSE + Print buttons are not selectable:
- When the MUSE database is not available or when the local
report has already been sent to the MUSE database.
- When a temporary medical record number is used and the care
unit default setting, Transmit with temp MRN, has not been
enabled.
- When the 12RL feature was used. The MUSE database does not
support a 12 lead report with the 12RL feature.
- When the monitor is connected to the S/5 Network.
To send or print the 12 lead ECG report:
1. Select Send to MUSE to send this local 12 lead report to a MUSE
database.
2. Select Print to print the 12 lead report.
3. Select MUSE + Print to send the local 12 lead ECG report to a
MUSE database and print the 12 lead ECG report,
4. Select Delete to delete the report and return to the real-time
window.
5. To generate a new 12 lead ECG analysis report, select Real-time
View and repeat the procedure, “Performing a 12 lead ECG
analysis.”
Viewing or printing saved 12 lead reports Returning to the real-time view
You can view and print 12 lead reports that are stored at the monitor • Select Real-time View to return to the real-time waveform view.
(local), or if available, stored at a MUSE database. The newest reports
are displayed first. Troubleshooting 12 Lead ECG analysis
1. Select the HR parameter window.
2. Select 12 Lead Analysis. NOTE: For a comprehensive list of system messages, see the “System
3. Select Saved Reports. messages” chapter.
4. Select the desired 12 lead ECG report from the list. NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
5. To view this report, select View. B650 Supplemental Information Manual.”
NOTE: A report that is stored locally at the monitor opens and
displays in the 12 Lead Analysis window. A report that is stored PROBLEM WHAT TO DO
at the MUSE database opens and displays in the MUSE Report Transmitting a 12 There are communication problems with
window. lead report to a MUSE the network or MUSE database.
NOTE: To open a report that is stored at the MUSE database, a database fails. • Contact authorized service personnel.
connection to the CARESCAPE Network IX is required.
6. To send a locally saved 12 lead report to the MUSE database, Printing a 12 lead There is a printer error or communication
select Send to MUSE. analysis report fails. problems with the network.
NOTE: You can only send the report to the MUSE database once. • Check the printer. If you cannot resolve
7. To resize a report displayed in the MUSE Report window, select a the problem, contact authorized service
value from the Zoom list. personnel.
NOTE: If you zoom in closer on the report, use the vertical scroll
bar to view all parts of the report.
8. To print a report displayed in the MUSE Report window, select
Print.
9. To stop printing, select Stop Printing or Cancel Printing.

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Pacemaker detection
Pacemaker detection points to note
• PDM: Pacemaker detection must be turned on at the monitor. It
must be used whenever the monitored patient has a pacemaker.
• E-modules: Pacemaker detection is always on.
• E-modules: If the patient has an atrial pacemaker, ST
calculations can be performed if the pacer spike does not
coincide with the ISO point’s adjustment range.
Pacemaker detection safety precautions
Pacemaker detection warnings
• RATE METERS — Keep pacemaker patients under close
observation. Rate meters may continue to count the pacemaker
rate during cardiac arrest and some arrhythmias. Therefore, do
not rely entirely on rate meter alarms. See the “CARESCAPE
Monitor B650 Supplemental Information Manual” for disclosure
of the pacemaker pulse rejection capability of this device.
• FALSE CALLS — False low heart rate indicators or false Asystole
calls may result with certain pacemakers because of pacemaker
artifact such as electrical overshoot of the pacemaker
overlapping the true QRS complexes.
• MONITORING PACEMAKER PATIENTS — For PDM only, the
monitoring of pacemaker patients can only occur with the pace
program activated.
• PACEMAKER INDICATION — Pacemaker activity is indicated on
the electrocardiogram through the display of a different colored
pacemaker marker pulse. All pacemaker marker pulses appear
upright and uniform and should not be used for diagnostic
interpretation.
• PATIENT HAZARD - A pacemaker pulse can be counted as a QRS
during Asystole when pacemaker detection is on. Keep
pacemaker patients under close observation.
Setting pacemaker detection
NOTE: E-modules: Pacemaker detection is always enabled.
NOTE: PDM only: If pacemaker detection is required, it must be
turned on. However, you may disable pacemaker event processing
by turning off pacemaker detection. When pacemaker detection is
turned off, the monitoring device ignores pacemaker pulse
detections which may adversely affect the heart rate accuracy of
the monitoring device.
To set pacemaker detection:
1. Select the HR parameter window.
2. Select the Advanced button.
3. Select a value from the Pacemaker Detection list.
Choices available are acquisition module dependent:
• E-modules:
Show - Displays pacemaker spikes on the ECG waveform.
Hide - Hides the pacemaker spikes on the ECG waveform.
Sensitive -Increases pacemaker detection sensitivity and
displays the pacemaker spikes on the ECG waveform.
NOTE: As the sensitivity for pacemaker detection increases,
so does the opportunity for false pacemaker detections.
• PDM: On or Off.
Troubleshooting pacemaker detection
NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”
Arrhythmia detection
Arrhythmia measurement limitations
• Since the arrhythmia detection algorithm sensitivity and
specificity is less than 100%, sometimes there may be some
false arrhythmias detected and also some true arrhythmia
events may not be detected. This is especially true when the
signal is noisy.
• PDM only: The ECG size and QRS width settings affect arrhythmia
detection and heart rate calculation sensitivity.
• If QRS amplitude is low, the monitor might not be able to
calculate HR and false Asystole may occur.
• During the learning phase of the algorithm, arrhythmia detection
may not be available. As a result, the patient condition should be
closely monitored during the learning phase and for several
minutes after the learning phase to allow the algorithm to reach
optimal detection performance.
Safety precautions
Arrhythmia warnings
• PDM - V Fib/V Tach should not be considered a substitute for the
V Tach arrhythmia alarm. Efforts to lower the V Tach alarm level
can result in missed ventricular tachycardia alarms.
• LOSS OR DETERIORATION OF ARRHYTHMIA DETECTION —
Automated arrhythmia analysis programs may incorrectly
identify the presence or absence of an arrhythmia. A physician
must therefore interpret the arrhythmia information in
conjunction with other clinical findings. Please take special note
of the following ECG waveform conditions:
- Noisy waveforms. Noisy portions of ECG waveforms are
typically excluded from analysis. The exclusions are
necessary to reduce the occurrence of inaccurate beat
168
interpretations and/or rhythm alarms. If the excluded noisy
portions of the ECG waveform contain true arrhythmia
events, those events may remain undetected by the system.
- Beat amplitude and duration. Accurate detection and
interpretation of beats becomes increasingly difficult as the
amplitude and/or duration of those beats approach the
design limits of the analysis program. Thus, as beats become
extremely wide or narrow, or especially as beats become
small, arrhythmia interpretation performance may degrade.
- Other morphology considerations. Automated arrhythmia
detection algorithms are designed fundamentally to detect
significant changes in QRS morphology. If an arrhythmia
event is present and does not exhibit a significant change
from the patient’s predominant morphology, it is possible for
those events to remain undetected by the system.
• PAUSED ANALYSIS — Certain conditions pause arrhythmia
analysis. When paused, arrhythmia conditions are not detected
and alarms associated with arrhythmias do not occur.
Conditions causing paused arrhythmia analysis include
arrhythmia off, arrhythmia paused, leads fail, alarm pause, all
alarms off, and discharged patient.
• FAILURE TO DETECT LETHAL ARRHYTHMIA — Always monitor ECG
for arrhythmia detection purposes. HR calculated from pulsatile
SpO2 waveform may differ significantly from ECG HR measured
values. Users should be aware that the ‘SpO2 probe off’ and ‘No
SpO2 pulse’ technical alarms escalate no higher than a Medium
priority.
• ARRHYTHMIA PAUSED alarm — The ‘Arrhythmia paused’ alarm
indicates that the system is no longer monitoring arrhythmia or
heart rate from ECG. If you adjust the alarm priority level lower
than the default value, keep the patient under close surveillance.
 169

Selecting the arrhythmia alarm settings

Setting arrhythmia alarms
1. Select the HR parameter window.
Depending on the care unit default ECG parameter setting for
2. Select the Arrhythmia tab.
Allowed Arrh. Levels, you may choose which arrhythmia categories
3. Select Lethal Alarms, Ventricular Alarms or Atrial Alarms.
will alarm.
4. Select an arrhythmia from the list.
See the “Arrhythmia alarm messages” section for the alarm 5. Select an alarm priority from the Alarm Priority list.
categories assigned to each arrhythmia message. 6. To create an arrhythmia alarm snapshot, select Create
Snapshot.
1. Select the HR parameter window.
7. To print during an arrhythmia alarm, select Print on Alarm.
2. Select the Arrhythmia tab.
3. Select Lethal Alarms.
NOTE: For arrhythmia alarm waveform printing, the printing will
4. Choose the arrhythmia category you want to alarm.
continue until 20 seconds has passed from the clearance of the
Choices are:
last active arrhythmia alarm (e.g., 10 seconds saved data,
- Full: All arrhythmias alarm.
arrhythmia alarm duration + 20 seconds data).
- Lethal: Lethal arrhythmias alarm only.
- Off: No arrhythmia alarms are generated. Setting the alarm pause interval

Lethal, ventricular, and atrial arrhythmia alarm conditions You can set the time interval between the two adjacent beats before
While monitoring ECG, you may choose which arrhythmia alarm the Pause alarm condition is annunciated.
conditions you want to adjust. Choices are: 1. Select the HR parameter window.
- Lethal Alarms- Detects and identifies lethal arrhythmias. 2. Select the Arrhythmia tab.
- Ventricular Alarms- Detects and identifies ventricular 3. Select Atrial Alarms.
arrhythmias. 4. Select a value from the Pause Interval list.
- Atrial Alarms- Detects and identifies atrial arrhythmias.

NOTE: Ventricular and atrial arrhythmia alarm conditions are only

adjustable with the Full Arrhythmia license.
Arrhythmia alarm messages
NOTE: A clinician must analyze the arrhythmia information in conjunction with the other clinical findings.
For details about detection perfomance and test results of the arrhythmia testing, see the “CARESCAPE Monitor B650 Supplemental Information
Manual.”

Alarm message Arrhythmia Alarm priority Arrhythmia detection criteria

analysis
A Fib Full: All other According to With the absence of P-waves, mapping the observed irregular RR intervals into the
software priority setting probability that the sequence was generated by atrial fibrillation.
packages except
NICU.
Accel. Ventric. Full According to Accelerated ventricular rhythm - Run of PVCs is detected with a run length of at least six
priority setting beats and the rate requirements have not met for V Tach or V Brady.
Asystole Lethal High HR is decreased to zero, the V Fib/V Tach alarm is not displayed and a beat detection
has not occurred in the last two seconds.
Bigeminy Full According to Following pattern is detected: N, V, N, V, N, V where N=normal, V=PVC (every other beat
priority setting is a PVC).
Brady Lethal: NICU According to PDM: Occurs when eight consecutive R-R intervals or the displayed 4/8-beat average
software priority setting ECG heart rate falls below the user-selected common HR low limit or ECG HR low limit.
package only.
Full: All other
software
packages except
NICU.
Couplet Full According to Two consecutive PVCs are detected between normal beats, N-V-V-N. The coupling
priority setting interval between the PCVs must be less than 600 ms.
Irregular Full According to PDM module NICU only: When atrial fibrillation detection is not enabled at the monitor,
priority setting the alarm message ‘Irregular.’ displays.

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Alarm message Arrhythmia Alarm priority Arrhythmia detection criteria

analysis
Missing beat Full According to E-modules: Actual RR interval more than 1.8 times the average RR interval.
priority setting
Multifocal PVCs Full According to E-modules: Over the last 15 beats two or more premature ventricular beats with
priority setting different morphologies are detected.
Pause Full According to Coupling interval between two beats exceeds a configured value (1-5 s).
priority setting
Rapid VT Lethal According to E-modules: Five or more consecutive PVCs and rate of successive beats 160 bpm or
priority setting greater.
R on T Full According to • PDM: Isolated PVC is detected within 100 ms of the peak of the T-wave of the
priority setting patient’s predominant normal beat.
• E-modules: Early PVC, beat detected as a PVC, preceded and followed by a normal
beat; current RR interval is less than half of the previous RR interval.
Single PVC Full According to PDM: Isolated PVC is detected.
priority setting
Tachy Full According to PDM: Occurs when 4 consecutive RR intervals or the displayed 4/8-beat average ECG
(Tachycardia) priority setting heart rate exceeds the common HR High Limit or ECG HR High Limit.
Trigeminy Full According to The following pattern is detected: N, N, V, N, N, V, N, N, V where N=normal, V=PVC (every
priority setting third beat is a PVC).
Alarm message Arrhythmia Alarm priority Arrhythmia detection criteria
analysis
V Brady Full According to Run of PVCs are detected with a run length of at least 3 beats. In addition, at least two
priority setting consecutive RR intervals in the run must have an effective heart rate less than the
following limits:
• E-modules: 50 bpm
• PDM:
• Adult: 50 bpm
• 11-13 years: 60 bpm
• 3-10 years: 60 bpm
• 0-2 years: 60 bpm
V Fib Lethal High Occurs when the ECG waveform indicates a chaotic ventricular rhythm.
V Fib/V Tach Lethal High PDM: Ventricular fibrillation occurs when the ECG waveform indicates a chaotic
ventricular rhythm.
V Tach Lethal: All other According to • PDM: A run of PVCs is detected with a run length of six beats or more. In addition at
software priority setting least three consecutive RR intervals in the run must have an effective HR that
packages except exceeds the following:
NICU. Adult: 100 bpm.
Full: NICU 11-13 years: 130 bpm
software 3-10 years: 140 bpm
package only. 0-2 years: 160 bpm
• E-modules: Six or more consecutive PVCs with a successive rate over 100 bpm.
VT>2 Full According to • PDM: A run of PVCs is detected with a run length of more than two beats but less
priority setting than the number required for V Tach. In addition at least two consecutive RR
intervals in the run must have an effective HR that exceeds the following limits:
Adult: 100 bpm
11-13years: 130 bpm
3-10 years: 140 bpm
0-2 years: 160 bpm
• E-modules: A run of PVCs with rate over 100 bpm is detected with a run length of
more than two beats but less than the number required for V Tach.

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Troubleshooting arrhythmia detection

NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.

NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor

B650 Supplemental Information Manual.”
ST detection
NOTE: Multi-lead ST Analysis license only.
Starting ST detection
If enabled, ST analysis starts automatically after the ECG leads have 1. Select the ST parameter window or select the HR parameter
been connected and QRS detection has started. The text message window > ST tab.
‘Learning’ displays within each QRS complex window. Once the 2. Select Setup.
program has completed the learning phase, ST values are updated 3. Select ST Analysis > On.
every 10 seconds, QRS complexes every 40 seconds.
Selecting the leads displayed in the ST parameter window
ST detection points to note To display either the ST leads or all available leads:
• PDM: When the PDM has stored ST data, and is then connected 1. Select the ST parameter window.
to the monitor, a new reference QRS is saved to the monitor at 2. Select Setup.
the time of connection. The reference QRS from the PDM cannot 3. Select the leads for display from the ST Window list.
be used because the reference QRS does not have time stamp. Choices are:
• E-modules: ST segment deviations are not displayed for patients - ST Leads: Displays the first three ST leads. See “Changing the
with ventricular pacemakers or if the rhythm is considered as displayed ST leads” for details. The ST lead with the greatest
from ventricular origin. deviation is also displayed in the parameter window to the
right of the ST leads.
ST detection measurement limitations - All Leads: Displays anterior, inferior, and lateral lead groups.
• ST values may be affected by such factors as some drugs or
metabolic and conduction disturbances. Changing the displayed ST leads
• Since ST is often calculated with a fixed delay from the J point, To select the display order of the first, second, and third displayed ST
changes in heart rate may affect ST. lead:
• The ST algorithm has been tested for accuracy of the ST segment 1. Select the ST parameter window.
data. The significance of the ST segment changes needs to be 2. Select Setup.
determined by a physician. 3. Select a lead from the ST Leads list.

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Adjusting the ST point manually Adjusting the isoelectric measurement point

NOTE: E-modules automatically set the ST point according to the
heart rate. Manual adjustments may be required if the following
automatic settings are not adequate for example when QT time is
short:
- If the heart rate is greater than or equal to 120 bpm, then the ST
point is set to J + 60 ms.
- If the heart rate is less than 120 bpm, then the ST point is set to
J + 80 ms.
NOTE: E-modules only. The E-modules automatically set the
isoelectric point. Manual adjustments may be required if, for
example, a P-wave is attached to the QRS-wave.
To manually adjust the isoelectric measurement point:
1. Select the ST parameter window.
2. Select Setup.
3. Adjust the ISO Point using the arrows.

NOTE: PDM sets the ST point automatically according to the Profile Adjusting the J point
default. Manual adjustments may be required if the default is not
NOTE: E-modules only. The E-modules automatically set the J point.
adequate.
Manual adjustments may be required.
NOTE: Manually adjusting the ST point overrides the automatic
To manually adjust the J point:
detection of the ST point. As a result, you are responsible for
monitoring the patient ST levels with new adjustments and required 1. Select the ST parameter window.
to make further setting adjustments as necessary according to 2. Select Setup.
changes in the patient’s rhythm. 3. Adjust the J Point using the arrows.

To manually adjust the ST measurement point: Viewing ST in a split screen

1. Select the ST parameter window. In the split screen window, you can view the reference QRS complex,
2. Select Setup. current QRS complexes, and ST trends.
3. Select a value from a ST Point list. 1. Select Monitor Setup from the monitor’s main menu.
2. Select Screen Setup > Split Screen.
3. Select ST to view a split screen.

Viewing realtime QRS/ST complexes
The initial reference QRS is stored and used as a comparison against
the incoming QRS complexes. The current complex is superimposed
over the reference complex in order to visually assess the change in
each QRS complex. QRS complexes are updated every 40 seconds.
Current ST values in millimeters shall be displayed in each QRS
window. Numeric values are updated every 10 seconds.
Reference QRS
NOTE: PDM saves the initial reference QRS after 64 beats have been
detected.
NOTE: E-modules save the initial reference QRS up to three minutes
after the ECG measurement is started.
Up to six additional reference QRS complexes can be stored
manually. Each QRS reference is identified with the date and
timestamp.
NOTE: If a new reference QRS complex is saved and there is no room
for another reference complex, then the oldest manual or automatic
reference complex is erased.
Saving a reference QRS manually
NOTE: You cannot save a reference QRS manually until an initial
reference QRS complex has been saved, or if ST Analysis is disabled.
Saving a new reference QRS manually
1. Select the ST parameter window.
2. Select Save Reference.
The current QRS becomes the new reference QRS.
Printing a realtime QRS/ST report
The QRS/ST report displays the current ST leads and the trends at 10
minute intervals.
To print a QRS/ST report to a laser printer:
1. Select the ST parameter window.
176
Saving reference QRS complexes automatically
NOTE: The QRS reference is not saved during an ST alarm condition,
only the ST snapshot is saved.
NOTE: If a new reference QRS complex is saved and there is no room
for another complex, then the oldest manual or automatic complex
is erased. You may want to manually erase QRS complexes to avoid
automated erasing.
A reference QRS complex is saved automatically whenever you do
one of the following:
• Change the Va or Vb lead.
• Change the ST point manually.
Selecting a saved reference QRS complex for display
To select and display a saved reference QRS for ST analysis:
1. Select the ST parameter window.
2. Select a saved reference QRS from the Reference QRS list.
Erasing a reference QRS
NOTE: You cannot erase the initial reference QRS.
1. Select the ST parameter window.
2. Select a reference QRS from the Erase Reference list.
If you delete the reference QRS currently displayed, then the
next, newer reference QRS is displayed as the reference QRS.
Selecting the ST trend time scale
NOTE: The length of the ST trend report is the same as the Time
Scale setting for ST trends.
1. Select the ST parameter window.
2. Select a value from the Time Scale list.
2. Select Print QRS/ST.
3. To stop printing, select Cancel Printing.
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Setting the ST trends time scale

Changing trend display
1. Select the ST parameter window.
Each QRS window displays the current QRS complex and ST value.
2. Select Trend View.
The QRS complexes and current measurement point lines are
3. Select a time value from the Time Scale list.
updated at least every 40 seconds. Each QRS window has a
corresponding trend window displaying the ST trend along with the Printing a ST trend report
trend scale and current time interval. Theprimary HR trend window NOTE: The length of the ST trend report is the same as the Time
is displayed below the last ST trend window. The ST trends for the Scale setting for ST trends.
available leads are updated every 10 seconds.
To print an ST report to a laser printer:
Displaying QRS complexes and ST trends for other leads
1. Select the ST parameter window.
1. Select the ST parameter window. 2. Select Trend View.
2. Select Trend View. 3. Select Print Page/ST.
3. Select a lead group from the Leads list. 4. To stop printing, select Cancel Printing.
Choices are:
- ST: The leads displayed in the ST window. Selecting the ST trend scales
- Anterior: The leads belonging to this lead group. 1. Select the ST parameter window.
- Inferior: The leads belonging to this lead group. 2. Select Trend View.
- Lateral: The leads belonging to this lead group. 3. Select Trend Scales.
- Display: The leads associated with the waveforms selected 4. Select an ST trend scale value from the list.
for display.
Displaying the ischemic burden in the ST trend window
Reviewing ST trends Ischemic Burden is a visualization of ischemia. In the ST Trend view,
You can review ST trend values and compare ST trend related QRS the area between the ST trend and the ischemic burden is colored.
complexes with realtime QRS complexes by using the yellow-colored
cursor. The current time of the cursor is displayed above the cursor.
Each yellow-colored trend value is displayed next to the cursor and
ST trend related QRS complexes are drawn in the QRS windows with
the color gray.
1. Select Trend View.
2. Select the right or left arrow above the QRS window to move the
ST trend cursor.
Enabling ischemic burden Setting ST alarm limits for individual leads
1. Select the ST parameter window. To set each ST lead and alarm limit individually:
2. Select Trend View. 1. Select the ST parameter window.
3. Select the Ischemic Burden button. 2. Select Alarms.
4. Select Ischemic Burden. 3. Select an ECG lead from the list.
Setting the ischemic burden limits NOTE: If the feature is not active, the alarm limits are greyed out.
To set the lower and upper threshold values: Select Alarm On to set the alarms.
1. Select the ST parameter window. 4. Set the alarm limits.
2. Select Trend View. Adjusting the relative ST alarm limits for all leads or for a lead
3. Select the Ischemic Burden. group
4. Set the lower threshold value with the Depression Limit (mm) You can adjust the high/low alarm limits set around the current ST
arrows. value for all of the individual ST leads or for the leads in a selected
5. Set the higher threshold value with the Elevation Limit (mm) lead group. For example, when you select a Relative Auto Limits
arrows. value of 2 mm, the high limit is set at the current ST value +2 mm,
and the low limit is set at the current ST value -2mm.
Setting ST alarm limits To set the high/low ST alarm limits around the current:
Depending on the care unit’s ECG parameter default for ST Alarms, 1. Select the ST parameter window.
you may set ST alarm limits for a lead group, for individual leads, or 2. Select Alarms.
for all leads relative to the patient’s current measurements. 3. Select Relative Auto Limits.
4. Choose an alarm limit value with the All Limits, Anterior,
The leads associated with each lead group are as follows: Inferior, or Lateral arrows.
- Anterior: V1, V2/dV2, V3/dV3, V4/dV4
- Inferior: II, III, aVF Troubleshooting ST detection
- Lateral: V5, V6/dV6, I, aVL
NOTE: The “d” in dV2 represents the derived lead value obtained NOTE: For a comprehensive list of system messages, see the “System
from a 12SL ECG with the 12RL feature. messages” chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
Setting ST alarm limits for lead groups
B650 Supplemental Information Manual.”
1. Select the ST parameter window.
2. Select Alarms.
3. Select an ECG lead group.
NOTE: If the feature is not active, the alarm limits are greyed out.
Select Alarm On to set the alarms.
4. Set the alarm limits.

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QT detection
NOTE: Multi-lead QT/QTc Analysis license only.
Setting QT/QTc alarms and alarm limits
The administration of some drug types can prolong the QT segment. 1. Select the HR parameter window.
Monitoring QT segment changes can help identify how these drugs 2. Select the QT tab.
are affecting the QT segment. 3. Select Alarms
NOTE: If the feature is not active, the alarm limits are greyed out.
QT/QTc measurement limitations Select Alarm On to set the alarms.
• At least one measured V-lead must be available in order for the 4. Set the alarm limits.
algorithm to process QT.
• QT/QTc values are calculated with 5-leadwire, 6-leadwire, or 10- Troubleshooting QT detection
leadwire ECG cables.
NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.
Starting the QT/QTc measurement
1. Select the HR parameter window.
2. Select the QT tab.
3. Select QT Analysis > On.

