PD W 28 2

Pooyandegan Rah Saadat
User's Reference ManuaI

Aria Patient Monitor
1254
POOYANDEGAN RAH SAADAT CO.
No. 48, EIm-o-Sanat university st., Hengam st.,
ResaIat highway,
TEHRAN
IRAN
Post box: 16765-965
Tel: +98 21 77180630-4
Fax: +98 21 77180629
Customer Services:
Tel: +98 21 77180650-4
Fax: +98 21 77180655
Cell: +98 912 1977157
LegaI responsibIe:
HEYER Medical AG
Mrs. Gertrud Werner
Carl-Heyer Str. 1-3
56130 Bad Ems, Germany
Tel: 49 2603 791-145
Fax: 49 2603 791-209
E-Mail: InIoheyermedical.de
Web site: www.saadatco.com
Email: info@saadatco.co
PD-W-28/2
1254
Chapters
Page
Chapters
1 Introduction 1
34 System conIiguration 2
61 Alarms 3
71 ECG monitoring 4
103 RESP monitoring 5
112 SPO2 monitoring 6
149 NIBP monitoring 7
178 TEMP monitoring 8
189 Patient saIety 9
194 Maintenance and Cleaning 10
201 Getting started 11
206 Contiuous patient monitoring 12
210 Technical speciIications 13
220 Accessories 14
224 Troubleshooting 15
Contents
Contents
1 Introduction
General Warnings ............... 2
General InIormation .................... 9
Indicators, connectors and controls....... 13
Indicators................ 14
Main Screen............... 16
DiIIerent Page conIigurations ......... 19
Keys Function............... 21
InterIaces................. 24
Battery......................... 32
2 System ConIiguration
SETUP.................. 36
PATIENT................... 41
SIGMA.................... 44
PAGE SETUP.................. 45
ALARM.................. 47
TREND................... 49
FACTORY................. 55
ABOUT................... 60
Contents
3 Alarms
4 ECG monitoring
5 RESP Monitoring
Alarm Categories................ 62
Alarm Causes................ 66
Alarms and Silence keys.............. 67
Parameters Alarm ............... 69
When an alarm occurs............ 70
General InIormation................. 71
ECG Parameter Menu................. 87
ECG Trace Menu................... 90
ECG Alarm Messages................. 96
ECG Cable Cleaning................... 101
General InIormation.............. 103
RESP Parameter Menu............. 106
RESP Trace Menu.............. 109
RESP Alarm Messages............. 110
Contents
6 SPO2 & Rainbow Parameters Monitoring
7 NIBP Monitoring
8 TEMP Monitoring
SPO2 Parameter Menu............. 131
SPO2Trace Menu............... 137
SPO2 Alarm Messages............. 138
SPO2 Probe Cleaning.............. 148
NIBP Parameter Menu............. 161
NIBP Alarm Messages............ 171
NIBP CuII Cleaning.............. 177
TEMP Parameter Menu............ 183
TEMP Error Messages............. 185
TEMP Sensor Cleaning and Maintenance........ 186
9 Patient SaIety
Contents
10 Maintenance and Cleaning
11 Getting Started
12 Contiuous patient monitoring
13 Technical SpeciIications
14 Accessories
System Check............... 194
Cleaning..................... 196
Sterilization................... 198
DisinIection................... 199
Open the package and check ............ 201
Plug the power cable into the system............ 202
Power on the monitor.................. 204
Attach the sensors to the patient........... 205
ECG Accessories................ 221
SPO2 Accessories.............. 221
NIBP Accessories............... 221
TEMP Accessories................... 223
Contents
15 Troubleshooting
1
1
Introduction
u For an overall saIety instruction, please reIer to
the general warning.
u For an overall introduction to the monitor, please
reIer to the general inIormation.
u For various messages displayed on the screen,
please reIer to the main Screen.
u For basic operating instructions, please reIer to
the button Iunctions.
u For system connectors description, please reIer
to the interIaces.
u For important Iacts to be noted during the
battery recharging procedure, please reIer to the
battery.
General Warnings
2
General Warnings
Vital signs monitoring through the patient
monitor should be perIormed by qualiIied health care
proIessionals.
The vital sign monitor is intended Ior use only
as an adjunct in patient assessment .It must be used
in conjunction with clinical signs and symptoms.
BeIore use, careIully read this manual, directions
Ior use oI any accessories, all precautions, and all
speciIications.
General Warnings
3
II the accuracy oI any measurement does not
seem reasonable, Iirst check the patient's vital signs
by alternate means and then check the monitor Ior
proper Iunctioning.
Do not use the patient monitor during magnetic
resonance imaging (MRI) scanning. Induced currents
could potentially cause burns. The monitor may
aIIect the MRI image, and the MRI unit may aIIect
the accuracy oI monitor measurements.
There could be hazard oI electrical shock by
opening the monitor casing. All servicing and Iuture
upgrading to this equipment must be carried out by
personnel trained and authorized by the
manuIacturer.
General Warnings
4
To prevent EMC eIIects on the monitor, the
system should not be used adjacent to or stacked
with other equipment and that iI adjacent or stacked
use is necessary, the equipment should be observed
to veriIy normal operation in the conditions in which
it will be used.
Equipment is not suitable Ior use in the
presence oI a Ilammable anesthetic mixture with air
or oxygen or nitrous oxide.
The user should make sure that equipment and
accessories Iunction saIely and see that it is in proper
working condition beIore being used.
General Warnings
5
Alarm must be adjusted according to diIIerent
situations oI individual patient. Make sure that audio
sounds can be activated when alarm occurs.
Do not use cellular phone in the vicinity oI this
equipment. High level oI electromagnetic radiation
emitted Irom such devices may result in strong
interIerence with the monitor perIormance.
Do not touch the patient, table nearby, or the
equipment during deIibrillation.
The system casing and equipment connected to
it should Iorm an equipotential body to ensure
eIIective grounding.
General Warnings
6
Do not use one monitor Ior monitoring two or
more patients at the same time.
The physician shall consider all well-known
side eIIects when using the patient monitor.
There will be some risks oI polluting the
environment associated with the disposal oI the
single use accessories and some system parts (e.g.
deIective and decommissioned accessories and
battery) at the end oI their useIul lives. The device
and accessories shall be disposed in accordance with
national laws aIter their useIul lives. Contact your
municipality to check where you can saIely dispose
oI old batteries.
General Warnings
7
Monitor soItware is designed in a way that
hazards arising Irom errors in the soItware
programm are minimized.
Do not expose the system near any local
heating item such as the direct sunlight.
It is possible to increase leakage current when
several systems are connected to the patient
simultaneously.
Do not connect items not speciIied as parts oI
the monitor. Vital sign monitor needs to be installed
and put into service according to the EMC
inIormation provided in the APPENDIX IV.
General Warnings
8
In case oI water splash on the system or
accessories , please turn oII the monitor , wipe it
with a soIt cloth and then turn on it.
General Information
9
General Information
Environmental conditions
c 40 5
Operating temperature
c 60 20 -
Storage and transport temperature
, 90 20
Humidity
3000m 200 -
Altitude
90 240 Vac
50/60 Hz
Pmax 15 W
Power supply
Aria Patient Monitor (Figure 1-1) is adaptable to adult and
neonatal usage. It can monitor vital signals as ECG,
Respiratory Rate(AWRR,RR), NIBP, SPO2, CO2, N2O,
O2, Anesthesia Agent(AA) , Dual channel IBP and Iour
channel IBP. It contains modules measuring various
parameters oI the patient and Ieatures in compactness,
lightweight and portability. Battery Iacilitates
transportation oI the patient.
General Information
10
Portable Patient Monitor perIorms monitoring oI
Iollowing parameters:
Heart Rate(HR)
ST segment
PVCs/min and Arrhythmias
ECG waveIorm
Respiratory rate(RR)
Respiration waveIorm
Percentage oI pulse oximetery Saturation ( SPO2)
Pulse Rate (PR)
SPO2 waveIorm
II SPO2 module oI Masimo Rainbow set is used in the
monitor, Iollow parameters can be measured:
RESP
SPO2
ECG
General Information
11
Measurement oI artery pulse signal pressure (PI)
Measurement oI total hemoglobin content(SPHb)
Measurement oI oxygen content (SpOC)
Percentage oI Carboxyhemoglobin saturation
(SPCO)
Percentage oI methemoglobin saturation(SPMet)
Pleth variability index(PVI)
Systolic pressure, Diastolic pressure and Mean
arterial pressure (MAP)
Channel 1 temperature(T1) and channel 2
temperature(T2)

NIBP
TEMP
General Information
12
ARIA vital sign monitor provides several Iunctions as
visible & audible alarms, Trend and NIBP data storage.
ARIA vital sign monitor is a user-Iriendly device with
operations conducted by a Iew keys and touch screen. ReIer
to Keys Function Ior more details.
Don`t tap the screen with sharp objects as it
may damage the monitor .
Indicators, Connectors and Controls
13
Indicators, Connectors and Controls
Figure 1-1
ON/OFF
key
ECG
connector
connector oI
TEMP1,2 probe
IBP1,3
connector
IBP2,4
connector
NIBP
connector
connector oI
CO2 and
Multi- gas
sensor
Alarm
indicator
DC IN
indicator
Battery
charge
indicator
AC IN
indicator
MASIMO
SPO2
connector
Menu
key
Start/Stop
key
Alarm
silence
Alarms
key
Rec/Stop
key
Silence
key
Indicators
14
Indicators
Five indicators Ior power, alarm , battery charge and
alarm silence are on the Iront panel oI the system. The
green indicator lights, when the device is powered on
(Figure 1-2 ), The battery indicator is green when the
battery is charged otherwise it is orange (Figure 1-2 )
and the alarm indicator Ilashes or lights when alarm
occurs (Figure 1-2 ). II alarm sings are deactivated Ior
an unlimited period oI time, alarm indicator Ilashes red.
( Figure 1-2 )
During the system is powered on, the
indicators light. II all indicators light, it will show
proper Iunctioning oI indicators.
Indicators
15
Figure1-2 Indicators
Alarm indicator in normal situation is oII,
when an alarm occurs this indicator turns on and
Ilashes.
Main screen
16
Main screen
Vital sign monitor has a color TFT display. The patient
Parameters, waveIorms, alarm messages, bed number,
date, time, system status and error messages are displayed
on the main screen. The screen can be divided into Iour
areas: (Iigure 1-3)

Header area , WaveIorm area , Parameter area and
Message area.
Figure 1-3 Main screen
Main screen
17
Header Area
The Header area is at the top oI the screen displaying
operating state oI the monitor and patient inIormation. bed
number, type oI patient (adult or neonate), patient name
current date , time and page number are displayed in the
header area. The above inIormation is displayed on the
screen throughout the monitoring process.
Other inIormation oI the Header area comes up only with
regard to the monitoring status.
1- indicates the remaining battery charge.
2- appears when the system is recording.
3- appears when the system is connected to central
system.
4- appears when alarm is disabled Ior an unlimited
period oI time .
5- blinks when the system is in the silence mode.
Main screen
18
Waveform / Menu Area
All waveIorms can be displayed at the same time. The
waveIorms Irom top to bottom are: ECG, SpO2, and
RESP.
Gain, Iilter, lead and sweep speed oI the ECG waveIorm
are displayed as well.
All menus oI the screen appear in certain areas on the
screen. Each menu may cover 2 or 3 waveIorms.
Parameter Area
Parameters values always are displayed at a Iixed position
on the screen. The parameters values are measured and
reIreshed every second.(except NIBP values that reIresh
with each new measurement)
Message Area
DiIIerent messages are displayed based on alarm priority
in this area. Background color changes Ior diIIerent alarm
levels (I,II and III).
Main screen
19
Level I alarm message : Red background Black text
Level II alarm message : Yellow background Black text
Level III alarm message: Cyan background Black text
When there is no alarm ,the message is displayed with
gray background.
Different page configurations
By deIault, There are six pages with diIIerent
conIigurations to display parameters and waveIorms:
P1 . In this page you can monitor HR, SPO2 ,PR, RESP,
NIBP and TEMP numeric parameters as well as ECG,
SPO2 and RESP waveIorms.
P2. You can monitor parameters oI P1 as well as 2-lead
ECG , SPO2 and RESP waveIorms.
Main screen
20
P3 . You can monitor parameters oI P1 and Iour traces oI
ECG waveIorm with diIIerent leads.
P4 . You can monitor parameters oI P1 and 7-lead ECG
waveIorms.
P5. You can monitor parameters oI P1 as well as ECG,
SPO2 and RESP waveIorms and PI, PVI, SpOC ,SpMet
,SpCo and SpHb parameters .
P6 . you can monitor parameters oI P5 and ECG
waveIorm.
For the Iirst time, P1 is displayed when you
turn on the monitor but aIterwards the page which
has been set beIore turning oII the monitor, will be
displayed.
Keys Functions
21
Keys function
Use Iront panel keys and touch screen to control the
monitor.
Figure 1-4 Keys
Power press this key to turn the patient monitor on
and oII.
Menu press it to enter HOME MENU or return to
the main screen.
Keys Functions
22
Start/Stop press this key to start pressure
measurement and press it again to stop measurement.
Rec/Stop press to record ECG waveIorm and all
numeric parameters through the central and press it again
to stop recording.
Alarms press it to unlimitedly disable alarms. Even
iI a new alarm occurs, alarm signs (indicator and alarm
sound) will be inactive until you press the key again.
Because oI standard points, operator can not use it but in
the Iuture user can apply it.
Silence press it to disable alarm Ior 120 s. A
countdown timer appears and a Silence symbol blinks on
Keys Functions
23
the Header area every 5 s .II you press it again, system will
exit Irom silence mode and alarm sounds will be activated.
iI in alarm condition a new alarm occurs ,
system will exit Irom silence mode.
BeIore monitoring the patient, check the keys
Iunctions and make sure that they are in proper
working condition.
Interfaces
24
Interfaces
Connectors oI patient cables and sensors are placed at the
leIt side oI the monitor.
Figure 1-5 Connectors
ECG cable
TEMP1/2 probe
Masimo SPO2 sensor
IBP1/3transducer
IBP2/4 transducer
NIBP cuII
CO2 , Multi-gas sensors and device programmer cable
Interfaces
25
Symbols on the side plate label are:
Means that consult user manual oI monitor and
pay attention to the warnings and cautions.
means that the applied part according to standard
IEC-601-1 is type CF. The modules with this symbol
contain an F- Type isolated (Iloating) patient applied part
which provides a high degree oI protection against shock,
and is usable during deIibrillation.
Means that the applied part according to standard
IEC-601-1 is Type BF. The modules with this symbol
contain an F- Type isolated (Iloating) patient applied part
For a proper connection, Connectors and cables
should match each other properly.
Interfaces
26
which contains an adequate degree oI protection against
shock, and is suitable Ior use during deIibrillation.
Battery is installed at the right side oI the ARIA monitor.
Follow Iacilities is obtained by installing the ARIA
monitor onthe station:
A- Charging internal battery and connecting to DC
B- Possibility to connect to the central system through
network with (LAN) wire
C- Being hanged beside stretcher rail while
transIerring the patient
D- Possibility to be installed on serum stand
AC IN, DC IN andnetwork sockets are placed in the right
side oI the station, and VGA connector is placed on tha
back oI the station
Interfaces
27
Figure 1-6 Power plate
u Power Supply: 90-240 V and 50/60 Hz (Socket )
u DC Input [socket
12-14 V/DC external power supply (e.g. in ambulances)
u Network InterIace (socket )
The data transmission is Iull duplex and is done through
LAN.
u VGA Slave monitor [socket )
Interfaces
28
Monitor interIace Ior external VGA color monitor.
Working mode: 800600,256 colors
InterIace : Dsub15 pins
Pin 1. Red Video Pin 9.NC
Pin 2. Green Video Pin 10.Ground
Pin 3. Blue video Pin 11. NC
Pin 4. Ground Pin 12.NC
Pin 5. NC Pin 13 Horizontal Sync
Pin 6. Red Ground Pin 14. Vertical Sync.
Pin 7. Green Ground Pin 15. NC
Pin 8. Blue Ground
How to use slave monitor?
1- Install the VGA slave monitor in a distance oI 1.5 m
Irom the patient bed. The monitor is intended to be used
as an assistant monitoring device.
2- Plug the cable while the VGA slave monitor is oII.
3- Power on slave monitor and then patient monitor.
4- Adjust monitor brightness and contrast properly.
Interfaces
29
Connecting to network
There are tow distinc parts Ior network connection, Iirst
network soItware in the monitor mother board and second
network hardware drive embeded in the station.
Aria monitor connect to the station through SPI (Serial
PreIeral Instructure) protocol.
Aria network is deIined as local network, Aria monitor
uses TCP/IP protocol and 100/10MPS Ior data
communication.
Saadat's monitors can only be connected to
Saadat central network.
Don't connect various Hub switches to local
network as this may cause network interIerence.
Interfaces
30
Use only SAADAT manuIactured Station
bases in the Iollowing situations:
- Aria monitor runs on AC input.
- Aria monitor runs on DC- IN.
- For network connection.
- For charging battery.
BeIore connecting Aria monitor to the
network, operator should determine bed number oI
each monitor.
II Aria monitor connects to the network
through the station and then Ior some reasons it is
detached Irom the station and then reconnected to it,
in order to connect the network , you should
unplug/plug AC power cable Ior one time.
Interfaces
31
II DC-IN power supply in cars such as
ambulance is used (ambulance body is connected to
the negative pole oI the battery), Ior saIety
requirements, DC to DC or DC to AC converter with
the isolation oI 1500Vac (at least) must be used.
Using oI 20V power in the ambulance is
recommended. To Provide mentioned DC-DC or
DC- AC converter, please contact technical
department oI the manuIacturer.
ARIA patient monitor can be connected only to
the SAHAND series oI the central system.
Use only the manuIacturer recommended
cable Ior connecting monitor to the central system.
Battery
32
Battery
Portable Patient Monitor is equipped with a rechargeable
battery. When the monitor is connected to the AC power,
the battery starts to be charged automatically. When the
battery is completely discharged, it takes at least 3 hours
to charge it again.