Selecting QT or QTc for analysis

1. Select the HR parameter window.
2. Select the QT tab.
3. Select QT or QTc from the Show list.
Impedance respiration
Respiration equipment to patient connection
Impedance respiration uses the same setup as the ECG
measurement. See the “ECG equipment to patient connection“
section.
Respiration module keys
There are no respiration related keys on the modules.
Respiration points to note
• Connect only one impedance respiration module to the monitor
simultaneously.
• Do not place electrodes on obvious layers of fat, or major
muscles.
• Make sure the electrode gel is moist.
• Make sure electrodes have good skin contact.
• Depending on the respiration module used, not all respiration
measurements and settings are available to view or change.
• For a list of acquisition modules capable of measuring this
parameter, see the “System introduction” chapter.
Respiration measurement limitations
• E-modules: Impedance respiration is intended for patients over
three years old.
• Electrical devices, such as electrosurgery units and infrared
heaters, that emit electromagnetic disturbance, may cause
artifacts or disable the respiration measurement completely.
Respiration measurement checks
• Check that the waveforms and parameter values are displayed
when the cable is connected to the patient.
180
Safety precautions
Respiration warnings
• Make sure that the leadwire set clips or snaps do not touch any
electrically conductive material including earth.
• E-modules — The impedance respiration measurement is
inherently very sensitive as it measures very small physiological
signals (changes of impedance of the patient’s chest area). With
E-modules, conducted and radiated field strengths above 1 V/m
may cause erroneous measurements at various frequencies, for
example interference with the signal/ waveform leading to
respiration rate readings inconsistent with the patient's true
respiration rate. If you notice this, use another form of
respiration monitoring, for instance end-tidal CO2.
• APNEA EVENTS — The monitor may not detect all episodes of
inadequate breathing, nor does it distinguish between central,
obstructive and mixed apnea events.
• DEFIBRILLATOR PRECAUTIONS — Patient signal inputs labeled
with the CF and BF symbols with paddles are protected against
damage resulting from defibrillation voltages. To ensure proper
defibrillator protection, use only the recommended cables and
leadwires.
• ELECTRODE CONFIGURATION — Impedance respiration
monitoring is not reliable when ECG electrodes are placed
anywhere but on the chest.
• PDM — If the Cardiac Artifact Alarm is turned off, apnea events
may not be detected.
 181

• ELECTRODES — Whenever patient defibrillation is a possibility,

use non-polarizing (silver/silver chloride construction) electrodes
Respiration lead I electrode placement
for ECG monitoring. Polarizing electrodes (stainless steel or silver
constructed) may cause the electrodes to retain a residual
charge after defibrillation. A residual charge will block
acquisition of the ECG signal.
Respiration cautions
• The impedance respiration measurement may cause rate
changes in Minute Ventilation Rate Responsive Pacemakers. Set
the pacemaker rate responsive mode off or turn off the
impedance respiration measurement on the monitor.
• When using an electrosurgery unit, ensure proper contact of the
ESU return electrode to the patient to avoid burns at the monitor
measurement sites. Also ensure that the ESU return electrode is
near the operating area.
IEC AAMI/AHA Electrode placement
Preparing the patient’s electrode sites R (red) RA (white) Just below the right clavicle.
Excessive body hair or skin oil reduces electrode contact with the L (yellow) LA (black) Just below the left clavicle.
skin and decreases the quality of electrode signal.

NOTE: When preparing the electrode sites, avoid obvious layers of

fat and major muscles.
1. Shave any hair from the electrode site.
2. Gently rub the surface of the skin to increase capillary blood
flow.
3. Clean the skin with alcohol or a mild soap and water solution to
remove skin oil and dead or abraded skin cells.
4. Dry the skin completely before applying the electrodes.
Respiration lead II electrode placement Respiration lead RL-LL electrode placement
NOTE: The RL-LL respiration lead is available with PDM only.

IEC AAMI/AHA Electrode placement

R (red) RA (white) Just below the right clavicle.
IEC AAMI/AHA Electrode placement
F (green) LL (red) Lower left edge of the rib cage.
N (black) RL (green) Lower right edge of the rib cage.

F (green) LL (red) Lower left edge of the rib cage.

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Turning on the respiration measurement
The respiration parameter must be selected to show on the screen.
See the "Selecting parameters to the screen" section for details.
1. Select the Impedance Respiration parameter window.
2. Select Respiration Measurement > On.
Respiration lead and breath detection
Respiration leads identify the ECG leads used for respiration
measurement. Each respiration lead is suited for specific breath
detection conditions:
- Lead I: Best for detecting thoracic breathing, but is more
susceptible to cardiogenic artifact.
- Lead II: Equally good at detecting thoracic or abdominal
breathing, but is more susceptible to cardiogenic and motion
(head, neck, or arm) artifact.
- Lead RL-LL: Best at detecting abdominal breathing and is not as
susceptible to cardiogenic or motion artifact. NOTE: The RL-LL
respiration lead is available with PDM only.
Selecting the respiration lead
1. Select the Impedance Respiration parameter window.
2. Select lead I, II, or RL-LL.
NOTE: E-modules use Lead II, and the RL-LL respiration lead is
available with PDM only.
Setting the respiration rate source
1. Select the Impedance Respiration parameter window.
2. Select Resp Rate Source.
3. Select AUTO, CO2, or Impedance.
NOTE: The AUTO selection lets the monitor choose the
respiration rate source. If CO2 is monitored, it is chosen to be
used. If not, then impedance respiration is chosen as the
respiration rate source.
Selecting the respiration waveform size
To manually select the waveform size
1. Select the Impedance Respiration parameter window.
2. Select Size.
The greater the value, the larger the waveform size.
To automatically set the respiration waveform size
NOTE: PDM only.
To automatically size the waveform to fit the available space:
1. Select the Impedance Respiration parameter window.
2. Select Autosize Waveform.
Selecting the waveform sweep speed
1. Select the Impedance Respiration parameter window.
2. Select Resp Sweep Speed.
The lower the value, the slower the sweep speed.
Selecting waveform sensitivity
Breath detection accuracy may be enhanced by increasing or
decreasing the waveform sensitivity.
1. Select the Impedance Respiration parameter window.
2. Select Sensitivity.
3. To increase the sensitivity, select a lower numeric value.
Relearning the respiration pattern Respiration measurement on the monitor screen
NOTE: PDM only. A text similar to ‘APN 15 s‘ indicates that the respiration apnea alarm
1. Select the Impedance Respiration parameter window. is set to a value other than 20 seconds. The example text indicates
2. Select Relearn Respiration. that it is set to 15 seconds.
The detection threshold and the waveform size update after the
new respiration pattern is learned. Turning off the respiration measurement
1. Select the Impedance Respiration parameter window.
Setting the respiration rate alarm limits 2. Select Respiration Measurement > Off.
1. Select the Impedance Respiration parameter window.
2. Select Alarms.
3. Set the Respiration Rate limits with the arrow selectors.

Setting the respiration apnea alarm limits

NOTE: PDM only.
1. Select the Impedance Respiration parameter window.
2. Select Alarms.
3. Set the Apnea Limit Seconds with the arrow selectors.

Setting the respiration cardiac artifact alarm

NOTE: PDM only.

To be alerted when the respiration rate is within 5% of the ECG heart

rate:
1. Select the Impedance Respiration parameter window.
2. Select Alarms.
3. Select Cardiac Artifact > Alarm On to set the alarm.

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Troubleshooting the respiration measurement

NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.

NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor

B650 Supplemental Information Manual.”

PROBLEM WHAT TO DO
Respiration • Check electrode quality and positioning.
measurement • Adjust the breath detection sensitivity. During
fails. ventilator-supported breathing, the respiration
calculation may count only ventilator-
produced inspirations and expirations.
• Other electrical devices may interfere with the
measurement.
Pulse oximetry (SpO2)
NOTE: For a comprehensive list of compatible supplies and
SpO2 equipment to patient connection accessories, see the supplies and accessories document delivered
(1) Acquisition module with SpO2 measurement capability with the monitor.
(2) Interconnect cable
(3) Reusable sensors NOTE: This illustration is an example of an equipment to patient
(4) Disposable sensors connection.

1
2

186
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SpO2 module keys SpO2 points to note

There are no SpO2 related keys on the modules. • GE sensors are latex-free.
• Use dry and clean sensors only.
Primary and secondary SpO2 measurement sources • Do not use damaged sensors.
It is possible to simultaneously measure SpO2 from two different • Check that you are not re-using a disposable sensor or other
disposable accessories.
measurement sources. The primary SpO2 source is labeled SpO2 and
• Primary and secondary SpO2 sites may be measured.
the secondary SpO2 source is labeled SpO2(2).
• Always check the patient and the sensor site if the accuracy of
The following table shows the acquisition modules that may be used the SpO2 values is questionable.
as primary and secondary SpO2 measurement sources. • Depending on the SpO2 module used (external devices included),
not all SpO2 measurements and settings are available to view or
Primary SpO2 source Compatible secondary SpO2 source(s) change.
• SpO2 signal strength indicators are displayed when using the
PDM, PSM, E-PRESTN, • E-NSATX module
following modules: E-NSATX or E-MASIMO modules, and PDM
or E-RESTN module • E-MASIMO module
with Masimo technologies. Not all SpO2 devices display a signal
• Unity Network ID connectivity device
strength indicator.
E-NSATX or E-MASIMO • Unity Network ID connectivity device • For a list of acquisition modules capable of measuring this
module parameter, see the “System introduction” chapter.
Unity Network ID • E-NSATX module1
connectivity device
• E-MASIMO module1

1 E-NSATX and E-MASIMO modules require a PDM with no SpO2 sensor

connected in order to work as a secondary SpO2 source when the Unity
Network ID connectivity device is the primary SpO2 source.

SpO2 measurement limitations
• E-modules are not suitable for use with neonatal patients.
• The pulse oximeter cannot distinguish between oxyhemoglobin
and dyshemoglobins.
• Poor perfusion may affect the accuracy of measurement,
especially when using an ear sensor.
• To avoid erroneous measurements, do not use a blood pressure
cuff or arterial blood pressure measurement device on the same
limb as the SpO2 sensor.
SpO2 measurement checks
• Check that the red light is lit in the sensor.
• Check that the waveforms and parameter values are displayed
when the sensor is connected to the patient.
Safety precautions
SpO2 warnings
• The operator is responsible for checking the compatibility of the
pulse oximetry monitor, sensor, and patient cable prior to use.
Incompatible components can result in degraded performance
and/or device malfunction.
• If the accuracy of any measurement does not seem reasonable,
first check the patient’s vital signs, then check for conditions that
may cause inaccurate SpO2 readings. If the problem is still not
resolved, check the monitor and the SpO2 module, cable, or
sensor for proper functioning.
• A pulse oximeter should not be used as an apnea monitor. A
pulse oximeter should be considered an early warning device. As
a trend toward patient deoxygenation is indicated, blood
samples should be analyzed by a laboratory CO-oximeter to
completely understand the patient's condition.
Check that the pulse oximetry waveform is physiological in
188
shape to ensure waveform quality and minimize noise spikes
caused by motion conditions. (Not applicable when monitoring
SpO2 with Masimo SET technology in Patient Data Modules (PDM),
and Masimo modules.)
• To prevent erroneous readings, do not use physically damaged
sensors, cables or modules. Discard a damaged sensor or cable
immediately. Never repair a damaged sensor or cable; never use
a sensor or cable repaired by others.
• Pulse rate measurement is based on the optical detection of a
peripheral flow pulse and therefore may not detect certain
arrhythmias. The pulse oximeter should not be used as a
replacement or substitute for ECG-based arrhythmia analysis.
• Many factors may cause inaccurate readings and alarms,
decreased perfusion, and or low signal strength:
Interfering substances:
- Carboxyhemoglobin may erroneously increase SpO2 reading.
- Methemoglobin (MetHb) usually represents less than 1% of
the total Hb, but in the case of methemoglobinemia that can
be congenital or induced by some IV dyes, antibiotics (such
as sulphas,) inhaled gases etc. this level increases sharply
and thus can cause inaccuracies in the SpO2 reading.
- Intravascular dyes (such as indocyanine green, methylene
blue, etc.)
Physiological characteristics:
- Cardiac arrest
- Hypotension
- Shock
- Severe vasoconstriction
- Severe anemia
- Hypothermia
- Venous pulsations
- Darkly pigmented skin
- Ventricular septal defects (VSDs)
 189
Environmental conditions:
- Excessive ambient light
- Electrical interference
- Electrosurgery
- Defibrillation - May cause inaccurate reading for a short
amount of time.
- Excessive patient/sensor motion. Artifact can simulate an
SpO2 reading, so that the monitor fails to sound an alarm. In
order to ensure reliable patient monitoring, the proper
application of the probe and the signal quality must be
checked at regular intervals.
Sensor placement:
- Incorrect sensor placement - prolonged monitoring or
incorrect sensor application can cause skin irritation or
impaired circulation. It is recommended that you check the
probe site every four hours (more frequently for poor
perfusion or for neonates). Refer to the instructions supplied
with the sensor.
- Sensor placement on the same extremity as a blood
pressure cuff, arterial catheter or intravascular line; or
arterial occlusion proximal to the sensor.
- Poor sensor fit
- Do not allow tape to block the sensor light emitter and
detector.
• CABLE/SENSOR AFTER CARE
- Do not immerse sensors or patient cables in water, solvents
or cleaning solutions.
- Do not reuse sensors intended for single patient use.
- Do not sterilize sensors or patient cables by irradiation,
steam, or ethylene oxide.
- Clean the surface of the probe before and after each patient
use.
- Allow sensor and cable to dry completely after cleaning.
Moisture and dirt on the connector can affect the
measurement accuracy.
- If a probe is damaged in any way, discontinue use
immediately.
- Inaccurate SpO2 data can result if a sensor is past its useful
life. Therefore, re-evaluate the measurement periodically by
performing additional assessment of the patient and
equipment, including consideration of use of alternate
monitoring methods such as direct measurement of arterial
oxyhemoglobin saturation (SaO2).
- A damaged sensor or a sensor soaked in liquid may cause
burns during electrosurgery.
• Do not use the monitor in high electromagnetic fields (for
example, during magnetic resonance imaging).
• NEONATAL — The display of inaccurate pulse oximetry (SpO2)
values has been linked to the presence of poor signal strength or
artifact due to patient motion during signal analysis. This
condition is most likely to be encountered when the monitor is
used on neonates or infants. These same conditions in adults do
not impact the SpO2 values to the same extent.
We recommend the application of the following criteria when
using the pulse oximetry function on neonates and infants:
1) The peripheral pulse rate (PPR) as determined by the SpO2
function must be within 10% of the heart rate, and
2) The SpO2 signal strength should be adequate. This is indicated
by the display of two or three asterisks or the absence of the
‘Low signal quality’ message.
Procedures or devices previously applied in your facility for SpO2
monitoring should be used in the event the SpO2 value from the
monitor cannot be validated by the above criteria.
Preparing the patient for SpO2 measurement
NOTE: Up to two SpO2 measurement sources can be monitored.
Refer to “Primary and secondary SpO2 measurement sources” for
more information.
1. Connect the SpO2 module(s) to the monitor.
2. Connect the adapter cable(s) to the SpO2 module connector(s).
3. Clean the surface of reusable sensors.
4. Prepare the application site(s):
- Remove nail polish.
- Remove earrings.
5. Follow the sensor manufacturer's instructions to position the
sensor(s).
6. Attach the sensor(s) to the patient.
7. Stabilize the sensor cable(s) to minimize sensor movement.
Changing the SpO2 waveform size
NOTE: Not available for E-NSATX and E-MASIMO.
1. Select the SpO2 parameter window.
2. Select the SpO2 tab or SpO2(2) tab.
3. Choose the size from the Size list.
190
Changing the SpO2 waveform scale
NOTE: PSM , E-PRESTN, or E-RESTN modules only.
1. Select the SpO2 parameter window.
2. Select the SpO2 tab or SpO2(2) tab.
3. Choose the scale from the Scale list:
- AUTO: The scale is automatically selected according to the
IrMod % (infrared modulation percentage) that is received
from the measurement source.
- Or, select 2, 5, 10, 20, or 50 for the scale.
Selecting the SpO2 hemodynamic sweep speed
NOTE: This setting adjusts the waveform speed for all of the
hemodynamic parameters.
1. Select the SpO2 parameter window.
2. Select the SpO2 tab orSpO2(2) tab.
3. Choose a numeric value from the Hemodynamic Sweep Speed
list.
The smaller the value, the slower the sweep speed.
 191

Selecting the SpO2 heart rate source Selecting the SpO2 averaging time
NOTE: PSM, E-PRESTN, E-RESTN, E-MASIMO, and PDM with Masimo
WARNING - FAILURE TO DETECT LETHAL ARRHYTHMIA technology and Masimo sensors.
Always monitor ECG for arrhythmia detection 1. Select the SpO2 parameter window.
purposes. HR calculated from pulsatile SpO2 2. Select the SpO2 tab.
3. Choose the number of seconds from the Averaging list.
waveform may differ significantly from ECG HR
measured values. Users should be aware that the Selecting the Masimo SpO2 sensor sensitivity level
‘SpO2 probe off’ and ‘No SpO2 pulse’ technical alarms
escalate no higher than a Medium priority. WARNING - Using the Maximum sensitivity setting
NOTE: Primary SpO2 measurement only.
delays the ‘Probe off’ detection alarm.

NOTE: HR Alarms must be configured as Single to enable SpO2 as NOTE: For SpO2 modules with Masimo technology and Masimo
the primary heart rate source. sensors.
1. Select the SpO2 parameter window.
NOTE: This setting adjusts the primary heart rate source for all of the 2. Select the SpO2 tab.
hemodynamic parameters. The primary heart rate source may be 3. Choose Sensitivity > Normal or Sensitivity > Maximum.
changed from the ECG, invasive pressures, or SpO2 Setup windows. • Use the Normal sensitivity setting for normal patient
Refer to the ECG chapter for more information about the primary monitoring purposes.
heart rate source. • Use the Maximum sensitivity setting for improved poor
1. Select the SpO2 parameter window. perfusion performance and for faster tracking of rapid SpO2
2. Select the SpO2 tab. saturation changes.
3. Choose the heart rate source from the Primary HR Source list.
Adjusting the SpO2 pulse beep tone volume
Showing the SpO2 pulse rate A variable pitch beep tone rises in pitch with increasing oxygen
1. Select the SpO2 parameter window. saturation or falls in pitch with decreasing oxygen saturation.
2. Select the SpO2 tab or SpO2(2) tab. To adjust the volume of the pulse beep tone:
3. Select Show Pulse Rate. 1. Select the SpO2 parameter window.
2. Select the SpO2 tab.
3. Set the volume with the Beat Volume arrows.
Setting the Nellcor SpO2 SatSeconds SpO2 measurement on the monitor screen
NOTE: PDM with primary SpO2 measurement and the Nellcor option
only. - Signal strength indicator for E-NSATX or E-MASIMO
modules, and PDM with Masimo technologies. The
You may show and set the SatSeconds threshold for the primary
signal strength is represented by zero to three asterisks:
SpO2 measurement:
0 - No signal
Showing SatSeconds in the SpO2 window 1 - Weak signal (*)
1. Select the SpO2 parameter window. 2 - Average signal (**)
3 - Strong signal (***)
2. Select the SpO2 tab.
3. Select Show Sat. Seconds. - Nellcor SatSeconds indicator for PDM using Nellcor
Setting the SatSeconds threshold technology.
1. Select the SpO2 parameter window.
2. Select the SpO2 tab. - Pulse beat detection signal
3. Set the threshold with the Saturation Seconds arrows.
For more information on signal indications, see the “CARESCAPE
Monitor B650 Supplemental Information Manual.”
Setting SpO2 alarms and alarm limits
To set the alarms and alarm limits for the primary SpO2 or secondary Stopping the SpO2 measurement
SpO2 measurements:
1. Remove the SpO2 sensor from the patient.
1. Select the SpO2 parameter window.
2. Disconnect the sensor from the sensor cable.
2. Select the SpO2 tab or SpO2(2) tab. 3. Disconnect the sensor cable from the module.
3. Select Alarms.
4. Set the alarm limits for the SpO2, HR, or PR(SpO2) channel. 4. Select to acknowledge the ‘SpO2 probe off’ alarm.
NOTE: If the feature is not active alarm limits are greyed out. 5. Discard single-use sensors.
Select Alarm On to set the alarm limits.
NOTE: HR appears when the HR Alarms unit setting is set to
Single. PR(SpO2) appears when the HR Alarms unit setting is set
to Multiple. The HR and PR(SpO2) settings are not available for
the secondary SpO2 measurement. Refer to the “CARESCAPE
Monitor B650 Supplemental Information Manual” for more
information about unit settings.
5. Set the alarm limits.

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Troubleshooting the SpO2 measurement

NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”
3

PROBLEM WHAT TO DO
SpO2 signal is • Check the sensor and sensor position.
poor • Make sure the patient is not shivering, moving,
or does not have tremors.
• The patient’s pulse may be too low to measure.
• Check that there are not two identical
measurement modules in the system.
Unable to The alarm limits are not adjustable when the
adjust alarm measurement source is from an external device
limits connected to the Unity Network ID connectivity
device.
Non-invasive blood pressure (NIBP)
NOTE: This illustration is an example of an equipment to patient
NIBP equipment to patient connection connection.
(1) Module with NIBP measurement capability
(2) Cuff hose NIBP module keys
(3) Cuff of correct size
There are two NIBP module keys on the hemodynamic E-modules:
(4) Brachial artery arrow (printed on cuff)
(5) Cuff index line (printed on cuff) Auto On/ Starts and stops automatic measurements at timed
NOTE: For a comprehensive list of compatible supplies and Off intervals.
accessories, see the supplies and accessories document delivered
with the monitor. Start Starts a single measurement, and cancels any
Cancel measurement in progress.

NOTE: You can also select NIBP Start/NIBP Cancel or NIBP Auto
Start/NIBP Auto Stop from the monitor’s main menu.

3 4 5
1

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Preparing the patient for a NIBP measurement
1. Select an appropriate NIBP cuff size for the patient.
2. Connect the NIBP cuff hose to the module's NIBP connector.
3. To position the NIBP cuff on the patient:
• Place the cuff arrow over the brachial artery (or whatever
artery is being used).
• Make sure that the cuff index line falls within the range
markings on the cuff.
• Wrap the cuff around the limb.
4. Make sure that the NIBP cuff tubes are not kinked, compressed,
or stretched.
5. Verify or select the correct Init. Pressure or Cuff Size from the
NIBP Setup window.
NIBP cuffs and cuff hoses
• E-modules: Black-colored Adult/Child cuff hoses and blue-
colored Infant cuff hoses are automatically detected by the
monitor and inflation limits are set accordingly. However, if the
cuff hoses cannot be detected automatically, you must set the
inflation limits manually in the NIBP Setup window.
• PDM: You must first select the NIBP cuff size in the NIBP Setup
window before starting a NIBP measurement.
NIBP points to note
• This equipment is suitable for use in the presence of
electrosurgery.
• Use the appropriate size NIBP cuff for the patient (adult, child, or
infant).
• NIBP can be measured by multiple acquisition modules. Connect
one NIBP cable only.
• Depending on the NIBP module used, not all NIBP measurements
and settings are available to view or change.
• For a list of acquisition modules capable of measuring this
parameter, see the “System messages” chapter.
NIBP measurement limitations
• A patient's vital signs may vary dramatically during the use of
cardiovascular agents such as those that raise or lower blood
pressure or those that increase or decrease heart rate.
• Although automated NIBP is generally safe and accurate, it has
some limitations. It may be difficult to obtain reliable readings
under the following circumstances:
- Shock accompanied by low blood pressure and pulse.
- Variations in blood pressure and pulse rate.
- In patients with anatomic abnormalities, such as calcified
(hardened) arteries or subclavian compression.
- Compression of the cuff caused by shivering, seizures, arm
movement, or bumping against the cuff.
• Proper sizing and position of the cuff are essential to obtaining
reliable readings:
- Too large a cuff is better than too small a cuff, which may
yield falsely high readings.
- The cuff should also fit properly over the brachial artery (or
whatever artery is being used) so that the cuff is sufficiently
sensitive to vibrations in the artery.