Symbol in Header area oI the screen indicates battery
charge capacity. Yellow part represents the remaining
battery charge. This symbol is only displayed when the
AC Input is not plugged in and the system works with
battery. II the AC Input is plugged in, an indicator at the
right side oI the screen will represent the battery charge
level .When the battery indicator is green, the battery is
Iully charged and when it is orange means that the battery
is being charged.
When the system is connected to the DC Input (e.g.
ambulance power),the battery can not be charged.
Battery
33
Features oI battery can be displayed by ARIA monitor:
Battery voltage, battery current consumption and charging
current, tempreture, time to empty and time to Iull.
Among the above items, battery voltage, current and
power consumption are displayed in "HOME/ABOUT
MENU" window.
II the battery charge is too low, the monitor
will power oII automatically. BeIore the battery is
completely depleted, an alarm will be sounded and
"BATTERY LOW" message displayed in Header
area. Apply AC power to the monitor at this moment
to recharge the battery. II you keep on using the
battery, the monitor will shut down automatically.
Battery oI Aria monitor can be charged at least
500 times.
34
2
System Configuration
u For stored ECG waveIorms, please reIer to SIGMA.
u For previous values oI parameters, please reIer to
TREND.
u For alarm setting including alarm volume adjustment,
please reIer to ALARM .
u For date and time setting, please reIer to SETUP.
u For modules setting, soItware versions oI modules
and Touch calibration ,please reIer to FACTORY.
u For screen setting, please reIer to PAGE SETUP.
u For setting oI screen pages, please reIer to PAGE
SETUP.
u For patient inIormation setting, please reIer to
PATIENT.
System Configuration
35
u For manuIacturer inIormation , please reIer to ABOUT.
Patient monitor contains Ilexible conIiguration. The
conIiguration setting is done through HOME MENU (Iigure
2-1). You can access this menu by pressing the MENU key
onthe Iront panel oI the monitor or touching middle oI
Header area on the screen.
Figure 2-1 HOME/MENU
SETUP
36
SETUP
By selecting SETUP, you can access Iollowing menu.
Figure 2-2 HOME/SETUP MENU
You can perIorm these settings through this menu:
CALENDER: available options are SOLAR and
CHRISTIAN
DATE: by touching this item you can set date in
the Iollowing window:
SETUP
37
Figure 2-3 DATE
TIME : by touching this item you can set time in
the Iollowing window:
Figure 2-4 TIME
BED NUMBER: (Irom 1to 99)
LANGUAGE: by touching this item you can set
time in the Iollowing window. available options
areENGLISH FRENCH, RUSSIAN ,
TURKISH, GERMAN and POLISH
SETUP
38
Figure 2-5 LANGUAGE
DISPLAY OFF: by selecting "OFF", display
screen is oII until a key is pressed or an alarm
occurs.
LOAD DEFAULT: by touching it, HOME /
SETUP/LOAD DEFAULT MENU is displayed
(Fig. 2-3) and you can load the manuIacturer
deIault setting Ior intended parameter. (ReIer to
appendix I Ior deIault settings). Because all your
previous setting by selecting deIault mode will be
missed, the system asks iI you are sure to change
setting or not . (Fig. 2-4)
SETUP
39
Figure 2-6 SETUP/DEFAULT MENU
Figure 2-7 ALERT
CLEAR MEMORY. you can clear stored
parameters in the system such as parameters saved
in TREND windowand NIBP LIST.
Following message will appear on the screen
which asks you whether to clear that item or not.
SETUP
40
Figure 2-8 SETUP/CLEAR MEMORY
MENU
DEMO: by inputting deIined code in Iollowing
window, you can see your intended waveIorms
and parameters in the Demo. In this mode, word
'Demo is displayed on ECG waveIorm.
To disable Demo mode, you can enter each code
other than deIined code.
Figure 2-9 DEMO
Operator can not access to this menu and only
expert users can use this menu.
PATIENT
41
PATIENT
By selecting PATIENT, you can access this window:
Figure 2-10 HOME/PATIENT MENU
To enter demographic patient inIormation, select ADMIT
in the patient menu .you can enter patient inIormation in
the HOME/PATIENT/ADMIT MENU window.(Iig 2- 11)
PATIENT
42
Figure 2-11 HOME/PATIENT/ADMIT
MENU
ID Hospital code Ior patient (Up to 15
characters)
NAME Patient name (Up to 15 characters)
FAMILY Patient Iamily (Up to 15 characters)
WEIGHT Optional Irom 0.5 to 300 Kg
HEIGHT Optional Irom 20 to 250 cm
BLOOD TYPE Available options are A, A-, B, B-,
AB, AB-, O and O-.
PATIENT
43
GENDER Available options are Female and Male
BIRTH DAY Date oI the birth
PAT. CONF Available options are neonate and adult
HOSPITAL Hospital name (Up to 15 characters)
WARD (Up to 10characters)
DR.NAME (Up to 10 characters)
To store inIormation oI a new patient, select DISCHARGE
in the patient menu to recall Iollowing message:
Figure 2-12 ALERT
SIGMA
44
SIGMA
Patient monitor is able to store ECG waveIorm Ior 35
seconds which is visible in 5 traces in "HOME/SIGMA
MENU" window .
By touching " SIGMA" in HOME MENU, you can access
this window.
Figure 2-13 HOME/SIGMA MENU
PAGE SETUP
45
PAGE SETUP
DiIIerent page conIigurations with desired waveIorms and
parameters can be set in this part.
Operator can not access to this menu and only expert users
can perIorm necessary adjustments.
By touching "PAGE SETUP", you can access this menu:
Figure 2-14 HOME/PAGE SETUP MENU
When you enter password correctly and touch OK, the
Iollowing menu will appear that in which you can enable
or disable diIIerent pages. II you enter incorrect password,
the message ' WRONG PASSWORD will be displayed
in red color.
PAGE SETUP
46
Figure 2-15 HOME/PAGE SETUP MENU
When you change setting and press EXECUTE button, the
Iollowing message will appear that byselecting YES all
settings will be executed.
Figure 2-16 ALERT
ALARM
47
ALARM
By touching "ALARM " in HOME MENU, you can
access this menu.
Figure 2-17 HOME/ALARM MENU
These alarmsetting s can be perIormed in this menu.
ALARM VOLUME
Select "ALARM VOLUME" to set the volume oI alarm
sound. The volume ranges Irom 1 to 8. 1 is minimum
volumeand 8 is maximum volume.
ALARM
48
All ALARMS ON/OFF
When you select this item, an alert message appears that
by selecting YES you can turn on/oII all alarms oI the
monitor.
Figure 2-18 ALERT
Select "ON" to enable all alarm Iunctions. Select "OFF"
to disable the alarm Iunctions such as alarm sound,
parameters blinking and alarm light indicator. In "OFF"
mode you can see symbol beside all parameters. This
Iunction changes alarm parameters ON or OFF all
together, but you are able to change every speciIied alarm
parameters separately in its own window. This setting will
aIIect all parameters alarms but you can set alarm oI
individual parameters ON or OFF in their own windows.
TREND
49
TREND
Monitor is able to store the latest 96 hours oI trend values
in graphical and tabular Iormat.
Data can be stored every 1 second and parameters numeric
values oI Trend (Graphic or Tabular) in case oI
(Interval/300) 5s , data is updated every 5 seconds
otherwise it is updated to extent oI Interval/300 . For
example iI the interval is set to 30 min, new data will be
displayed every 6 seconds.
Select Trend in HOME/MENU to access "TREND
GRAPH" window. You can also select "HOME/TREND
GRAPH" to ccess TREND TABLE window.
TREND
50
Figure 2-19 HOME/TREND GRAPH
Figure 2-20 HOME/TREND TABLE
In Iigure 2-19 Y-axis stands Ior related parameter value
and X-axis Ior time.
TREND
51
u Selecting trend graph or parameter values:
In Trend Graph touch the Iirst item in the leIt to select
parameter. Available options are HR, SPO2, PR, RESP,
TEMP, SpHb, PI, SpCo, SpMet, PVI and SpOc.
This item is not active in Trend Table and you can only
view selected parameters in the graph.
II SPO2 module oI Masimo Rainbow set is used instead oI
TEMP parameter, in Tabular Trend you will see one oI
Rainbow parameters selected in the graph.
u Changing display scale:
In Trend Graph select the second leIt item to change
display scale. You can set the Y-axis scale corresponding
to the parameters values.
TREND
52
view the selected scale in graph.
SCL1 SCL2 SCL3
PARAMETER
MIN MAX MIN MIN MIN MAX
HR 0 60 0 120 0 240
SPO2 80 100 60 100 0 100
PR 0 60 0 120 0 240
RESP 0 60 0 120 0 240
TEMP 30 42 24 48 0 48
SpHb 0 25 5 17 - -
PI 0 20 0 12 0 12
SpCo 0 60 0 42 - -
SpMet 0 70 0 16 - -
PVI 0 100 0 30 - -
SpOc 0 36 8 20 - -
TREND
53
u Selecting time intervals of parameters values
In Trend Graph select the third leIt item to change time
intervals oI displaying parameters values. Available
options are 5, 10, 15, 20 , 30, 45min and 1, 2, 4, 8, 12, 16,
24,36,48,72 and 96hours.
view the selected time interval in graph.
u Obtaining Trend values of a specific time
In Trend Graph select or > to view trend values oI a
speciIic time. By touching these buttons, you can move
the cursor through the graphic trend and the corresponding
time will be displayed. You can do this only Ior 5, 10, 15,
20, 30, 45 m, and 1, 2, 4, 8 and 12 hr intervals (set in the
third leIt item). Numeric values related to these times are
displayed above the cursor.
TREND
54
In Trend Table select or to move up or down to
view diIIerent parameters values in speciIic times.
u Selecting the previous or next page in Trend
In Trend Graph select or to view the previous or
next page oI graph, in other word, you can adjust start and
end time in x-axis. By every touching on these buttons,
the intervals oI x-axis will be changed in the extent oI the
speciIied time oI the third leIt item.
In Trend Table the previous or next page oI table is
displayed by selecting or .
u Viewing First and Last pages of Trend
In Trend Graph select or to view last or Iirst page oI
trend Ior your intended parameter.
In Trend Table the last or Iirst page oI table is displayed
by selecting .
FACTORY
55
FACTORY
Monitor is able to turn on /oII parameters or waveIorms oI
diIIerent modules.
By touching FACTORY, you can access this menu:
Figure 2-21 HOME/FACTORY MENU
Operator can not access to "MODULE SET UP MENU",
"TOUCH CALIB MENU" and "IP SELECTION MENU"
and only expert users can perIorm necessary adjustments
in these menues.
FACTORY
56
u Module Setup
By touching this item, you can access this window:
Figure 2-22 HOME/FACTORY/MODULE
SETUP MENU
II you enter the password correctly and touch OK, the
Iollowing menu will appear that you can turn on/oII your
desired modules.
Figure 2-23 HOME/FACTORY/MODULE
SETUP MENU
FACTORY
57
u TOUCH CALIB
Figure 2-24 HOME/FACTORY/TOUCH
CALIB MENU
Iollowing menu will appear, in which you can calibrate
touch in Iour points.
Figure 2-25 HOME/FACTORY/TOUCH
CALIB MENU
FACTORY
58
u MODULE VER
By touching this item, the Iollowing menu appear that you
can record and view soItware version oI diIIerent modules.
Figure 2-26 HOME/FACTORY/MODULE VER
MENU
u IP SELECTION
Figure 2-27 HOME/FACTORY/IP SELECTION
MENU
FACTORY
59
Iollowing menu will appear, in which you can select your
intended IP.
Figure 2-28 HOME/FACTORY/IP SELECTION
MENU
ABOUT
60
ABOUT
By selecting "ABOUT" in HOME MENU, you can see
system and manuIacturer inIormation in this menu.
Figure 2-29 HOME/ABOUT MENU
61
3
Alarms
This chapter gives general inIormation about alarms
and their Iunctions.
Always veriIy the audible and visual
alarms when power on the monitor.
Alarm Categories
62
Alarm Categories
Alarm level and setting
Patient Monitor oIIers three levels oI alarm.
High level alarm (level 1) indicates that patient is in a liIe
threatening situation or monitor has a serious problem.
Medium level alarm (level 2) indicates an abnormal vital
signs and serious warning.
Low level alarm (level 3) indicates general warning.
Patient monitor has some predeIined alarm levels Ior
parameters but user can also adjust alarm level oI each
module in its own menu.
Alarm setting will not change Ior 30 seconds
aIter power Iailure.
Alarm Categories
63
Alarm Categories
When an alarm occurs, patient monitor will indicate it to
the user through the indicators on the screen or by
diIIerent levels oI audio alarms.
Display screen
When an alarm is triggered by a parameter, the parameter
value will blink on the screen and its message wiil be
displayed with suitable colour Ior background according
to the alarm's level.
Level I alarm message: Red background Black text
Level II alarm message: Yellow background Black text
Level III alarm message: Cyan background Black text
In inIormative message (or aIter pressing SILENCE key),
message wiil be displayed with gray color.
Alarm Categories
64
Alarm indicator
Alarm indicator Ilashes red Ior high level and yellow Ior
medium level alarm and Iixed yellow Ior low alarm level.
Alarm sound
Alarm sound will be activated iI the system is not in
silence mode (e.g. Alarms key has not been pressed).
Patient monitor uses diIIerent alarm tone patterns to match
the alarm levels:
High level alarm sounds "DO-DO-DO--DO-DO "every 10
seconds.
Medium level alarm sounds "DO-DO-DO" every 25
seconds.
Low level alarm sounds "DO" every 50 seconds.
Alarm Categories
65
Alarm verification when the system is poweredon
When the monitor is being powered on, audible and
visible alarms (yellow or red indicator) will be selI tested.
Every time the monitor is powered on, the system beeps
and yellow and red indicators light about 4 seconds
simultaneously. II no beep is heard or no alarm indicator
lights, please do not use this device Ior any patient and
contact customer Service.
When multiple alarms oI diIIerent levels occur
simultaneously, alarm indicator Ilashes red (high
level) and messages oI other alarms with respective
background colors wiil appear circularly on the
screen..
II two or several alarms with similar levels
occure simultaneously, their message will be
displayed circularly.
Alarm Causes
66
Alarm Causes
An alarm occurs when it is triggered by a parameter or
when there is some system problem.
Time delay between occuring alarm conditions to
displaying alarm signs (parameter blinking, message
blinking and indicator Ilashing) is up to 50 mS.
ARIA monitor is designed in a way that you are capable
oI recognizing alarm occurance Irom 1 meter distance in
Iront oI it.
Conditions that trigger the parameter alarms:
When the measurement numeric value violates the adjusted
alarm limits and the alarm is in "ON" mode, an alarm
occurs. In case oI ASYSTOLE or APNEA detection, alarm
will occur even iI the alarm system is in "OFF" mode.
Alarms and Silence keys
67
SILENCE Key
By pressing "Silence" key, you can disable all alarm
sounds Ior 2 minutes. A countdown timer and a Silence
symbol are displayed alternately every 5 sec above the
screen. During the 2 minutes iI a new alarm occurs, the
silence status will be terminated and both audible and
visible alarms will be triggered again. II within the 2
minutes oI alarm silence, the user presses "Silence" key,
the alarm suspension status will be ended and the normal
alarm status resumed immediately.
ALARMS Key
By pressing "Alarms" key, you can disable all alarm signs
Ior an unlimited period oI time (even iI a new alarm
occurs, silence status still remains). Sound alarm and
alarm's indicator will be enabled iI you press the key
again.
Alarms and Silence keys
68
When Alarms key is activated, its indicator blinks in Iront
panel.
Operator can not use it but in the Iuture user can apply it.
Parameters Alarm
69
Parameters Alarm
The alarm setting oI the parameters can be Iound in their
windows separately. You can monitor alarm limits and
categories oI each individual parameter in its own special
window.
When a parameter alarm is "OFF", this symbol is
displayed near the parameter. For the parameter which its
alarm is "ON", an alarm will be triggered when it violates
the speciIied alarm limits. In this situation Iollowing
actions will take place:
1- Alarm message is displayed on the screen and has a
background color with respect to its level.
2- The monitor beeps corresponding to alarmleve l and
adjusted alarm volume.
3- Alarm indicator Ilashes.
When an alarm occurs
70
When an alarm occurs
Youneed to identiIy the alarm and act appropriately
according to the cause oI the alarm.
1- Check the patient`s condition.
2- IdentiIy alarms related to each module.
3- IdentiIy the alarm cause.
4- Silence alarm (press Silence key), iI necessary.
5- When alarm condition is removed, check that the
alarm is working properly.
You will Iind the alarm messages Ior the parameters in the
respective parameter chapters oI this manual.
71
4
ECG Monitoring
General Information
Through the ECG Monitoring, you can see a
continuous waveIorm oI the patient's cardiac
electric activity which enables physician to perIorm
a precise assessment oI patient current physiological
condition. The process oI depolarization and
repolarization oI the myocardium generates an
electric potential that are sensed by ECG electrodes
on the skin.
General Information ECG
72
These electrodes are typically attached to the patient's
right arm, leIt arm and leIt leg .The monitor processes and
ampliIies this signal and displays it as ECG waveIorm on
the screen. Proper connection oI the ECG cables and
electrodes can ensure accurate assessment.
According to standard AAMI:EC13:2002, it shall
take up to 10 seconds to change heart rate Irom 80
to 120 bpm which in Aria monitor is about 6
seconds.
According to standard AAMI:EC13:2002 it shall
take up to 10 seconds to change heart rate Irom 80
to 40 bpm which in Aria monitor is 8 seconds.
When Tachycardia (HR 200 bpm) happens,
system takes 6 seconds to sound alarm.( In this
case the low limit alarm should be set to 60 bpm
and high limit alarm to 100 bpm.)
It takes 10 seconds to sound alarm when a cardiac
arrest happens (Irom 80 bpm to 0 bpm)
The above results are Ior HR average oI 4 seconds.
73
The ECG module is able to reject 1.2 mV TALL-T
The current that is applied to the patient Ior
lead-sensing is 90nA.
Noise suppression circuit: A noise signal oI 10 A
is given reversely to the reIerence lead.