NIBP measurement checks
• E-modules only: Check that the cuff hose was detected (if cuff
detection is supported).
• For children and when using hoses without identification with an
E-module, the inflation limit must be set manually.
• PDM only: Always select the NIBP cuff size before starting a
measurement.
• Check that the pressure values are displayed.
• E-modules only: Start the Venous Stasis mode and check that
the pump is not restarting during the measurement. If it does,
the cuff may be leaking.
Safety precautions
NIBP warnings
• E-modules — Non-invasive blood pressure measurement is
intended for patients weighing over 5 kg (11 lb).
• The NIBP parameter will not measure blood pressure effectively
on patients who are experiencing seizures or tremors.
Arrhythmias will increase the time required by the NIBP
parameter to determine a blood pressure and may extend the
time beyond the capabilities of the parameter.
• Do not apply external pressure against the cuff while monitoring.
Doing so may cause inaccurate blood pressure values. Use care
when placing the cuff on an extremity used to monitor other
patient parameters.
• NIBP AUTO DISCONTINUED — The NIBP Auto setting reverts to
OFF when the Patient Data Module (PDM) is removed from one
monitor and is connected to another monitor if the PDM battery
is not installed. If the Patient Data Module (PDM) is used for
bedside and transport monitoring, its battery should be installed
when in use. In the event that the PDM battery is not installed,
the settings for NIBP Auto can be reset after connecting the
Patient Data Module to the monitor.
196
• GE monitors are designed for use with dual-hose cuffs and
tubing. The use of single-hose cuffs with dual hose tubing can
result in unreliable and inaccurate NIBP data.
• Do not place the cuff on a limb being used for A-V fistulas,
intravenous infusion or on any area where circulation is
compromised or has the potential to be compromised.
• PDM - For SuperSTAT™ NIBP (Adult/Child) only — It takes one to
three minutes for the NIBP parameter to identify an irregular
rhythm after ECG is connected. For patients with irregular
rhythms, simultaneous monitoring of ECG will enhance NIBP
performance. Wait three minutes after ECG has been connected
and ECG heart rate is present on the monitor screen before
performing an NIBP determination.
• Accuracy of NIBP measurement depends on using a cuff of the
proper size. It is essential to measure the circumference of the
limb and choose the proper size cuff.
• NIBP READINGS MAY TIME OUT WHEN USING IABP — An IABP
balloon pump creates non-physiological arterial waveforms.
These waveforms create an oscillometric signal that may not be
interpreted by the NIBP algorithm, causing NIBP to time out. The
patient blood pressure can be monitored from the balloon pump
device.
• The NIBP cuff size for PDM or the inflation limits for E-modules
(with undetected cuff hoses) must be correctly selected in the
NIBP Setup window to obtain reliable NIBP data and to prevent
excessive cuff pressure during infant or child use.
 197
NIBP cautions
• The acquisition module sets the inflation pressure automatically
according to the previous measurement. Reset the case or
discharge the patient to reset the inflation limits before
measuring NIBP on a new patient.
• Devices that exert pressure on tissue have been associated with
purpura, skin avulsion, compartmental syndrome, ischemia,
and/or neuropathy. To minimize these potential problems,
especially when monitoring at frequent intervals or over
extended periods of time, make sure the cuff is applied
appropriately and examine the cuff site and the limb distal to the
cuff regularly for signs of impeded blood flow. Periodically check
patient limb circulation distal to the cuff. Check frequently when
using auto NIBP in 1 and 2 minute intervals. The 1 and 2 minute
intervals are not recommended for extended periods of time.
Starting or stopping a single NIBP measurement
To start or stop a single measurement from the monitor’s
main menu
1. Select NIBP Start.
2. To stop the measurement, select NIBP Cancel.
To start or stop a single measurement from the NIBP Setup
window
1. Select the NIBP parameter window.
2. Select Start Manual NIBP.
3. To stop the measurement, select Cancel NIBP.
To start or stop a single measurement from the E-module
1. Press the Start Cancel button.
2. To stop the measurement, press the Start Cancel button again.
Starting or stopping automatic NIBP measurements
To automatically measure NIBP at set time intervals, you must first
set the cycle time before setting the automatic measurements.
Setting the cycle time between NIBP measurements
1. Select the NIBP parameter window.
2. Choose the cycle time between NIBP measurements from the
Cycle Time list.
Setting NIBP Auto
To set NIBP Auto from the monitor’s main menu
1. Select NIBP Auto Start.
2. To stop the measurement, select NIBP Auto Stop.
To set NIBP Auto from the NIBP Setup window
1. Select the NIBP parameter window.
2. Select NIBP Auto > Start Cycling.
3. To stop the measurement, select NIBP Auto > Stop Cycling.
To set NIBP Auto from the E-module
1. Press the Auto On/Off button.
2. To stop the measurement, press the Auto On/Off button again.
Starting or stopping a Stat NIBP measurement
To measure NIBP for five consecutive minutes:
1. Select the NIBP parameter window.
2. Select Start Stat.
3. To stop the measurement, select Stop Stat.
198
Venous stasis
NOTE: E-modules only.
Venous stasis allows you to apply continuous NIBP cuff pressure for
a short period of time. The cuff inflation pressure and duration are
dependent on the detected cuff or selected inflation limits.
Adult Child Infant
Pressure 80 +/- 5 mmHg 60 +/- 5 mmHg 40 +/- 5 mmHg
(10.7 +/- 0.7 kPa) (8.0 +/- 0.7kPa) (5.3 +/- 0.7 kPa)
Duration 2 minutes 2 minutes 1 minute
Venous stasis pressure may be lower than the values above if the
patient has low blood pressure. The venous stasis pressure adapts
to the measured mean pressure being approximately the same as
the mean pressure but always at least the following:
- Infant 20 +/- 5 mmHg (2.7 +/- 0.7 kPa)
- Child 30 +/- 5 mmHg (4.0 +/- 0.7 kPa)
- Adult 40 +/- 5 mmHg (5.3 +/- 0.7 kPa)
Starting or stopping venous stasis
1. Select the NIBP parameter window.
2. Select Start Venous Stasis.
3. To stop the measurement, select Stop Venous Stasis.
 199

Adjusting the initial NIBP cuff inflation pressure manually

Selecting the NIBP cuff size
NOTE: PDM only.
NOTE: PDM only.
1. Select the NIBP parameter window. To change the target inflation pressure for the first NIBP
2. Choose Adult, Child, or Infant from the Cuff Size list. measurement:
1. Select the NIBP parameter window.
Initial NIBP cuff inflation pressure 2. Check that Auto Initial Inflate is deselected.
Initial NIBP cuff inflation pressures 3. Select a value from the Init. Pressure list.

Module Adult Child Infant Selecting the cuff inflation limits

PDM 135 mmHg 125 mmHg 100 mmHg NOTE: E-modules only.
(18 kPa) (16.7 kPa) (13.3 kPa)
When using cuff hoses that are not auto-detected, you must set the
E-modules 170 mmHg 150 mmHg 120 mmHg inflation limits manually:
(22.7 kPa) (20.0 kPa) (16.0 kPa)
1. Select the NIBP parameter window.
NOTE: PDM only: When the Auto Initial Inflate setting is enabled, the 2. Choose Infant, Child, or Adult from the Inflation Limits list.
initial cuff inflation pressures are dependent on the NIBP module
used and selected cuff size. The initial target pressure preset can be Adjusting the NIBP measurement completion tone volume
adjusted if you desire a lower or higher initial target pressure. 1. Select the NIBP parameter window.
2. Set the Completed NIBP Volume.
Setting initial NIBP cuff inflation pressure automatically The lower the value, the softer the tone.
NOTE: PDM only.
Setting the NIBP display options
To automatically determine the cuff inflation pressure based on the
1. Select the NIBP parameter window.
cuff size:
2. Choose Sys/Dia (Mean) or (Mean) Sys/Dia from the Display
1. Select the NIBP parameter window. Format list.
2. Select Auto Initial Inflate.
Setting NIBP alarms NIBP measurement on the monitor screen
1. Select the NIBP parameter window. - Progress bar
2. Select Alarms. - Indicates the time remaining until the next
3. Select the Systolic, Mean, or Diastolic pressure.
NOTE: If the feature is not active, the alarm limits are greyed out. automatic NIBP measurement starts or the time remaining
Select Alarm On to set the alarms. for venous stasis.
4. Set the alarm limits.

Silencing NIBP alarms Troubleshooting the NIBP measurement

The Silence Alarm behavior is different for NIBP than for any other NOTE: For a comprehensive list of system messages, see the “System
parameter. Unlike the continuously monitored parameters, NIBP is messages” chapter.
measured periodically. As a result, silencing a physiological NIBP NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
alarm will clear that active alarm until the next NIBP measurement is B650 Supplemental Information Manual.”
taken. If the new measurement is outside the alarm limits, the alarm
is activated again. PROBLEM WHAT TO DO

NIBP recheck after alarm limit violation NIBP measurement • Check that the cuff tubing is not bent,
does not work or stretched, compressed, or loose.
If the NIBP value exceeds the alarm limits, a new measurement
the values seem • Check the cuff position and cuff tube
takes place automatically. If the NIBP measurement is taken
unstable. connection.
manually, the recheck measurement is taken immediately after the
• Prevent motion artifact.
first measurement. When the NIBP measurement is taken
• Use NIBP cuffs of correct size.
automatically, the recheck measurement is delayed by 30 seconds
before the second measurement is taken.

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For your notes

Invasive blood pressures
NOTE: For a comprehensive list of compatible supplies and
Invasive blood pressure equipment to patient connection accessories, see the supplies and accessories document delivered
(1) Module with invasive blood pressure measurement capability with the monitor.
(2) Fluid bag or bottle with pressure infusor NOTE: This illustration is an example of an equipment to patient
(3) Transducer setup connection.
(4) Invasive blood pressure adapter cable; single or dual cable
(optional)

3
1

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Invasive blood pressure measurements are mapped to one of eight

Invasive blood pressure module keys invasive blood pressure channels as follows:
There is one invasive blood pressure module key on the modules:
Pressure Pressure measurement source
Zero Px E-modules: Zeros the reference for each pressure
channel
transducer individually.
P1 PDM (Masimo), PDM (Nellcor), E-PSMP, E-PRESTN, or E-
Zero All PDM: Zeros the reference for all pressure
PRETN module
tranducers connected to the PDM.
P2 PDM (Masimo), PDM (Nellcor), E-PSMP, E-PRESTN, or E-
PRETN module
P3 PDM (Masimo), PDM (Nellcor)
P4 PDM (Masimo), PDM (Nellcor)
P5 E-PP module
P6 E-PP module
P7 E-P or E-PT module
P8 E-COP or E-COPSv module

Connecting invasive blood pressure transducer and cable

1. Prepare the transducer kit according to the manufacturer’s
instructions.
2. Connect the pressure transducer to the transducer cable.
3. Remove entrapped air from within the transducer setup.
4. Connect the transducer cable to the acquisition module’s
invasive pressure connector.
5. Connect the transducer to the patient line.
Invasive blood pressure points to note Invasive blood pressure measurement checks
• Depending on the invasive blood pressure module used, not all • Check that the monitor recognizes cable connections (activates
invasive blood pressure measurements and settings are the display) for all the pressure channels used and the pressure
available to view or change. values and appropriate waveforms are displayed.
• Do not turn on the IABP algorithm unless a balloon pump is in • Make sure that all the transducers are zeroed correctly.
use.
• For a list of acquisition modules capable of measuring this Safety precautions
parameter, see the “System introduction” chapter.
• If two pressure measurement modules that map to the same
Invasive blood pressure warnings
pressure channel are connected, the first detected pressure • All invasive procedures involve risks to the patient. Use aseptic
measurement module is assigned to the indicated pressure technique. Follow catheter manufacturer's instructions.
channel. • Make sure that no part of the patient connections touches any
• A pressure channel is activated when a pressure transducer electrically conductive material including earth.
interface cable is connected to the PDM (Masimo), PDM (Nellcor), • Use only defibrillator proof transducers and cables.
E-COP, or E-COPSv module, or when a pressure transducer is • Mechanical shock to the invasive blood pressure transducer may
connected to the E-PSMP, E-PRESTN, E-PRETN, E-PP, E-P, or E-PT cause severe shifts in zero balance and calibration, and cause
module. erroneous readings.
• A pressure channel is deactivated when the pressure transducer
interface cable is disconnected from the PDM (Masimo), PDM
(Nellcor), E-COP, or E-COPSv module or when the pressure
transducer is disconnected from the E-PSMP, E-PRESTN, E-
PRETN, E-PP, E-P, or E-PT module.
• A deactivated pressure channel does not release the assigned
pressure channel. To release an assigned pressure channel,
remove the module from the system.

Invasive blood pressure measurement limitations

• E-modules are not suitable for use with neonatal patients.

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Invasive blood pressures analog output
Invasive blood Analog output signal
pressure
module
E-modules P1 channel
PDM module Sets the first available arterial channel (Art, ABP,
Fem, UAC) for invasive blood pressure analog
output.
• If there are no arterial channels available, the
first zeroed channel will be used.
• If there are no zeroed channels available, a
flat line will be the output of the IP Analog
output channel.
Zeroing invasive blood pressure transducers
NOTE: E-modules record a time stamp of the last successful zeroing
for each invasive blood pressure channel.
NOTE: PDM: When you first insert an invasive blood pressure cable
into the PDM and zero the pressure line, the following messages
display in the parameter window: ‘Not zeroed’ > ‘Zeroing’ > ‘Zeroed’.
However, if the invasive blood pressure cable is already connected
to the PDM and Smart BP is enabled, the following messages display
when you zero the pressure line: ‘Zeroing’ > ‘Artifact.’
NOTE: You can zero all active transducers on the E-modules by
pressing each Zero Px key, or on the PDM module by pressing the
Zero All (  ) key.
1. Level the transducer following your care unit’s policy (usually
level of the phlebostatic axis).
2. Close the transducer stopcock to the patient and open the
venting stopcock to air.
NOTE: If the pressure line you are trying to zero does not have
the transducer open to air, a ‘Pressure Sensed’ message
displays.
Choices are:
• To zero all connected pressure transducers simultaneously,
select Zero All Pressures from the monitor’s main menu or
from the remote control.
NOTE: Zero All Pressures does not zero a connected ICP
channel. The ICP channel must be zeroed separately. When
the ‘Zero ICP separately’ message displays, you can zero the
ICP channel by pressing the Zero Px or the Zero All module
key or by selecting Zero from the ICP Setup window.
• To zero a single active pressure transducer, select the
invasive pressure window and select Zero from the Setup
window.
3. Check that a zero reference has been established.
(Watch the pressure parameter window for messages).
4. Close the venting stopcock to air and open the transducer
stopcock to the patient.
5. Check that pressure numerics display on screen.
 Selecting invasive blood pressure as the primary heart rate
Measuring an invasive blood pressure
source
Selecting an invasive blood pressure channel label NOTE: Art, ABP, Fem, or UAC invasive blood pressure channels only.
1. Select the invasive blood pressure parameter window. UAC is only available in the NICU software package.
2. Choose a channel label from the Label list.
NOTE: HR Alarms must be configured as Single to enable invasive
Selecting the size of the invasive blood pressure waveform blood pressures as the primary heart rate source.
1. Select the invasive blood pressure parameter window. NOTE: This setting adjusts the primary heart rate source for all of the
2. Set the waveform scale with the Scale arrows. hemodynamic parameters.
The larger the scale value, the smaller the waveform size.
The primary heart rate can be calculated from the ECG leads, SpO2
Selecting the hemodynamic waveform sweep speed
measurement, or invasive blood pressure waveform.
NOTE: This setting adjusts the waveform speed for all of the
hemodynamic parameters. To calculate the primary heart rate from an invasive blood pressure
1. Select the invasive pressure parameter window. channel:
2. Select a numeric value from the Hemodynamic Sweep Speed 1. Select the invasive blood pressure parameter window.
list. 2. Select a value from the Primary HR Source list.
The smaller the value, the slower the sweep speed.
Selecting the invasive blood pressure noise reduction filter
NOTE: If arterial blood pressure is used to trigger the balloon pump,
use the 40 Hz pressure filter.
1. Select the invasive blood pressure parameter window.
2. Select a numeric value from the Filter list.
The smaller the filter value, the greater the degree of filtering
that occurs.
Selecting the displayed invasive blood pressure format
To display the mean only or systolic, diastolic or mean pressure
values in different formats:
1. Select the invasive blood pressure parameter window.
2. Select the format from the Parameter Format list.

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Showing the pulse rate in the invasive blood pressure
parameter window
NOTE: Art, ABP, Fem, or UAC invasiveblood pressure channels only.
1. Select the invasive blood pressure parameter window.
2. Select Show Pulse Rate.
Showing the CPP value in the ICP parameter window
NOTE: A valid mean arterial pressure is required to compute the CPP
value.
1. Select the invasive blood pressure parameter window.
2. Select Show CPP.
Selecting Smart BP
NOTE: PDM only. Art, ABP, and Fem, invasive blood pressure
channels only.
Smart BP is an algorithm that temporarily deactivates the arterial
and femoral alarms when it detects the zeroing of a transducer, fast
flushing of the system, or blood draws. The message ‘Artifact’
displays during the alarm deactivation. When pulsatile pressure
returns and 15-20 beats are detected, numerics are displayed and
alarms are reactivated.
1. Select the invasive blood pressure parameter window.
2. Select Smart BP.
Setting an arterial invasive blood pressure disconnection
alarm
NOTE: PDM only. Art, ABP, and Fem invasive blood pressure channels
only.
To set an additional alarm if the mean pressure falls below 25 mmHg
(3.33 kPa):
1. Select the invasive blood pressure parameter window.
2. Select Art disconnect.
Compensating for intra-aortic balloon pump (IABP)
waveform irregularities
WARNING - INCORRECT PULSE RATE - Be sure to turn
off the IABP setting when the cardiac assist device is
no longer used. Failure to do so could result in
incorrect pulse rate readings.
CAUTION - PATIENT HAZARD — If you choose to trigger
the balloon pump from the monitor, contact the balloon
pump manufacturer directly for interface requirements,
as they vary among manufacturers. Some trigger
modes on certain balloon pump devices may not be
compatible with the GE analog output signal, and use
may contribute to patient injury or sub-optimal
pumping results.
NOTE: PDM only. Art, ABP, and Fem invasive blood pressure channels
only.
NOTE: ‘IABP’ displays in the invasive blood pressure channel
parameter window when you select IABP On.
1. Select the invasive blood pressure parameter window.
2. Select IABP On.
Selecting the invasive blood pressure response time
NOTE: E-modules only.
1. Select the invasive blood pressure parameter window.
2. Select Normal or B-to-B (beat-to-beat) from the Response list.
Compensating for spontaneous or controlled ventilation
Setting invasive blood pressure alarm limits
artifact for invasive blood pressure
To set the invasive blood pressure alarm limits:
NOTE: P2-P8, CVP, FemV, PA, RAP, RVP, or LAP invasive pressure 1. Select the invasive blood pressure parameter window.
channels only. 2. Select the desired Alarms setting.
Choices are:
NOTE: E-modules only. • Alarms x: (Alarms Art) Settings for the selected invasive
1. Select the invasive blood pressure parameter window. blood pressure channel.
2. Select the P2-P8, CVP, FemV, PA, RAP, RVP, or LAP blood pressure • Alarms HR: Settings when the heart rate alarms are from a
channel. single source.
3. Select the Ventilation Mode. • Alarms PR(x): (Alarms PR(Art)) - Settings when the heart rate
Choices are: alarms are calculated from multiple sources.
- Spontaneous: For patients that are not ventilated. For more information, see the “CARESCAPE Monitor B650
- Controlled: For patients that are ventilated. Supplemental Information Manual.”
NOTE: If a feature is not active, the alarm limits are greyed out.
Invasive blood pressure waveform cursor Select Alarm On to set the alarms.
You can display an invasive blood pressure waveform cursor for the 3. Set the alarm limits.
selected invasive blood pressure channel.

NOTE: The cursor is selectable when a pressure waveform channel is

active and using the selected pressure channel.
Showing the invasive blood pressure waveform cursor
1. Select the invasive blood pressure parameter window.
2. Select Show Cursor.
Selecting specific invasive blood pressure points
Up to 10 pressure points can be saved and displayed. The oldest
value, displayed at the top of the list, is discarded in order to save the
newest value.
1. Move the cursor to a specific point with the arrows.
2. To save the pressure value, select Save.
3. To stop showing the cursor, de-select Show Cursor.

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Invasive blood pressure measurement on the monitor

screen
The invasive blood pressure channel labels are as follows:
Art arterial pressure
ABP arterial blood pressure
Fem femoral arterial pressure
FemV femoral venous pressure
PA pulmonary arterial pressure
CVP central venous pressure
LAP left atrial pressure
RAP right atrial pressure
ICP intracranial pressure
RVP right ventricular pressure
UAC umbilical arterial pressure
UVC umbilical venous pressure
P1-P8 non-specific pressure channel labels

NOTE: UAC and UVC invasive blood pressure channels are only
available in the NICU software package.
Troubleshooting the invasive blood pressure measurement
NOTE: For a comprehensive list of system messages, see the “System NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
messages” chapter. B650 Supplemental Information Manual.”

PROBLEM WHAT TO DO
Artifact detected and the • Check the patient.
Smart BP option is turned on. • Reposition the catheter.
• Zero the transducer.
• If problem persists, turn off the Smart BP option.
• If the Smart BP option is turned off, use the Audio Pause feature before drawing blood to reduce nuisance
alarms.
Invasive blood pressure • Make sure there are no air bubbles in the transducer systems.
readings seem unstable • Flush and zero.
• Place the transducer on the patient’s phlebostatic axis.
---/--- (80) Change the invasive blood pressure format from Sys/Dia/Mean to Mean. See the “Selecting the displayed
Systolic and diastolic invasive blood pressure format” section.
pressure values do not
display.
Invasive blood pressure Zero the channel. Invasive blood pressure numerical values are displayed only for successfully zeroed
waveform is displayed but no channels.
numeric values are displayed.
Zeroing of invasive blood Ensure that the channels are open to air. For further reference, see “Zeroing invasive blood pressure
pressure channel(s) fails. transducers” section.

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PA catheter insertion
The catheter insertion mode optimizes and enlarges the PA
waveform field during SWAN-GANZ thermodilution catheter
insertion. Waveforms display at a rate of 12.5 mm/s and appear in
the following display order: ECG1, Art, CVP, PA.
NOTE: The arterial priority order is: Art, ABP, Fem, or UAC.
Selecting the PA catheter insertion mode
1. Select the PA invasive blood pressure parameter window.
2. Select Zero to zero the invasive blood pressure channel.
3. Select Catheter Insertion.
NOTE: The pressure scale settings in the Catheter Insertion
window follow the scale settings in the Setup menu.
4. To freeze the moving waveforms, select Freeze Waveforms.
At any time, select Restart Waveforms to restart the waveforms.
5. To print the catheter insertion waveforms, select Print
Waveforms.
6. At any time, select Stop Printing or Cancel Printing to stop
printing the waveforms.
7. To start a SvO2 procedure, select SvO2.
See the “Mixed venous oxygen saturation (SvO2)” chapter for
details.
8. To start a pulmonary capillary wedge pressure procedure, select
Wedge.
9. To start a cardiac output procedure, select C.O.
Pulmonary capillary wedge pressure (PCWP) measurement
You can obtain a PA wedge measurement (PCWP) manually or with
the automated wedge program. The manual measurement mode
allows the clinician to manually determine the PCWP value. The
automated wedge program displays on-screen messages to inflate
or deflate the catheter balloon. In either mode, the wedge algorithm
then determines the PCWP value. You can confirm this value or
adjust the measurement with the provided cursor.
NOTE: E-modules always use the automated wedge program to
determine the PCWP value. PDM may use either the automated
wedge program or a manual measurement to determine the PCWP
value.
NOTE: PDM only: The PA wedge algorithm requires a 30% change in
waveform size between the PA and Wedge waveform in order to
initiate the automated program. If the algorithm fails to distinguish
between the waveforms, you should use the manual measurement
mode.
PCWP points to note
• Follow your care unit’s policy and procedures for obtaining
PCWP measurements, including balloon inflation duration.
Showing the PCWP value in the PA window
1. Select the PA invasive blood pressure parameter window.
2. Select Show PCWP.
212
Taking a manual PA wedge measurement
NOTE: PDM only.
1. Select the PA parameter window.
2. Select Wedge.
3. Select Mode: Manual.
4. To record a realtime PA wedge waveform during analysis, select
Print PA Waveform. To stop printing, select Stop Printing or
Cancel Printing.
5. Inflate the catheter balloon when the ‘Manually "Freeze /
Adjust" when ready’ message displays.
6. Select Freeze/Adjust once the PCWP waveform is displayed. The
‘Wedge Complete’ message displays.
7. To adjust the PA wedge value, move the cursor up or down with
the PCWP / Cursor arrows.
8. To save the PCWP value, select Confirm Wedge.
The saved PA wedge value displays in the parameter window
and is stored in Trends and the hemodynamic calculations.
9. To print a PCWP report, select Print PA Report.
To stop printing, select Stop Printing or Cancel Printing.
The PA wedge report contains 20 seconds of waveform data
displayed at a waveform speed of 12.5 mm/s.
 213

Taking an automated PA wedge measurement To start a new PA wedge measurement

1. Select the PA parameter window. • To clear the current PA wedge measurement and restart a new
2. Select Wedge. measurement, select Restart Wedge.
3. Select Mode: Auto.
4. To record a realtime PA wedge waveform during analysis, select To start a cardiac output procedure
Print PA Waveform. To stop printing, select Stop Printing or • Select C.O.
Cancel Printing. See the “Cardiac output (C.O.)” chapter for more details.
5. Inflate the catheter balloon when the ‘Inflate the Balloon’
message displays. To enter hemodynamic calculations
NOTE: PDM: Once the PCWP waveform is detected, the ‘Wedge • Select Calculations.
processing’ message displays. See the “Hemodynamic, oxygenation or ventilation calculations”
NOTE: After 10 seconds, the automated wedge program displays chapter for more details.
the ‘Deflate the balloon’ message, followed by the ‘Wedge
Complete’ message.
6. To adjust the PA wedge value, move the cursor up or down with
the PCWP / Cursor arrows.
7. To save the PCWP value, select Confirm Wedge.
The saved PA wedge value displays in the parameter window
and is stored in trends and the hemodynamic calculations.
8. To print a PCWP report, select Print PA Report.
To stop printing, select Stop Printing or Cancel Printing.
The PA wedge report contains 20 seconds of waveform data
displayed at a waveform speed of 12.5 mm/s.
Temperature
(5) Disposable temperature probe
Temperature equipment to patient connection NOTE: For a comprehensive list of compatible supplies and
(1) Acquisition module with temperature measurement capability accessories, see the supplies and accessories document delivered
(2) Temperature cable with the monitor.
(3) Reusable temperature probe
(4) Temperature interconnect cable for disposable temperature NOTE: This illustration is an example of an equipment to patient
probes connection.