The ECG patient cable consists oI 2 parts: The
cable that is connected to the monitor and the lead
set that is connected to the patient.
During electric shock , do not touch patient,
monitor and bed while monitoring.
Use only the recommended manuIacturer ECG
cable Ior monitoring. Other ECG cables and leads
may cause improper system perIormance and
decrease saIety during deIibrillation.
74
Line Isolation Monitor (LIM) transient may
generates waveIorms similar to the actual cardiac
waveIorms and thus trigger heart rate alarms. Such
transients may be minimized by proper electrode and
cable placement as later described in this chapter .
InterIerence Irom non-grounded devices near
the patient or electrosurgical units can cause
inaccurate ECG waveIorm.
When you connect the cables and electrodes,
make sure that no metal part oI electrods is in
contact with the saIety ground. check that all ECG
electrodes are correctly attached to the patient.
75
1. Prepare the patient`s skin beIore electrode placement.
u proper skin preparation is necessary Ior good
electrode placement, as the skin is a poor conductor
oI electricity.
u Shave the selected sites iI necessary.
u Cleanse the site with a mild soap and water
solution.(Never use pure alcohol, because it
increases body resistance.)
u Gently rub the skin surIace to increase capillary
blood Ilow in the tissues .
2. Place chest leads on the patient. II your chest lead has
not conductive gel, apply some conductive gel on
intended site oI the skin.(Iigures 1-4 and 4-2)
3. Attach the clips or snaps to the chest leads beIore
placing them.
76
Figure 4-1 ECG 3-lead electrode placement
Use only one type oI electrode on the same
patient to avoid variations in electrical resistance.
For ECG monitoring, it is recommended to use
silver/silver chloride electrode. When dissimilar
metals are used Ior diIIerent electrodes, the
electrodes may cause large oIIset potentials due to
polarization which it can cause problems with ECG
waveIorm. Using dissimilar metals may also increase
recovery time aIter deIibrillation.
77
3-lead electrode placement (Figure 4-1)
Right arm (RA) placement: red electrode, near the right
shoulder, directly below the clavicle.
LeIt Arm (LA): yellow electrode, near the leIt shoulder,
directly below the clavicle.
LeIt Leg (LL): green electrode, on the leIt hypogastrium.
Figure 4-2 ECG 5-lead electrode placement
78
5-lead electrode placement (Figure 4-2)
Right arm (RA) placement: red electrode, near the right
shoulder, directly below the clavicle.
LeIt Arm (LA): yellow electrode, near the leIt shoulder,
directly below the clavicle.
Chest (C): white electrode, placement is shown in the
Iigure 4-2.
LeIt Leg (LL): green electrode, on the leIt hypogastrium.
Right Leg (RL): black electrode, on the right hypogastrium.
For 5-lead set, the C electrode can be placed on one oI the
Iollowing positions:
V1 on the Iourth intercostal space at the right sternal
border.
To ensure the patient saIety , all leads must be
attached to the patient.
79
V2 on the Iourth intercostal space at the leIt sternal
border.
V3 midway between V2 and V4 electrode positions.
V4 on the IiIth intercostal space at the leIt midclavicular
line.
V5 on the leIt anterior axillary line, horizontal with V4
electrode .
V6 on the leIt middle axillary line, horizontal with V4
electrode.
V3R-V6R on the right side oI the chest in positions
corresponding to those on the leIt.
VE over the xiphoid position.
For posterior C lead placement, place the C electrode at
one oI the Iollowing positions.
V7 on posterior chest at the leIt posterior axillary line
in the IiIth intercostal space.
V7R on posterior chest at the right posterior axillary
line in the IiIth intercostal space.
80
Figure 4-3 placement of the C electrode
for 5-lead ECG
Depending on lead type (3-lead or 5-lead), you can choose
diIIerent leads including I, II, III, aVR, aVL, aVF, V.
81
Figure 4-4 ECG leads
periodically inspect the electrode application
site to ensure skin quality. II there is skin irritation,
replace the electrodes or change the application site.
82
VeriIy the cable Iault detection prior to start
monitoring phase. Unplug the ECG cable Irom the
socket, the monitor will display the error message
"ECG NO CABLE" on the screen.
ECG cable may be damaged iI it is connected
to the patient during deIibrillation. Cables which
have been connected to the patient during
deIibrillation should be checked Iunctionally beIore
being used again.
II ECG waveIorm is not accurate while the
electrodes are properly attached, try to change the
lead.
83
When using Electro cautery equipment, leads
should be placed in a long distance Irom the
dispersive electrode and electro cautery pencil to
prevent unwanted burns .
Depending on type oI surgery, ECG leads are placed
in diIIerent positions. For example electrodes should
be placed horizontally on the chest(rib cage) or back
in open heart surgery. InterIerences Irom electro
cautery equipment may cause problems with the
ECG waveIorm. To avoid these interIaces, place
electrodes near the right or leIt shoulder and above
the tummy. Never place electrodes above the arm
(except Ior weak ECG signal).
84
When using electro cautery equipment, never
place ECG electrodes near the Return electrode oI
the electro cautery, otherwise there will be a great
deal oI interIerence with the ECG signal.
Patient burning is probable due to an improper
connection oI the dispersive electrode oI electro
cautery.
interIerence Irom non-grounded devices or
electro cautery near the patient can cause inaccurate
ECG waveIorm.
85
Normal QRS waveIorm contains:
. Tall R-wave completely above or below the
baseline.
. T -wave less than one-third oI the R-wave
height.
. P-wave much smaller than the T -wave.
Figure 4-5 Standard ECG waveform
86
Do not immerse ECG leads completely in
water, solvents or cleaning solutions because the
connectors are not waterprooI. Do not sterilize ECG
cable by irradiation, steam, or ethylene oxide.
For the patients with pacemaker, the monitor
may continue to count the pacemaker heartbeat rates
during occurrence oI cardiac arrest or arrhythmia.
Do not rely entirely upon monitor alarms. Keep
paced patients under close surveillance.
Pay attention that signals with slope oI up to
1V/s would not be considered as pace pulses.
ECG PARAM MENU
87
ECG PARAM MENU
By touching ECG parameter area on the screen, you can
access this menu:
Figure 4-6 ECG PARAM MENU
u BEAT VOLUME
It ranges Irom 1 to 8. Select "OFF" to turn oII heart beat
sound and 8 to hear the highest volume.
u ECG AVERAGE
Available options Ior ECG average are 4, 8 and 16 sec.
u HR SOURCE
Heart rate may be derived Irom 'ECG or 'SPO2. In
AUTO mode iI ECG cable is connected to the patient,
ECG PARAM MENU
88
monitor automatically derives heart rate Irom ECG
otherwise the heart rate value is derived Irom SPO2
signal.
u LEAD TYPE
Select it to access diIIerent ECG modes including 3-lead
and 5-lead.
u HR ALARM
Select "ON" to enable all alarm Iunctions such as
parameters blinking, audio alarm and light indicator.
Select "OFF" to disable the alarm Iunctions and there will
be a " " symbol in ECG Parameter area.
u ALM LIM
By selecting "ALM LIM" in ECG PARAM MENU, you
can access this window:
ECG PARAM MENU
89
Figure 4-7 ECG ALARM LIMIT
ECG alarm is triggered when the heart rate violates
adjusted ALARM HIGH or LOW limit.
Low limit: 30 (high limit - 5)
High limit: (low limit 5) 250
u ALARM LEVEL
Available options are 1and 2. Level 1 means the most
serious case.
ECG TRACE MENU
90
ECG TRACEMENU
By touching middle oI ECG signal area on the screen, you
can access this menu:
Figure 4-8 ECG TRACE MENU
u ECG LEAD
LEAD
to count the heart rate and show RA-
LA waveIorm
I
to count the heart rate and show RA-
LL waveIorm
II
ECG TRACE MENU
91
You can choose V, aVF, aVL and aVR just when ECG is
in 5-lead mode.
to count the heart rate and show
LA-LL waveIorm
III
RA -
2
LL LA
WaveIorm
aVR
to count the heart rate and show LA-
2
LL RA
waveIorm
aVL
LL -
2
LA RA
WaveIorm
aVF
C -
3
LL LA RA
waveIorm
V
ECG TRACE MENU
92
u ECG GAIN
Select to adjust the height oI ECG waveIorm. Gain
options Ior each lead are 0.25, 0.5, 1, 2, 4 and
AUTO. In AUTO mode, the monitor chooses the best
level automatically.
u ECG SWEEP
Available options Ior ECG SWEEP are 12.5, 25 and 50
mm/s.
u ECG FILTER
There are Iour optional Iilter modes to obtain clearer and
more accurate ECG waveIorm:
ECG TRACE MENU
93
Application Frequency Range Filter mode
In normal conditions 0.5-40HZ NORMAL
In diagnostic
application. but the
ECG waveIorm
might have some
noises.
0.05-100 HZ DIAGNOSE
0.05-100 HZ
(excluding 50HZ )
DIAG HUM
This mode reduces
InterIerence Irom
Electro cautery
equipment. This
mode also can be
used when the system
has high noises or
doesn't have
equipotential earth.
0.5-28 HZ MONITOR
ECG TRACE MENU
94
u PACE DETECT
II monitoring a patient with pacemaker, set pace to "ON",
otherwise, set it to "OFF". When PACE DETECT is
"ON", the system detects and rejects pacemaker-generated
signals Irom ECG signal so that they will be ignored in
calculating heart rate. Detected pacemaker signals will be
marked on the ECG waveIorm as 1 centimeter vertical
line. II the patient does not have a pacemaker, it may be
desirable to turn the detection Iunction OFF so that
artiIacts in the waveIorm will not be mistaken Ior a
pacemaker signal.
Ior patients with Pacemaker , you must set
PACE DETECT to "ON", otherwise, patient
monitor could mistake a pace pulse Ior a QRS.
ECG TRACE MENU
95
u ECG CALIB
By selecting "ON", a calibrated ECG wave with 1 mv
amplitude always will be displayed and also ' CAL
appears above it even iI you close the ECG TRACE
MENU.
II more than one ECG trace is displayed in the intended
page, you can select lead oI each trace separately by
touching that trace. For example iI there are Iour ECG
traces in the P3, by touching third trace you can access
ECG EXTRA MENU.
Figure 4-9 ECG EXTRA MENU
ECG Alarm Messages
96
ECG Alarm Messages
Alarm sounds when:
The heart rate exceeds adjusted alarm limits, and/or the
ECG ASYSTOLE happens.
Alarm Situation Visual Alarm
Audio
Alarm
HR HIGH
Heart rate
violates
adjusted high
alarm limit
HR value blinks.
Alarm indicator
Ilashes.
Message with
apprppriate
background color is
displayed.
Activated
HR LOW
Heart rate
violates
adjusted low
alarm limit
HR value blinks.
Alarm indicator
Ilashes.
Message with
apprppriate
background color is
displayed.
Activated
ECG
ASYSTOLE
Heart beat is
not detected
in last 10
seconds.
HR with "0" value
blinks.
Alarm indicator
Ilashes.
Message with red
background is
displayed.
Activated
ECG Alarm Messages
97
ECG alarm messages include:
Message Cause/Solution Remarks
ECG NO
CABLE
Cause: ECG cable is
not connected to the
system.
Solution: Connect ECG
cable
Alarm level 3 -
message with cyan
background is
displayed and by
pressing Silence
key, background
oI message will be
gray and system
will ignore this
Iault.
ECG NOISE
Cause: ECG signal is
noisy or saturated.
Solution: Check Ior any
possible sources oI
signal noise Irom the
area around the cable
and electrode, and check
the patient Ior great
motion or improper
placement oI the lead
wires.
Alarm level 3 -
message with cyan
background is
displayed and by
pressing Silence
key, background
oI message will be
gray and system
will ignore this
Iault.
ECG Alarm Messages
98
ECG
CHECK
LA,RA,LL
Cause: Mentioned leads
are not properly
connected to the patient.
Solution: Make sure
that mentioned
electrodes are properly
connected.
Alarm level 2 -
message with yellow
background is
displayed and by
pressing Silence key,
background oI
message will be gray
and system will
ignore this Iault.
ECG
SIGNAL
WEAK
Cause: ECG amplitude
is lower than standard
limit.
Solution: Check the
position oI the chest
leads.
ECG Alarm Messages
99
ECG
DEFECT
Cause: ECG module
Iault
Solution: Turn oII and
then on the system .II
this message is
displayed again, contact
customer Service.
Alarm level 2 -
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
CHECK RL
OR ALL
Cause: RL or other
leads are not properly
Solution: Make sure
that all electrodes and
ECG cable are properly
connected.
Alarm level 2 -
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
CHECK LL
OR ALL
Cause: LL or other
Solution: Make sure
connected.
Alarm level 2 -
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
ECG Alarm Messages
100
Last 4 messages in the table are just Ior 5-lead mode.
AIter perIorming the mentioned solution, iI above
messages are displayed again, the ECG cable may have
been damaged and you should contact the customer
Service.
CHECK LA
OR ALL
Cause: LA or other
Solution: Make sure
connected
Alarm level 2 -
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
CHECK RA
OR ALL
Cause: RA or other
connected to the patient
Solution: Make sure that
all electrodes and ECG
cable are properly
connected
Alarm level 2 -
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
ECG Cable Cleaning
101
ECG Cable Cleaning
II there is any sign indicating that the ECG cable may
have been damaged or deteriorated, replace it with a new
one instead oI continuing its application on the patient.
u Cleaning
Use soIt cloth moistened with mild soap and water solution
or cleaning agent containing 70 ethanol to clean the ECG
cable.
u Sterilization
To avoid extended damage to the system, sterilization
should be perIormed only according to the hospital
maintenance schedule. Sterilization Iacilities should be
cleaned Iirst.
It is recommended to use 70 alcohol or isopropanol 70
as sterilization material.
ECG Cable Cleaning
102
u Disinfection
To avoid extended damage to the system, disinIection
should be perIormed only according to the hospital
maintenance schedule. DisinIection tools should be
cleaned Iirst.
103
5
Monitoring RESP
General Information
The monitor measures respiration Irom the amount
oI thoracic impedance between two ECG electrodes
(RA-LL, RA-LA). The changes oI impedance
between the two electrodes, (due to the thoracic
movement), produce a respiratory waveIorm on the
screen.
The signal with Irequency greater than 62.5KHZ is
applied to the patient Ior respiration measurement.
RESP General Information
104
For RESP monitoring, it is not necessary Ior additional
electrodes, however, position oI electrodes is important.
Some patients, due to their clinical condition, expand their
chest laterally, causing a negative intrathoracic pressure.
In these cases it is better to place the two RESP electrodes
laterally in the right auxiliary and leIt lateral chest areas at
the maximum point oI breathing movement to optimize
the respiratory waveIorm.
The RESP monitoring is not recommended to
be used on patients, who are very active, as this can
cause Ialse alarms.
RESP General Information
105
Preparing patient Ior RESP monitoring:
1- Prepare the patient's skin beIore placing the electrodes.
2- Attach the electrodes to the patient and the cable.
3- Switch on the monitor
Place the red and green electrodes diagonally
to optimize the respiration waveIorm. Avoid the
liver area and the ventricles oI the heart in the line
between the RESP electrodes to prevent artiIacts
Irom pulsating blood Ilow. This is particularly
important Ior neonates.
RESP PARAM MENU
106
RESP PARAM MENU
By touching the RESP parameter area, you can access this
menu:
Figure 5-1 RESP PARAM MENU
u RR ALARM
Select "ON" to enable RESP alarm Iunctions such as
parameters blinking, audio alarm and light indicator.
Select "OFF" to disable the alarm Iunctions, and there will
be a" "symbol in the parameters area.
RESP PARAM MENU
107
u ALM LIMIT
Touch this option to open this window:
Figure 5-2 RESP ALARM LIMIT
RESP alarm is activated when the respiration rate (RR)
violates adjusted ALARM HIGH and LOW limits.
Low limit: 5 ~ (High limit- 5)
High limit: (Low limit 5) ~ 250
u ALM LEVEL
serious case.
RESP PARAM MENU
108
u APNEA LIMIT
Touch this option to set the standard oI judging an apnea
case in the Iollowing window:
Figure 5-3 RESP APNEA ALARM LIMIT
It ranges Irom 0 to 40 and increases/decrease by 5 sec.
(Low limit: 0, High limit: 5 ~ 40).
RESP TRACE MENU
109
RESP TRACE MENU
By touching middle oI RESP waveIorm area, you can
access Iollowing menu:
Figure 5-4 RESP TRACE MENU
u LEAD
Available options are RA-LA and RA-LL.
u GAIN
Select to adjust the size oI ECG waveIorm. Gain options
Ior each lead are 0.25,0.5,1, 2 and 4 .
u SWEEP
Available options Ior RESP SWEEP are 3, 6, 12/5 and 25
mm/s.
RESPAlarm Messages
110
RESP Alarm Messages
Alarm is triggered when the respiration rate violates
adjusted alarm limits.
Audio
Alarm
RR
HIGH
Respiration
rate violates
adjusted high
alarm limit
RESP value blinks.
Alarm indicator
Ilashes.
Message with
apprppriate background
color is displayed.
Activated
RR
LOW
Respiration
rate violates
adjusted low
alarm limit
RESP value blinks.
Alarm indicator
Ilashes.
Message with
apprppriate background
color is displayed.
Activated
APNEA
No respiration
is detected Ior
a certain time
Alarm indicator
Ilashes.
RESPA PNEA
message with red
background is
displayed.
Activated
RESPAlarm Messages
111
RESP messages include:
RESP
CHECK
LEADS
Cause: The RESP
leads are not
properly connected.
Solution: Make
sure that all
electrodes, lead are
securely connected.
Alarm level 3:
message with cyan
background is
displayed and by
pressing Silence
key, background oI
message will be
gray and system
will ignore this
Iault.
112
6
SPO2 & Rainbow Parameters
Monitoring
General Information
SPO2 Rainbow module is the only technology which
measures multiple blood parameters as well as
common pulse oximetry parameters in a continuous
and noninvasive method that traditionally measured
through the invasive and time-consuming methods.
This module is designed by Masimo company and
oIIered to its approved companies.
General Information SPO2
113
Physiological parameters measured by
Masimo Rainboew module
SpO2
Pulse Rate
PerIusion Index (PI)
and optional parameters such as:
SpHb
SpOC
SpCo
SpMet
Pleth Variability Index (PVI)
Extent oI oxygen saturation in hemoglobin oI arterial
blood can be detected Irom the SPO2 waveIorm. For
example, iI 97 hemoglobin molecules in the red blood
cells oI the arterial blood combine with oxygen, then the
blood has an oxygen saturation oI 97. The SPO2 value
SPO2
114
on the monitor will be 97. The SPO2 value shows the
percentage oI hemoglobin molecules which have
combined with oxygen molecules to Iorm oxyhemoglobin.
100
2
2
2

HHb Hb O
Hb O
SPO
PR indicates the Heart Rate per minute which SpO2
module extracts Irom the pulseoximetry signal.
PerIusion index (PI) indicates arterial pulse signal
strength as a ratio oI pulsatile blood Ilow to the
nonpulsatile blood.
PerIusion Index enables you to choose the best position
Ior sensor placement.
PI x 100
Pulse Rate
PerIusion Index
AC
DC
115
Figure 6-1 PI definition
SPHb indicates the level oI total hemoglobin in arterial
blood.
SpOC indicates oxygen content in the blood.
This parameter indicates the level oI carbon monoxide
concentration in arterial blood.
SpOC
SpCO
SpHb
116
This parameter indicates the level oI methemoglobin
concentration in arterial blood.
This parameter is to measure dynamic changes in PI
that occur during the respiratory cycle (i.e. modulation
oI PI amplitude on the respiration signal) which can be
extremely associated with intrathoracic pressure
changes.
PVI can be a useIul noninvasive monitoring method or
an advanced indicator to detect physiological changes
oI intrathoracic pressure ( inIluenced blood cycle).
PI x 100
SpMet
PI
Max
- PI
Min
PI
Max
Pleth Variability Index
117
u The SPO2, PR, PI, PVI, SPOC, SpMet, SpCo
and SpHb values can be displayed on the main screen. The
Pleth waveIorm is displayed as a normalized waveIorm
and its amplitude does not comply with real blood volume
variations.
u User can be inIormed oI inadequacy oI signal and
physiological parameters value by various messages and
alarms in necessary situations.
118
Principle of operation:
1. Oxyhemoglobin (oxygenated), deoxyhemoglobin
(non-oxhygenated blood), carboxyhemoglobin
(blood with carbon monoxide content),
methemoglobin (blood with oxidized
hemoglobin) and blood plasma constituents diIIer
in their absorption oI visible and inIrared light
(using spectrophotometry).
Figure 6-2 Absorption Spectra
2. The amount oI arterial blood in tissue changes
with your pulse (photoplethysography) .
119
ThereIore, the amount oI light obsorbed by the
varying quantities oI arterial blood changes as
well.
A multi-wavelenght sensor is used to distinguish between
oxygenated blood, deoxygenated blood, blood with carbon
monoxide, oxidized blood and blood plasma. This sensor
is utilized with various light-emitting diodes (LEDs) that
pass light through the site to a photodiode (detector).
Signal data is obtained by passing various visible and
inIrared lights (LED's, 500 to 1400 nm) through a
capillary bed (Iore example, a Iingertip, a hand, a Ioot)
and measurimg changes in light absorption during thr
blood pulsatile cycle. This inIormation may be useIul to
clinicians. The maximum radiant power oI the strongest
light is rated at 25 mW. The detector receives the light,
converts it into an electronic signal and sends it to the
module Ior calculation.
Figure 6-3 Light Emitting Diods and Detector
120
Once the signal is received Irom the sensor, it utilizes
Masimo Rainbow SET signal extraction thecnology to
calculate the patient's Iunctional oxygen saturation (SPO2
()), blood levels oI carboxy hemoglobin (SpCO ()),
methemoglobin (SpMet ()), Total Hemoglobin
concentration (SpHb g/dl) and pulse rate (PR (BPM)). The
SpCO, SpMet and SpHb measurements rely on a
multiwavelenght calibration equation to quantiIy the
percentage oI carbon monoxide and methemoglobin and
the cincentration oI total hemoglobin in arterial blood. In
an ambient temperature oI 35 C the maximum skin
surIace temperature has been measured at less than 106 F
(41 C), veriIied by Masimo sensor skin temperature test
procedure.
Signal Extraction Technology (SET)
Signal Extraction Technology signal proccessing diIIers
Irom conventional pulse oximeters. Conventional pulse
oximeters assume that arterial blood is the only blood
moving (pulsating) in the measurement site. During
patient motion, however, the venous blood also moves,
causing conventional pulse oximeters to read low valuse,
because the y cannot distinguish between the arterial and
venous blood movement (sometimes reIered to as noise).
121
Masimo SET pulse oximetry utilizes parallel engines and
adaptive digital Iiltering. Adaptive Iilters are powerIul
because they are able to adapt to the varying physiologic
signals and/or separate them by looking at the whole
signal and breaking it down to its Iundamental
components. The Masimo SET signal proccessing
algorithm, Descrete Saturation TransIorm (DST), reabily
identiIies the noise, isolates it and, using adaptive Iilters,
cancels it. It then reports the true arterial oxygen
saturation Ior display on the monitor.
A pulseoximetry is an early warning system.
Use lab co-oximeter to understand the patient's
condition completely.
For more inIormation about Masimo Rainbow
module , please reIer to APPENDIX III.
122
Assessment oI pulse oximeter probe or a pulse
oximeter monitor accuracy can not be perIormed by
simulators and Iunctional testers.
Use only the recommended manuIacturer
SPO2 sensors. Other SPO2 sensors may cause
improper monitor perIormance.
Regarding the installed SPO2 module in the
system, use suitable sensor speciIied in chapter 14.
BeIore using sensor, consider sensor direction
Ior use, written on the package such as patient's age
and weight or iI the sensor is reusable or disposable.
123
Pulseoximetry may overestimate the SPO2
value in the presence oI Hb-CO, Met-Hb or dye
dilution chemicals.
Electro cautery wire and SPO2 cable must not
be tangled up.
SPO2 module updates the displayed
parameters every 1 second.
Do not apply the sensor on the hand with
arterial catheter or venous syringe.
124
Do not perIorm SPO2 and NIBP measuring in
the same arm simultaneously; because obstruction oI
blood Ilow during NIBP measurement may
adversely aIIect the SPO2 value.
High ambient light sources such as surgical
lights (especially those with a xenon light source),
bilirubin lamps, Iluorescent lights, inIrared heating
lamps and direct sunlight can interIere with the
perIormance oI an SPO2 sensor. To prevent
interIerence Irom ambient lights, ensure that the
sensor is properly applied and cover the sensor site
with opaque material. Failure to take this action in
high ambient light conditions may result in
inaccurate measurements.
125
Measurement
Range
Parameter
0 100 SpO2
0 99.9 SpMet
0 99 SpCO
0 25g /dL SpHb
0 35ml /dL SpOC
25 240 Pulse Rate
0.02 20 PerIusion Index
0 100 PVI
Materials used in our SPO2 sensors are innoxious.
SPO2 Measurement
1. Turn on the monitor.
2. Attach the sensor to the appropriate site oI the
patient Iinger. (ReIer to Figure 6-4 Ior the proper
method.)
3. Plug the connector oI the sensor cable into the SPO2
socket on the leIt side oI the device.
126
Figure 6-4 placing the SPO2 sensor
SPO2 value always displays in the same position. But
when "PULSE RATE is set to 'ON in SPO2 WINDOW
and 'HR SOURCE is set to SPO2 in ECG WINDOW,
PR value will display in the place oI HR value too.
Make sure the nail covers the light window.
The sensor wire should be placed above the
hand.
127
VeriIy sensor cable Iault detection beIore
beginning SPO2 monitoring. Unplug the SPO2
sensor cable Irom the socket, the screen will display
the error message "SPO2 NO PROBE" .
Do not use the SPO2 sensor which its
packaging or the sensor is damaged and return them
to the vendor.
128
Measurement Limitations
During operation, the accuracy oI SPO2 measurement can
be aIIected by:
Using Electro cautery and deIibrillator devices
simultaneously
Excessive Patient movement
Injection oI intravascular dye such as indocyanine
methylen blue or green.
SigniIicant concentrations oI dysIunctional
hemoglobin, such as carboxyhemoglobin and
methemoglobin.
Increase or decrease oI sensor temperature (best
Iunctional temperature is between 28 C and 42 C)
Excessive illumination (more than 5000 lumens
/Squre meter)
Improper sensor application.
Venous pulsations
Cabling entanglement or strangulation.
129
Placement oI the sensor on a site that has a blood
pressure cuII, arterial catheter, or intravascular line.
Prolonged and continuous SPO2 monitoring
may cause unexpected change oI dermal condition
such as abnormal sensitivity, vesicle, repressive
putrescence, and so on. It is especially important to
check the sensor placement oI neonate and patient oI
poor perIusion. Check per 2-3 hours the sensor
placement and move it when the skin deteriorates.
Tissue damage can be caused by incorrect
application oI sensors, Ior example by pasting the
sensor or by wrapping it too tightly.
130
Do not immerse sensor completely in water,
solvents, or cleaning solutions because the sensor
and its connector are not waterprooI.
Low pulse signal can occur when
The patient is in cardiac arrest.
The patient has hypotension, severe
vasoconstriction, severe anemia, or
hypothermia.
There is arterial occlusion proximal to the
sensor.
SPO2 Alarm Messages
131
SPO2 PARAM MENU
By touching SPO2 parameter area, you can access this
menu:
Figure 6-5 SPO2 PARAM MENU
u Avg. Time
Available options Ior this item are 2, 4, 8, 10, 12, 14
and 16 seconds.
u PULSE RATE
Select 'ON to display HR and SPO2 values simultaneously.
II there is high quality ECG signal and HR SOURCE is set to
'AUTO mode, PR value is displayed next to SPO2 value,
Otherwise, (no suitable ECG signal) HR is measured Irom
SPO2 signal and PR value is displayed instead oI HR value.
SPO2 Alarm Messages
132
u SENSITIVITY
Available options Ior SPO2 SENSITIVITY are "NORMAL",
"MAX" and "APOD".
NORMAL .
The perIusion threshold has diIIerent limits as the
perIusion calculation is data dependent .Specially; There
is an intelligent algorithm which adjusts the low
perIusion limit in accordance with the quality oI the
incoming plethysmography waveIorm between 0.50
and 0.02. This mode provides the best combination oI
sensitivity and probe-oII detection perIormance. This
mode is recommended Ior the majority oI patients.
MAX .
Recognizing that some clinicians may want the absolute
low perIusion perIormance (0.02) all oI the monitoring
time and may be willing to ignore sensor oII detection,
they can achieve this by setting SPO2 SENS MODE to
SPO2 Alarm Messages
133
MAX. This mode is recommended Ior patients in critical
conditions. Maximum Sensitivity is designed to interpret
and display data Ior even the weakest oI signals.
This mode is recommended during surgeries and when
clinician and patient contact is continuous.
In MAX mode, the message "SPO2 MAX SENS." Is
displayed on the screen with white colour.
APOD .
This mode is not advisable Ior patients with low
perIusion because the system has the least sensitivity to
signal changes in this mode. It is used in situations
having risk oI probe detachment (e.g. children or uneasy
patients).
In this mode, 'APOD appears in white colour on the
screen.
SPO2 Alarm Messages
134
u ALARM ON/OFF
Select "ON" to enable SPO2 alarm Iunctions such as
parameters blinking, audio alarm, and light indicator.
be a " " symbol in SPO2 and PR Parameter areas.
u ALARM
By touching this item, you can access SPO2 ALARM
MENU to adjust SPO2 and PR alarm limits.
Figure 6-6 SPO2 ALARM MENU
You can change alarm limit oI PI, PVI, SpOC, SpCO,
SpMet and SpHb by touching this item in P5 and P6
including Rainbow parameters.
SPO2 Alarm Messages
135
Figure 6-7 SPO2 ALARM MENU (with Rainbow
parameters)
By touching each item in SPO2 ALARM MENU, you can
access alarm limit oI that item such as shown in Iig. 6-8.

Figure 6-8 SPO2 ALM LIMIT
Alarm limit oI SPO2, PR and Rainbow parameters is as
Iallowing:
SPO2 Alarm Messages
136
Alarm Limit
Parameter
SPO2 LOW Alarm 1 to 99 HIGH Alarm
1 to SPO2 HIGH Alarm -1 LOW Alarm
SPO2
PR LOW Alarm 5 to 235 HIGH Alarm
30 to PR HIGH Alarm -5 LOW Alarm
PR
PI LOW Alarm 0.1 to 20 HIGH Alarm
0 to PI HIGH Alarm -0.1 LOW Alarm
PI
PVI LOW Alarm 1 to 99 HIGH Alarm
1 to PVI HIGH Alarm -1 LOW Alarm
PVI
SpCO LOW Alarm 1 to 98 HIGH Alarm
1 to SpCO HIGH Alarm -1 LOW Alarm
SpCO
SpMet LOW Alarm 0.5 to 99.5 HIGH Alarm
0 to SpMet HIGH Alarm -0.5 LOW Alarm
SpMet
SpHb LOW Alarm 0.1 to 24.5 HIGH Alarm
1 to SpHb HIGH Alarm -0.1 LOW Alarm
SpHb
SpOC LOW Alarm 1 to 34 HIGH Alarm
1 to SpOC HIGH Alarm -1 LOW Alarm
SpOC
u ALARM LEVEL
serious case.
SPO2 Alarm Messages
137
SPO2 TRACE MENU
By touching the area displaying the SPO2 waveIorm ,
you can access this menu:
Figure 6-9 SPO2 TRACE MENU
u PLETH SWEEP
Available options Ior this item are 12.5 m/s and 25m/s.

Signal quality detection
In addition to plethysmograph waveIorm, there is SIQ or
SQ waveIorm which indicates signal quality simultaneous
to plethysmograph pulse. The height oI vertical lines
indicates the quality oI the signal (i.e. The lines are
higher, signal quality is better).
SPO2 Alarm Messages
138
SPO2 Alarm Messages
Alarm occurs when SPO2 and PR exceeds the alarm limit.
Audio
Alarm
SPO2
HIGH
SPO2
violates
adjusted
high alarm
limit
SPO2 value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SPO2 LOW
SPO2
violates
adjusted
low alarm
limit
SPO2 value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SPO2
ASYSTOLE
Pulse beat
is not
detected in
last 10 sec.
HR is "0" and
blinks.
Alarm indicator
Ilashes.
Message with red
backgrounds is
displayed
Activated
SPO2 Alarm Messages
139
Audio
Alarm
PR HIGH
PR violates
adjusted
high alarm
limit
PR value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
PR LOW
PR violates
adjusted
low alarm
limit
PR value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SPO2 Alarm Messages
140
Rainbow Parameters Alarm Messages
Alarm occurs when Rainbow parameters exceeds the
alarm limit in P5 and P6 including Rainbow parameters.
Audio
Alarm
PI HIGH
PI violates
adjusted
high alarm
limit
PI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
PI LOW
PI violates
adjusted low
alarm limit
PI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
PVI HIGH
PVI violates
adjusted
high alarm
limit
PVI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SPO2 Alarm Messages
141
Audio
Alarm
PVI LOW
PVI violates
adjusted low
alarm limit
PVI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SpOC
HIGH
SpOC
violates
adjusted
high alarm
limit
SpOC value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SpOC
LOW
SpOC
violates
adjusted low
alarm limit
SpOC value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SPO2 Alarm Messages
142
Audio
Alarm
SpCO
HIGH
SpCO
violates
adjusted
high alarm
limit
SpCO value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SpCO
LOW
SpCO
violates
adjusted low
alarm limit
SpCO value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SpMet
HIGH
SpMet
violates
adjusted
high alarm
limit
SpMet value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SPO2 Alarm Messages
143
Audio
Alarm
SpMet
LOW
SpMet
violates
adjusted low
alarm limit
SpMet value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SpHb
HIGH
SpHb
violates
adjusted
high alarm
limit
SpHb value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed
Activated
SpHb
LOW
SpHb
violates
adjusted low
alarm limit
SpHb value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color is
displayed.
Activated
SPO2 Alarm Messages
144
SPO2 messages include:
SPO2 NO
PROBE
Cause: SPO2 probe is
disconnected Irom the
monitor.
Solution: Make sure
that the probe is
correctly connected to
the monitor.
Alarm level 3,
message with cyan
background is
displayed and by
background oI
and system will
ignore this Iault.
SPO2 PROBE
DEFECT
Cause: The SPO2
probe is damaged.
Solution: Change the
SPO2 probe.
Alarm level 2,
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
SPO2 Alarm Messages
145
SPO2 PROBE
OFF
Cause: SPO2 probe
may be detached Irom
the patient Iinger.
Solution: Make sure
that SPO2 probe is
properly attached to the
patient.
Alarm level 3,
message with cyan
background is
displayed and by
background oI
and system will
ignore this Iault.
SPO2 CHECK
PROBE
Cause: SPO2 probe is
not properly attached
to the patient.
Solution: Make sure
that SPO2 probe is
properly connected to
the patient (reIer to
Iigure 6-1).
Alarm level 2,
message with yellow
background is
displayed and by
background oI
and alarm is disabled
Ior at least 120s.
SPO2 Alarm Messages
146
SPO2 HIGH
AMBIENT
LIGHT
Cause: This may be
caused by entering
environmental light
into the probe.
Solution: Make sure
that SPO2 probe is
properly connected to
the patient .
Alarm level 2,
message with yellow
background is
displayed and by
background oI
Ior at least 120s.
SPO2
SEARCH
Cause: SPO2 is not
calculable due to
diIIerent reasons such
as long time motions.
Solution: Move the
sensor to another place,
provoke blood recycle,
and calm the patient.
Alarm level 2,
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
SPO2
SIGNAL
WEAK
Cause: The SPO2
signal amplitude is too
weak or undetectable.
Solution: Change the
place oI the probe.
SPO2 Alarm Messages
147
AIter perIorming the mentioned solutions iI above
mentioned messages are displayed again, the SPO2 probe
may be damaged and you should contact with local
customer Service.