1 3
2

2 5

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Temperature module keys Temperature points to note

There are no temperature related keys on the modules. • Use only GE approved accessories.
• Depending on the temperature module used, not all temperature
Temperature measurement mappings measurements and settings are available to view or change.
• If two temperature measurement modules that map to the same
Temperature measurements are mapped to one of five temperature temperature channel are connected, the first detected
channels as follows: temperature measurement module is assigned to the indicated
temperature channel.
Temp. Temperature measurement source • A temperature channel is activated when the module detects a
channel temperature transducer interface cable.
T1 PDM (Masimo), PDM (Nellcor), E-modules. • A temperature channel is deactivated when a temperature
transducer interface cable is detached from the module.
T2 PDM (Masimo), PDM (Nellcor), E-modules. • A deactivated temperature channel does not release the
T3 E-PT module assigned temperature channel. To release an assigned
temperature channel, remove the module from the system.
T4 E-PT module • For a list of acquisition modules capable of measuring this
Tblood PDM (Masimo), PDM (Nellcor), E-COP, or E-COPsv module parameter, see the “System introduction” chapter.
or Unity ID.
Temperature measurement limitations
• E-modules are not suitable for use with neonatal patients.

Temperature measurement checks

• Check that the temperature value is displayed when the probe is
connected to the patient.
Temperature safety precautions
WARNING: There are hazards associated with the
reuse of single-use temperature sensors.
WARNING: The response time of the temperature
measurement system when used with the Esophageal
stethoscope with temperature probe accessory
exceeds 150 seconds for probe sizes 18Fr and 24Fr.
CAUTION: When using an electrosurgery unit, ensure
proper contact of the electrosurgical cautery unit’s
return electrode to the patient to avoid burns at the
monitor measurement sites.
Preparing the patient for a temperature measurement
1. Follow the manufacturer's instructions for probe application and
instructions.
2. Connect the adapter cable to the acquisition module connector.
Starting the temperature measurement
Connect the temperature probe to start the measurement. If the
parameter window displays Off in the value field:
1. Select the Temperature parameter window.
2. Confirm that Measurement > On is selected.
216
Changing the temperature site label
NOTE: In addition to the default channel labels, you can configure up
to six user-defined channel labels in the care unit settings. See the
“CARESCAPE Monitor B650 Supplemental Information Manual” for
details.
1. Select the Temperature parameter window.
2. Choose a site label from the Label list.
Displaying the delta value between two temperature
channels
NOTE: This selection is available when two temperatures are
displayed in the same temperature parameter window.
1. Select the Temperature parameter window.
2. Select Show Tx-Ty (e.g., T2-T1).
Setting temperature alarms
NOTE: The high limit alarm setting for delta values is also adjustable.
To set the alarm and alarm limits:
1. Select the Temperature parameter window.
2. Select Alarms.
3. Choose a temperature channel or temperature delta.
NOTE: If the feature is not active, the alarm limits are greyed out.
Select Alarm On to set the alarms.
4. Set the alarm limits.
 217

Temperature measurement on the monitor screen Stopping the temperature measurement

1. Select the Temperature parameter window.
The default temperature site labels are as follows:
2. Select Measurement > Off.
• T1, T2 = general label
• T3, T4 = general label Troubleshooting temperature
• Eso = esophageal NOTE: For a comprehensive list of system messages, see the “System
• Naso = nasal messages” chapter.
• Tymp = tympanic
• Rect = rectal PROBLEM WHAT TO DO
• Axil = axillary Temperature • Check that the probe adapter is properly
• Skin = skin measurement connected to the acquisition module.
• AirW = airway fails. • Check that the probe is properly connected to
• Room = room the probe adapter.
• Myo = myocardial • Check that you are using the correct probe for
• Core = core the anatomical location being monitored.
• Surf = surface • Use a probe that is compatible with your
NOTE: A maximum of six user-defined site label names can be system.
configured. See the “CARESCAPE Monitor B650 Supplemental • Try using a known good probe in case the
Information Manual” for details. sensor is damaged.
• Check that the acquisition module is properly
connected to the monitor.
• Check the patient connection.
• Contact service if the problem continues.
• Check that there are not two identical
measurement modules in the system.
Cardiac output (C.O.)
Cardiac output equipment to patient connection with an in-line probe
(1) Module with C.O. measurement capability (11) Thermistor connector
(2) Cardiac output cable (12) Balloon
(3) In-line injectate probe (13) Balloon inflation valve
(4) Injectate syringe
(5) Injectate solution NOTE: For a comprehensive list of compatible supplies and
(6) CVP line to InvBP transducer or fluid infuser accessories, see the supplies and accessories document delivered
(7) Proximal injectate port with the monitor.
(8) PA distal port NOTE: This illustration is an example of an equipment to patient
(9) Optical module connector (used for SvO2 measurement) connection.
(10) SWAN-GANZ thermodilution catheter

13

12

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Cardiac output equipment to patient connection with a bath probe

(1) Module with C.O. measurement capability (8) PA distal port
(2) Cardiac output cable (9) Balloon inflation valve
(3) Thermistor connector (10) SWAN-GANZ thermal dilution catheter
(4) Injectate bath probe (11) Balloon
(5) Injectate fluid
(6) Injectate syringe NOTE: This illustration is an example of an equipment to patient
(7) Proximal injectate port connection.

1 5
11

10 4
9

6
7
Cardiac output module key
There is one C.O. module key on the E-COP and E-COPSv modules:
Start C.O. Starts and stops the cardiac output measurement.
C.O. points to note
• Cardiac output measurements from the PDM require a C.O.
license.
• The C.O. connector cables are module-specific and can only be
used with the appropriate C.O. module. To confirm that the C.O.
cable is the correct cable for the C.O. module, see the supplies
and accessories document delivered with the monitor.
• The patient's height and weight values are required for
determining Cardiac Index (C.I.).
• E-modules only: Predefined catheters are already pre-configured
for a right ventricular ejection fraction (REF) measurement, and
user-defined catheters can be configured to support it. NOTE:
You need a password to do this. To use the REF measurement,
you must select its check box from the C.O. Setup window.
• Blood temperature measurement, Tblood, is provided from any
supported acquisition module that provides C.O. measurements.
Tblood can only be measured from a C.O. Unity Network ID
connectivity device if the C.O. parameter is not provided by any
other supported acquisition module.
• Depending on the module used, (including external devices), not
all cardiac output measurements and settings are available to
view or change.
• For a list of acquisition modules capable of measuring this
parameter, see the “System introduction” chapter.
C.O. measurement checks
• Check that the monitor recognizes cable connections (activates
the display) and all C.O. menu selections are available.
• Remember that in order to get Cardiac Index (C.I.) you must first
enter the patient demographics. See the “Starting and ending
monitoring” chapter for details.
• For E-modules, check that the message ‘Press Start C.O.’
appears on the screen.
Safety precautions
C.O. warnings
• When using an electrosurgery unit, ensure proper contact of the
electrosurgical cautery unit’s return electrode to the patient to
avoid burns at the monitor measurement site.
• The cardiac output measurement results may be erroneous
during electrosurgery.
• All invasive procedures involve risks to the patient. Use aseptic
technique. Follow catheter manufacturer's instructions.
C.O. caution
• The C.O. time stamp indicates the time at which the C.O. value
was received by the monitor from the connected device. In cases
when the C.O. device is disconnected and then reconnected to
the Unity Network ID connectivity device, the time stamp may
not indicate the actual time of the reading.

C.O. measurement limitations

• E-modules are not suitable for use with neonatal patients.

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Taking an automatic C.O. measurement

Preparing for a C.O. measurement
PDM: When measuring C.O. using the automatic mode, the monitor
1. Connect the C.O. cable to the acquisition module, thermistor, and
averages approximately 8.5 seconds of the patient’s blood
injectate temperature port.
temperature before establishing a stable baseline and displaying the
2. Follow your care unit’s policy and procedures for positioning the
‘Inject When Ready’ message.
patient for the C.O. measurement.
3. Follow the catheter manufacturer's instructions to set up the in- E-modules: When measuring C.O. using the automatic mode, new
line or bath probe patient cables. measurements can be taken when the ‘Press Start C.O. Serial’
4. For an in-line setup, make sure the in-line sensor is securely message displays.
connected to the tubing. NOTE: Holding the injectate syringe by the plunger, not the barrel,
5. For the bath probe setup, make sure the bath probe is correctly improves measurement accuracy.
sensing the injectate temperature. 1. Select the C.O. parameter window.
2. Select Setup.
Entering patient data for the C.I. value 3. Select Automatic to use the automatic measurement mode.
NOTE: The patient's height and weight values are required for 4. Verify that the catheter and injectate volume settings are
determining Cardiac Index (C.I.). correct. See the “Selecting a C.O. catheter” and “Setting the C.O.
1. Select the C.O. parameter window. injectate volume” sections.
2. Select Demographics. 5. Select Procedure.
3. Select the values from the lists. 6. Complete the following when you see this message:
- ‘Inject When Ready’: Get ready to inject the injectate solution
Measuring C.O. (PDM modules).
C.O. measurements can be taken using the automatic or manual - ‘Press Start C.O. Serial’: Select Start C.O. Serial (E-modules).
measurement modes. Both measurement modes allow you to use 7. Inject the injectate solution smoothly within 4 to 5 seconds.
up to six C.O. measurements for calculating a C.O. average. The message ‘Measuring’ displays until the calculation is
completed.
NOTE: Selecting Close to close the C.O. window erases all trial
8. Observe the washout curve displayed on the screen. The
measurements. To save trial measurements before you close the
message ‘C.O. Complete’ displays after the C.O. determination
C.O. window, select Confirm C.O.
has been made.
9. To take another C.O. measurement, wait for this message to
display before injecting the injectate:
- ‘Inject When Ready’ (PDM).
- ‘Inject now!’ (E-modules).
Taking a manual C.O. measurement Averaging the C.O. measurements
Measuring C.O. using the manual mode allows you to determine The averaging of the C.O measurements is done automatically.
when to begin the injection procedure. This mode may be preferred • To exclude some of the measurement trials from the average,
for patients with extreme blood temperature fluctuations, or when select Edit Average. See the “Editing the C.O. average” section.
the automatic mode is unable to establish a stable baseline.
Printing a report of the C.O. trials
NOTE: Holding the injectate syringe by the plunger, not the barrel, NOTE: The C.O. report must be initiated before confirming the C.O.
improves measurement accuracy. measurements. Otherwise, the print button cannot be selected from
1. Select the C.O. parameter window. the C.O. menu.
2. Select Setup. To print a C.O. procedure report with all of the C.O. trials:
3. Select Manual to use the manual measurement mode.
4. Verify that the catheter and injectate volume settings are 1. Select Procedure.
correct. See the “Selecting a C.O. catheter” and “Setting the C.O. 2. Select Print.
injectate volume” sections. Editing the C.O. average
5. Select Procedure. 1. Select Edit Average.
6. Select Start C.O. (E-modules: select Start C.O. from the 2. Deselect the C.O. trials you do not want included in the C.O.
procedure window or press the Start C.O. key on the front of average.
the E-module.) 3. To print a C.O. report with the C.O. trials you want to keep, do the
7. When the ‘Inject now!’ message appears, inject the injectate following:
solution smoothly within 4 to 5 seconds. - Select Procedures.
The message ‘Measuring’ displays until the calculation is - Select Print
completed. - Select Edit Average to return to the Edit Average window.
8. Inject the injectate solution smoothly within 4 to 5 seconds. 4. Select Confirm C.O. to store the calculated C.O. average and
The message ‘Measuring’ displays until the calculation is display it in the C.O. parameter window.
completed.
9. Observe the washout curve displayed on the screen. The
message ‘C.O. Complete’ displays after the C.O. determination
has been made.
10. Allow 1 to 1.5 minutes between injections to stabilize the
catheter baseline temperature.
11. To perform another C.O. measurement, wait for the ‘Press Start
C.O.’ message to display, then select Start C.O.

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Cancelling a C.O. measurement Entering a user-defined catheter

When a C.O. measurement has just completed, you can remove this 1. Select the C.O. parameter window.
C.O. measurement trial without entering the Edit Average window. 2. Select Setup.
3. Select User Defined from the Manufacturer list.
NOTE: E-modules only: In addition to removing the previous 4. Set the injectate volume value to match the value listed on
measurement, you can also cancel an in-process measurement. catheter manufacturer's packaging.
• Select Cancel/Reject Injection. 5. Set the computation constant values to match the value listed
on catheter manufacturer's packaging.
Editing hemodynamic, oxygenation, or ventilation
NOTE: The user-defined catheter settings are erased when the
calculations
monitor is discharged.
You can review and if necessary adjust hemodynamic, oxygenation,
or ventilation calculation values. Setting the C.O. injectate volume
1. Select Procedure.
To enter the injectate volume for catheters that are not
2. Select Calculations.
preconfigured or to change the injectate volume:
NOTE: See the “Hemodynamic, oxygenation or ventilation
1. Select the C.O. parameter window.
calculations” chapter for details.
2. Select Setup.
NOTE: Calculations are not available until after the C.O. values
3. Choose the amount of injectate from the Injectate Volume list.
are confirmed.
Setting the C.O. computation constant
Selecting a C.O. catheter
To enter the computation constant for catheters that are not
You can select a cardiac output catheter from a list of default
preconfigured:
catheters and preconfigured catheters, or enter a catheter for
1. Select the C.O. parameter window.
temporary use.
2. Select Setup.
Pre-configured catheters which show up in the list can be added or 3. See the catheter manufacturer's packaging for the right
changed. For more information, see the “CARESCAPE Monitor B650 constant for your catheter, injectate volume, and temperature.
Supplemental Information Manual.” 4. Set the computation constant with the Computation Constant
arrows.
Selecting a catheter from a list
1. Select the C.O. parameter window.
2. Select Setup.
3. Select a name from the Manufacturer list.
4. Select a model from the Model list.
Selecting the type of C.O. injectate probe Setting the blood temperature alarm
NOTE: PDM only. E-modules detect the type of injectate probe 1. Select the C.O. parameter window.
automatically. 2. Select Setup.
1. Select the C.O. parameter window. 3. Select Tblood Alarm.
2. Select Setup. NOTE: If a feature is not active, the alarm limits are greyed out.
3. Choose Probe Type > Bath or Probe Type > In-Line. Select Alarm On to set the alarms.
4. Set the alarm limits.
Setting a C.O. right ventricular ejection fraction (REF)
measurement Stopping the C.O. measurements
NOTE: E-COP and E-COPSv modules and catheters that support right To stop taking C.O. measurements:
ventricular ejection fraction measurement only. PDM does not 1. Remove the catheter from the patient.
provide a REF measurement. 2. Disconnect the probe patient cables.

NOTE: The REF Measurement check box must be selected and a valid
heart rate is required to take a REF measurement.
1. Select the C.O. parameter window.
2. Select Setup.
3. Select REF Measurement.

Selecting the C.O. scale

1. Select the C.O. parameter window.
2. Select Setup.
3. Choose the upper limit from the Scale list.

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Troubleshooting C.O.
NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.

NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor

B650 Supplemental Information Manual.”

PROBLEM WHAT TO DO
C.O. The amount of injectate is too small or the injectate
measurement is too warm.
fails • Inject smoothly and within 4 to 5 seconds.
Mixed venous oxygen saturation (SvO2)
SvO2 equipment to patient connection SvO2 module keys
(1) Module with SvO2 measurement capability, E-COPSv There are no SvO2 related keys on the module.
(2) Optical module
(3) Optical connector
(4) SWAN-GANZ thermodilution catheter

NOTE: For a comprehensive list of compatible supplies and

accessories, see the supplies and accessories document delivered
with the monitor.

2
1 3

226
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SvO2 points to note
• Follow the catheter manufacturer's instructions for inserting the
catheter.
• For reliable saturation values, the signal strength indicator
should be higher than one asterisk.
• Depending on the SvO2 module used (external devices included),
not all SvO2 measurements and settings are available to view or
change.
• For a list of acquisition modules capable of measuring this
parameter, see the “System introduction” chapter.
SvO2 measurement limitations
• SvO2 is not intended for neonatal patients.
SvO2 measurement checks
• Check that the SvO2 value is displayed when the catheter is
inserted, the measurement has been started and the ‘Warming
up’ message has disappeared.
• Check the position of the catheter regularly.
• Calibrate In Vivo and update the Hb value every 24 hours. See
the “Calibrating SvO2 In Vivo” section.
Safety precautions
SvO2 warnings
• All invasive procedures involve risks to the patient. Use aseptic
technique. Follow catheter manufacturer's instructions.
• When using an electrosurgery unit, ensure proper contact of the
ESU return electrode to the patient to avoid burns at the monitor
measurement site.
• There are hazards associated with the reuse of single-use
catheters.
In Vitro SvO2 calibration
(1) Module E-COPSv (3) Optical connector
(2) Optical module (4) SWAN-GANZ thermodilution catheter

Calibrating a new SvO2 catheter In Vitro
NOTE: Do not perform In Vitro calibration if the catheter has been
flushed. Using a wet catheter and calibration cup results in an
inaccurate calibration.
Always perform In Vitro calibration with a new catheter before
removing it from its package.
Follow the Advice to User information displayed in the Calibration
window to guide you through the calibration steps.
1. Connect the optical module to the SvO2 module and let it warm
up for 20 minutes.
2. Aseptically expose the catheter's optical connector.
3. Connect the catheter to the optical module.
4. Select the SvO2 parameter window.
5. Select Calibration.
6. If replacing an existing catheter, select New Catheter, otherwise,
skip to step 7.
7. Select Calibrate to perform In Vitro calibration.
8. Select Start SvO2 to complete the In Vitro calibration.
9. Insert the catheter into the patient.

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Calibrating SvO2 In Vivo Setting SvO2 alarms

NOTE: For optimal accuracy, perform In Vivo calibration at least To set the SvO2 alarm and alarm limits:
every 24 hours. 1. Select the SvO2 parameter window.
2. Select Alarms.
Follow the Advice to User information displayed in the Calibration
NOTE: If the feature is not active, the alarm limits are greyed out.
window to guide you through the calibration steps.
Select Alarm On to set the alarms.
1. Select the SvO2 parameter window. 3. Set the alarm limits.
2. Select Calibration.
3. Select In Vivo Calibration > Calibrate to perform In Vivo SvO2 measurement on the monitor screen
calibration using the SvO2 and Hb values measured from the
- Signal quality from the catheter:
blood sample.
0 - No signal
4. Select Draw Blood Sample and slowly draw a blood sample.
1 - Poor signal (*)
5. Enter your laboratory results:
2 - Fair signal (**)
- Select a value for Lab SvO2.
3 - Good signal (***)
- Select a value for Update Hb.
NOTE: The signal quality indicator is only present when SvO2 is
6. Select Save Lab Values to complete calibration.
measured from an external device.
Recalling a previous In Vitro calibration measurement
Stopping the SvO2 measurement
After completing a successful initial calibration, you can recall the
previous In Vitro calibration measurement when: 1. Remove the catheter from the patient.
- The optical module is connected and has not been calibrated 2. Disconnect the catheter from the optical sensor.
since being connected. 3. Disconnect the optical sensor from the SvO2 module.
- An In Vitro calibration was completed with this optical module 4. Discard the catheter.
using the same catheter within the last 24 hours.

To recall a previous In Vitro calibration measurement:

1. Select the SvO2 parameter window.
2. Select Calibration.
3. Select Recall Calibration.
Troubleshooting the SvO2 measurement
NOTE: For a comprehensive list of system messages, see the “System
messages” chapter.

PROBLEM WHAT TO DO
SvO2 levels • Position the catheter correctly.
are too high • Calibrate In Vivo.

In Vivo • Check the connections.

calibration • Check that the optical cables have no sharp
fails bends.
• If the In Vitro calibration fails again, replace the
catheter and/or the optical module, and repeat
the procedure.

230
 231

For your notes

Airway gases with E-modules
Airway gases equipment to patient connection with E-modules, anesthesia setup
(1) Compact airway module (1b) or E-miniC (1a). Certain compact (3) Airway adapter with sampling line connector
airway modules can also be used for Patient Spirometry and gas (4) Sampling line connector on the water trap
exchange measurements. The E-miniC and accessories are (5) Sample gas outlet (gas exhaust)
indicated for monitoring CO2 and respiration rate of all hospital (6) Returning sample gas to patient circuit. NOTE: Not with E-miniC.
patients. E-miniC is intended for patients weighing over 5 kg (11
NOTE: For a comprehensive list of supplies and accessories, see the
lbs).
supplies and accessories document delivered with the manual.
(2) Anesthesia gas sampling line

232
 233

Airway gases equipment to patient connection with E-modules, critical care setup
(1) Compact airway module (1b) or E-miniC (1a) NOTE: For a comprehensive list of compatible supplies and
(2) Gas sampling line accessories, see the supplies and accessories document delivered
(3) Adapter with sampling line connector with the monitor.
(4) Sampling line connector on the water trap
Alternative airway gases patient connections with
4
E-modules
• With E-CAiO, E-CO, and E-miniC modules, use an airway adapter
3
and a sampling line.
• With E-CAiOV, E-CAiOVX, E-COV, and E-COVX modules, use the
D-lite(+)/Pedi-lite(+) sensor and a gas sampling line with Patient 2
Spirometry tubing. When monitoring pediatric patients,
remember to select the sensor type accordingly from the 1
monitor menu.

2 (1) Mask
(2) Bacterial filter
(3) Airway adapter
(4) Sample line
3

1
4

(1) Tracheostomy tube with 15 mm connector

1
(2) Heat and Moisture Exchanger (HME)
(3) Airway adapter
(4) Sample line

(1) Endotracheal tube

(2) Pediatric airway adapter
(3) Fresh gas inlet
(4) Sample line

234
 235

Compact airway module connectors
(1) D-fend water trap with
washable container
(2) Sampling line connector on
the water trap
(3) Water trap latch
(4) Oxygen reference gas inlet
(5) Sample gas outlet (gas
exhaust)
(6) Cooling fan with dust filter
(7) Connectors for Patient
Spirometry only
E-miniC connectors
(1) Water trap latch
(2) Sampling line connector
on the water trap
1 7. Visually check that the airway adapter connections are tight and
(3) Sample gas outlet (gas
exhaust)
2 8. Position the adapter with sampling port upwards. This prevents
Airway gases measurement setup with E-modules
NOTE: Check that the sample line is connected to the water trap
before connecting the module to the monitor or turning on the
monitor.
1. Make sure that the water trap container is empty and properly
attached.
2. Connect the sample gas outlet to gas scavenging if N2O or
volatile agents are used.
3. Connect the gas sampling line to the sampling line connector on
the water trap.
4. The monitor performs a self-check for the module when the
module is connected. Automatic agent identification is activated
in those modules that have this feature.
5. Before connecting the patient, wait until the message
‘Calibrating’ disappears.
6. Connect the sampling line to the airway adapter.
that the adapter is operating properly, then attach it to the
patient’s breathing circuit.
any condensed water from entering the sampling line.