SPO2
DEFECT
Cause: SPO2 module
Iailure.
Solution: turn oII and
then on the system .II
this message is
displayed again, the
user should contact
local customer Service.
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
SPO2 Probe Cleaning
148
SPO2 Probe Cleaning
To clean the probe, Iirst remove it Irom the patient and
disconnect it Irom the monitor. Clean the probe by a cloth
damping with 70 isopropyl alcohol and then dry it prior
to placement on a patient.
Do not sterilize the patient cable and probes
by autoclave, irradiation, or ethylene oxide.
To prevent damage, do not immerse the probe
in any liquid solution.
Do not use any probe or cable that may be
damaged or deteriorated.
149
7
Monitoring NIBP
General Information
NIBP (Non-invasive Blood Pressure) processing by
the monitor uses the oscillometric measuring
technique. A motorized pump inIlates the cuII
initially, until the pressure eIIectively occludes Ilow
oI blood in the extremity. Then, under monitor
control, the pressure in the cuII is gradually reduced,
until a pressure transducer detects air pressure and
transmits a signal to the NIBP circuit.
NIBP General Information
150
As the cuII pressure is reduced, blood Ilows in the
previously occluded artery and changes the measured
pressure values sensed by the transducer. The point at
which oscillation increases sharply is deIined as systolic
pressure. As the cuII continues to deIlate, oscillation
amplitude increases to a maximum, and then decreases.
The peak oscillation amplitude is deIined as the mean
arterial pressure. The point at which the system detects a
loss oI oscillation is deIined as the diastolic pressure.
Blood pressure measurement according to this method is
equivalent to the cuII-stethoscope method.
u This module has been designed in accordance with EN
1060-1: Non-invasive sphygmomanometers Part 1:
General requirements
u It is applicable Ior adults and neonates.
u There are three modes oI measurement available:
manual , automatic and stat.
151
In the manual mode, only one measurement is
perIormed.
In the AUTO mode, the measurement is cycled.
You can set the interval time to 1, 2, 3, 5, 10, 15,
20, 30, 45 minutes and 1, 2, 4, 8, 12, 16, 20, 24
hours.
In STAT mode, measurement is perIormed up to ten
times during 5 minutes and with 30s interval
between measurements. In case oI any error, the
pressure measurement is suspended.
Use only recommended manuIacturer Blood
Pressure CuIIs and Hose. Using other cuIIs or hoses
may result in inaccuracies.
152
1. You must not perIorm NIBP measurement on
patients under any condition which the skin is
damaged or expected to be damaged.
2. Ensure that the correct setting is selected when
perIorming measurements on children. pressure
measurement Ior children in adult mode may cause
damage to extremity.
Do not apply the cuII to a limb that has an
intravenous inIusion or catheter in place. This
could cause tissue damage around the catheter
when inIusion is slowed or blocked during cuII
inIlation.
Make sure that the air hose oI the cuII is
neither blocked nor tangled.
153
Blood pressure measurement can be aIIected
by the position oI the cuII and patient's physiological
condition.
In this module the maximum cuII inIlation
pressure is 288 mmHg in adult mode and it is 146
mmHg Ior neonate mode. Furthermore independent
maximum pressure control preservative is Iorecasted
inside the system.
Also maximum time oI being under pressure Ior cuII
has been limited to 2 minutes in each measurement,
however it is necessary that operators pay attention
that long-time and continuous measurements can
result in muscular and neurotic harms or dermal
injuries.
154
1- Plug in the air hose and switch on the system.
2- Apply the blood pressure cuII to the patient's arm or leg
(Figure 7-1) and Iollowing the instructions below.
u Ensure that the cuII is completely deIlated.
u Apply the appropriate size cuII to the patient. Ensure
that the cuII is not wrapped too tightly around the limb.
Excessive tightness may cause discoloration and
dermal sensitivity.
According to saIety standard , Luer lock
connectors are not used .Don't use NIBP cuII with
Luer lock connector because iI Luer lock connector
is used, there is a possibility that they might be
unintentionally connected to intravascular Iluid
systems, allowing air to be pumped into blood
vessel.
155
Figure 7-1 Applying Cuff
The width oI the cuII should be either 40
oI the limb circumIerence (50 Ior neonates) or
2/3 oI the upper arm length. The inIlatable part oI
the cuII should be long enough to encircle 50-80
oI the limb. The wrong size oI cuII can cause
erroneous measurement. II the cuII size is in
question, then use a larger cuII. (ReIer to chapter
17 Ior more detail.)
156
3- Connect the cuII to the air hose. The limb chosen Ior
taking the measurement should be placed at the same level
as the patient's heart.
4- The patient mode should be selected appropriately. To
select the patient mode, press Menu key to enter
HOME/MENU, then By selecting PATIENT- ADMIT,
you can access HOME/PATIEN/ADMIT MENU and
perIorm your settings in PAT CONF. option .
5- Select a measurement mode(Manual, Auto) in the
NIBP WINDOW menu.
6- Press the START/STOP key on the Iront panel to start
a NIBP measurement.
157
Operation Hints
1- To start a MANUAL measuring, press the START/STOP
key on the Iront panel.
2- To stop MANUAL measuring, press the START/STOP
key on the Iront panel.
3- To start AUTO measuring, select measuring intervals in
NIBP WINDOW and then Press START/STOP key on the
Iront panel.
4- To start a MANUAL measuring during the AUTO mode,
press the START/STOP key on the Iront panel.
Prolonged NIBP measurements in Auto mode
may cause irritation and neuropathy in the limb
wearing the cuII. BeIore monitoring a patient,
examine the limb Ior normal color, warmth and
sensitivity. II any abnormality is observed, stop the
blood pressure measurements.
158
5- To stop AUTO measuring, Select the NIBP WINDOW
and set AUTO mode to MANUAL.
6- To start a STAT measuring, press the START/STOP key
on the Iront panel.
II you are in doubt about the accuracy oI any
measurement, check the patient's vital signs by an
alternative method beIore checking connections,
cuII, hose and the system Iunctionality.
Long-time and continuous measurements in
STAT mode can result in muscular and neurotic
harms or dermal injuries.
159
Measurement Limitations
In diIIerent patient conditions, the oscillometric
measurement has certain limitations. The measurement is
in search oI regular arterial pressure pulses. In those
circumstances, when the patient's condition makes it
diIIicult to detect, the measurement becomes unreliable
and measuring time increases. The user should be aware
that the Iollowing conditions could interIere the
measurement and make the measurement unreliable or
longer. In some cases, the patient's condition will make a
measurement impossible.
Patient movement
Measurements will be unreliable or may not be possible iI
the patient is moving, shivering or having convulsions.
These motions may interIere the detection oI the arterial
pressure pulses. In addition, the measurement time will be
prolonged.
160
Cardiac Arrhythmia
Measurements will be unreliable and may not be possible
iI the patient's cardiac arrhythmia causes an irregular heart
beat. Thus the measuring time will be prolonged.
Heart - Lung Machine
Measurements will not be possible iI the patient is
connected to a heart-lung machine.
Pressure Changes
Measurements will be unreliable and may not be possible
iI the patient's blood pressure changes rapidly over a short
period oI time.
Severe Shock
II the patient is in severe shock or hypothermia,
measurements will be unreliable because oI reduced
pulsation oI the arteries.
Abnormal Heart Rate
Measurements can not be perIormed at a heart rate oI less
than 40 bpm and greater than 240 bpm.
NIBP PARAM MENU
161
NIBP PARAM MENU
Figure 7-2 Different parameters of NIBP
NIBP PARAM MENU is displayed in this Iorm.
Figure 7-3 NIBP PARAM MENU
NIBP PARAM MENU
162
u UNIT
Select this item to adjust measurement unit. (Options:
mmHg or KPa)
u NIBP START
Select this item to start NIBP measurement.
u NIBP ALM
By touching this item ,you can access NIBP ALARM
MENU .
Figure 7-4 NIBP ALARM MENU
NIBP PARAM MENU
163
NIBP ALM
be a" "symbol in NIBP Parameter area.
SYS LIM
By touching this item , you can access NIBP
ALARM/SYS ALM LIMIT window.
Figure 7-5 NIBP ALARM/SYS ALM LIMIT
SYS alarm is activated when the systolic pressure exceeds
adjusted ALARM HIGH and LOW limits.
NIBP PARAM MENU
164
LOW limit: 30 ~ (HIGH limit - 5)
HIGH limit: (LOW limit 5) ~ 300
MAP LIM
By touching this item , you can access NIBP
ALARM/MAP ALM LIMIT window.
Figure 7-6 NIBP ALARM/MAP ALM LIMIT
MAP alarm is activated when the mean arterial pressure
exceeds adjusted ALARM HIGH and LOW limits.
ALARM REC
Select "ON", the system will start recording automatically
when a NIBP alarm occurs.
NIBP PARAM MENU
165
ALARM LEVEL
serious case.
DIA LIM
By touching this item, you can access NIBP ALARM/DIA
ALM LIMIT window.
Figure 7-7 NIBP ALARM/DIA ALM LIMIT
DIA alarm is activated when the diastolic pressure
LOW limit: 30 ~ (HIGH limit - 5)
HIGH limit: (LOW limit 5) ~ 300
NIBP PARAM MENU
166
u STAT \AUTO \MANUAL
There are three modes oI measurement available:
MANUAL, AUTO and STAT. In the MANUAL mode,
only one measurement is perIormed. In the AUTO mode,
measurement is repeated over a speciIied period oI time ;
available intervals are 1,2,3,5,10,15,20,30 and 45 minutes
and 1, 2, 4, 8,12,16,20 and 24 hours. In STAT mode,
measurement is perIormed up to ten times in 5 minutes
and with 30s interval between measurements. II an error
occurs, NIBP measurement is suspended.
u NIBP LIST
Patient monitor can store the latest 100 NIBP measurement
values.
Touch "NIBP LIST" in the NIBP WINDOW to review the
results and times oI the latest NIBP measurements, as
shown in Figure 7-8.

NIBP PARAM MENU
167
Figure 7-8 NIBP LIST MENU
Select or to view Iirst or last measurement value.
Select or to scroll down or up to view preceding or
Iollowing page.
Select or to scroll down or up to view previous or
next measurement value.
By selecting 'DEL button, you can delete highlighted
data in this menu.
NIBP PARAM MENU
168
You can also delete all stored measurement values in this
menu by selecting 'DEL ALL button and pressing YES
in pop-up alert window.
Figure 7-9 ALERT
u AUTO SLEEP
Select 'ON and press START button until ' WAKEUP
AT 9 appears on NIBP window in red color.
Measurement resumes aIter 10 s and a 'SELF TEST is
done during this time. (SELF TEST should be 'ON)
u CHECK
By touching this item , you can access this menu:
NIBP PARAM MENU
169
Figure 7-9 ALERT
Figure 7-10 NIBP CHECK MENU
SELF TEST
Select this item to perIorm a selI test onNIBP module.
MANOMETER
Wrap the cuII around a rigid cylinder. Connect a
mercurial reIerence manometer and a ball pump by means
oI a T-piece connector and hose to the monitor.
Set the monitor to " MANOMETER" mode. InIlate the
pneumatic system to 0, 50 and 200 mmHg by ball pump
separately. The diIIerence between the indicated pressure
oI the reIerence manometer and the indicated pressure oI
the monitor should not exceed +3 mmHg.
NIBP PARAM MENU
170
LEAKAGE
Wrap the cuII around a cylinder oI an appropriate size,
(The circumIerence oI the applied cuII does not exceed
that oI the cylinder more than 7). Set the monitor to
" LEAKAGE" mode. The monitor inIlates the cuII up to
170 mmHg and keeps it constant Ior 15 sec .II air leakage
result is satisIactory, "NIBP LEAK OK" message is
displayed; otherwise you will receive "PNEUMATIC
LEAK" message.
Above tests must only be done by manuIacturer trained
and authorized personnel.
STOP
To stop NIBP measurement.
u RESET MODULE
To set maximum inIlation pressure oI cuII to 150mmHg
Ior adults and 70mmHg Ior neonates.
NIBP Alarm Messages
171
NIBP Alarm Messages
Alarm occurs when the pressure (SYS, DIA or MAP)
exceeds the alarm limits.
ALARM Situation Visual Alarm
Audio
Alarm
NIBP SYS
HIGH
SYS pressure
violates
adjusted high
alarm limit.
SYS value blinks.
alarm indicator Ilashes.
Message with
appropriate backhground
color is displayed.
Activated
NIBP SYS
LOW
SYS pressure
violates
adjusted low
alarm .
SYS value blinks.
Message with
color is displayed.
Activated
NIBP DIA
HIGH
DIA pressure
violates
adjusted high
alarm .
DIA value blinks.
Message with
color is displayed.
Activated
NIBP Alarm Messages
172
ALARM Situation Visual Alarm
Audio
Alarm
NIBP DIA
LOW
DIA pressure
violates
adjusted low
alarm limit.
DIA value blinks.
alarm indicator
Ilashes.
Message with
appropriate
backhground color is
displayed.
Activated
NIBP MAP
HIGH
MAP violates
adjusted high
alarm limit.
MAP value blinks
alarm indicator
Ilashes.
Message with
appropriate
displayed.
Activated
NIBP MAP
LOW
MAP violates
adjusted low
alarm limit.
MAP value blinks
alarm indicator
Ilashes.
Message with
appropriate
displayed.
Activated
NIBP Alarm Messages
173
NIBP messages include:
Message Cause
SELF-TEST FAILED NIBP hard ware module Iailure
NIBP LOOSE CUFF
CuII is not properly wrapped or
no cuII applied.
NIBP MODE ERROR
Adult cuII is used instead oI
neonate cuII or occlusion
happened in air way.
NIBP AIR LEAK Air leak in cuII, hose or connector.
NIBP AIR PRESSURE
ERROR
Unstable pressure value (e.g.
tangled hose) because valves
cannot open normally.
NIBP SIGNAL WEAK
Very weak patient signal due to a
tightly wrapped cuII or weak
pulse Irom patient.
NIBP Alarm Messages
174
Message Cause
NIBP RANGE EXCEED
Measuring pressure exceeded
upper limit (255mmHg) Ior adult
or (135mmHg) Ior neonate.
NIBP EXCESSIVE
MOTION
Arm movement, noisy signal or
irregular pulse (e.g. arrhythmia)
NIBP OVER PRESSURE
SENSED
Measuring pressure exceeded
saIe soItware limit, 290 mmHg
Ior adult and 145 mmHg Ior
neonate.
NIBP SIGNAL
SATURATED
Large motion artiIact and noise
that saturates the ampliIier's
amplitude handling capability.
NIBP PNEUMATIC
LEAK
Leakage during leak test
NIBP TIME OUT
Measuring time exceeds 120
seconds Ior adult or 90 seconds
Ior neonate.
NIBP Alarm Messages
175
Message Cause
SYSTEM FAILURE
Error occurs in pump, A/D
sampling, pressure transducer or
soItware.
NIBP DEFECT NIBP module Iailure
NIBP LOW BATTERY
The Charge oI battery is low so
NIBP measurement is not
possible (while the monitor is
working with battery).
NIBP NO MODULE No NIBP module is installed.
NIBP MODULE ERROR
There is a Iailure during
measurement.
NIBP STOP PRESSED
Stop key has been pressed during
measurement.
NIBP STOP
Measurement is stopped by
NIBP module because oI a
special reason.
NIBP Alarm Messages
176
Alarm level Ior above messages (except the last three
messages) is set in NIBP ALARM MENU.
By pressing SILENCE key, background oI message will be
gray and system will ignore this Iault.
Message Cause
NIBP LEAKAGE O.K SuccessIul leakage test.
NIBP Cuff Cleaning
177
NIBP Cuff Cleaning
u Cleaning
Durable cuIIs can be saIely cleaned with a cloth
damped with 70 alcohol or 0.5 bleach solution or
washed in water and soap solution (maximum 60C).
u Sterilization
Do not use steam or heat to sterilize the cuII. Gas
sterilization can be used iI necessary.
u Disinfection
Glutaraldehyde type liquid disinIectants may be used
on reusable cuIIs. Prolonged use oI these disinIectants
may cause discoloration oI cuII and its marking.
178
8
Monitoring TEMP
General Information
Measurement oI patient temperature is accomplished
by processing the signal Irom a probe containing
temperature dependent resistor called thermistor.
Value oI this resistor is measured by the monitor
continuously and displayed on screen.
TEMP General nformation
179
SpeciIication:
Two TEMP probes can be used together to obtain 2
temperature data and compare them to determine the
temperature diIIerence.
u Plug TEMP probe directly into the monitor.
u Attach the TEMP probe(s) properly to the patient.
u Switch on the system.
0~50 C Measuring and alarm range
+ 0.2 C Accuracy
50 sec For Rectal/esophageal probe
20 sec For skin probe
Delay
time
180
Inspection and recalibration
Inspect the probe Ior cracks, holes, cracking etc, prior to
each use. II any such degradation in probe is discovered,
discard probe according to your hospital's regulations Ior
medical waste. When using temperature probe, the user
must ensure that a probe style is suitable and suIIiciently
Ilexible Ior esophageal or rectal use.
TEMP Probe can not be recalibrated Ior each use, but
should be inspected monthly by the hospital Biomedical
Equipment personnel to ensure that they are working
properly.
Plug Probe into a patient monitor and look Ior an
electrical open or shortcircuit, Intermittent reading or
extremely inaccurate readings which would indicate probe
wire damage.
181
The probe stability is well-documented; Probe accuracy
should not exceed the tolerance over the normal liIe oI
probe.
Please note that the metal side oI probe
contacts with the body.
Over straining will result in mechanical damage
oI the probes.
The calibration oI the temperature
measurement is necessary every two years or
according to hospital procedures. When you need to
calibrate the temperature measurement, contact the
ManuIacturer Customer Service.
182
Using electro cautery with TEMP probe
simultaneously, may cause patient burn. II possible,
remove the probe Irom patient contact beIore
activating electro cautery device or other RF source.
II probe must be used simultaneously with electro
cautery apparatus, hazards can be reduced by
selecting a temperature measurement point which is
remote Irom the expected RF current path to the
ground return plate.
The temperature probe carry a one-year
warranty and normal and proper use will increase
liIe time more than one year.