3
Airway gases points to note when using E-modules
• For a list of airway gas acquisition modules, see the "System
introduction" chapter.
• Anesthetic agent identification, MAC or MACage, N2O and EtBal
are available with certain software packages only. See the
“CARESCAPE Monitor B650 Supplemental Information Manual”
for more information.
• Use GE Healthcare anesthesia sampling lines (PE/PVC) when
anesthetic agents are used. If no anesthetic agents are present,
you can use GE Healthcare CO2 sampling line (PVC).
• Make sure that you are using a water trap that is compatible
with the module:
 compact airway modules: D-fend, or D-fend+ for humid
conditions
 E-miniC: Mini D-fend
• Empty the water trap container as soon as it is half full.
• Place the airway adapter between the HME and Y-piece.
• Place the airway adapter with all sampling ports upwards.
• Always check the tightness of all connections.
• Compact airway modules: The message ‘Sample line blocked’
may result if you attach the sampling line to the water trap after
the monitor has completed the self-check for the module. Attach
the sampling lines to the water trap before turning on the
monitor.
• For cleaning and disinfection of modules, see the “Care and
cleaning” chapter.
Airway gases measurement limitations
• E-modules are not suitable for use with neonatal patients.
236
Airway gases measurement checks
• Check that the water trap is empty.
• Occlude the sampling line and check that the ‘Sample line
blocked’ message appears within 30 seconds and gas
waveforms are showing zero at the same time.
Safety precautions
Airway gases warnings
• Always inspect the airway adapter for a tight connection and
proper operation before attaching it to the patient.
• Leaks in the gas sampling circuit (water trap and sampling line)
may cause inaccurate readings.
• Handle the water trap and its contents as you would any body
fluid. Infectious hazard may be present.
• Do not wash, disinfect or open the water trap cartridge. Do not
touch the water trap membrane. The hydrophobic membrane is
damaged if any cleaning is attempted, and this may result in the
contamination of the gas sensors.
• Remove the airway sampling line from the patient’s airway while
nebulized medications are being delivered.
• Compact airway modules: Never connect any tubing to the
reference gas inlet connector. The inlet must be open at all times.
• Since sample gas may contain anesthetic agents, make sure
that it is not released in the room. Connect exhaust to a
scavenging system to prevent exposure to anesthetic agents.
• Strong scavenging suction may cause excessive sample gas
flow and inaccurate readings.
• Route all tubing away from the patient’s throat to avoid
strangulation.
• To avoid the spread of infectious disease, do not allow the
exhaust to discharge in the direction of the patient or user.
• EtCO2 values may differ from blood gas readings.
 237

• Compact airway modules: Do not use these modules on patients Selecting the CO2 sweep speed
that cannot tolerate the removal of 200 ml/min from their total This selection affects the waveform: Slow equals to 0.625 mm/s and
minute ventilation. Fast to 6.25 mm/s.
• E-miniC: Do not use this module on patients that cannot tolerate 1. Select the gases parameter window.
the removal of 150 ml/min from their total minute ventilation. 2. Select CO2 > Setup.
• Always keep the monitor horizontal when a compact airway 3. Select an option from the CO2 Sweep Speed list.
module is used. Tilting the monitor may cause erroneous results The smaller the value, the slower the sweep speed.
in the compact airway module’s readings.
Setting CO2 limit alarms
Airway gases cautions
1. Select the gases parameter window.
• Never connect the loose end of the gas sampling line to the
2. Select CO2 > Alarms.
Patient Spirometry connector as this may break the spirometry
3. Set high and/or low limit values for EtCO2, FiCO2 and
unit. The Patient Spirometry connector is meant for the
Respiration Rate: select the parameter and set the limits.
spirometry tube only.
• Do not apply pressurized air or gas to any outlet or tubing Selecting the respiration rate source
connected to the monitor. Pressure may destroy sensitive You can select the respiration rate source to be calculated from the
elements. impedance respiration measurement or from the CO2 measurement.
1. Select the gases parameter window.
CO2 measurement with E-modules 2. Select CO2 > Setup.
NOTE: Available menu selections may differ according to the 3. Select an option from the Resp Rate Source list.
modules and/or software packages. Please read the following
NOTE: AUTO mode defaults to CO2 if CO2 is being measured.
instructions carefully. If nothing is mentioned about the availability
of the selection, it is the same for all modules and/or software Selecting what to show with EtCO2
packages.
1. Select the gases parameter window.
Selecting the CO2 scale 2. Select CO2 > Setup.
If EtCO2 is above 6% (45 mmHg), change the scale for capnogram: 3. Select an option from the Show with EtCO2 list.
1. Select the gases parameter window.
2. Select CO2 > Setup.
3. Select an option from the Scale list.
Selecting the FiO2 level
O2 measurement with compact airway modules
NOTE: E-miniC module and OR, PACU, ED, and ICU software
packages only. Selecting the O2 scale
NOTE: FiO2 and N2O compensations must be selected manually If the difference between FiO2 and EtO2 is more than 6%, change the
when E-miniC is used. O2 scale:
The presence of a large concentration of oxygen causes the CO2 1. Select the gases parameter window.
2. Select O2 > Setup.
level appear lower than the actual value. Use this option to
3. Select an option from the Scale list.
compensate for the presence of O2.
1. Select the gases parameter window. Selecting the O2 sweep speed
2. Select CO2 > Setup. This selection affects the waveform.
3. Select an option from the FiO2 level list. 1. Select the gases parameter window.
2. Select O2 > Setup.
Selecting the N2O level 3. Select an option from the O2 Sweep Speed list.
NOTE: E-miniC module and anesthesia option only (available for OR, The smaller the value, the slower the sweep speed.
PACU or ICU software packages).
NOTE: FiO2 and N2O compensations must be selected manually Setting O2 alarms
when E-miniC is used. 1. Select the gases parameter window.
2. Select O2 > Alarms.
The presence of N2O causes the CO2 value to appear higher than the 3. Check that the required alarm (EtO2 or FiO2) is on, and set its
actual value. Use this option to compensate for the presence of N2O. high and/or low limit values.
1. Select the gases parameter window.
2. Select CO2 > Setup.
3. Select an option from the N2O level list.

WARNING: E-miniC modules: O2, N2O and anesthetic

agent gases may interfere with EtCO2 readings.

238
 239
Anesthetic agent and N2O measurement with compact
airway modules
NOTE: These selections are available in OR, PACU and ICU software
packages only.
The E-CAiOV and E-CAiOVX modules automatically identify the agent
being used. When two agents are administered one after the other,
both concentrations are displayed until the concentration of the
agent with lower percentage is less than 0.3 vol%.
Selecting the agent scale
1. Select the gases parameter window.
2. Select Agent/N2O > Setup.
3. Select an option from the Agent Scale list.
Selecting the agent sweep speed
This selection affects the waveform.
1. Select the gases parameter window.
2. Select Agent/N2O > Setup.
3. Select an option from the Agent Sweep Speed list.
The smaller the value, the slower the sweep speed.
Setting agent limit alarms
1. Select the gases parameter window.
2. Select Agent/N2O > Alarms.
3. Check that the required alarm (EtAA or FiAA) is on and set its
high and/or low limit values.
Minimum Alveolar Concentration (MAC) with compact
airway modules
The use of either traditional MAC or MACage is selected during
monitor configuration.The MACage provides age and temperature
compensated measurement. To enable MACage calculations, enter
patient’s age to the monitor and attach a temperature sensor. If the
patient’s age is not given, the monitor shows normal MAC even if
MACage has been selected. For more information, see the
"CARESCAPE Monitor B650 Clinical Reference Manual" and the
“CARESCAPE Monitor B650 Supplemental Information Manual.”
NOTE: The MAC value displayed by the monitor is that of exhaled air,
and it does not always correspond to the amount of anesthetic in
the patient’s organs.
CAUTION: Patient-specific MAC is affected by several
factors such as patient age and body temperature.
Preventing Operating Room pollution with E-modules
When N2O and volatile anesthetics are used, prevent operating
room pollution by connecting the sample gas outlet (gas exhaust) of
the monitor to the scavenging system or by returning the sample
gas to the patient circuit.
Returning sampling gas to the patient circuit
(compact airway modules)
NOTE: If the E-miniC is used, do not return sample gas to the patient
circuit.
NOTE: See the anesthesia machine’s user documentation to find out
where and how the sample gas can be connected.
To check what accessories are required for sample gas return and
scavenging, see the supplies and accessories document delivered
with the monitor.
Scavenging through the ventilator reservoir
1. Connect an exhaust line to the sample gas outlet (gas exhaust)
on the module's front panel.
2. Attach the other end of the line to the ventilator reservoir. Make
sure that the reservoir tube diameter is at least 2 to 3 times
larger than the exhaust line.
Scavenging through the anesthesia gas scavenging system
Anesthesia machines are equipped with an anesthesia gas
scavenging system (AGSS), and in some machines you can connect
the sample gas outlet directly to it. See the anesthesia machine's
user documentation to find out where and how the sample gas can
be connected.
Connecting directly to the scavenging system
1. Connect the exhaust line to the monitor's sample gas outlet.
2. Connect the exhaust line only to an open scavenging system
where gas is removed at room pressure.
Stopping the airway gas measurement with E-modules
1. Remove the added adapters from the patient’s breathing circuit
and gas scavenging.
2. Check the patient’s breathing circuit.
3. Remove the gas module from the monitor when it is not used.
Troubleshooting the airway gases measurement with
E-modules
NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”

NOTE: Do not connect the monitor directly to a strong vacuum Problem What to do
scavenging system. Airway gas values • Check the sampling line and connectors
are too low for leakage.
• Check the patient status.
Airway gas values • Check the sampling line for blockage.
are too high • Check the patient status.
Module does not • Check and clean the filter if necessary.
work • Check the water trap. If it was too full,
liquid may have entered the module.
Replace the module and have it checked
by authorized service personnel.
No airway gas • Check that the gas sampling line is
values connected to the water trap.

240
 241
Gas calibration for E-modules
Perform calibration every six months in normal use, once every two
months in continuous use, and whenever there are indications of
errors in the gas readings to ensure that the measurement accuracy
remains within specifications.
NOTE: Ensure that the calibration gas and regulator are functioning
properly before calibration. Perform annual maintenance of the
regulator as required.
Make sure that you are using a correct GE Healthcare calibration
gas, see the supplies and accessories document delivered with the
manual. Do not use any other calibration gases.
1. Turn on the patient monitor. For maximum accuracy, let the
monitor warm up for 30 minutes.
2. Attach a regulator to the calibration gas cylinder.
3. Attach a new sampling line to the water trap. Connect the other
end of the sampling line to the regulator on the gas container.
4. Select the gases parameter window > Calibration.
5. Wait until the messages 'Zero OK' and 'Feed gas' appear after
each gas on the screen.
6. Open the regulator and feed gas until the message ‘Adjust’
appears, then close the valve.
7. Check that the displayed values match the values on the
calibration gas container. Adjust if necessary:
 Select the first gas to be adjusted.
 Adjust the value until it matches the desired value on the gas
container, and confirm by selecting Accept.
8. If the calibration is successful, the message ‘Calibration OK’ is
displayed for a few seconds. If the calibration fails, the message
‘Calibration error’ appears instead. In this case, start a new
calibration by selecting Recalibrate.
If the message ‘Zero error’ appears, repeat the calibration
procedure. If the problem persists, contact authorized service
personnel.
Patient Spirometry
Patient Spirometry equipment to patient connection Patient Spirometry module keys
(1) Compact airway module with Patient Spirometry measurement
There are three keys on the module:
capability: E-COV, E-COVX, E-CAiOV, or E-CAiOVX
(2) Patient Spirometry tube
Save Loop Saves the currently active loop with
(3) D-lite(+)/Pedi-lite(+) sensor
corresponding numeric data.
(4) Gas sampling line
Print Loop Prints the current pressure-volume (Paw-Vol) or
NOTE: For a comprehensive list of compatible supplies and flow-volume (Flow-Vol) loop with corresponding
accessories, see the supplies and accessories document delivered numeric data.
with the monitor.
Change Loop Toggles between a Paw-Vol and a Flow-Vol
loop.

242
 243
Preparing the Patient Spirometry connection
1. Take a new Patient Spirometry tube and connect the tube to the
D-lite(+)/Pedi-lite(+) sensor by inserting the angle connectors in
the sensor connectors.
2. Connect the other end of the Patient Spirometry tube to the
pressure connectors on the module. See the illustration above or
the “Airway gases with E-modules“ chapter to locate these.
3. Connect a gas sampling line to the Luer connector on the other
side of the D-lite(+)/Pedi-lite(+) sensor.
4. Connect the other end of the gas sampling line to the sampling
line connector on the module’s water trap.
5. Make sure that the connections are tight.
6. Select the correct sensor type, see next page.
7. Connect the D-lite(+)/Pedi-lite(+) between the Y-piece and the
intubation tube in the breathing circuit.
Patient Spirometry points to note
• Place an HME/HMEF/filter between the D-lite(+)/Pedi-lite(+)
sensor and the patient.
• Disconnect the HME/HMEF/filter and D-lite(+)/Pedi-lite(+) during
nebulization of medications.
• Place all D-lite(+)/Pedi-lite(+) ports upwards with a 20 to 45° tilt to
prevent condensed water from entering the sensor interior and
the tubings.
• The flow measurement should be calibrated once a year or
when there is a permanent difference between inspiratory and
expiratory volume. For further information, see the technical
manual.
• For monitoring airway flow, gas exchange and metabolism, use
the E-CAiOVX module when anesthetic agents are present.
• For a list of acquisition modules capable of measuring this
parameter, see the “System introduction” chapter.
Patient Spirometry measurement limitations
• With the NICU software package, some spirometry parameters
are available through the Unity Network ID connectivity device.
You cannot use the E-modules with the NICU software package.
• E-modules are not suitable for use with neonatal patients.
• The presence of Helium or Xenon in the breathing circuit causes
incorrect measurement values.
Patient Spirometry measurement checks
• Check that the water trap is empty.
• Occlude the sampling line and check that the ‘Sample line
blocked’ message appears within 30 seconds and gas
waveforms are showing zero at the same time.
• Check that the loops are whole. A gap between the starting and
ending points may indicate a leak.
Safety precautions
Patient Spirometry warnings
• Always keep the monitor horizontal when a compact airway
module is used. Tilting the monitor may cause erroneous results
in the compact airway module’s readings.
• Remove the airway sampling line from the patient’s airway while
nebulized medications are being delivered.
Patient Spirometry cautions
• Never connect the loose end of the gas sampling line to the
Patient Spirometry connector as this may break the spirometry
unit. The Patient Spirometry connector is meant for the Patient
Spirometry tube only.
• Do not apply pressurized air or gas to any outlet or tubing
connected to the monitor. Pressure may destroy sensitive
elements.
244
Patient Spirometry settings
Selecting the Patient Spirometry sensor type
When monitoring pediatric patients with tidal volumes of 15 ml to
300 ml, use the Pedi-lite/Pedi-lite+ sensor. For other patients, use the
D-lite/D-lite+ sensor. Select the sensor type accordingly:
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select the sensor type (Pedi or Adult) from the Sensor Type list.
Selecting the Patient Spirometry scaling type
This setting affects pressure (Paw) and flow waveform scales, and
pressure-volume (Paw-Vol) and flow-volume (Flow-Vol) loop scales.
Auto scaling adjusts the scales automatically. With Vol, all scales will
change when you change one (see below). With Independent, you
can change each scale separately.
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select an option from the Scaling list.
 245
Selecting the Patient Spirometry scaling speed
This option is available with automatic scaling only. It determines
how frequently the scales are changed. Fast reacts quickly if current
scales are not optimal. The minimum time between scale changes is
2 seconds with Fast and 20 seconds with Slow.
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select an option from the Scaling Speed list.
Selecting the Patient Spirometry scales
This option is not available with automatic scaling. This selection
affects Paw and Flow waveform scales, and Paw-Vol and Flow-Vol
loop scales. With Vol scaling type this setting affects all scales at
once, and with Independent scaling type you can change each scale
separately.
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select suitable options from the lists Vol Scale, Paw Scale or
Flow Scale.
Selecting the Patient Spirometry sweep speeds
This setting affects the sweep speed of Flow and Paw waveforms. It
does not affect the loops.
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select suitable options from the Paw Sweep Speed or Flow
Sweep Speed list.
The smaller the value, the slower the sweep speed.
Selecting the displayed Patient Spirometry volume type
This setting determines which numeric data (tidal volumes TVinsp
and TVexp, or minute volumes MVinsp and MVexp) will appear in the
Flow parameter window.
NOTE: In OR and PACU software packages, this setting also affects
the Spiro 1 split screen accordingly.
1. Select the Patient Spirometry parameter window.
2. Select Setup.
3. Select an option from the Show Volume list.
Selecting Patient Spirometry split screen
To have Patient Spirometry displayed in a split screen, see the
“Setting up the monitor before use” section.
246
Changing the Patient Spirometry loop type
To change the displayed loop from a Paw-Vol loop to a Flow-Vol
loop or vice versa, press the Change Loop module key, or:
1. Select the Patient Spirometry parameter window.
2. Select Loops.
3. Select Paw-Vol Loop or Flow-Vol Loop.
NOTE: In OR and PACU software packages, the loop view shows
Ppeak, Pplat, Pmean and PEEPtot numbers. In other software
packages, the loop view shows Ppeak, Pplat, Pmean, PEEPe and
PEEPi numbers.
Saving Patient Spirometry reference loops
Save a loop for reference of the current lung mechanics, and
whenever major changes in the patient's status occur.
Press the Save Loop module key, or:
1. Select the Patient Spirometry parameter window.
2. Select Loops > Save Loop.
The monitor automatically displays the first saved loop as a
reference loop. You can save up to six pairs of loops. If you save
another pair of loops after the sixth one, the second oldest reference
loop is automatically erased.
 247
Selecting a Patient Spirometry reference loop
To select a saved loop to the screen for reference:
1. Select the Patient Spirometry parameter window > Loops.
2. Select a loop from the Reference Loop list.
Erasing a Patient Spirometry reference loop
To erase unnecessary reference loops:
1. Select the Patient Spirometry parameter window > Loops.
2. Select a loop from the Erase Loop list.
3. Erase the loop by selecting Erase Selected.
Printing a Patient Spirometry loop
To print the currently displayed loop, press the Print Loop module
key, or:
1. Select the Patient Spirometry parameter window.
2. Select Loops > Print Loop.
To print all saved loops, see the “Printing” chapter.
Setting Patient Spirometry alarm limits
You can set the limit alarms on or off, and adjust their activation
limits according to your needs:
1. Select the Patient Spirometry parameter window.
2. Select Paw Alarms or MV/Vent Alarms. NOTE: If the feature is
not active, the alarm limits are greyed out. Select Alarm On to
set the alarms. NOTE: MV/Vent Alarms cannot be selected off
except when an interfaced device is used. Their limits can be
adjusted with all modules.
3. Set the alarm limits: PEEPtot (OR and PACU software packages),
PEEPi and PEEPe (other software packages), Ppeak and MVexp.
Troubleshooting the Patient Spirometry measurement
NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”
PROBLEM WHAT TO DO
Erroneous • Check that the Patient Spirometry tube
values connectors and their connections are tight and
not leaking.
Values seem • Check the sensor type selection.
unstable • Remove the D-lite(+)/Pedi-lite(+) and shake
drops away.
• Check that the connectors on the D-lite(+)/Pedi-
lite(+) are intact and that connections are tight.
Strong • Check the patient status.
vibrations in • Check the system for water or secretions.
the loop
Gas exchange
Gas exchange equipment to patient connection
Use the same setup as for Patient Spirometry. Use the compact
airway modules E-CAiOVX and E-COVX to measure gas exchange.
NOTE: For a comprehensive list of compatible supplies and
accessories, see the supplies and accessories document delivered
with the monitor.
NOTE: By-pass flow together with long expiration flow pause time
may disturb the measurement. Consider using shorter expiration
time to diminish the effect. In addition, a 5 ml spacer between the
Y-piece and D-lite(+)/Pedi-lite(+) may be used. The by-pass flow
effect may exist even in an adult setting, but it is more emphasized
when monitoring pediatric patients and using the Pedi-lite(+).
Gas exchange patient connections with flexible tube

Gas exchange module keys

There are no gas exchange related keys on the modules.

Preparing the gas exchange connections

See instructions in the “Patient Spirometry” chapter, and also note
the following connection-related issues.
Gas exchange patient connections with HME/HMEF/filter ~45°

NOTE: Place all D-lite ports upwards with a 20° to 45° tilt to prevent
condensed water from entering the sensor interior and the tubings.
NOTE: When monitoring pediatric patients with tidal volumes of
15 to 300 ml, use the Pedi-lite(+) sensor. Remember to select the
sensor type accordingly in the monitor menu.

NOTE: Always place the HME/HMEF/filter between the D-lite(+)

sensor and the patient.

248
 249
Gas exchange points to note
• Gas exchange measurement is for intubated patients only.
• Use only 2-meter (7-ft) gas sampling lines. Using other lines may
cause inaccurate readings.
• High PEEP or ventilating pressures may activate the ‘Check
Water Trap' alarm.
• To ensure measurement accuracy, check the accuracy of airway
gas measurement once a month: feed calibration gas mixture to
the monitor during normal operation and check that the
readings on the monitor match those on the calibration gas
bottle. If they do not match, calibrate airway gases.
• For monitoring airway flow, gas exchange and metabolism, use
the E-CAiOVX module when anesthetic agents are present.
• For a list of acquisition modules capable of measuring this
parameter, see the "System introduction" chapter.
Gas exchange measurement limitations
• This measurement is not available in the NICU software package.
• E-modules are not suitable for use with neonatal patients.
NOTE: VO2/VCO2 values cannot be measured correctly:
• with leaking airway
• with FiO2 higher than 85%
• when N2O is used in ventilation
• when Helium or Xenon are used in ventilation
NOTE: Measurement results are valid only when the respiration rate
is below 35 /minute due to non-adequate time for accurate
sampling.
NOTE: Routine calibration checks are required to ensure the
measurement accuracy.
NOTE: Measurements cannot be taken during the following
ventilation modes: high by-pass flow, high frequency ventilation
(HFV) or bi-level positive airway pressure (BiPAP) due to non-
adequate time for accurate sampling.
Gas exchange measurement checks
• Check that the water trap is empty.
• Occlude the sampling line and check that the ‘Sample line
blocked’ message appears within 30 seconds and gas
waveforms are showing zero at the same time.
WARNING: Always keep the monitor horizontal when
a compact airway module is used. Tilting the monitor
may cause erroneous results in the compact airway
module’s readings.

Gas exchange settings
Selecting the gas exchange sensor type
Select the sensor type (Adult or Pedi) according to the sensor you
are using:
1. Select the gas exchange parameter window.
2. Select Setup.
3. Select the sensor type from the Sensor Type list.
Selecting EE and RQ averaging time
Averaged values of energy expenditure (EE) and respiratory quotient
(RQ) update every minute. The bar in the EE+RQ parameter window
indicates with green color the amount of data that the monitor uses
for performing the average calculations.
When a patient is admitted/a case is started, no averaged value is
displayed until 10 minutes of valid EE and RQ data is available. After
that, the EE and RQ values are gray until there is enough (> 1/5 of the
selected averaging time) data to perform reliable calculations.
Weighted VO2 and VCO2
To have weighted values for VO2 (VO2/kg or VO2/m2) and VCO2
(VCO2/kg or VCO2/m2), you must enter the patient’s height and
weight. For VO2/kg and VCO2/kg, measured values are divided by
the patient’s weight, and for VO2/m2 and VCO2/m2, measured
values are divided by the patient’s BSA.
For more information on entering patient data, see the “Starting and
ending monitoring” chapter.
Stopping the gas exchange measurement
Remove the gas exchange parameter windows from the screen. You
can continue measuring airway gases and Patient Spirometry with
the same module.

To select the averaging time:

1. Select the gas exchange parameter window.
2. Select Setup.
3. Select a value from the EE Average Time list.

NOTE: The values in the parameter window turn gray whenever

there is not enough valid EE and RQ averaging data.

NOTE: If the RQ is out of the physiological range (<0.6 or >1.3), the

monitor does not store the EE and RQ values in the trend history or
use them for average calculations.

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Troubleshooting the gas exchange measurement

NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.

NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor

B650 Supplemental Information Manual.”

Problem What to do
Gas exchange • Check the sampling line and connectors
values are too low for leakage.
Gas exchange • Check the ventilation mode.
values seem • Check the inspired oxygen concentration
unreliable and correct if necessary (max. 85%).
Module does not • Check and clean the filter if necessary.
work • Check the water trap. If it was too full,
liquid may have entered the module.
Replace the module and have it checked
by authorized service personnel.
No gas exchange • Check that the gas sampling line is not
values connected to the sample gas out
connector.
VO2 values are • Verify that the oxygram curve is stable.
non-physiologic • Change the sampling line.
• Check the D-lite placement.
Entropy
NOTE: This measurement is available in OR and PACU softwarepackages only.
NOTE: A portion of the Entropy software is derived from the RSA Data Security, Inc. MD5 Message-Digest Algorithm.

Entropy equipment to patient connection Entropy module keys

(1) Module with Entropy measurement capability There are two keys on the module:
(2) GE Entropy sensor cable
(3) GE Entropy sensor, or Entropy Opens or closes the Entropy menu on the screen
(4) Entropy sensor Check Starts the manual sensor check
NOTE: For a comprehensive list of compatible supplies and Sensor
accessories, see the supplies and accessories document delivered
with the monitor.

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Preparing the patient for Entropy measurement
1. Connect the Entropy sensor cable to the module.
2. Clean the application site according to the sensor’s instructions
for use and let it dry before attaching the sensor.
3. Place the Entropy sensor on the patient's forehead; see sensor
package for instructions.
4. Connect the sensor to the Entropy sensor cable.
5. Observe the results of the automatic sensor check in the
parameter window.
6. The measurement starts automatically after the sensor has
passed the check.
Entropy points to note
• Entropy sensors are latex- and PVC-free, disposable and for
single-patient use only.
• Make sure that the sensor connectors of the sensor cable are
not in contact with fluids.
• Always ensure that the sensor is properly attached to the patient
and connected to the cable.
• For a list of acquisition modules capable of measuring this
parameter, see the "System introduction" chapter.
Entropy measurement limitations
• Entropy measurement is not indicated for pediatric patients
younger than two years old.
• Entropy is not validated with patients undergoing sedation.
• Unusual or excessive electrical interference is a potential cause
for artifact. During extended periods of electrocautery there may
not be any good EEG epochs, and Entropy values will not be
displayed.
• ECG, frequent eye movements, coughing, muscle rigidity and
patient movement cause artifact and may interfere with the
measurement. Epileptic episodes may also cause interference.
• Entropy readings may be inconsistent when monitoring patients
with neurological disorders, traumas or their sequelae.
• Entropy readings may be inconsistent when using
benzodiazepines, nitrous oxide or ketamine as anesthetics.
• Psychoactive medication or very high opiate doses may
suppress EEG and cause inconsistent Entropy readings.
• Cooling the patient may suppress their EEG and cause
inconsistent Entropy readings.
Entropy measurement checks
• Check that the sensor/electrode passes the sensor/electrode
check when you are starting to monitor a new patient.
Safety precautions Selecting the display format for Entropy
You can select which Entropy parameters are shown in the
Entropy warnings
parameter windows:
• Make sure that the electrodes, sensor and connectors do not
1. Press the Entropy module key, or select the Entropy parameter
touch any electrically conductive material, including earth.
window.
• DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled
2. Select Setup.
with the CF and BF symbols with paddles are protected against
3. Select an option from the Display Format list:
damage resulting from defibrillation voltages. To ensure proper
defibrillator protection, use only the recommended cables and  RE = Response Entropy
leadwires.  SE = State Entropy
• DEFIBRILLATOR PRECAUTIONS - Proper placement of defibrillator  RE+SE = both of the above
pads in relation to the electrodes is required to ensure successful  All = RE, SE and Burst Suppression Ratio (BSR)
defibrillation.
Selecting the Entropy scale
Entropy cautions
This selection affects the Entropy waveform and snapshots:
• When using an electrosurgery unit, ensure proper contact of the
1. Press the Entropy module key, or select the Entropy parameter
ESU return electrode to the patient to avoid burns at the monitor
window.
measurement sites. Also ensure that the ESU return electrode is
2. Select Setup.
near the operating area.
3. Select a value from the Scale µV list.
• Strong 30-40 Hz magnetic fields may cause erroneous Entropy
measurement. Do not use devices with such a field close to the
Selecting the EEG sweep speed
module or sensor.
• The Entropy measurement is always to be used only as an NOTE: This same setting is available in BIS, EEG and Entropy setups.
adjunct to other physiological parameters. Clinicians are advised Regardless of where you change it, it will affect all three parameters.
to use their knowledge and experience when making clinical
1. Press the Entropy module key, or select the Entropy parameter
judgements. Entropy values are not to be used as sole indicators
window.
of the patient status.
2. Select Setup.
• Check the sensor expiration date on the sensor package. Do not
3. Select a value from the EEG Sweep Speed list.
use expired sensors. Do not use a sensor for more than 24 hours.
The smaller the value, the slower the sweep speed.
• Automatic sensor check may need to be disabled if the 70 Hz
impedance check signal interferes with other equipment, such
as EEG module with evoked potentials measurement.