TEMP PARAM MENU
183
PARAM MENU
TEMP PARAM MENU is as Iollows:
Figure 8-1 TEMP PARAM MENU
u UNIT
Select this item to set measurement unit. Available options
are C or F .
u TEMP ALM
be a" " symbol in TEMP Parameter area.
TEMP PARAM MENU
184
u ALM LIM
By touching this item, you can access TEMP ALARM
LIMIT window.
Figure 10-2 TEMP ALARM LIMIT
TEMP alarm is activated when the temperature value
LOW limit: (HIGH limit 0.5) ~ 0

C
HIGH limit: 50 ~ (LOW limit 0.5)
C
u ALARM LEVEL
serious case.
TEMP Error Messages
185
TEMP Error Messages
Alarm occurs when TEMP alarm is 'ON and exceeds the
adjusted limits.
TEMP Sensor Cleaning and Maintenance
186
To clean the temp sensor, Iirst remove it Irom the patient
and disconnect it Irom the monitor.
u Cleaning
When wiping clean, hold the probe in one hand at the
sensing tip and wipe the probe and cable toward the
connector. Excessive pressure and stretch could damage
cable jacket and break the internal wires, destroying the
probe. Avoid cleaning the sensor with substances such as
ether, ketone, or ester solvents.
Temperature sensors are sold non- sterile.
Don` t immerse probe connector in the water.
187
u Sterilization
Ethylene oxide is the preIerred substance to sterilize the
sensor. AIter sterilization, probes must be thoroughly
ventilated beIore handling or use. Use a generic EtO
sterilizing procedure. An aeration time oI 12 hours to
dissipate residual EtO in probe is recommended.
u Disinfection
Probes may be disinIected by washing with 70
isopropanol, activated dialdehyde (Cidex) or sodium
hypochlorite (bleach diluted 1:10 minimum in water.)
AIter disinIecting the probes should be washed thoroughly
with water. BrieI immersion oI the probe in detergent
solutions is not harmIul.
ManuIacturer does not make any claim as to the eIIicacy
oI these chemicals Ior inIection control.
188
Please consult your hospital's InIection Control OIIicer Ior
more disinIection guides.
Sensor Maintenance
When not in use, probes should be loosely twisted and
stored at room temperature .Do not wrap sensor around
the monitor to avoid damaging it.
Never immerse the temperature probes in the
boil water.
189
9
Patient Safety
The Patient Monitor is designed to comply with the
international saIety standard requirements Ior
medical electrical equipment. This device has
Iloating inputs (i.e. Accessories are isolated against
AC power) and it is protected against the eIIects oI
deIibrillator and electro cautery. II the correct
electrodes are used and applied in accordance with
the manuIacturer instructions, the system will
recover within 10 seconds aIter deIibrillation.
Patient Safety
190
This symbol indicates that the monitor has CF type and
DeIibrillation ProoI applied part according to IEC-601-1.
The modules with this symbol contain an F- Type isolated
(Iloating) patient applied part providing a high degree oI
protection against shock, and is usable during
deIibrillation.
This symbol indicates that the monitor has BF type and
DeIibrillation ProoI applied part according to IEC-601-1.
The modules with this symbol contain an F- Type isolated
(Iloating) patient applied part which contains a high
degree oI protection against shock, and is usable during
deIibrillation.
Do not touch the patient, bed or instrument
during deIibrillation.
Patient Safety
191
Follow the instructions below to ensure a completely saIe
electrical installation.
The environment where the Patient Monitor will be used
should be reasonably Iree Irom vibration, dust, corrosive
or explosive gases, extremes oI temperature and humidity.
The Patient Monitor properly operates at ambient
temperatures between 0C and 40C. Ambient
temperatures that exceed these limits could aIIect the
accuracy oI the monitor and cause damage to the modules
and electric circuits.
Patient Safety
192
Grounding the patient monitor
To protect the patient and hospital personnel, the case oI
patient monitor must be grounded. The patient monitor is
equipped with a detachable 3-wire cable which grounds
the instrument to the power line ground (protective earth)
when plugged into an appropriate 3-wire receptacle .II a
3-wire receptacle is not available, consult the hospital
electricians. II there is any doubt regarding the
completeness oI the protective grounding wire, the device
must be operated with internal battery or DC input.
There is possible explosion hazard iI system is
used in the presence oI Ilammable anesthetic agents.
Patient Safety
193
Monitor Symbols
This symbol means "BE CAREFUL". Consult
accompanying documents (this manual)
194
10
Maintenance and Cleaning
System Check
BeIore using the monitor, do the Iollowing
instructions:
u Check iI there is any mechanical damage on the
system and accessories.
u Check iI all the power cable and accessories are
tightly connected.
u Check iI all keys and modules oI the system
Iunction properly.
II you Iind any damage on the monitor, stop
monitoring, and contact the biomedical engineer oI
the hospital or local Customer Service.
System Check
195
The overall check oI the monitor, including the saIety
check, should be perIormed only by qualiIied personnel.
All the checks that need to open the monitor and the saIety
check should be perIormed by Customer Service.
It is recommended to calibrate the system by
manuIacturer every 2 years.
To ensure maximum battery liIe, it is
recommended that, at least once a month, the
monitor be run on battery until it turns itselI oII and
then recharged.
II user do not Iollow a satisIactory maintenance
schedule, the monitor may become invalid, and
patient health may be endangered.
System Cleaning
196
Cleaning
The Patient Monitor must be kept dust-Iree.
Regular cleaning oI the monitor shell and the screen is
strongly recommended. Use detergents such as soap and
water solution to clean the monitor shell.
Please pay special attention to the Iollowing items:
1. Don`t use cleaning agents including ammoniac or
acetone.
2. Most cleaning agents must be diluted beIore use.
3. Don't use rough material, such as steel wool etc.
BeIore cleaning the monitor or the sensors,
make sure that the system is switched oII and
disconnected Irom the power line.
System Cleaning
197
4. Don't allow the cleaning agent to enter into the
monitor.
The monitor and sensors surIace can be cleaned
with hospital-grade ethanol and dried with a clean
cloth.
System Sterilization
198
Sterilization
To avoid extended damage to the system, sterilization
should be perIormed according to the Hospital
Maintenance Schedule.
It is recommended to use activated dialdehyde (Cidex) Ior
sterilizing the monitor.
u Do not let liquid enter the monitor.
u No part oI the monitor can be subjected to
immersion in liquid.
u Do not pour liquid onto the monitor during
sterilization.
u Use a soIt cloth to wipe up any agent remaining
on the monitor.
System Disinfection
199
Disinfection
Some disinIectants that can be used Ior disinIection are as
below:
u Hydrogen Peroxide 3
u Alcohol 70
u Isopropanol
u Enpropanol
To avoid extended damage to the equipment, disinIection
should be perIormed according to the Hospital
Maintenance Schedule.
Do not use ETO gas to disinIect the monitor.
Do cleaning, sterilization and disinIection oI
slave monitor same as the bed side monitor.
System Disinfection
200
Appropriate cleaning, sterilization and disinIection
materials Ior accessories are introduced in each module's
chapters.
ManuIacturer has no responsibility Ior the
eIIectiveness oI controlling inIectious disease using
these chemical agents. Please reIer to inIectious
disease experts in your hospital Ior details.
201
11
Getting Started
Open the Package and Check
Open the package and take out the monitor and
accessories careIully. Keep the package Ior possible
Iuture transportation or storage.
u Check Ior any mechanical damage.
u Check Ior the existence oI the power cable and
accessories.
II there is any problem, contact the distributor
immediately.
Getting Started
202
Insert the battery
When you use the system Ior the Iist time, you should
insert the battery into the monitor.
Place the monitor into the station base
Set the monitor in the station base.
Plug the Power Cable into the system
u Make sure the AC power supply is 200-240 VA and
50/60Hz.
u Plug the power cable into the power supply socket oI
the station base and connect the other end oI the power
cable to a grounded power receptacle.
Getting Started
203
Make sure that the battery indicator lights. II it
does not light, check your local power supply and
power cable connection. II the problem still exists,
contact the local Customer Service.
The battery needs to be charged aIter
transportation or storage. II the power cable is not
properly connected beIore turning on the monitor, it
may not work properly because oI insuIIicient
power. Connect the power supply to charge the
battery Ior about 24 hours while the monitor is oII.
Getting Started
204
Power on the monitor
Press POWER key to turn on the monitor. At the same
time a beep will be heard and yellow and red indicator
light about 2.5 seconds separately. AIter 30 seconds or so,
the system will display the monitoring screen aIter selI-
test, and you can start normal monitoring now.
Check the Iunctions oI all modules and make
sure that the monitor is in good connection.
The battery must be recharged aIter each use.
To do so, you should only connect the system to AC
INPUT.
II any sign oI damage is detected, or the
monitor displays any error messages, do not use it on
any patient until resolving that problem.
Getting Started
205
Attach the Sensors to the patient
Connect all the necessary accessories between the monitor
and the patient.
For inIormation on correct accessories
connections, reIer to each module's chapter.
206
12
Continuous patient monitoring
Aria monitor is intended to be used as a Iull
Iunction monitor. By using some accessories, the
monitor can be easily used in diIIerent places inside
and outside oI the hospital.
You can connect the monitor to peripheral devices
or change its usability during the monitoring
without any disturbance in measuring or recording
oI physiological parameters.
The monitor can be used in an ambulance by
mounting it on the rollstand as shown in Iigure 12-1
and 12-2.

Figure 12-1 Installation on the rollstand
207
Figure 12-2 Monitoring in ambulance
During patient transport to diIIerent wards or operation
room oI hospital, the monitor can be hung on the bed rail
by its base (Iigure 12-3).
Figure 12-3 Installation on bed rail
208
In order to have a suitable and clear view oI the screen in
ICU, CCU or operation room, you can connect the
monitor to a large LCD as second monitor (installed above
patient bed). (Figure 12-4)

Figure 12-4 Connection to large LCD
Aria monitor also can be used as a detachable multi-
module in Zagros and Alborz monitors when patient
should be transIerred to diIIerent wards oI hospital.
(Figure 12-5)

Figure 12-5 Detachable multi-module
209
The monitor can be placed in an special shoulder bag and
easily carried by patient with regard to its portable and
lightweight Ieatures .(Figure 12-6)

Figure 12-5 Placement in special bag
210
13
Technical Specifications
CLASSIFICATION
Protection against electroshock
Class I, Type CF Ior all modules (except
Multi-gas module & NIBP module that are
BF) (based on IEC 60601-1)
Mode of operation
Continuous operation equipment
Harmful Liquid Proof Degree
IPX2
Method of sterilization and disinfection
ReIer to each module's chapters and chapter
14 Ior detail.
Safety of anesthetic mixture
Not suitable Ior use in the presence oI a
Ilammable anaesthetic mixture with air or
with oxygen or nitrous oxide.
211
DISPLAY
ARIA Display
COLOR TFT 480 272, 4.3
Waveforms
ECG, SPO2, RESP
Numeric Parameters
HR, SPO2, NIBP (SYS, DIA, MAP) , RR, T1,
T2
Operation Method
Membrane and Touch screen
ECG
Leads Selectable 3 or 5 Wires
For 3 wire: I, II, III
For 5 wire :I,II,III,V,aVR,aVF,aVL
Dynamic Range
5 mV
Leakage Current
10 A
Lead Off Current
90 nA
Gain 4, 2, 1, 1/2, 1/4, Auto
212
Calibration
1mV, 0.5 sec
Filters 'MONITOR ( 0.5 - 28 Hz )
'NORMAL ( 0.5 - 40 Hz )
'DIAGNOSE ( 0.05 - 100 Hz )
'DIAG HUM ( 0.05-100 Hz excluding 50 Hz)
CMRR ~ 98 dB
Internal Noise
30 V RTI
Input Impedance
~ 5 Mohm
QRS Detection
Duration : 40 to 120 msec
Amplitude : 0.25 to 5 mV Ior Adult
0.2 to 5 mV Ior Neonate
Heart Rate Range
15 - 300 bpm Ior adult
15 - 350 bpm Ior neonate
Accuracy
1 or 2 bpm
Tall T-Wave
Reject up to 1.2 mV Amp.
Pacer Detection/Rejection
Duration : 0.1 - 2 msec
Amp: 2 to 700 mV (Without over/undershoot)
Reject From Heart Rate Counter
Re-insert into ECG to display on screen
213
Protection
DeIibrillator and Electro cautery
Standards
ANSI/AAMI EC-13, IEC 60601-2-27
NIBP (CAS ND)
Measurement method
Oscillometric
Measurement mode
Manual/Automatic/Stat
Measurement time
20-25 sec (excluding cuII pressurization time)
Measurement Range
Adult: SYS 30 ~ 255 mmHg
DIA 15 ~ 220 mmHg
MAP 20 ~ 235 mmHg
Neonate: SYS 30 ~ 135 mmHg
DIA 15 ~ 110 mmHg
MAP 20 ~ 125 mmHg
Pressure Transducer accuracy
3 mmHg Iull range
Initial Inflation Target
Adult 150 mmHg , Neonate 85 mmHg
214
Overall System Efficacy
ANSI/AAMI SP-10/2002
Memory
100 Records
SPO2 & Rainbow parameters
MASIMO Rainbow -MX Series
Method
2 WaveLength Pulse Wave Type
Range
SpO2 0 100
SpMet 0 99.9
SpCO 0 99
SpHb 0 25 g/dL
SpOC 0 35 ml/dL
PR 25 240 bpm
PI 0.02 20
PVI 0 100
Accuracy
Oxygen Saturation
During no motion conditions:
Adult: 3 (SPO2 60 ~ 80)
2 (SPO2 70 ~ 100)
Neonate: 3 (SPO2 70 ~ 100)
215
During motion conditions:
3 (SPO2 70 ~ 100)
During low perIusion conditions:
2 (SPO2 70 ~ 100)
Pulse Rate
During no motion conditions:
3bpm
During motion conditions:
5bpm
During low perIusion conditions:
3bpm
Carboxyhemoglobin Saturation
Adult: 1 - 40 3
Methemoglobin Saturation
1 - 15 1
Total Hemoglobin
Adult: 8 17 g/dL 1g/dL
Resolution
SpO2 1
SpCO 1
SpMet 0.1
SpHb 0.1 g/dL
PR 1 bpm
216
TEMPERATURE
Channel
2
Probe Type
YSI 400 Compatible
Range 0 - 50 C
Accuracy
0.2 C
RESPIRATION
Method
Impedance
Base Resistance
250 -1250 Ohm
Dynamic Range
0.2 - 2 Ohm
Breath Rate Range
0 - 253 BrPM
Accuracy
+2 or 2 BrPM
217
ALARM
Sources
Error messages, All other Parameter Limits
Alarm On/Off
Selectable Ior All Parameters
Alert Blinking on Display,
Volume Selectable Audio Alarms
Light indicator
TREND
Sources
HR, SPO2, PR, Resp, TEMP, SpHb, PI, SpCo,
SpMet, PVI, SpOc
Trend Time
5, 10, 15, 30, 45 Min, 1, 2, 4, 8, 12,16, 24, 36, 48,
72, 96Hours
Resolution
1 sec
218
INPUT/OUTPUT
Network
Digital, Serial, RS422 , Full Duplex
Connection
8/12 BED to One CENTRAL system
GENERAL
Application
Compact and Mobile Monitor
Safety
Based on IEC 60601-1, Class I
Protection
Against Electro cautery, DeIibrillator and EMC
AC Power
90 - 240 VAC, 50/60 Hz
Internal Battery
Nickel-Metal Hydride (Ni-MH), user replaceable
rechargeable battery
Usage: Over 90 min with ECG, Resp, Temp,
SPO2
DC Power Plug
12-14 V, Maximum 3 A
219
Dimension
150 (W) 109 (H) 67 (D)
Weight
800 g
ENVIRONMENTAL
Temperature
Operating: 5 to 40 C
Storage: -20 to 60 C
Humidity
20-90 (Noncondensing)
Altitude
-200 to 3000 m
220
14
Accessories
General Information
This chapter lists the recommended accessories used
Ior patient monitor.
The accessories listed below are speciIied to
be used Ior patient monitor. ManuIacturer does not
take responsibility Ior any possible hazard to the
patient or monitor iI other accessories are used.
Accessories
221
ECG PATIENT CABLE 3 LEAD
PART.#:10-003
ECG PATIENT CABLE 5 LEAD
PART.#:10-038
SPO2 Sensor - Reuseable- Finger/Toe-Adult ~ 30Kg ,
Red DCI dc 12 PART.#: 18-55
SPO2 Extension Cable
PART.#: 18-56
NIBP CuII Adult thigh - 18 36cm MINDRA
PART.#:13-026
NIBP CuII Large Adult - 15 33 cm - MINDRAY
PART.#:13-027
NIBP CuII Adult - 1223cm MINDRAY
PART.#:13-028
ECG
SPO2 (Masimo Rainbow)
NIBP
Accessories
222
NIBP CuII Child - 918cm MINDRAY
PART.#:13-029
NIBP CuII InIant - 612cm MINDRAY
PART.#:13-030
CUFF HOSE - MINDRAY
PART.#:13-031
NIBP CuII InIant - 618cm CAS - CR5206
PART.#:13-019
NIBP CuII - Small Child - 721cm CAS - CR5207
PART.#:13-020
NIBP CuII - Child - 927cm CAS - CR5209
PART.#:13-021
NIBP CuII - Small Adult - 1230 cm CAS - CR5212
PART.#:13-022
NIBP CuII Adult 14 37.5cm CAS -CR5214
PART.#:13-023
NIBP CuII - Large Adult - 1642 cm CAS - CR5216
PART.#:13-024
Accessories
223
CUFF HOSE CAS
PART.#:13-025
TEMP Probe Skin Adult - FMT400AS
PART.#:10-045
TEMP Probe Esophageal / Rectal Adult FMT
PART.#:10-046
TEMP
224
15
Troubleshooting
Repairing the internal parts oI the monitor must be
only done by trained and authorized personnel oI
Customer Service; otherwise manuIacturer will not
take any responsibility Ior any possible hazard to
the patient and the monitor.
This section is intended to help users to solve minor
problems caused by incorrect use oI the monitor or
Iailure oI accessories.
When you Iace any problem, please be sure that you
have Iollowed all mentioned procedures beIore you
contact with Customer Service.
Troubleshooting
225
Problem Possible Cause Correct Action
Not to be turned
Check power cable
path.
Call Customer
service.
Unable to work
with Battery
Battery is Iully
discharged
Fuse oI Battery is
Iaulty.
Others
Charge the battery
Ior 10 hours.
Check Iuse
existence.
Call Customer
service.
Noisy ECG
waveIorm
Loose connection oI
electrodes.
Earth connection
Iailure.
Wrong ECG Iilter
Others
Check electrodes
and leads
Check earth
Set Iilter mode
correctly
Call Customer
service.
NO ECG
waveIorm
ECG cable is not
connected correctly.
Bad placement oI
leads and electrodes
Others
Connect ECG cable
correctly.
Check leads and
electrodes.
Don`t use old and
Iaulty electrodes.
Call Customer
service.
Troubleshooting
226
Problem Possible Cause Correct Action
Spike on ECG
waveIorm
II PACE is "ON"
Ior patient without
Pace marker, ECG
noise will be received
as PACE.
Others
Turn 'Pace
detection OFF in
ECG menu.
Unstable HR
ECG signal is noisy
or isn`t suitable
Others
Check leads and
electrodes.
Change lead to
display the best
ECG signal
Call Ior service
1
APPENDIX I
LIST OF MONITOR PARAMETERS (SELECTIONS
AND DEFAULTS)
Default selection Menu item
The parameters in ECG menu
II
I,II,III,aVR,aVF,aVL,
V
ECG LEAD
AUTO
0.25,0.5,1,2,4,
AUTO
ECG GAIN
25 12.5,25 and 50mm /s ECG SWEEP
1 1,2
ALARM
LEVEL
OFF ON,OFF HR ALARM
150Bpm
HR LOW ALARM 5
to 250
HR HIGH
ALARM
50Bpm
30 to HR HIGH
ALARM -5
HR LOW
ALARM
NORMAL
MONITOR,NORMA
L,DIAGNOSE, DIAG
HUM
ECG FILTER
AUTO ECG, SPO2, AUTO HR SOURCE
1 1,2,3,4,5,6,7,8, OFF
BEAT
VOLUME
2
OFF ON,OFF
PACE
DETECT
OFF ON,OFF ECG CALIB
8SEC 4,8,16SEC ECG
AVERAGE
3LEAD 3LEAD,5 LEAD LEAD TYPE
The parameters in RESP menu
RA-LA RA-LA,RA-LL RESP LEAD.
1 0.25,0.5,1,2,4 RESP GAIN
12.5mm/s 3,6,12.5,25mm/s RESP SWEEP
1 1,2
ALARM
LEVEL
OFF ON ,OFF RR ALARM
25Brpm
RR LOW ALARM 5
to 250
RR HIGH
ALARM
5Brpm
5 to RR HIGH
ALARM -5
RR LOW
ALARM
10S 0 to 40S
APNEA
LIMIT
The parameters in SPO2 menu
8 2, 4, 8, 10, 12, 14, 16 Avg. Time
12.5mm/s 12.5,25mm/s
SPO2 PLETH
SWEEP
3
1 1,2
ALARM
LEVEL
OFF ON,OFF ALARM
99
SPO2 LOW ALARM
1 to 99
SPO2 HIGH
ALARM
90
1 to SPO2 HIGH
ALARM -1
SPO2 LOW
ALARM
140
PR LOW ALARM 5
to 235
PR HIGH
ALARM
50
30 to PR HIGH
ALARM -5
PR LOW
ALARM
3
SpMet LOW ALARM
0.5 to 99.5
SpMet HIGH
ALARM
0
0 to SpMet HIGH
ALARM -0.5
SpMet LOW
ALARM
10
SpCO LOW ALARM
1 to 98
SpCO HIGH
ALARM
1
1 to SpCO HIGH
ALARM -1
SpCO LOW
ALARM
17
SpHb LOW ALARM
0.1 to 24.5
SpHb HIGH
ALARM
7
1 to SpHb HIGH
ALARM -0.1
SpHb LOW
ALARM
19
PI LOW ALARM
0.1 to 19
PIHIGH
ALARM
4
0
0 to PI HIGH
ALARM -0.1
PI LOW
ALARM
99
PVI LOW ALARM
1 to 99
PVI HIGH
ALARM
1
1 to PVI HIGH
ALARM -1
PVI LOW
ALARM
34
SpOC LOW ALARM
1 to 34
SpOC HIGH
ALARM
1
1 to SpOCI HIGH
ALARM -1
SpOC LOW
ALARM
NORMAL
NORMAL , MAX ,
APOD
SPO2
SENSITVITY
OFF ON,OFF
SPO2 PULSE
RATE
The parameters in NIBP menu
mmHg mmHg , KPa NIBP UNIT
1 1,2
ALARM
LEVEL
OFF ON,OFF NIBP ALARM
150 mmHg
SYS LOW ALARM
5 to 300
SYS HIGH
ALARM
80 mmHg
30 to SYS HIGH
ALARM -5
SYS LOW
ALARM
120 mmHg
DIA LOW ALARM
5 to 300
DIA HIGH
ALARM
5
60 mmHg
30 to DIA HIGH
ALARM -5
DIA LOW
ALARM
120 mmHg
MAP LOW ALARM
5 to 300
MAP HIGH
ALARM
80 mmHg
30 to MAP HIGH
ALARM -5
MAP LOW
ALARM
MANUAL
MANUAL, STAT,
AUTO, 1min, 2min,
3min,5min,10min,
15min,20min,
30min,45min, 1hr
2hr,4hr, 8hr, 12hr,
16hr, 20hr, 24hr
AUTO/Manual
/STAT
ON ON, OFF AUTO SLEEP
The parameters in TEMP menu
C C,F TEMP UNIT
1 1,2
ALARM
LEVEL
OFF ON ,OFF
TEMP
ALARM
39
T1 LOW ALARM 1
to 50
TEMP HIGH
ALARM
35
0 to T1 HIGH
ALARM -1
TEMP LOW
ALARM
6
SYSTEM DEFAULT
P1 P1, P2, P3, P4, P5, P6 PAGE
1 1, 2, 3, 4, 5, 6, 7, 8
ALARM
VOLUME
CHRISTIAN
SOLAR,
CHRISTIAN
CALENDAR
ADULT ADULT,NEONATE
ADULT/
NEONATE
01 1..250
BED
NUMBER
7
APPENDIX II
Technical Alarms
Message cause Solution explanation
ECG ERROR MESSAGES
ECG NO
CABLE
ECG cable
is not
connected to
the system.
Connect ECG
cable.
alarm level 3
message with cyan
background is
displayed and by
pressing Silence
key, background oI
message will be
gray and system
will ignore this
Iault.
ECG
NOISE
Noisy or
saturated
ECG signal.
Inspect existence
oI a noise source
around the cable
and electrode.
Noise source
may be patient
movement or
improper lead
placement.
alarm level 3
message with cyan
background is
displayed and by
pressing Silence
key, background oI
message will be
gray and system
will ignore this
Iault.
8
ECG
CHECK
LA,RA,LL
Mentioned
lead is not
properly
connected.
Ensure that
mentioned lead
is connected
properly.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
ECG
SIGNAL
WEAK
ECG
amplitude is
lower than
standard limit.
Check chest
leads
placement.
ECG
DEFECT
ECG module
Iailure
Turn oII and
on the monitor
, iI problem
still exists
contact
Customer
Service.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
9
CHECK
RL OR
ALL
RL or other
leads are not
properly
connected to
the patient.
Ensure that RL
lead and ECG
cable are
connected
properly.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
CHECK
LL OR
ALL
LL or other
leads are not
properly
connected to
the patient.
Ensure that all
leads esp. LL
and ECG cable
are connected
properly.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
CHECK
LA OR
ALL
LA or other
leads are not
properly
connected to
the patient.
Ensure that all
leads esp. LA
and ECG cable
are connected
properly.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
10
CHECK
RA OR
ALL
RA or other
leads are not
properly
connected to
the patient.
Ensure that all
leads esp. RA
and ECG cable
are connected
properly.
alarm level 2
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
RESP ERROR MESSAGES
RESP
CHECK
LEADS
The RESP
leads are not
properly
connected.
Ensure that all
electrodes are
connected
properly.
alarm level 3
message with cyan
background is
displayed and by
background oI
and system will
ignore this Iault.
11
SPO2 ERROR MESSAGES
SPO2 NO
PROBE
SPO2 probe
is
disconnected
Irom the
monitor.
Ensure that
SPO2 probe
is connected
properly to
the monitor.
alarm level 3
message with cyan
background is
displayed and by
background oI message
will be gray and system
will ignore this Iault.
SPO2
PROBE
DEFECT
The SPO2
probe is
damaged
Change
SPO2 probe
by a correct
one.
alarm level 2
message with yellow
background is
displayed and by
SPO2
PROBE
OFF
SPO2 probe
may be
detached
Irom the
patient
Iinger.
Ensure that
the probe is
connected
properly to
the patient.
alarm level 3
message with cyan
background is
displayed and by
12
SPO2
CHECK
PROBE
SPO2 probe
is not
properly
positioned to
the patient
Make sure
that the probe
is attached
properly to
the
patient.(ReIer
to Fig. 6-1)
alarm level 2 and
message with yellow
background is
displayed and by
background oI
Ior at least 120s.
SPO2
HIGH
AMBIENT
LIGHT
This may be
caused by
entering
environmental
light into the
probe
Make sure
that the probe
is attached
properly to
the patient.
(ReIer to Fig.
6-1)
alarm level 2 and
message with yellow
background is
displayed and by
background oI
Ior at least 120s.
SPO2
SEARCH
SPO2 is not
calculable due
to some
reasons such
as long time
motions
Attach the
sensor to
another
place,
provoke
blood
recycle, and
calm the
patient.
alarm level 2 and
message with yellow
background is
displayed and by
background oI
and system will
ignore this Iault.
13
SPO2
SIGNAL
WEAK
The SPO2
signal
amplitude is
too weak or
undetectable.
Change the
probe
position.
SPO2
DEFECT
SPO2
module
Iailure
Turn oII and
then on the
monitor, iI
problem still
exists,
contact
Customer
Service.
alarm level 2
message with yellow
background is
displayed and by
will be gray and
system wil ignore this
Iault.
NIBP ERROR MESSAGES
SELF-
TEST
FAILED
NIBP hard
ware module
Iailure
alarm level is set in
NIBP alarm menu and
by pressing Silence
key, background oI
and system wil ignore
this Iault.
14
NIBP
LOOSE
CUFF
CuII is not
completely
wrapped, no
cuII attached.
NIBP alarm menu and
by pressing Silence
key, background oI
this Iault.
NIBP
MODE
ERROR
Use adult cuII
instead oI
neonate cuII
or occlusion
happened in
air way
NIBP alarm menu and
by pressing Silence
key, background oI
this Iault.
NIBP
AIR
LEAK
Air leak in
cuII, hose or
connector
NIBP alarm menu and
by pressing Silence
key, background oI
this Iault.
15
NIBP AIR
PRESSURE
ERROR
Unstable
pressure value
(e.g. Tangled
hoses) because
valve cannot
open normally.
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
NIBP
SIGNAL
WEAK
Very weak
patient signal
due to a loosely
wrapped cuII
or extremely
weak pulse
Irom patient.
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
NIBP
RANGE
EXCEED
Measuring
pressure is
more than
upper limit
(255mmHg)Ior
adult or
(135mmHg)
Ior neonates
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
16
NIBP
EXCESSIVE
MOTION
Arm
movement,
noisy signal
or irregular
pulse(e.g.
arrhythmia)
NIBP alarm menu
and by pressing
Silence key,
background oI
message will be
gray and system wil
ignore this Iault
NIBP OVER
PRESSURE
SENSED
Measuring
pressure
exceeded
saIe soItware
limit, 290
mmHg Ior
adult and
145mmHg
Ior neonate.
NIBP alarm menu
and by pressing
Silence key,
background oI
message will be
gray and system wil
ignore this Iault.
NIBP
SIGNAL
SATURATED
Large
motion
artiIact and
extreme
noise that
saturate the
ampliIier's
amplitude
handling
capability
NIBP alarm menu
and by pressing
Silence key,
background oI
message will be
gray and system wil
ignore this Iault.
17
NIBP
PNEUMATIC
LEAK
Air leakage
during leak
test
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
NIBP TIME
OUT
Measuring
time exceeds
120 seconds
Ior adult or
90 seconds
Ior neonates.
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
SYSTEM
FAILURE
Error occurs
in pump,
A/D
sampling,
pressure
transducer or
soItware.
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
18
NIBP
DEFECT
NIBP module
Iailure
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
NIBP
LOW
BATTERY
The Charge
oI battery is
low so NIBP
measurement
is not
possible.
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
NIBP
MODULE
ERROR
Failure
during
measurment
Waite Ior
10
seconds
then
measure .
NIBP alarm menu
and by pressing
Silence key,
background oI
and system wil
ignore this Iault.
19
NIBP NO
MODULE
No NIBP
module is
installed.
NIBP STOP
PRESSED
NIBP stop
key has been
pressed
during
measurement.
NIBP STOP
Measurement
is stopped by
NIBP module
because oI a
special
reason.
NIBP
LEAKAGE
O.K
SuccessIul
leakage test
20
Physiological Alarms
Audio
Alarm
ECG Alarm
HR HIGH
Heart rate
violates
adjusted high
alarm limits.
HR value blinks.
Alarm indicator
Ilashes.
Message with
appropriate
displayed.
Activated
HR LOW
Heart rate
violates
adjusted low
alarm limits.
HR value blinks.
Alarm indicator
Ilashes.
Message with
appropriate
displayed.
Activated
ECG
ASYSTOLE
Heart beat is
not detected
in last 10
seconds.
HR is "00" and
blinks
"ECG ASYSTOLE"
is displayed.
Alarm indicator
Ilashes.
Message with red
backhground is
displayed.
Activated
21
Audio
Alarm
RESP Alarm
RR HIGH
Respiration
rate violates
adjusted
high alarm
limit.
RESP value
blinks.
Alarm indicator
Ilashes.
Message with
appropriate
backhground
color is displayed.
Activated
RR LOW
Respiration
rate violates
adjusted low
alarm limit.
RESP value
blinks.
Alarm indicator
Ilashes.
Message with
appropriate
backhground color
is displayed.
Activated
APNEA
Non-
respiration
condition
overruns
adjusted
time
Alarm indicator
Ilashes
"RESP APNEA"
message with red
backhground is
displayed.
Activated
22
Audio
Alarm
SPO2 Alarm
SPO2
HIGH
SPO2
violates
adjusted
high alarm
limit.
SPO2 value
blinks.
Alarm
indicator Ilashes.
Message with
appropriate
background color
is displayed
Activated
SPO2
LOW
SPO2
violates
adjusted
low alarm
limit
SPO2 value
blinks.
Alarm
indicator Ilashes.
Message with
appropriate
background color
is displayed
Activated
SPO2
ASYSTOLE
Pulse beat
is not
detected in
last 10
seconds.
HR is "0" and
blinks.
Alarm
indicator Ilashes.
"SPO2
ASYSTOLE"
message with red
backhground is
displayed.
Activated
23
Audio
Alarm
PR HIGH
PR violates
adjusted
high alarm
limit.
PR value
blinks.
Alarm
indicator Ilashes.
Message with
appropriate
background color
is displayed
Activated
PR LOW
PR violates
adjusted
low alarm
limit
PR value
blinks.
Alarm
indicator Ilashes.
Message with
appropriate
background color
is displayed
Activated
PI HIGH
PI violates
adjusted
high alarm
limit
PI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
24
Audio
Alarm
PI LOW
PI violates
adjusted low
alarm limit
PI value blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
PVI HIGH
PVI violates
adjusted
high alarm
limit
PVI value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
PVI LOW
PVI violates
adjusted low
alarm limit
PVI value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
25
Audio
Alarm
SpCO
HIGH
SpCO
violates
adjusted
high alarm
limit
SpCO value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
SpCO LOW
SpCO
violates
adjusted low
alarm limit
SpCO value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
SpMet
HIGH
SpMet
violates
adjusted
high alarm
limit
SpMet value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
26
Audio
Alarm
SpMet
LOW
SpMet
violates
adjusted low
alarm limit
SpMet value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
SpHb HIGH
SpHb
violates
adjusted
high alarm
limit
SpHb value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
SpHb LOW
SpHb
violates
adjusted low
alarm limit
SpHb value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
27
Audio
Alarm
SpOC
HIGH
SpOC
violates
adjusted
high alarm
limit
SpOC value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed.
Activated
SpOC LOW
SpOC
violates
adjusted low
alarm limit
SpOC value
blinks.
Alarm indicator
Ilashes
Message with
apprppriate
background color
is displayed
Activated
NIBP Alarm
NIBP SYS
HIGH
SYS
violates
adjusted
high alarm
limit.
SYS value
blinks
alarm indicator
Ilashes.
Message with
appropriate
background color
is displayed
Activated
28
Audio
Alarm
NIBP SYS
LOW
SYS violates
adjusted low
alarm limit.
SYS value blinks
alarm indicator
Ilashes.
Message with
appropriate background
color is displayed
Activated
NIBP DIA
HIGH
DIA violates
adjusted
high alarm
limit.
DIA value blinks
alarm indicator
Ilashes.
Message with
color is displayed
Activated
NIBP DIA
LOW
DIA violates
adjusted low
alarm limit.
DIA value blinks
alarm indicator
Ilashes.
Message with
color is displayed
Activated
NIBP
MAP
HIGH
MAP
violates
adjusted
high alarm
limit.
MAP value blinks
alarm indicator
Ilashes.
Message with
color is displayed
Activated
29
Audio
Alarm
NIBP
MAP
LOW
MAP
violates
adjusted low
alarm limit .
MAP value blinks
alarm indicator
Ilashes.