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Selecting the Entropy trend length Bypassing the Entropy sensor check
1. Press the Entropy module key, or select the Entropy parameter If the sensor does not pass the impedance check, this option
window. becomes selectable. It allows you to start the measurement without
2. Select Setup. completing the sensor check. NOTE: In this case, the measurement
3. Select a trend length from the Trend Length list. may be unreliable.
1. Press the Entropy module key, or select the Entropy parameter
Showing Entropy microtrend window.
To see an Entropy microtrend on screen together with numeric 2. Select Setup > Bypass Check.
values:
1. Press the Entropy module key, or select the Entropy parameter Setting Entropy alarm limits
window. You can set the limit alarms on or off and adjust their activation
2. Select Setup > Show Entropy Microtrend. limits according to your needs:
1. Press the Entropy module key, or select the Entropy parameter
Using the manual Entropy sensor check window.
Whenever required, you can perform the sensor check manually. 2. Select Alarms.
Press the Check Sensor module key, or: 3. Select the parameter (RE or SE). NOTE: If the feature is not active,
1. Press the Entropy module key, or select the Entropy parameter the alarm limits are greyed out. Select Alarm On to set the
window. alarms.
2. Select Setup > Check Sensor. 4. Set the alarm limits.
3. Observe the results on the screen. Do not press the sensor
during the check to avoid signal noise.
4. The measurement continues automatically after the sensor has
passed the check.

Using the automatic Entropy sensor check

To take the automatic sensor check into use:
1. Press the Entropy module key, or select the Entropy parameter
window.
2. Select Setup.
3. Select Check Sensor > Automatic.
Stopping the Entropy measurement
1. Remove the Entropy sensor from the patient.
2. Disconnect the sensor from the sensor cable.
3. Discard the sensor.
Troubleshooting the Entropy measurement
NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”

Problem What to do
Entropy values • Check that the sensor is not dried out.
seem unstable • Check the sensor attachment and placement.
• Check the patient status.
Entropy EEG • Remove disturbing equipment from the
signal is noisy proximity of the Entropy module or sensor.
• Check the sensor’s contact with skin.
• Check electrodes.
Entropy EEG • Check the sensor’s contact with skin.
signal is poor • Check electrodes.
Entropy • Check raw EEG as impedance check may
waveform and cause a temporary increase in the numeric
numbers do values.
not correspond • Check the patient’s overall status.
Entropy • Check raw EEG for QRS or other artifact.
readings seem • Check electrode placement.
inconsistent
with the
patient status

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For your notes

Neuromuscular transmission (NMT)
NMT equipment to patient connection NMT module keys
(1) Module with NMT measurement capability There are two keys on the module:
(2) NMT sensor cable
(3) MechanoSensor or Pediatric MechanoSensor lead wire set  Starts the search for supramaximal current
(4) Electrode, white lead connection site for nerve stimulation and reference level
Start-up
(5) Electrode, brown lead connection site for nerve stimulation  Proceeds with the selected measurement
(6) ElectroSensor leadwire set cycle
(7) White stimulating electrode
Stop  Interrupts monitoring
(8) Brown stimulating electrode
Continue  Restarts monitoring of the same patient
(9) Electrode, black lead connection site, ground
(10) Electrode, green lead connection site, recording muscle- NOTE: For a comprehensive list of compatible supplies and
contraction effect accessories, see the supplies and accessories document delivered
(11) Electrode, red lead connection site, recording muscle- with the monitor.
contraction effect

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Ulnar nerve and corresponding muscles

Preparing the patient for NMT measurement
1. Connect the NMT sensor cable to the module. (1) m. adductor pollicis
2. Clean the skin at the NMT application area. (2) m. abductor digiti minimi
3. When applying the electrodes, make sure that the entire (hypothenar)
electrode surfaces make an optimal contact to the skin. (3) m. flexor pollicis brevis (thenar)
4. Connect the white NMT stimulation lead always to the proximal (4) n. ulnaris
electrode. (5) medial epicondyle
5. Connect the sensor cable to the MechanoSensor or
ElectroSensor leadwire set.
Preparing MechanoSensor setup
1. Place the two electrodes along the ulnar nerve traject. Prevent
them from making contact with each other. Palpating the
ulnar artery near the wrist area may be helpful in identifying the
ulnar nerve traject.
2. Attach the sensor between thumb and index finger. If necessary,
fix with narrow tape only.
3. Make sure that the sensor sets tightly in the groove and that the
thumb can move freely. Do not immobilize the hand.
Preparing ElectroSensor setup
1. Place two electrodes for white and brown lead connection along
the ulnar nerve traject. Prevent them from making contact with
each other.
2. Place the electrodes for red and green lead connection as
indicated in the illustration above.
3. Place the electrode for black lead connection where convenient,
preferably between the stimulating and recording lead
connection electrodes.
Alternative patient connections for NMT NMT points to note
If the patient's arm and/or hand cannot be used for NMT • Start monitoring before the administration of a muscle relaxant
measurement, the foot may be an alternative measurement site. drug (but after the induction of sleep in general anesthesia) to
Place the electrodes for white and brown lead connection along the prevent voluntary muscle contraction and tension from
posterior tibial nerve (causing plantar reflexion of the great toe and interfering with the reference search.
foot) or peroneal nerve traject (stimulated behind the head of fibula). • When placing the electrodes, make sure that they do not touch
Place the electrodes for red and green lead connection site on the m. each other.
flexor hallucis brevis, and the electrode for black lead connection • Do not place electrodes on areas with excessive body hair or
(ground) as indicated in the figure below. lesions.
• If the electrodes are placed incorrectly, wrong nerves are
stimulated and this causes wrong muscle response.
• When multiple nerves are stimulated, the measured response
7 may be affected by electrical activity of other muscles.
• If the stimulation electrodes are placed very close to the palm of
4 the hand, the muscles are stimulated directly by the stimulation
2 3
pulses.
• If the current is too strong, it may stimulate the muscles too
6 much.
• Moving or touching the patient during measurement may cause
incorrect results.
• For safe extubation, the TOF% should be higher than 90.
1 5 • For a list of acquisition modules capable of measuring this
parameter, see the "System introduction" chapter.
(1) Flexor hallucis brevis
(2) Red measuring electrode NMT measurement limitations
(3) Green measuring electrode • This measurement is not available in the NICU software package.
(4) Black ground electrode • NMT measurement is not indicated for pediatric patients
(5) Brown stimulating electrode weighing less than 5 kg (11 lbs).
(6) White stimulating electrode • Pediatric MechanoSensor is validated for children weighing 5 to
(7) Tibial nerve 20 kg (11 to 44 lbs).
• Electrosurgery may cause incorrect measurement results.
• NMT measurement is not indicated for patients with known
abnormal function of neuromuscular junction.

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NMT measurement checks
• Check that the electrodes are correctly positioned on the ulnar
nerve and the message ‘Supramax search’ is displayed. Ensure
that you get a stimulus response. If the supramaximal stimulus
current is not found, the message ‘Supramax not found’ is
displayed.
• Always check the electrode quality
Safety precautions
NMT warnings
• Make sure that the lead set clips or snaps do not touch any
electrically conductive material including earth.
• Do not place the NMT stimulating electrodes on the patient's
chest. Application of the electrodes near the thorax may
increase the risk of cardiac fibrillation.
• DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled
with the CF and BF symbols with paddles are protected against
damage resulting from defibrillation voltages. To ensure proper
defibrillator protection, use only the recommended cables and
leadwires.
• DEFIBRILLATOR PRECAUTIONS - Proper placement of defibrillator
pads in relation to the electrodes is required to ensure successful
defibrillation.
• There are hazards associated with the reuse of single-use NMT
stimulation or recording electrodes.
NMT cautions
• When using an electrosurgery unit, ensure proper contact of the
ESU return electrode to the patient to avoid burns at NMT
electrode sites.
• Always stop the NMT measurement before handling the
stimulating electrodes.
• Never subject a patient with an implanted electronic device to
electrical stimulation without consulting a medical specialist
first.
• If used in close proximity to shortwave or microwave therapy
equipment, stimulator output may become unstable.
Starting the NMT measurement
Press the Start-up module key, or:
1. Select the NMT parameter window > Setup.
2. Select Stimulus Mode > TOF, DBS or ST.
3. Select Start with > New patient.
4. Select Start-up.
Changing the NMT stimulus current
1. Select the NMT parameter window > Setup.
2. Select a value from the Current list.
Changing the NMT cycle time
This selection also affects the recovery note, see below.
1. Select the NMT parameter window > Setup.
2. Select a value from the Cycle Time list.
Changing the NMT pulse width
1. Select the NMT parameter window > Setup.
2. Select a value from the Pulse Width µs list.
Continuing the NMT measurement
To continue interrupted NMT measurement with the same patient
and monitor, press the Stop Continue module key, or:
1. Select the NMT parameter window > Setup.
2. Select Start with > Current patient.
3. Select Continue.
Restarting the NMT measurement in OR after induction Measuring deep relaxation
When you move the patient with the module to the OR and want to When no responses are detected for TOF stimulation, the post
continue the measurement with the already found and determined tetanic count (PTC) is the only way to measure the neuromuscular
current and reference values, use the restart function. block. A tetanic stimulation (50 Hz) is generated for five seconds and
Connect the module to the monitor and press the Stop Continue post-tetanic responses to single-twitch stimulation are counted. The
module key, or: larger the PTC (the number of detected responses), the sooner the
1. Select the NMT parameter window > Setup. normal TOF responses return. To monitor the relaxation level, start a
2. Select Start with > Recall reference. five-second tetanic stimulation:
3. Select Restart. 1. Select the NMT parameter window > Setup.
2. Select Start Tetanic/PTC.
Adjusting the NMT beep volume
You can set the beep value to best suit your care environment. NMT measurement on the monitor screen
1. Select the NMT parameter window > Setup. Different NMT values have their own specific colors in the graphical
2. Select a value from the Stimulus Beep Volume list. trends. The bar colors indicate the following: white = Ratio% (TOF);
green = T1%; blue = PTC; purple = Count
Using the NMT recovery note
The recovery note alarms you with a single beep and the 'Block Stopping the NMT measurement
recovery' message when the count reaches the value you have Press the Stop Continue module key, or:
selected. It indicates that the patient is responding more clearly to 1. Select the NMT parameter window > Setup.
the stimuli and the neuromuscular block is decreasing. 2. Select Stop.
The note is activated according to the count number and cycle time:
 Cycle time < one minute: The count must be below the Troubleshooting the NMT measurement
selected limit in two consecutive measurements. NOTE: For a comprehensive list of system messages, see the “System
 Cycle time > one minute or manual measurement: At least messages“ chapter.
one count must be below the selected limit. NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”
To take this feature into use:
1. Select the NMT parameter window > Setup. PROBLEM WHAT TO DO
2. Select Recovery Note. NMT calibration and • Check the electrode quality and
3. Select the count limit that will activate the note. measurement fail positioning.
• Replace stimulating electrodes.
Measurement is disturbed • Check the black ground electrode.

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NMT alternative uses

Local nerve and plexus localization
Single stimulation pulses may be helpful for determining the correct
needle tip position from a local nerve in plexus procedures. The NMT
module delivers single stimulation pulses at a selected rate until it is
manually stopped. Muscle contractions from the stimulated
innervating motoric nerve(s) may be observed. After having localized
the correct position, the needle may be used for intended drug
administration by connecting a syringe to the needle.
Note that you need specific accessories for this measurement:
2
1
Preparing for local nerve or plexus localization
1. Connect the E-NMT regional block adapter to the sensor cable.
2. Connect a disposable needle and syringe set to the adapter.
3. Press the Start-up module key and select a suitable current
from the Current mA list that appears on screen. You can also do
this by selecting the NMT parameter window > Regional Block >
Current mA.
4. Start stimulation by selecting Start.
5. When the needle approaches the motor nerve, reduce the
current. The pulse width is 40 ms and somewhat higher currents
may be needed than in other similar systems.
6. When ready, stop the stimulation by pressing the Stop
Continue module key, or:
 Select the NMT parameter window > Regional Block > Stop.
Troubleshooting the regional block measurement
NOTE: Also see the comprehensive list of system messages.

PROBLEM WHAT TO DO
Difficulty in getting the • You may try using the local muscle
response when locating response as an indication of current
3
the nerve for plexus in the needle. If there is no response,
stimulation the needle may be broken.
(1) Regional block adapter • Change the needle if necessary.
(2) Sensor cable
(3) Needle with syringe
EEG and auditory evoked potentials (AEP)
EEG equipment to patient connection
EEG module keys
(1) Module with EEG, AEP and FEMG measurement capability
There are two keys on the module:
(2) EEG headbox and cable, N-EEG
(3) EEG leadset: preconfigured or your own montage EP Start/ Starts and stops auditory evoked potential
- EEG electrodes (cup, needle or adhesive) Stop measurement with the defined settings.
(4) Earphones are required for AEP (auditory evoked potentials)
Imp. Check Starts the manual measuring of the electrode
NOTE: For a comprehensive list of compatible supplies and impedance.
accessories, see the supplies and accessories document delivered
with the monitor. These same keys can be found on the headbox.

NOTE: When measuring both AEP and BIS, or Entropy, see also the CAUTION: Do not cover the EEG headbox as it may
“Bispectral index (BIS)” or “Entropy“ chapter.
overheat.

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Preparing the patient’s electrode sites for EEG
measurement
• Follow the electrode manufacturer’s instructions for the
frequency of changing the electrodes.
• Only use electrodes that are intended for EEG measurement.
• Use one type of electrodes in the whole montage.
Connecting the EEG leadset
1. Connect the headbox to the module.
1. Select a suitable preconfigured leadset or your own montage.
2. Connect the leadset to the headbox.
3. Attach the electrodes to the patient as indicated in the leadset or
according to your own montage.
4. Observe the results of the electrode check. Reconnect the
electrodes if the impedance is too high.
International 10-20 system
The international 10-20 system’s standardized electrode locations:
The numbers and letters of the 10-20 system refer to electrode
locations:
- Odd numbered electrodes: placed on the left
- Even numbered electrodes: placed on the right
- Letters: F = frontal; T = temporal; C = central; P = parietal;
O = occipital; Z = midline electrodes
Attaching different types of EEG electrodes
Attaching EEG electrodes within hair area
• Preferably use cup electrodes if montage includes placements
within hair area.
1. Mark the spots on the patient’s head according to the montage
you have chosen.
2. Comb or cut the hair away from the spots and rub the skin with
abrasive paste to remove oil and grease.
3. Clean the skin with alcohol.
4. Attach the electrodes using conductive paste.
NOTE: Use water to detach the electrodes.
Attaching EEG electrodes outside hair area
• Preferably use adhesive electrodes if all montage placements
are within skin area.
1. Clean the skin with alcohol.
2. Remove the electrode from its package and attach it to the
desired location.
3. Press the electrode gently for several seconds to attach it.
Attaching EEG needle electrodes
• Always make sure that the needles are sterile.
1. Wipe the skin clean with alcohol.
2. Insert the needle into the subcutaneous area.
3. You may also use a small amount of paste to attach the cable to
the patient's hair. This prevents the cables from pulling the
needles out of the skin.
Using preconfigured EEG leadsets
A preconfigured leadset tells the monitor which montage (electrode
positioning) is used. Therefore, no menu selections are necessary.

NOTE: Since the monitor sets lead positions automatically according

to the identification pin, make sure that you use preconfigured lead
positions. If you change them, always update the montage settings
according to the instructions in the “Defining an EEG montage“
section.
BASIC montage GENERAL montage

(1) ground
(1) ground
Montage Settings Electrodes
Montage Settings Electrodes
1: Fp1 - T3 Four channels, bipolar Nine cup electrodes
1: A1 -Fp1 Two channels, bipolar Five adhesive electrodes 2: Fp2 - T4
2: A2 - Fp2 3: C3 - 01
Ground 4: C4 - 02
Ground

You can also define your own montage, see “Defining an EEG
montage.” Note that your own montages will not be automatically
recognized when you start the measurement.

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EEG points to note Safety precautions

• Make sure that you have attached the ground electrode.
EEG warnings
• Monitor the FEMG value and other parameters.
• - DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled
• Referential measurement is usually more prone to artifact.
with the CF and BF symbols with paddles are protected against
• Keep electrical devices as far away from the patient as possible.
damage resulting from defibrillation voltages. To ensure proper
• Use short cables, or braid the long ones.
defibrillator protection, use only the recommended cables and
• Keep the headbox as close to the patient’s head as possible.
leadwires.
• For best results, use Ag/AgCl electrodes for the EEG
• - DEFIBRILLATOR PRECAUTIONS - Proper placement of
measurement.
defibrillator pads in relation to the electrodes is required to
• A cloth bandage over cup electrodes and around the patient’s
ensure successful defibrillation.
head may enhance good contact.
• Make sure that the electrodes do not touch any electrically
• For a list of acquisition modules capable of measuring this
conductive material including earth.
parameter, see the "System introduction" chapter.
EEG cautions
EEG measurement limitations • When using an electrosurgery unit, ensure proper contact of the
• This measurement is not available in the NICU software package. ESU return electrode to the patient to avoid burns at the monitor
• E-modules are not suitable for use with neonatal patients. measurement sites. Also ensure that the ESU return electrode is
• External radiating devices may disturb the measurement. near the operating area.
• EEG measurement is inherently very sensitive. Radiated field
EEG measurement checks strengths above 0.8V/m may cause erroneous measurements at
• Check that the EEG waveforms are displayed after you have various frequencies. Do not use electrical radiating equipment
completed patient connections. close to the EEG measurement module.
• Perform impedance check to ensure proper electrode contact.
When the leads are disconnected, the message ‘Leads off’ is
displayed.
• Always check the electrode quality.
Starting the EEG measurement Selecting the EEG sweep speed
EEG measurement starts automatically. Observe the results of the
NOTE: This setting is available in BIS, EEG and Entropy setups.
electrode check. Reconnect the electrodes if the impedance is too
Regardless of where you change it, it will affect all three parameters.
high.
1. Select the EEG parameter window.
Using your own EEG montage 2. Select EEG tab > Setup.
If you are using your own montage, you will have to select it from the 3. Select a value from the EEG Sweep Speed list.
list. Preconfigured montages will be automatically recognized. The smaller the value, the slower the sweep speed.
1. Select the EEG parameter window. Selecting EEG numeric parameters
2. Select EEG tab > Montage.
To select which numeric values are shown in EEG parameter
3. Select the montage from the Select Montage list.
windows and trends:
NOTE: Since the monitor sets lead positions automatically according 1. Select the EEG parameter window.
to the identification pin, make sure that you use preconfigured lead 2. Select EEG tab > Setup.
positions. If you change them, always update the montage settings 3. Select a parameter from the Numeric 1 list.
according to the instructions in the “Defining an EEG montage“ 4. Select a parameter from the Numeric 2 list.
section.
EEG trends are factory enabled in the OR, ICU and ED software
packages. For more information, see the “Setting up the monitor
Selecting the EEG scale
before use” and the “Trends and snapshotsTrends and snapshots”
To select the scale for EEG parameter windows, waveform and chapters.
spectral displays:
1. Select the EEG parameter window. Selecting SEF%
2. Select EEG tab > Setup.
To set the percentage of the spectral power to define the edge
3. Select a value from the Scale µV list.
frequency:
1. Select the EEG parameter window.
2. Select EEG tab > Setup.
3. Select a value from the SEF % list.

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Selecting the time scale for Compressed Spectral Array Selecting the CSA view
(CSA) To view a graphical view of the spectrum as a single, continuously
1. Select the EEG parameter window. updating curve, CSA:
2. Select EEG tab > Setup or View. 1. Select the EEG parameter window.
3. Select a value from the CSA Time Scale list. NOTE: Changing the 2. Select EEG tab > View.
scale will erase the previous CSA content. 3. Select CSA. NOTE: Changing the view will erase the previous CSA
content.
Selecting the EEG frequency scale
NOTE: You can select a value from the CSA Time Scale list or use the
The frequency selection affects the screen only, numeric parameters default time scale.
are always calculated from the entire measurement range. This
selection affects the curve frequency scale in EEG parameter
Selecting the EEG numerical view
windows, CSA displays, and trend displays.
To view a numeric list of all EEG parameters on all channels:
1. Select the EEG parameter window.
1. Select the EEG parameter window.
2. Select EEG tab > Setup.
2. Select EEG tab > View.
3. Select a value from the Freq. Scale Hz list.
3. Select Numerical.
Selecting the EEG impedance cycle time
Checking EEG electrodes
To set the time interval for the automatic impedance check:
1. Select the EEG parameter window. Press the Imp. Check key on the module or headbox, or:
2. Select EEG tab > Setup. 1. Select the EEG parameter window.
3. Select a value from the Imped. Cycle list. 2. Select EEG tab > View.
3. Select Check Electrodes.
Defining an EEG montage Printing EEG
You can define your own montage by plugging the leadwires directly You can print the currently displayed EEG view:
into the headbox or by building your own leadset. 1. Select the EEG parameter window.
2. Select EEG tab > View.
NOTE: Since the monitor sets lead positions automatically according 3. Select Numerical or CSA.
to the identification pin, make sure that you use preconfigured lead 4. Select Print Page.
positions. If you change them, always update the montage settings.

To define a montage: Stopping the EEG measurement

1. Select the EEG parameter window. To stop the EEG measurement, disconnect the electrodes.
2. Select EEG tab > Montage.
3. Select a montage (Montage 4 to Montage 8) from the Select
Montage list.
4. Go through the different menu items and select the options to
suit the application.
For instance, to rename the selected montage: select Name
Montage, remove the previous name, type the new name in the
Name field, and then select Enter. NOTE: The name can contain
nine characters at the most.
5. You can save the montage for later use by selecting Save
Montage > Yes. NOTE: If you select Factory, all settings,
including the name, will return to factory defaults.

Your own montages will not be automatically identified by the

monitor. You must select them from the menu when starting the
measurement, see “Using your own EEG montage.“

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Measuring auditory evoked potentials (AEP)

Preparing the patient for AEP measurement AEP montage

1. Prepare the patient and electrodes as in the EEG measurement.
2. Connect the leadset and electrodes.
3. Connect earphones to the headbox and place them on the
patient's ear/s.
NOTE: Make sure that the earphones do not press the patient's
head in any position (for example, when the patient is lying on
one side).
NOTE: Use only GE Healthcare supplied headphones/earphones.
In other headphones/earphones the sensitivity may vary causing
too high an intensity, which may damage the ear, or too low an
intensity, which may cause a poor response.

(1) ground
(2) reference

Montage Settings Electrodes

1: A1 -Fz Two channels, Four adhesive electrodes
2: A2 - Fz reference (Fz)
Ground

Starting the AEP measurement

Press the EP Start/Stop key on the headbox or module, or:
1. Select the EEG parameter window.
2. Select AEP tab > View.
3. Select Start AEP.
4. Observe the results of the electrode check. Reconnect the
electrodes if the impedance is too high.
Selecting AEP channels Selecting the AEP sweep length
You can select AEP to be measured from one or two channels: To select the length of the recorded and displayed waveform, and of
1. Select the EEG parameter window. the AEP split screen and AEP view:
2. Select AEP tab > Setup. 1. Select the EEG parameter window.
3. Select the number of channels from the AEP Channels list. 2. Select AEP tab > Setup.
3. Select a value from the Sweep Length list.
Selecting the number of AEP responses
To select the number of responses to be averaged: Selecting the AEP filter
1. Select the EEG parameter window. To select the cut-off frequency of the high pass filter:
2. Select AEP tab > Setup. 1. Select the EEG parameter window.
3. Select the number of responses from the Responses list. 2. Select AEP tab > Setup.
3. Select a value from the Filter list.
Selecting the AEP stimulus frequency
To select how often the stimulus is given: Selecting the AEP cycle
1. Select the EEG parameter window. To select a manual, continuous or frequently repeated AEP
2. Select AEP tab > Setup. measurement:
3. Select a value from the Stimulus Frequency list. 1. Select the EEG parameter window.
2. Select AEP tab > View.
Selecting the AEP stimulus intensity 3. Select a value from the Cycle list.
To select the volume of the clicks:
1. Select the EEG parameter window. Selecting the AEP size
2. Select AEP tab > Setup. To select the scale for the auditory evoked potentials display:
3. Select a value from the Stimulus Intensity list. 1. Select the EEG parameter window.
2. Select AEP tab > View.
NOTE: The decibel scale over the hearing threshold is only indicative 3. Select a value from the EP Size list.
because a complete audiologic calibration is not possible with the
stimulus type used. The stimulus intensity has been calibrated
according to peak equivalent sound pressure levels, and 10 dB on
the scale corresponds to 50 dB peak equivalent sound pressure
level.

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Saving auditory evoked potentials Printing an AEP report

You can set two markers per channel on the AEP waveforms, and You can print an indivual AEP report:
save them for later reference. The monitor calculates and saves the 1. Select Monitor Setup > Printing.
latency at these points and the amplitude between them. You can 2. Select Reports > Individual Reports > AEP.
save up to six auditory evoked potentials. These six can also be the NOTE: You can only print saved AEP’s.
same response with different cursor positions. For more information on printing, see the “Printing“ chapter.
1. Select the EEG parameter window.
2. Select AEP tab > Save. Stopping the AEP measurement
3. Select Channel 1 > Lat1. Press the EP Start/Stop key on the headbox or module, or:
4. Move the marker line to a suitable point. 1. Select the EEG parameter window.
5. Repeat steps 3 to 4 for Lat2, and then for Channel 2 > Lat1 and 2. Select AEP tab > View.
Lat2. 3. Select Stop AEP.
6. Select Save Response.

NOTE: After six responses have been saved, the next saved response Troubleshooting the EEG/AEP measurement
will overwrite the second response in the monitor memory. NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.
For instructions on how to view saved auditory evoked potentials,
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
see “Selecting a reference AEP“ below.
B650 Supplemental Information Manual.”
Selecting a reference AEP PROBLEM WHAT TO DO
You can select a saved auditory evoked potential as a reference that
will be displayed simultaneously with the real time auditory evoked EEG signal • Check that the electrodes are properly connected
is noisy and not dried out.
potential.
• Check the electrodes’ contact with skin.
1. Select the EEG parameter window.
• Perform electrode impedance check.
2. Select AEP tab > View. • Calm the patient since frontal muscle activity can
3. Select a reference AEP from the Reference EP list. cause artifact.
• Remove sources of external electrical noise (for
Erasing an AEP reference example, some lamps) from the vicinity of the
NOTE: This selection is not available if you have not saved any patient’s head.
references. • ECG may cause artifact; change electrode
1. Select the EEG parameter window. positioning.
2. Select AEP tab > View. • Check that there are not two identical measurement
3. Select the reference to be erased from the Erase EP list. modules in the system.
Bispectral index (BIS)
BIS equipment to patient connection BIS module keys
(1) Module with BIS measurement capability There are two keys on the module:
(2) Digital Signal Converter, DSC
(3) Patient Interface Cable, PIC Plus
(4) BIS Sensor BIS Opens or closes the BIS menu on the screen

NOTE: For a comprehensive list of compatible supplies and Check Starts the manual sensor check
accessories, see the supplies and accessories document delivered Sensor
with the monitor.

4
1

3
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Preparing the patient for BIS measurement
1. Connect the digital signal converter (DSC) cable to the module.
2. Connect the patient interface cable to the DSC.
3. Secure the DSC to a convenient location, preferably close to the
patient’s head.
4. Clean the application site with alcohol and let dry.
5. Place the BIS sensor on the patient; see sensor package for
instructions.
6. Connect the sensor to the patient interface cable.
7. Observe the results of the automatic sensor check in the
parameter window.
8. The measurement starts automatically after the sensor has
passed the check.
BIS points to note
• Make sure that the sensor connectors of the patient interface
cable are not in contact with fluids.
• BIS sensors are latex-free, disposable and for single patient use
only.
• Check the sensor expiration date on the sensor package.
• Do not use a sensor for more than 24 hours.
• Use only Aspect BIS sensors.
• For a list of acquisition modules capable of measuring this
parameter, see the "System introduction" chapter.
BIS measurement limitations
• This measurement is not available in the NICU software package.
• E-modules are not suitable for use with neonatal patients.
• The BIS module is intended for use by personnel trained in its
proper use. It is intended for use on adult and pediatric patients
within a hospital or medical facility providing patient care to
monitor the state of the brain by data acquisition of EEG signals.
The Bispectral index (BIS), a processed EEG variable, and one
component of the BIS module, may be used in adults as an aid in
monitoring the effects of certain anesthetic agents. The
Bispectral index is a complex technology, intended for use only
as an adjunct to clinical judgement and training. In addition, the
clinical utility, risk/benefit, and application of BIS have not
undergone full evaluation in the pediatric population.
• BIS is a complex monitoring technology intended for use as an
adjunct to clinical judgment and training. Clinical judgment
should always be used when interpreting BIS in conjunction with
other available clinical signs. Reliance on BIS alone for
intraoperative anesthetic management is not recommended.
• BIS values should be interpreted cautiously with certain
anesthetic combinations, such as those relying primarily on
either ketamine or nitrous oxide/narcotics to produce
unconsciousness.
• External radiating devices may disturb the measurement.
• Poor signal quality may lead to inappropriate BIS values.
• Artifact may lead to inappropriate BIS values. Potential artifact
may be caused by unusual or excessive electrical interference or
high EMG activity like shivering, muscle activity or rigidity,
sustained eye movements, head and body motion. Also,
improper sensor placement and poor skin contact (high
impedance) may cause artifact and interfere with the
measurement.
• Due to limited clinical experience in the following applications,
the BIS value should be interpreted cautiously in patients with
known neurological disorders and those taking psychoactive
medications.
BIS measurement checks
• Check that the sensor/electrode passes the sensor/electrode
check when you are starting to monitor a new patient.

Safety precautions
BIS warnings
• Make sure that the electrodes, sensor and connectors do not
touch any electrically conductive material, including earth.
• Do not autoclave the DSC. Do not open it for any reason.
• The sensor must not be located between defibrillator pads when
a defibrillator is used on a patient connected to BIS devices.
• DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled
with the CF and BF symbols with paddles are protected against
damage resulting from defibrillation voltages. To ensure proper
defibrillator protection, use only the recommended cables and
leadwires.
• This monitor uses a component modular device in deriving the
Bispectral index (BIS) purchased from Aspect Medical Systems. It
is important to recognize this index is derived using solely that
company’s proprietary technology. It is recommended that
clinicians have reviewed applicable information on its utility and/
or risks in published articles and literature/web site information
from Aspect Medical Systems, Inc (www.aspectmedical.com) or
contact that company itself if they have clinical-based BIS
questions relating to this module portion of the GE monitor.
Failure to do so could potentially result in incorrect
administration of anesthetic agents and/or other potential
complications of anesthesia or sedation. We recommend that
clinicians also review the following practice advisory (that
includes a section on BIS monitoring): The American Society of
Anesthesiologists, Practice Advisory for Intraoperative
Awareness and Brain Function Monitoring (Anesthesiology 2006;
104:847-64). Clinicians are also recommended to maintain
current knowledge of government regulatory, practice or
research information on BIS and related topics.
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BIS cautions
• Due to elevated surface temperature, do not place the BIS device
in prolonged direct contact with the patient’s skin, as it may
cause discomfort.
• When using an electrosurgery unit, ensure proper contact of the
ESU return electrode to the patient to avoid burns at the monitor
measurement sites. Also ensure that the ESU return electrode is
near the operating area.
• The BIS measurement based on measuring the EEG signal is
inherently very sensitive. Radiated field strengths above 1V/m
may cause erroneous measurements at various frequencies. Do
not use electrical radiating equipment close to the DSC.
• Automatic sensor check may need to be disabled if the 1 nA 128
Hz impedance check signal interferes with other equipment,
such as EEG module with evoked potentials measurement.
• BIS module has been designed to operate with a disposable BIS
sensor.
• Do not use the BIS sensor if it is dry. To avoid dryout, do not open
the pack until you are ready to use the sensor.
• If skin rash or any unusual symptom develops, discontinue the
BIS measurement and remove the sensor.
• Misinterpretation of BIS can result in incorrect administration of
anesthetic agents and/or other potential complications of
anesthesia or sedation.
• When connecting or disconnecting BIS, take care not to touch
the exposed contacts of either connector. Damage due to
electrostatic discharge may result.
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Selecting the BIS waveform size Selecting the BIS smoothing rate
To select the scale for BIS waveforms: Smoothing rate affects the appearance of the BIS trend and the BIS
1. Press the BIS module key or select the BIS parameter window. value.
2. Select Setup. 1. Press the BIS module key, or select the BIS parameter window.
3. Select a value from the Scale µV list. 2. Select Setup.
3. Select a value from the Smoothing Rate list.
Selecting the EEG sweep speed
Using the manual BIS sensor check
NOTE: This same setting is available in BIS, EEG and Entropy setups.
Whenever required, you can perform the sensor check manually.
Regardless of where you change it, it will affect all three parameters.
Press the Check Sensor module key, or:
1. Press the BIS module key or select the BIS parameter window. 1. Select the BIS parameter window.
2. Select Setup. 2. Select Setup > Check Sensor.
3. Select a value from the EEG Sweep Speed list. 3. Observe the results on the screen.
The smaller the value, the slower the sweep speed. 4. The measurement continues automatically after the sensor has
passed the check.

Using the automatic BIS sensor check

To put the automatic sensor check into use:
1. Press the BIS module key or select the BIS parameter window.
2. Select Setup.
3. Select Sensor Check > Automatic.
Testing the digital signal converter
To make sure that the digital signal converter functions properly:
1. Press the BIS module key or select the BIS parameter window.
2. Select Setup > Test DSC.
3. Observe the results on the screen.
Setting BIS filters
To filter out disturbances from the EEG signal:
1. Press the BIS module key or select the BIS parameter window.
2. Select Setup > Filters.
3. Select a filter according to your needs.
BIS measurement on the monitor screen
- Suppression ratio (SR) number: the percentage of suppressed
(flatline) EEG detected over the last 63 seconds
- Bar graphs:
- Signal Quality Index (SQI): the quality of the EEG signal.
NOTE: When the SQI is in the range 15% to 50%, the BIS
number is displayed in gray.
- Electromyograph (EMG): the absolute power in the 70 Hz to
110 Hz frequency band

Setting BIS alarm limits

To set the BIS alarm limits:
1. Press the BIS module key or select the BIS parameter window.
2. Select Alarms. NOTE: If the feature is not active, the alarm limits
are greyed out. Select Alarm On to set the alarms.
3. Set the alarm limits.

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Stopping the BIS measurement Troubleshooting the BIS measurement

1. Remove the BIS sensor from the patient.
2. Disconnect the sensor from the patient interface cable.
3. Discard the sensor.
NOTE: For a comprehensive list of system messages, see the “System
messages“ chapter.
NOTE: For clinical-level troubleshooting, see the “CARESCAPE Monitor
B650 Supplemental Information Manual.”

Problem What to do
Measurement • Check sensor attachment to the patient and
does not start the sensor placement.
• Check the sensor’s contact with skin.
• Check the sensor type.
• Check all connections and the patient
interface cable.
• Check the digital signal converter.
BIS signal is • Check the sensor’s contact with skin.
poor • Check the sensor.
• Ensure that the digital signal converter is not
close to other electrical radiating equipment.
Printing
The monitor can print to an optional recorder or a laser printer.
Recorder option
You can have the recorder option in a pivoting module frame with
either PDM and PSM or PDM, PSM and E-module support.
Recorder option
Recorder functions
A recorder can print waveforms, alarm waveforms, and numeric
trends.
NOTE: Recorders print on thermal paper. The data printed on
thermal paper may be destroyed by exposure to light, heat, acids,
and alcohol. Make a photocopy of the printout for your archives.
You can use the recorder option locally in the pivoting module frame
of the monitor, or you can use a recorder over the network in a
remote monitor or central station. NOTE: Remote recording is only
possible to another GE monitor or a central station, whereas no
remote recording can be done from another monitor to the
CARESCAPE Monitor B650.
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Laser printer
(1) Cancel Print key:
Press to cancel print
request
Laser printer functions
A laser printer can print waveforms, alarm waveforms, numeric
trends, and reports.
A laser printer may be connected to the monitor, network, or to a
central station on the network. A local printer may be directly
connected to the monitor’s network port with a crossover cable or
via a network hub.
NOTE: The laser printer manages multiple laser printouts at a time by
queuing them. If one printout is being processed and another is
initiated for the same laser printer, the second printout will be
queued and printed after the first one. An exception is continuous
printing. If waveforms are being printed continuously and another
printout is initiated for the same laser printer, continuous printing is
stopped and the second printout is printed. After the second printout
is finished, the continuous waveform printing is restarted.
NOTE: Printing of continuous waveform data to a laser printer is
limited to a maximum duration of 5 minutes.
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Points to note Assigning a print location

• Printouts shall be generated via an alarm or a manual request. There are three print locations: Local, Network, and Remote.
• There are four printout types: NOTE: You may assign one printout type to one print location only.
- Waveforms: Realtime waveforms printed via a manual
request. NOTE: Changing the print location does not affect printing currently
- Alarm Waveform: Realtime waveform generated via an in progress.
alarm. To select the printout data that always prints at a specific location:
- Numeric Trends: Printout of vital sign information. 1. Select Monitor Setup > Printing.
- Reports: See below. 2. Select the Devices tab.
• There are two alarm types to print: arrhythmia alarms and non- 3. Select Setup.
arrhythmia alarms. A non-arrhythmia alarm that prints includes: 4. Choose the printout type from the Printout list.
- HR high and low 5. Select the location for the printout.
- Art, ABP, Fem, UAC sys/dia/mean high and low
- SpO2 high and low If you are printing to this location Select this option
- ST high and low Local recorder (optional) Local
• There are three report types:
- Care: User configurable printout that can include items from
Network printer. NOTE: This is always the Network
print location for reports.
individual reports accompanied with graphic trend
information (e.g., graphic trends, QRS/ST, spirometry loops, Remote printer or recorder Remote
etc.). Reports can be configured to print automatically at a
given time interval (e.g., at the beginning of each shift). 6. If you selected Network above:
- Individual: User selectable reports that include ST/QRS data, - Choose the print device from the Network Device list.
spirometry loop, EEG spectral waves, evoked potentials, If you selected Remote above:
stored laboratory, calculations and patient demographic - Choose the monitor or central station from the Unit list.
data. - Choose the print device from the Remote Device list.
- Trend: User configurable graphic trend printout. Trend
interval and printout intervals can be set by the user.
 Setting the print speed
Configuring manual waveform printouts
NOTE: Alarm waveforms will print at 25 mm/s regardless of the
Setting the print delay Paper Speed setting.
NOTE: Alarm waveforms (arrhythmia and non-arrhythmia) start by
To select the sweep speed for a laser printed report or the actual
printing 10 seconds of the most recently saved data, regardless of
paper speed of a recorder:
the Delay setting.
1. Select Monitor Setup > Printing. 1. Select Monitor Setup > Printing.
2. Select the Waveforms tab. 2. Select the Waveforms tab.
3. Choose a value from the Delay list: 3. Select Paper Speed.
- 0 s: Manual waveform printing starts with real time data. 4. Choose a time value from the Paper Speed list.
- 10 s: Manual waveform printing starts with 10 seconds of the Selecting waveforms to print (Manual only)
most recently saved data first. After that, the real time data
1. Select Monitor Setup > Printing.
begins to print.
2. Select the Waveforms tab.
Setting the print duration 3. Choose the desired ECG lead/parameter for waveforms 1-4.
NOTE: Non-arrhythmia alarms print 30 seconds of waveforms
regardless of the Print Length setting.

NOTE: An arrhythmia alarm waveform continues to print up to 20

seconds after the arrhythmia resolves or a new arrhythmia has been
identified. The length of the event shall determine the length of the
printout.
1. Select Monitor Setup > Printing.
2. Select the Waveforms tab.
3. Choose a time value from the Print Length list: 10, 30 or
Continuous. NOTE: If you select Continuous, waveforms
continue to print until you stop the printing. To stop printing, see
“Printing waveforms.”

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Printing waveforms manually

Printing waveforms
There are two ways to print waveforms manually:
Printing waveforms for an arrhythmia alarm • From the main display:
1. Select Alarm Setup from the main menu. Select Print Waveforms. NOTE: If print length has been
2. Select the Arrhythmia tab. configured for Continuous, you will be required to stop or cancel
3. Select Print on Alarm for the arrhythmias you would like to print. the print request.
NOTE: For arrhythmia alarm waveform printing, the printing will • From the waveforms window:
continue until 20 seconds has passed from the clearance of the 1. Select Monitor Setup > Printing.
last active arrhythmia alarm (e.g., 10 seconds saved data, 2. Select the Waveforms tab > Print Waveforms.
arrhythmia alarm duration + 20 seconds data).
Stopping a waveform printout
Printing waveforms for a non-arrhythmia alarm There are two ways to stop printing:
• From the main display: Select Stop Printing.
The following applies to non-arrhythmia alarm waveform printouts:
• From the Waveforms window:
• The print delay is 10 seconds. 1. Select Monitor Setup > Printing.
• The print duration is 30 seconds. 2. Select Waveforms.
• The waveform speed is 25mm/s. 3. Select Stop Printing or Cancel Printing.
To print during a non-arrhythmia alarm condition:
1. Select Monitor Setup > Printing.
2. Select the Waveforms tab.
3. Choose a value from the Print on Alarm list:
- No: No alarm waveforms print during an alarm condition.
- High: Alarm waveforms print during high priority alarm
conditions only.
- All: Alarm waveforms print during any alarm condition.
Printing trends Printing trend reports
Configuring numeric trends for printing Configuring a trend report
To print numeric trend data, you first need to configure the printer to NOTE: Before printing a report, ensure that you have selected the
print either currently viewed numeric trend data (Data on Screen) or proper settings.
all numeric trend data (All Data) relating to the currently viewed 1. Select Monitor Setup > Printing.
page. For details about selecting the data printout type in the Printer 2. Select the Reports tab > Trends.
menu, see the “CARESCAPE Monitor B650 Supplemental Information 3. Choose the desired print length.
Manual.” 4. Choose the desired hour and minutes using the up and down
arrows.
Automatic printing
5. Select Trend pages 1-4.
NOTE: Event, snapshot and ST snapshot printouts can be printed
6. Select hours per page.
automatically by an alarm. See the ”Arrhythmia detection” and
”Trends and snapshots” chapters for alarms that automatically Printing a trend report
create snapshots. For configuration of automatic snapshot and ST NOTE: Before printing a report, ensure that you have selected the
snapshot printing, see the “CARESCAPE Monitor B650 Supplemental proper settings - see above.
Information Manual.” 1. Select Monitor Setup > Printing.
2. Select the Reports tab.
NOTE: iCentral can also start snapshot printing, see the "iCentral and
3. Select Trends > Print.
iCentral Client, User's Reference Manual" for details.
Manual printing
NOTE: Manual printing is possible only when the printing device is
not processing another job at the same time.
1. Select Trends.
2. Select trend type from the View list: Graphic, Numeric, Event,
Snapshot and ST-Snapshot. NOTE: For Numeric trends, see
“Configuring numeric trends for printing“ below.
3. Select desired Time Scale.
NOTE: Time Scale is not selectable in the Numeric and Event
views.
4. Select Print Page.

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Printing care reports Printing individual reports

NOTE: Care reports are predefined in the default setup. For details, 1. Select Monitor Setup > Printing.
see the “CARESCAPE Monitor B650 Supplemental Information 2. Select the Reports tab > Individual Reports.
Manual.” 3. Select the report type you wish to print: QRS/ST, Loops, AEP,
Calculation Trends and Patient Information.
You can print care reports that include graphic trends printouts,
calculation trends printouts, saved spirometry loops printouts and/
or AEP printouts.
Printing care reports manually
1. Select Monitor Setup > Printing.
2. Select the Reports tab.
3. Select Care Report > Print.
Printing care reports automatically
An automatically initiated care report consists of a cover page and
reports selected in the Profile Settings/Care Report menu. The care
report setup allows you to select the content, duration, and
resolution of the reports. The automatic printing of care reports is
possible only in the ICU, ED and NICU software packages. For details,
see the “CARESCAPE Monitor B650 Supplemental Information
Manual”.
Printing calculations Printing laboratory data
Printing Hemo, Oxy or Vent calculations 1. Select Data & Pages > Laboratory Data.
2. Select View > Print.
Before printing calculation printouts or calculation trends, you first
need to enter the calculation values in the Edit Input menu and save NOTE: The Laboratory Data menu is accessible also through the
them in the View menu. For details, see the “Hemodynamic, Hemo, Oxy and Vent Calculations menus.
oxygenation or ventilation calculations” chapter.

To print the currently viewed calculation page:

Printing parameter printouts
You can print parameter printouts from the parameters' own menus.
1. Select Data & Pages > Calculations. For details, see the appropriate parameter chapters.
2. Select Hemo, Oxy or Vent.
3. Select View > Print. The available printouts from parameter menus are 12SL printout, ST
trends printout, QRS/ST printout, cardiac output printout, spirometry
Printing calculation trends
loops printouts, EEG printouts, all ECG waveforms, catheter insertion
To print all calculation trends in the currently selected calculations and PA waveforms/reports, and calculation printouts.
menu:
1. Select Data & Pages > Calculations. Checking print status
2. Select Hemo, Oxy or Vent. You can view the assigned print locations for each type of printout
3. Select Trend > Print. and check the printer status for each print device.
4. To stop printing, select Cancel Printing.
1. Select Monitor Setup > Printing.
To print all calculation trends as individual reports, see the “Printing 2. Select Devices.
individual reports” section for details. 3. Select Status.

Printing drug calculations

1. Select Data & Pages > Drug Calculator.
2. Select Calculator > Print.
Printing drug titration table
1. Select Data & Pages > Drug Calculator.
2. Select Titration Table > Print.

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Print header information for laser printer Print header for recorder
The print header is printed with all patient waveforms and includes: • Patient name
• Patient name (displayed if configured in the care unit default • Second ID
settings). • Medical record number
• Second ID • Bed number
• Medical record number • Unit name
• Bed number • Date and time of the printout
• Unit name (if the monitor is on the CARESCAPE Network MC) • Printout name
• Hospital name
• Date and time of the printout
• Current page/total number of pages (e.g., 1/12)
• Printout title (e.g., alarm, waveforms, and reports).
• Identification field for a patient identification sticker.
• Notes field for manually written notes.
Laboratory data
The laboratory data entry process in the Laboratory Data menu is
similar whether entering data manually or from an interfaced
device. For an interfaced device, the values are updated
automatically to the table. For details, see the “Loading laboratory
data from an interfaced device” section.
Manually entering laboratory data
Temperature correction
In the laboratory, blood gas values are measured and calibrated at
+37°C (+99°F). The pH, PCO2 and PO2 values may need to be
corrected to the actual patient temperature since an increase or
decrease in temperature changes the amount of dissolved blood
gas molecules and pH.
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The monitor has three options for temperature correction. To choose:
1. Select Data & Pages > Laboratory Data.
2. Select Enter Data.
3. In the Temperature Correction field, select one of the following:
• Laboratory = Temperature correction has been done in the
laboratory and the values have already been corrected to
patient temperature. The entered pH, PCO2 and PO2 values
are stored without adjustment and shown in the Temp
corrected column.
• Yes = The monitor will perform correction calculations. In the
Temperature Source field, you can select any of the
available temperature sources for recalculating the entered
values (Manual, T1-T4, Eso, Naso, Tymp, Rect, Blad, Core,
Tblood). The monitor recalculates, corrected to patient
temperature, the entered blood gas values and displays both
the corrected and uncorrected values.
• No = No temperature correction is needed. The entered
blood gas values are stored as such.
NOTE: While the Enter Data menu shows both the corrected and
uncorrected values, the View menu shows either the corrected or
uncorrected values depending on the Temperature Correction
selection.
For formulas used to calculate values when Temperature Correction
(Tcorr) is enabled, see the “CARESCAPE Monitor B650 Supplemental
Information Manual.”
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Selecting sample site

To select the blood sample site: To manually enter laboratory values:
1. Select Data & Pages > Laboratory Data. 1. Select Data & Pages > Laboratory Data.
2. Select Enter Data. 2. Select Enter Data.
3. In the Sample Site field, select Arterial, Venous or Other. 3. Depending on your selection in the Temperature Correction
NOTE: Selecting Arterial or Venous affects the labeling of pH, field, in the Measured values or Temp corrected column, set the
PCO2, PO2 and SO2: with Arterial the labels are pHa, PaCO2, PaO2 value for the selected parameter.
and SaO2, and with Venous they are pHv, PvCO2, PvO2 and SvO2. NOTE: When setting a value, it first changes to its default value.
After that, it can be adjusted to the desired value.
Selecting sample time 4. Select Save to confirm the values.
To select the blood sample time:
NOTE: Save is enabled only after Sample Time has been set.
1. Select Data & Pages > Laboratory Data.
2. Select Enter Data. NOTE: The entered data is lost if you exit the menu without saving.
3. Set the Sample Time.
Entering laboratory values
The Laboratory Data menus show many laboratory values but you
can manually enter a limited number of them (pH, PCO2, PO2, HCO3,
BE, TCO2, SO2, FiO2 and Hb). The rest of the laboratory values are only
available through interfaced devices.