Message with
color is displayed
Activated
30
APPENDIX III
MASIMO MODULE
Signal Extraction Technology
INTRODUCTION
Masimo SET pulse oximetry is a new and Iundamentally
distinct method oI acquiring, processing and reporting
arterial oxygen saturation and pulse rate. As illustrated
below, Masimo SET technology enables the power oI
adaptive Iilters to be applied to real-time physiologic
monitoring by utilizing proprietary techniques to
accurately establish a 'noise reIerence in the detected
physiologic signal, thus enabling the direct calculation oI
arterial oxygen saturation and pulse rate. Because it is not
bound by a conventional 'red over inIrared ratio
approach, the Masimo SET system substantially
eliminates the problems oI motion artiIact, low peripheral
perIusion and most low signal-to-noise situations. This
greatly extends the utility oI SpO2 in high motion, low
signal and noise intensive environments.
31
Discrete Saturation Transformation (DST)
Algorithm
Masimo SET's most powerIul algorithm is DST. All
algorithms depend upon assumptions. The more
assumptions, the weaker the algorithm. DST makes only
one assumption - that arterial blood has a higher
oxygenation than venous making it the most powerIul
pulse oximetry algorithm.
32
CONVENTIONAL FILTERS
While pulse oximetry is readily accepted as a standard oI
care in the Operating Room, Recovery Room and most
Intensive Care Units, its perIormance in high motion
environments or in patients with low perIusion is
substantially less than ideal. The reported high incidence
oI Ialse alarms due to motion artiIact and the inability oI
conventional pulse oximetry systems to provide
inIormation during times oI crisis have led to its
characterization as a 'Iair weather Iriend. ConIronted
with the problem oI motion artiIact, Ialse alarms and poor
"signal to noise" environments, medical equipment
manuIacturers have utilized band-pass Iiltering in an
attempt to address these conIounding clinical problems.
Band-pass Iilters, whether in analog or digital Iorm, are
designed to allow only a physiologic window oI interest to
pass while rejecting Irequencies outside the desired
Irequency band. With the advent oI Digital Signal
Processing (Digital Filtering), the perIormance oI band-
pass Iiltering was improved, but was still unable to
address the problem oI noise occurring within the
bandwidth oI interest.
33
ADAPTIVE FILTERS
To address the conIounding issue oI "in-band" noise, a
class oI Iilters known as adaptive digital Iilters has
evolved. These Iilters take advantage oI the Iact that the
construction oI the Iilter itselI is contained within the
memory oI the microprocessor, allowing its multiplication
coeIIicients, symbolized as W0, W1,...Wn-1, to be
changed in real time, hence altering the Iilter's
characteristic. Thus, the Iilter can be tuned 'on the Ily.
The multiplication coeIIicients determine whether the
Irequency components oI an input signal should be
cancelled (e.g., multiplied by zero) or allowed to pass
(e.g., multiplied by one). Given that the Iilter's coeIIicients
can be rapidly changed, adaptive Iilters derive their name
34
in their ability to change their Iiltering characteristics in
response to changing in-band noise.
The detected physiologic signal is generally composed oI
both desired signal (S) and undesired signal (N) or noise
portions. To remove the eIIects oI the undesired signal,
some knowledge oI the noise characteristics, or
equivalently its noise reIerence (N'), must be known. The
adaptive Iilter will adjust its Iiltering characteristics, so
that the noise reIerence input is transIormed into an
estimate oI the undesired signal portion (N`) oI the
physiologic signal. A subtracter subsequently removes the
undesired signal Irom the physiologic signal to yield an
estimate oI the desired signal portion (S`). The
combination comprising the adaptive Iilter and the
subtracter is commonly called an adaptive noise canceller
(ANC).
35
This approach has been widely used in the
telecommunications and aerospace industries where a
suitable noise reIerence is accessible. Probes are utilized
to obtain a noise reIerence that can then be used in
conjunction with an adaptive noise canceller to extract a
desired signal portion Irom a composite signal containing
both desired and undesired signal portions. The problem
in applying this technique to physiological monitoring is
that a noise reIerence is rarely available. In addition, both
the noise and the desired signal vary Irom patient to
patient and are quickly and continually changing in terms
oI Irequency, amplitude and phase, even within the same
patient. In pulse oximetry, the noise reIerence signal
required to make an adaptive noise canceller work in real
time was unavailable until the advent oI Masimo Signal
Extraction Technology.
CONVENTIONAL PULSE OXIMETRY
The conventional "red over inIrared" approach measures
the diIIerential optical density oI red (o) and inIrared (Iir)
light as projected through a vascular bed and calculates a
ratio (r) oI the optical densities. Utilizing the optical
density ratio, an arterial oxygen saturation (SpO2) value is
empirically reported based on the ratio obtained.
36
In the presence oI patient motion, the optical densities oI
red and inIrared light contain noise portions (Nrd, Nir),
thereby Ialsely altering the optical density ratio and
providing an inaccurate saturation value. During periods
oI routine patient motion or low perIusion, the noise
components within the physiologic signals can be much
larger than the desired signals (Srd, Sir). In these cases,
the optical density ratio is primarily determined by the
noise contributions. This represents a situation whereby
the noise is simply 'drowning out the desired signal.
37
In a large noise environment, conventional wisdom holds
that pulse oximetry will yield an optical density ratio
substantially equivalent to "noise over noise" or a ratio oI
one. This is equivalent to a saturation value oI
approximately 82 in most conventional systems.
ConIronted with the problems oI overwhelming noise and
prevented Irom utilizing adaptive digital Iilters, pulse
oximetry manuIacturers have resorted to 'managing Ialse
alarms. This can include extending averaging times or
employing a decision matrix to Ireeze when it decides it
has detected motion. II the motion persists, it reports zero.
The attempt to treat the "symptom" rather than the 'core
problem does not provide clinicians with continuous real-
time inIormation and can be unreliable in critical medical
situations.
38
MASIMO SET PULSE OXIMETRY
Masimo Signal Extraction Technology rejects the
conventional wisdom and begins with an understanding
that during patient motion the venous blood, being at a
relatively low pressure, is quite susceptible to the local
eIIects oI perturbation during motion. Considering the
Iinger Ior example, the venous blood in the vascular bed
will be easily deIormed during motion, representing a
signiIicant source oI in-band noise within the Irequency
bandwidth oI interest. In addition, the venous blood is a
strong absorber oI light. Hence, it can represent a
signiIicant contributor to the total optical density during
motion episodes. Furthermore, the venous blood
saturation is normally lower than the arterial blood
saturation. This explains why saturation values tend to
drop in conventional pulse oximeter systems during
episodes oI patient motion.
During routine patient motions (shivering, waving,
tapping, etc.), the resulting noise can be quite substantial
and can easily overwhelm a conventional ratio based
oximetry system. Having identiIied the venous blood as a
signiIicant contributor to noise during motion, it Iollows
that iI the noise reIerence corresponding to the venous
component could be measured, then an adaptive noise
canceller might be utilized to cancel its contribution.
39
GENERATING A NOISE REFERENCE
The detected physiologic signals in response to both red
(Ird) and inIrared (Iir) light consist oI desired signal
portions (Srd, Sir) as well as undesired signal portions
(Nrd, Nir). It is commonly understood in pulse oximetry
that the desired signal portions are proportional to one
another through the arterial optical density ratio (ra). This
suggests that one should simply subtract the product oI the
arterial optical density ratio and the physiologic signal due
to inIrared light Irom the physiologic signal due to red
light. The resultant is a reIerence signal that contains only
noise portions. This is the noise reIerence signal (N`)
40
II the arterial optical density ratio is known, one can easily
calculate the noise reIerence as just described. However, iI
it were known, one could simply calculate the arterial
oxygen saturation directly. One would not need to utilize
the adaptive noise cancellation process. How does one
then use the power oI adaptive Iilters and noise reIerence
signals Ior pulse oximetry? The answer lies in the Discrete
Saturation TransIorm algorithm.
DISCRETE SATURATION TRANSFORM
The Discrete Saturation TransIorm algorithm allows one
to separate and, consequently, calculate the optical density
ratios that correspond to both the arterial oxygen
saturation (ra) and an estimate oI the venous oxygen
saturation (rv).
These optical densities are not known beIorehand but are
required to obtain the appropriate reIerence signals Ior
41
adaptive noise cancellation. Every optical density ratio,
corresponding to the patient`s physiological range (SpO2
1 to 100) must be considered. ThereIore, the DST
algorithm not only uses a noise reIerence signal, but a
whole Iamily oI reIerence signals. Each reIerence signal is
used in the adaptive noise cancellation process and each
yields inIormation regarding the oxygen saturation content
oI the physiological signals.
A Iamily oI reIerence signals, N'(r), is generated similar to
that oI a noise reIerence signal. The reIerence signal, as
discussed earlier, is the diIIerence between the
physiologic signal due to red light (Ird) and the product oI
an arbitrary optical density ratio (r) and the physiologic
signal due to inIrared light (Ird). Although there is a
Iamily oI reIerence signals, based on the selected optical
density ratio, there are only three distinct cases to
consider. II one selects an optical density ratio that does
not correspond to either arterial or venous oxygen
saturation (Case I), the reIerence signal consists oI a
42
desired signal portion and an undesired signal portion. In
the adaptive noise cancellation process, such a signal will
not only remove the undesired signal portions oI the
physiologic signal, but also remove the desired signal
portions. When an optical density ratio that corresponds to
the venous oxygen saturation is selected (Case II), the
reIerence signal only contains signal portions. ThereIore,
the output oI the adaptive noise canceller will consist
oI the undesired signal portions only. Similarly, when an
optical density ratio that corresponds to the arterial
oxygen saturation is selected (Case III), the reIerence
signal only contains noise portions. ThereIore, the output
oI the adaptive noise canceller will consist oI the desired
signal portions only.
43
For each selected value oI the optical density ratio, the
corresponding reIerence signal is calculated and
subsequently processed through an adaptive noise
canceller.
When the selected value Ior the optical density ratio does
not correspond to either the arterial or the venous oxygen
saturation (Case I), the corresponding output signal will
contain little power. When the selected value Ior the
optical density corresponds to either the venous oxygen
saturation (Case II) or the arterial oxygen saturation (Case
III), the output signal will contain signiIicant output
power.
The power output oI the adaptive noise canceller
represents the probability that the selected optical density
ratio, or its corresponding saturation value, is present in
the physiologic signal. The output power or probability
value is plotted Ior a series oI consecutive ratio values
generating the DST transIorm. During periods oI no
44
motion, a singular peak is generated in the DST transIorm
corresponding to the arterial oxygen saturation.
In summary, the procedure Ior determining the arterial
oxygen saturation utilizing Masimo SET processing is as
Iollows:
1) Sweep all optical density ratios that correspond to
oxygen saturations oI 1 to 100.
2) Compute the reIerence signal Ior each optical density
ratio.
45
3) Measure the output power oI the adaptive noise
canceller Ior each reIerence signal.
4) IdentiIy the appropriate peak in the DST transIorm that
corresponds to the arterial oxygen saturation (largest
SpO2 value).
The procedure demonstrates another important Ieature oI
Masimo SET pulse oximetry. It is able to calculate the
arterial oxygen saturation without Iirst extracting or
determining discrete pulses in the physiologic data. For
Masimo SET processing, the saturation algorithm is
independent oI the pulse rate algorithm. This is a
signiIicant distinction between Masimo SET systems and
conventional pulse oximetry systems where the
recognition oI a clean pulse is a prerequisite Ior the
calculation oI accurate arterial oxygen saturation. Another
advantage oI Masimo SET technology is that it can
monitor arterial oxygen saturation and pulse rate even iI
the motion starts beIore the pulse oximeter is turned on. It
does not require clean data during instrument start-up.
46
APPENDIX IV
EMC
Use only the recommended manuIacturer
accessory .Using the accessory other than in relevant
chapter may cause to increase the EMISSION or
decrease the IMMUNITY oI system.
Measurements can be aIIected by mobile and
RF communications equipment. It should be assured
that the bedside monitor is used in the
electromagnetic environment speciIied.
47
Do not use cellular phone in the vicinity oI this
equipment. High level oI electromagnetic radiation
emitted Irom such devices may result in strong
interIerence with the monitor perIormance.
To prevent EMC eIIect on the monitor, the
system should not be used adjacent to or stacked
with other equipment and that iI adjacent or stacked
use is necessary, the equipment should be observed
to veriIy normal operation in the conIiguration in
which it will be used.
48
Guidance and manufacturer's declaration -
electromagnetic emissions
The ARIA Patient Care Monitor is intended Ior use in the
electromagnetic environment speciIied below. The customer or
the user oI the ARIA should assure that it is used in such an
environment.
Emissions test Compliance
Electromagnetic
environment -
guidance
RF emissions
CISPR 11
Group 1
The ARIA uses RF energy
only Ior its internal
Iunction. ThereIore, its RF
emissions are very low
and are not likely to cause
any interIerence in nearby
electronic equipment.
RF emissions
CISPR 11
Class B
Harmonic emissions
IEC 61000-3-2
Not applicable
Voltage Iluctuations/
Ilicker emissions
IEC 61000-3-3
Not applicable
The ARIA is suitable Ior
use in all establishments,
including domestic
establishments and those
directly connected to the
public low-voltage power
supply network that
supplies buildings used Ior
domestic purposes.
49
electromagnetic immunity
environment.
Immunity
test
IEC 60601
test level
Compliance
level
Electromagnetic
environment -
guidance
Electrostatic
discharge
(ESD)
IEC 61000-4-
2
+6 kV
contact
+8 kV air
Floors should be
wood, concrete or
ceramic tile. II
Iloors are covered
with synthetic
material, the
relative humidity
should be at least
30.
Electrical Iast
transient/burst
IEC 61000-4-
4
+2 kV Ior
power
supply lines
+1 kV Ior
input/output
lines
Mains power
quality should be
that oI a typical
commercial or
hospital
environment.
50
Surge
IEC 61000-4-
5
+1 kV
diIIerential
mode
+2 kV
common
mode
Mains power
quality should be
that oI a typical
commercial or
hospital
environment.
Voltage dips,
short
interruptions
and voltage
variations on
power supply
input lines
IEC 61000-4-
11
5 U
T
(~95 dip
in U
T
)
Ior 0.5 cycle
40 U
T
(~60 dip
in U
T
)
Ior 5 cycles
70 U
T
(30 dip in
U
T
)
Ior 25
cycles
5 U
T
(~95 dip
in U
T
)
Ior 5 sec
Mains power
quality should be
that oI a typical
commercial or
hospital
environment. II the
user oI the ARIA
requires continued
operation, it is
recommended that
the ARIA be
powered Irom an
uninterruptible
power supply or a
battery.
51
Power
Irequency
(50/60 Hz)
magnetic
Iield
IEC 61000-4-
8
3 A/m
Power Irequency
magnetic Iields
should be at levels
characteristic oI a
typical location in a
typical commercial
or hospital
environment.
NOTE U
T
is the a.c. mains voltage prior to application oI test
level.
52
electromagnetic immunity
environment.
Immunity
test
IEC
60601
test level
Compliance
level
Electromagnetic
environment -
guidance
Conducted
RF
IEC 61000-4-
6
Radiated RF
IEC 61000-4-
3
3 Vrms
150 kHz
to 80
MHz
3 V/m
80 MHz
to 2.5
GHz
3 V
3 V/m
Portable and mobile
RF communications
equipment should be
used no closer to any
part oI the ARIA,
including cables,
than the
recommended
separation distance
calculated Irom the
equation applicable
to the Irequency oI
the transmitter.
Recommended
separation distance
d 1.17
53
d 1.17 P 80
MHz to 800 MHz
d 2.33 P 800
MHz to 2.5 GHz
Where P is the
maximum output
power rating oI the
transmitter in watts
(W) according to the
transmitter
manuIacturer and d
is the recommended
separation distance
in meters (m).
Field strengths Irom
Iixed RF
transmitters, as
determined by an
electromagnetic site
survey,
a
should be
less than the
compliance level in
each Irequency
54
range.
b
InterIerence may
occur in the vicinity
oI equipment marked
with the Iollowing
symbol:
NOTE 1 At 80 MHz and 800 MHz, the higher Irequency range
applies.
NOTE 2 These guidelines may not apply in all situations.
Electromagnetic propagation is aIIected by absorption and
reIlection Irom structures, objects and people.
a
Field strengths Irom Iixed transmitters, such as base stations
Ior radio (cellular/cordless) telephones and land mobile
radios, amateur radio, AM and FM radio broadcast and TV
broadcast cannot be predicted theoretically with accuracy. To
assess the electromagnetic environment due to Iixed RF
transmitters, an electromagnetic site survey should be
considered. II the measured Iield strength in the location in
which the ARIA is used exceeds the applicable RF
compliance level above, the ARIA should be observed to
veriIy normal operation. II abnormal perIormance is
observed, additional measures may necessary, such as
reorienting or relocating the ARIA.
b
Over the Irequency range 150kHz to 80 MHz, Iield strengths
should be less than 3 V/m.
55
Recommended separation distances between
Portable and mobile RF communications equipment
and the Jital Sign Monitor
electromagnetic environment in which radiated RF disturbances
are controlled. The customer or the user oI the ARIA can help
prevent electromagnetic interIerence by maintaining a minimum
distance between portable and mobile RF communications
equipment (transmitters) and the ARIA as recommended below,
according to the maximum output power oI the communications
equipment.
Separation distance according to frequency
of transmitter
m
Rated
maximum
output
power of
transmitter
W
150 kHz to
80 MHz
d 1.17 P
80 MHz to
800 MHz
d 1.17 P
800 MHz to
2.5 GHz
d 2.33 P
0.01 0.12 0.12 0.23
0.1 0.37 0.37 0.74
1 1.17 1.17 2.33
10 3.70 3.70 7.37
100 11.7 11.7 23.3
56
For transmitters rated at a maximum output power not listed
above, the recommended separation distance d in meters (m) can
be estimated using the equation applicable to the Irequency oI
the transmitter, where P is the maximum output power rating oI
the transmitter in watts (W) according to the transmitter
manuIacturer.
NOTE 1 At 80 MHz and 800 MHz, the separation distance Ior
the higher Irequency range applies.
NOTE 2 These guidelines may not apply in all situations.
Electromagnetic propagation is aIIected by absorption and
reIlection Irom structures, objects and people.

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