NOTE: When entering laboratory values, make sure that the units are
the same as the ones on the screen. If not, convert the values or
change the units on the screen. For details on changing the units,
see the “CARESCAPE Monitor B650 Supplemental Information
Manual.”
Loading laboratory data from an interfaced device Viewing, editing, and trending calculations
The message ‘Lab data available’ is displayed in the message field To view, edit, or trend hemodynamic, oxygenation, or ventilation
when lab data is available. calculation information, see the “Hemodynamic, oxygenation or
ventilation calculations” section.
If new laboratory data is available from an interfaced device, it is
displayed when the Enter Data menu is opened. The values are Viewing and printing the latest laboratory data
updated automatically to the table.
NOTE: The View menu shows either the corrected or uncorrected
NOTE: It is not possible to edit interfaced values, but it is possible to values depending on the Temperature Correction status. For
perform temperature correction to them. For details, see the details, see the “Temperature correction” section.
“Temperature correction” section.
To view the most recently saved laboratory data:
To view interfaced laboratory values: 1. Select Data & Pages > Laboratory Data.
1. Select Data & Pages > Laboratory Data. 2. Select View.
2. Select Enter Data.
NOTE: The View menu shows the laboratory data values with the
3. In the Temperature Correction field, select Laboratory, Yes or
newest time stamp.
No.
NOTE: All interfaced values are first displayed in the Measured To print the most recently saved laboratory data:
values column. If Laboratory is selected to the Temperature
1. Select Data & Pages > Laboratory Data.
Correction field, the pH, PCO2 and PO2 values are shifted to the
2. Select View.
Temp corrected column. 3. Select Print.
4. In the Sample Site field, select Arterial, Venous or Other.
NOTE: Unsaved, previously obtained interfaced laboratory data
continues to be displayed with the sample time from collection in
the Enter Data menu, even when new laboratory data is
available from interfaced devices and the Enter Data menu is
closed and re-entered.
NOTE: The sample time is obtained from an interfaced device if
sent by the device.
5. Check the Sample Time if obtained from an interfaced device. if
needed, change or set it to the correct time.
6. Select Save to confirm the values.

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Hemodynamic, oxygenation or ventilation calculations

Calculations are used to derive calculated hemodynamic,
oxygenation and ventilation values from actual measurements.
Indexing parameters
Calculations also provide trending for the calculated values. NOTE: Indexing parameters is possible in Hemo View and Oxy View.

Laboratory data saved in the Laboratory Data menu can be used as To index parameters:
input data for oxygenation and ventilation calculations. For details, 1. Select Data & Pages > Calculations.
see the “Source data for calculations” section. 2. Select Hemo or Oxy.
3. Select View.
NOTE: The monitor marks the temperature corrected values in the
4. By checking the box Indexed, parameters that can be indexed
Oxy and Vent calculations menus with the letter 'c', when PCO2 and
are displayed as indexed and indexed parameter values are
PO2 are obtained through the Laboratory Data menu and the calculated.
temperature correction selection has been Laboratory or Yes. For
details, see the “Temperature correction” section. NOTE: The indexed values are calculated only if the patient’s BSA
(body surface area) value is available at the time when the
Viewing calculation values calculations are performed.
1. Select Data & Pages > Calculations.
2. Select Hemo, Oxy or Vent.
3. Select View.

NOTE: When the View menu is entered, parameter data is displayed

in two columns, labeled Input Parameters and Calculated
Parameters.

For a list of input and calculated parameters displayed, see the

“CARESCAPE Monitor B650 Supplemental Information Manual.”

Editing calculation input values
1. Select Data & Pages > Calculations.
2. Select Hemo, Oxy or Vent.
3. Select Edit Input.
4. Enter or edit the parameter values in the Value column.
The edit time for each parameter is displayed to the left of each
value in the column labeled Entry time.
NOTE: IMPORTANT - If the Previous Menu is selected defore
saving the values, the values are lost.
5. To perform the calculation and save the values, select the View
tab.
From the Hemo >Edit Input window, you can select the following
options:
• Demographics: opens the Edit Demographics window. See
the “Starting and ending monitoring” chapter for details.
• C.O.: opens the Cardiac Output procedure window. See the
“Cardiac output (C.O.)” chapter for details.
• PCWP: opens the Wedge procedure window. See the
“Invasive blood pressures” chapter for details.
From the Oxy and Vent > Edit Input window, you can select the
following option:
• Lab Data: Opens the Laboratory Data window View tab. See
"Source data for calculations" for details.
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Source data for calculations
Several types of data (ventilator, blood gas, laboratory) are required
to complete a calculation. Data can be entered automatically using
a network interface, or manually by the clinician. The monitor uses
the C.O. measurement as source data for hemodynamic
calculations. For oxygenation calculations it uses laboratory data. If
laboratory data is unavailable C.O measurement is used as the
source data for calculations. Other input values (e.g. HR, PA
Mean, CVP, Art Mean) used in the calculation are chosen from the
same time the sample is drawn or the cardiac output is measured.
NOTE: C.O. or CCO and/or their indexed values that are older than 15
minutes are not used as source data for hemodynamic or
oxygenation calculations.
In oxygenation calculations, you can select any arterial laboratory
data samples (if multiple values are available) or any C.O.
measurement (if no laboratory data, but multiple C.O. values are
available) from the current patient case to be used as source data:
1. Select Data & Pages > Calculations.
2. Select Oxy.
3. Select Edit Input.
4. In the Select Lab Data field, select the desired sample with
corresponding date and time.
NOTE: The C.O measurement values are selectable only when
there is no laboratory data available.
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In ventilation calculations, you can select any arterial laboratory

data samples from the current patient case to be used as source
Viewing saved calculations
data: To view values of up to 12 most recently saved calculations:
1. Select Data & Pages > Calculations.
1. Select Data & Pages > Calculations.
2. Select Hemo, Oxy or Vent.
2. Select Vent.
3. Select Trend.
3. Select Edit Input.
4. In the Select Lab Data field, select the desired sample with The monitor displays indexed values if the box Indexed has been
corresponding date and time. checked in the Trend menu and Save has been selected to add the
calculations to the trends.
Estimated values in oxygenation calculations
In normal circumstances, about 3% of the total arterial oxygen NOTE: The indexed values are calculated and trended only if the
content is dissolved in the blood and 97% is hemoglobin bound. patient’s BSA (body surface area) value is available at the time when
When no SaO2 laboratory result is saved in the Laboratory Data the calculations are performed.
menu, the measured SpO2 value is used to estimate the clinically
To navigate between the pages of the Trend menu, use the left or
relevant SaO2 value. Also, the measured EtCO2 value is used to
right arrow keys in the lower part of the menu.
estimate the PaCO2 value. The monitor marks the estimated value by
adding the letter ‘e’ to the SaO2 and PaCO2 values in the Oxy > View Printing calculations
and Oxy > Trend menus. NOTE: The Print button is disabled if the displayed calculations have
not been saved.
Saving calculation values To print hemodynamic, oxygenation or ventilation calculations:
1. Select Data & Pages > Calculations. 1. Select Data & Pages > Calculations.
2. Select Hemo, Oxy or Vent. 2. Select Hemo, Oxy or Vent.
3. Select View. 3. Select View.
4. Select Save. 4. Select Print.
Selecting Save saves the input parameter values and calculated To print all calculation trends:
parameter values to the corresponding calculation trends. 1. Select Data & Pages > Calculations.
2. Select Hemo, Oxy or Vent.
NOTE: The Save button is disabled if neither the input parameters 3. Select Trend.
nor the calculated parameters have values available, or if the 4. Select Print.
displayed values have already been saved.
For more details about printing calculations, see the “Printing”
chapter.
Drug calculations
Adding a new drug name temporarily
Calculating drug doses
You can temporarily add a new drug name and calculate drug doses
The drug calculator allows you to calculate and print the doses and
for that drug. The drug name is deleted when the patient is
infusion rates for intravenous medications. You can select a drug
discharged from the monitor.
name from a pre-defined list, or add a drug name that is used until
1. Select Data & Pages > Drug Calculator.
the patient is discharged from the monitor.
2. Select Calculator > Additional Drug.
NOTE: For details about modifying the list of pre-defined drug names 3. Enter the drug name with the on-screen keyboard.
configured in the care unit defaults, see the “CARESCAPE Monitor 4. Select Add > Previous Menu.
B650 Supplemental Information Manual.” 5. To select this drug, choose the drug name from the Drug Name
NOTE: Changing the weight value in the drug calculator menu does list.
not change the weight in the patient demographics. Printing drug dose calculations
1. Select Data & Pages > Drug Calculator. To print the calculated drug dose and infusion rate:
2. Select Calculator 1. Select Data & Pages > Drug Calculator.
3. Choose a drug from the Drug Name list. 2. Select Calculator.
4. If the patient’s weight was not entered at the time of admission, 3. Select Print.
set the Patient's Weight. 4. To stop printing, select Stop Printing or Cancel Printing.
5. Set the Solution Volume.
6. Set the Drug Amount. The concentration level is automatically
calculated.
7. Set the Dose Unit, if appropriate.
8. Set the Dose.
The infusion rate and infusion time in hours and minutes are
automatically calculated.

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Calculating drug titrations
The titration table calculator allows you to calculate and print
titration information for a selected drug.
NOTE: To change the drug’s unit of measure in the titration table,
select Calculator > Dose Unit.
NOTE: For details about setting the patient weight unit, see the
"CARESCAPE Monitor B650 Supplemental Information Manual.”
NOTE: Changing the weight value in the drug calculator menu does
not change the weight in the patient demographics.
1. Select Data & Pages > Drug Calculator.
2. Select Titration Table.
3. If the patient’s weight was not entered during admission, select
the Patient's Weight.
Changing increments between dose values in titration
table
1. Select Data & Pages > Drug Calculator.
2. Select Titration Table.
3. Set the Dose Increment.
Printing titration table calculations
1. Select Data & Pages > Drug Calculator.
2. Select Titration Table.
3. Select Print.
4. To stop printing, select Stop Printing or Cancel Printing.
Calculating resuscitation medication doses
NOTE: With the NICU software package only.
The resuscitation medication calculator allows you to calculate,
view, and print resuscitation medication information for neonates.
1. Select Data & Pages > Drug Calculator
2. Select Resuscitation Medications.
3. If the patient’s weight was not entered at the time of admission,
set the Patient's Weight.
NOTE: Changing the weight value in the Calculator, Titration
Table, or Resuscitation Medications menu changes the weight
value displayed in each of these menus.
4. Select Confirm.
NOTE: You must confirm the patient’s weight value before the
monitor will calculate the dose values.
Printing resuscitation medication doses
To print a list of resuscitation medications and their concentration
level, delivery method, and dose value:
1. Select Data & Pages > Drug Calculator.
2. Select Resuscitation Medications.
3. Select Print.
4. To stop printing, select Stop Printing or Cancel Printing.
Abbreviations
/min beats per minute, breaths per minute Arrh arrhythmia
°C Celsius degree Art; ABP arterial pressure
°F Fahrenheit degree ASA American Society of Anesthesiologists
µ micro ASB assisted spontaneous breathing
12RL twelve reduced leads ASY asystole
12SL twelve simultaneous leads ATMP atmospheric pressure
a arterial ATPD atmospheric/ambient temperature and pressure,
A auricular dry gas
A Fib atrial fibrillation ATPS ambient temperature and pressure,
A alveolar saturated gas
a/AO2 arterio-alveolar PO2 ratio aVF left foot augmented lead
AA anesthetic agent avg average
AaDO2 alveoli-arterial oxygen difference aVL left arm augmented lead
AAMI Association for the Advancement of Medical AVOA automatic view on alarm
Instrumentation aVR right arm augmented lead
AC alternating current Axil axillary temperature
Accel. Ventric. accelerated ventricular rhythm BAEP brainstem auditory evoked potential
ACI-TIPI acute cardiac ischemia - time insensitive BE base excess
predictive instrument Beta beta frequency band
ACL access control list Beta% beta frequency band percentage
ACT activated clotting time BIPAP biphasic positive airway pressure
ADU Anesthesia Delivery Unit BIS bispectral index
AEP auditory evoked potential Blad bladder temperature
AGSS anesthetic gas scavenging system BNP B-type natriuretic peptide
AHA American Heart Association Brady bradycardia
AirW airway temperature BSA body surface area
Alpha alpha frequency band BSR burst suppression ratio
Alpha% alpha frequency band percentage B-to-B beat-to-beat
Amp amplitude BTPS body temperature and pressure, saturated gas
ANSI American National Standards Institute BUN blood urea nitrogen
Ant. anterior C central
APN apnea C (C1-C6) chest

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C(a-v)O2 arteriovenous oxygen content difference CPAP/PPS continuous positive airway pressure &
C.I. cardiac index proportional pressure support
C.O. cardiac output CPAP Demand continuous positive airway pressure on demand
C1 to C6 ECG lead C1 to ECG lead C6 (IEC) CPB cardiopulmonary bypass
cal. calibration CPP cerebral perfusion pressure
Calcs calculations CPPV continuous positive pressure ventilation
CaO2 arterial oxygen content CPU central processing unit
cc cubic centimeter Cr creatinine
CCI continuous cardiac index CSA Canadian Standards Association
CCO continuous cardiac output CSA compressed spectral array
CcO2 capillary oxygen content CT computed tomography
CCU cardiac (coronary) care unit CUI common user interface
CIC Clinical Information Center CvO2 venous oxygen content
CICU cardiac intensive care unit CVP central venous pressure
CISPR International Special Committee on Radio d day
Interference dB decibel
CK-MB cardiac muscle type creatine kinase DBS double burst stimulation
Cl chlorine DC direct current
cmH2O centimeter of water Delta delta frequency band
CMRR common mode rejection ratio Delta% delta frequency band percentage
CNS central nervous system Des desflurane
CO2 carbon dioxide Dia; dia diastolic pressure
COHb carboxyhemoglobin Diagn. diagnostic
Compl; C compliance DIDCA Device IDentification Cable Adapter
Contin Flow continuous flow DIFF difference
Contrl; Controlled controlled ventilation DO2 oxygen delivery
Core core temperature DO2I oxygen delivery index
Count count of responses DS dead space ventilation
CPAP continuous positive airway pressure DSC digital signal converter
CPAP Contin continuous positive airway pressure continuous e estimated
CPAP/ASB continuous positive airway pressure & assisted ECG electrocardiogram
spontaneous breathing ED emergency department
CPAP/IMV TCPL continuous positive airway pressure & control EDV end-diastolic volume
time-cycle pressure-limited EDVI end-diastolic volume index
EE energy expenditure (kcal/24h) Fem femoral
EEG electroencephalogram FEMG frontal electromyogram
EEMG evoked electromyogram FemV femoral venous
EEPROM electrically erasable programmable read only FEO2 mixed expired oxygen concentration
memory FFT fast Fourier transform
EEtot total energy expenditure FI; Fi fraction of inspired gas
EMBC module frame for PDM and E-modules FiAA fraction of inspired anesthetic agent
EMC electromagnetic compatibility Fib fibrillation
EMG electromyogram FiCO2 fraction of inspired carbon dioxide
EMMV extended mandatory minute ventilation FiN2 fraction of inspired N2
EMI electromagnetic interference FiN2O fraction of inspired nitrous oxide
Enf enflurane FiO2 fraction of inspired oxygen
Entr. entropy Flow; F flow
EP evoked potential Flow-Vol Loop flow volume loop
ESD electrostatic discharge Fp fronto-polar
ESD electrostatic sensitive devices Fr French (unit of measure for a Catheter diameter
Eso esophageal temperature scale)
ESU electrosurgical unit ft feet
ESV end-systolic volume ft foot
ESVI end-systolic volume index g gram
ET endotracheal g/dl grams per deciliter
ET; Et end-tidal concentration g/l grams per liter
EtAA end-tidal anesthetic agent GEDI global end-diastolic volume index
EtBal end-tidal balance gas GND ground
EtCO2 end-tidal carbon dioxide Graph. graphical
EtN2O end-tidal nitrous oxide h hour
EtO2 end-tidal oxygen Hal halothane
Exp; exp expiratory Hb hemoglobin
F foot (describing location) HbO2 oxyhemoglobin
f frequency HCO3- bicarbonate
F frontal Hct hematocrit
F(I-E)O2 inspiratory mixed expiratory oxygen HDU high dependency unit
fraction difference Hemo hemodynamic
FECO2 mixed expired carbon dioxide concentration Hemo Calcs hemodynamic calculations

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HFV high frequency ventilation IP invasive blood pressure

HIS hospital information system IPPV intermittent positive pressure ventilation
HME heat and moisture exchanger IPPV/ASSIST intermittent positive pressure ventilation &
HMEF heat and moisture exchanger with filter assisted
hPa hectopascal IrMod% infrared modulation percentage
HR heart rate ISO International Standards Organization
HRdif heart rate difference Iso isoflurane
HW hardware IV intravenous
Hz hertz IVR idioventricular rhythm
I lead I J joule
I.U. international unit K potassium
I:E inspiratory-expiratory ratio kbps kilobits per second
IABP intra-aortic balloon pump kcal kilocalorie
iCa ionized Calcium kg kilogram
ICP intracranial pressure kJ kilojoule
ICU intensive care unit kPa kilopascal
ID identification l liter
IEC International Electrotechnical Commission l/min liters/minute
II lead II LA left arm (describing location)
III lead III Lab laboratory
IM intramuscular LAN local area network
Imped impedance LAP left atrial pressure
ImpResp impedance respiration Lat. lateral
IMV intermittent mandatory ventilation lb pound
IMV Contin continuous intermittent mandatory ventilation LCD liquid crystal display
IMV Demand intermittent mandatory ventilation on demand LCW left cardiac work
in inch LED light emitting diode
IND induction LL left leg (describing location)
Inf. inferior LVEDP left ventricular end diastolic pressure
Infl. inflation (limit) LVEDV left ventricular end diastolic volume
INR international normalized ratio LVSW left ventricular stroke work
Insp; insp inspiratory LVSWI left ventricular stroke work index
Insp Pause inspiratory pause time MAC minimum alveolar concentration
IP internet protocol Man manual
Man/Spont manual/spontaneous MRI magnetic resonance imaging
MAP mean arterial pressure MRN medical record number
Max. maximum ms millisecond
MB megabyte Multif. PVCs multifocal premature ventricular contractions
mbar millibar MV minute volume
MBC module bus controller MVexp expired minute volume (l/min)
mcg/l microgram per liter MVexp(BTPS) expired minute volume in BTPS conditions
mcmol/l micromole per liter MVexp(STPD) expired minute volume in STPD conditions
MD medical device MVinsp inspired minute volume (l/min)
MDN medical device network MVspont expired spontaneous minute volume
MDNS medical device network server Myo myocardiac temperature
Mean; mean mean blood pressure N neutral
mEq milliequivalent N/A not applicable
mEq/l milliequivalent per liter N2 nitrogen
MetHb methemoglobin N2O nitrous oxide
MF median frequency Na sodium
mg milligram Naso nasopharyngeal temperature
mg/dl milligram per deciliter Neo neonate
mI.U. milli International Unit Net network
MICU medical intensive care unit Neuro neurological
Min minimum Neuro ICU neurological intensive care unit
min minute ng/l nanogram per liter
ml milliliter ng/ml nanogram per milliliter
MLAEP middle-latency auditory evoked potential NIBP non-invasive blood pressure
mm millimeter NIC network interface card
mmHg millimeters of mercury NICU neonatal intensive care unit
mmol millimole NMBA neuromuscular blocking agent
mmol/l millimole per liter NMT neuromuscular transmission
MMV mandatory minute ventilation NTPD normal temperature and pressure, dry gas
MMV/ASB mandatory minute ventilation & assisted O occipital
spontaneous breathing O2 oxygen
Moder. moderate O2ER oxygen extraction ratio
mol mole OR operation room
Monit. monitoring Oxy oxygenation

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Oxy Calcs oxygenation calculations PEEPe extrinsic positive end expiratory pressure (ICU, ED
OxyCRG oxycardiorespirogram software packages)
P parietal PEEPe+PEEPi total positive end expiratory pressure (ICU, ED
P partial pressure software packages)
P pressure PEEPi intrinsic positive end expiratory pressure (ICU, ED
Pa Pascal software packages)
PA pulmonary arterial pressure PEEPtot total positive end expiratory pressure (OR and
PAC premature atrial contraction PACU software packages)
Paced paced beats pg/ml picogram per milliliter
PaCO2 partial pressure of carbon dioxide in the arteries pH potential of hydrogen
PACU post anesthesia care unit pHa arterial pH
PAO2 partial pressure of oxygen in the alveoli pHv mixed venous pH
PaO2 partial pressure of oxygen in the arteries pHv venous pH
Paw airway pressure PIC patient interface cable
Paw-Vol Loop pressure volume loop PICU pediatric intensive care unit
Pbaro barometric pressure Pinsp inspiratory (target) pressure
PC personal computer PIr perfusion index (relative)
PCO2 carbon dioxide partial pressure Pleth plethysmographic pulse waveform
pCO2 partial pressure CO2 Pmean mean pressure
pcs pieces Pmin minimum pressure
PCV pressure controlled ventilation PN part number
PCV-A/C pressure controlled ventilation & assisted control PO2 oxygen partial pressure
PCV-CMV pressure controlled ventilation – controlled pO2 partial pressure O2
mandatory ventilation Ppeak peak pressure
PCV-CPAP pressure controlled ventilation & continuous Pplat plateau (pause) pressure
positive airway pressure PR pulse rate
PCWP pulmonary capillary wedge pressure PSM patient side module
PCV-SIMV pressure controlled ventilation & synchronized PSU polysulfone
intermittent mandatory ventilation PT prothrombin time
PDF portable document format PTC post tetanic count
PDM patient data module PVC polyvinyl chloride
PE polyethylene PVC premature ventricular contraction
Pedi pediatric PvCO2 carbon dioxide partial pressure in mixed venous
PEEP positive end-expiratory pressure blood
PvO2 partial pressure of oxygen in (mixed) venous RVSW right ventricular stroke work
blood RVSWI right ventricular stroke work index
PVR pulmonary vascular resistance s second
PVRI pulmonary vascular resistance index SaO2 arterial oxygen saturation
QRS QRS complex SDU step-down unit
QS system Quantitative Sentinel SE state Entropy
Qs/Qt venous admixture SEF spectral edge frequency
QT Q-T interval SEMG spontaneous electromyogram
QTc corrected value of the QT interval Sev sevoflurane
R right (describing location) SI stroke index
RA right arm (describing location) SICU surgical intensive care unit
RAM random access memory SIMV synchronized intermittent mandatory ventilation
RAP right atrial pressure SIMV/ASB synchronized intermittent mandatory ventilation
Raw airway resistance & assisted spontaneous breathing
RCW right cardiac work SIMV/CPAP synchronized intermittent mandatory ventilation
RCWI right cardiac work index & continuous positive airway pressure continuous
RE response Entropy SIMVPS synchronized intermittent mandatory ventilation
Rect rectal temperature & pressure support
ref reference SjO2 jugular bulb oxygen saturation
REF right ventricular ejection fraction Skin skin temperature
Resp Rate respiration rate (total) (measured) SL simultaneous leads
RF radio frequency SN serial number
RHb reduced hemoglobin SO2 saturated oxygen
RL reduced leadset Spiro Patient Spirometry
RMS average (root mean square) power SpO2 oxygen saturation
ROM read only memory Spont spontaneous
Room room temperature SPS samples per second
RQ respiratory quotient SQ subcutaneous
RV residual volume SQI signal quality index
RVEDV right ventricular end-diastolic volume SR suppression ratio
RVEDVI right ventricular end-diastolic volume index SRAM static random access memory
RVESV right ventricular end-systolic volume SSEP somatosensory evoked potentials
RVESVI right ventricular end-systolic volume index ST single twitch
RVP right ventricular pressure ST ST segment

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STBY standby Tinsp inspiratory time

STPD standard temperature and pressure, dry gas TOF train of four
Supra supramaximal TOF% train of four %
Surf surface temperature Torr Torr (unit of pressure)
SV stroke volume Tpause pause time
SV supraventricular TV tidal volume
SW software TVexp expired tidal volume (ml)
SVI stroke volume index TVinsp inspired tidal volume (ml)
SvO2 mixed venous oxygen saturation Tx-Ty temperature difference
SVR systemic vascular resistance Tymp tympanic temperature
SVRI systemic vascular resistance index UAC umbilical arterial catheter
SVV stroke volume variation UI user interface
Sync MAS Synchrom Master UVC umbilical venous catheter
Sync SLV Synchrom Slave v venous
Sys; sys systolic pressure V ventricular
T temperature V; Vent ventilation
T temporal electrode placement V (V1-V6) chest
T(BTPS) temperature in BTPS conditions V Brady ventricular bradycardia
T1 first twitch V Fib ventricular fibrillation
T1% first stimulus as % of the reference value NMT V Tach ventricular tachycardia
Tab tabular V1 to V6 ECG lead V1 to ECG lead V6 (AAMI/AHA)
Tachy tachycardia VA alveolar ventilation
Tblood blood temperature VC vital capacity
TC transcutaneous VCO2 carbon dioxide production
tcCO2 transcutaneous carbon dioxide Vd dead space
TCO2 total carbon dioxide Vd/Vt dead space ventilation
tcO2 transcutaneous oxygen Vent ventilator
Tcorr patient temperature used to correct pH, PCO2, Vent Calcs ventilation calculations
PO2 VO2 oxygen consumption
TCP/IP transmission control protocol / internet protocol VO2calc calculated oxygen consumption
Texp expiration time VO2calcI calculated oxygen consumption index
Theta theta frequency band VO2I oxygen consumption index
Theta% theta frequency band percentage Vol; V volume
Tinj injectate temperature Vol Assist volume assisted
WLAN wireless local area network
yr year
yrs years

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GE Healthcare Finland Oy
Kuortaneenkatu 2
FI-00510 Helsinki, Finland
Tel: +358 10 39411
Fax: +358 9 1463310
www.gehealthcare.com

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