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Unauthorized copying of this publication may not only infringe copyright laws, but may also reduce the ability of Philips Medical Systems to provide accurate and current information to users. Compliance The Philips Medical Systems PageWriter Trim cardiograph complies with all relevant international and national standards and laws. Information on compliance will be supplied on request by a local Philips Medical Systems representative, or by the manufacturer. Intended Use of this Instructions for Use This Philips product is intended to be operated only in accordance with the safety procedures and operating instructions provided in this Instructions for Use, and in accordance with the purposes for which it was designed. Installation, use, and operation of this product is subject to the laws in effect in the jurisdiction(s) in which the product is being used. Users must only install, use, and operate this product in such a manner that does not conflict with applicable laws or regulations that have the force of law. Use of this product for purposes other than the express intended purpose provided by the manufacturer, or incorrect use and operation, may relieve the manufacturer (or agent) from all or some responsibility for resultant noncompliance, damage, or injury. United States federal law restricts this device to use by or on the order of a
physician. THIS PRODUCT IS NOT INTENDED FOR HOME USE. Training Users of this product must receive adequate clinical training on its safe and effective use before attempting to operate the product as described in this Instructions for Use. Training requirements vary by country. Users must ensure that they receive adequate clinical training in accordance with local laws or regulations. For further information on available training on the use of this product, please contact a Philips Medical Systems representative, or the manufacturer. Medical Device Directive The PageWriter Trim Cardiograph complies with the requirements of the Medical Device Directive 93/42/EEC and carries the 0123 mark accordingly. Authorized EU-representative: Philips Medizin Systeme Bblingen GmbH Hewlett Packard Str. 2 71034 Bblingen Germany
2004-2005 Koninklijke
Philips Electronics N.V. All rights are reserved. All other product names are the property of their respective owners. Reproduction in whole or in part in any form, or by any means, electrical, mechanical or otherwise, is prohibited without the written consent of the copyright holder. Philips Medical Systems 3000 Minuteman Road Andover, MA 01810 USA (978) 687-1501
Contents
About the PageWriter Trim Cardiograph
About the Instructions for Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i-i Safety Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i-i Safety and Regulatory Symbols Marked on the Cardiograph . . . . . . . . . . . . . . . . . . . . . . .i-i Safety Symbols Marked on the Cardiograph Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . i-ii Important Patient and Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-iv The PageWriter Trim Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-vii Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-vii Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-vii The Philips 12-Lead Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-vii Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-viii Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-viii
Getting Started
PageWriter Trim Cardiograph Learning Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 About the PageWriter Trim Learning Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 Philips 12-Lead ECG XML Information and Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Using the Philips InCenter Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4 About Adobe Acrobat Versions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4 Attaching the Cardiograph to the Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5 PageWriter Trim I Cardiograph Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6 PageWriter Trim II and III Cardiograph Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8 PageWriter Trim II and III Token Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9 Patient Interface Module (PIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10 Inserting the Lead Wires into the PIM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 Connecting the PIM to the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12 Placing the PIM in the Holder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13 Installing the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14 Charging the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15 PageWriter Trim II and III, Battery Charging Indicator . . . . . . . . . . . . . . . . . . . . . . . . . 1-15 PageWriter Trim I, Battery Charging Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16 Powering on the Cardiograph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17 Using the On/Standby Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18 Loading Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19 Tips for loading printer paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19 Using the PC Card Slot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21 Using the PC Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21 Using the Wireless LAN Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22 Using the LAN Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-23
Contents-1
Using the Modem Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-23 Installing and Removing a PC Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-24 Using the USB Memory Stick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-24 Using the Barcode Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-25 Using the Magnetic Card Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-26 Using the SmartCard Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-26 Using the Trim Knob . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-27 Navigation Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-27 Opening and Closing Screens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-27 Opening and Closing Menus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-27 Selecting Tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-28 Entering Information on a Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-28 Selecting Check Boxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-29 PageWriter Trim I Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-29 Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-30 LCD Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-30 Function Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-31 PageWriter Trim II and III Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-32 PageWriter Trim II and III Status Bar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-33 PageWriter Trim II and III Command Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-34 Supplies and Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Ordering Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 PageWriter Trim Cardiograph Supply Part Numbers. . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Patient Interface Module (PIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Replacement Fuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Complete Lead Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Replacement Lead Sets and Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-35 Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-36 Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-37 Optional Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-37 Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-37 Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-37 Contacting a Philips Response Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-38 North America Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-38 South America Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-38 Europe Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-38 Asia Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-39 Africa and Middle East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-40
Opening the Configuration Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2 Analysis Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 About Algorithm Versions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 Setting the Default Pacing Detection Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4 Setting the Report Status Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 Setting the Default Adult Bradycardia Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 Setting the Philips 12-Lead Algorithm Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 About the Borderline Statement Suppression Setting. . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 Patient ID Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 Patient ID Configuration Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 Configuring Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 User Defined Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11 Configuring Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12 User Defined Clinical Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14 Configuring Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14 User Defined Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17 Configuring Auto ECG Report Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17 Editing the Profile Report Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-20 Editing Profile Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-20 Editing Profile Scale Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21 Editing Report Type Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21 Saving the Report Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21 Setting the Default Auto Report and Copy Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-22 Setting Other Print Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-23 System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-23 Setting the Default Paper Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24 Setting the Caps Lock Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24 Printed ECG Lead Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25 Default Display Format Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25 Battery Power Saving Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25 Setting the Notification Message Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-26 Simulated Waveform Data Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27 Order Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-28 Rhythm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-29 Filter Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-30 About High and Low Pass Frequency Filter Settings . . . . . . . . . . . . . . . . . . . . . . . 2-31 Setting Default Rhythm Filter Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32 TraceMasterVue ECG Management System Remote Sites . . . . . . . . . . . . . . . . . . . . . . . . . 2-33 Remote Site Fax and Modem Connection (USA and Canada only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-34 Remote Sites Network Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-36 Network Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-38 Networking Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-39 DHCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-39 Fixed IP Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-39 Auto Negotiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-39 Password Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-40
Contents-3
Lost Passwords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-41 Locale Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-41 Cardiograph Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-42 Metronome Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-44 Magnetic Card Reader Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-45 Saving Configured Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-46 Loading the Configuration Settings File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-47 Restoring Factory Default Configuration Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-48 Printing the Configuration Settings Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-48
Entering Patient ID Information with the SmartCard Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Editing Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Emergency (STAT) ECGs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking a STAT ECG with the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking a STAT ECG with the PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . . . Taking an Auto ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking an Auto ECG with the PageWriter Trim I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking an Auto ECG with the PageWriter Trim II and III. . . . . . . . . . . . . . . . . . . . . . . The Preview Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changing Auto ECG Report Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Using the Metronome with Auto ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhythm ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking a Rhythm Report on the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . Taking a Rhythm Report on the PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . Disclose ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pacing Detection Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Getting Help on the Cardiograph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-23 3-23 3-24 3-24 3-24 3-25 3-25 3-26 3-26 3-26 3-27 3-28 3-28 3-29 3-30 3-31 3-33
Contents-5
Severity Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3 Basic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4 Patient ID Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5 Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6 Additional Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7 Institution Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7 Configurable Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-8 ECG Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9 Physician Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10 Report Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10 Calibration Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11 Time Separator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-13 Pacing Detection Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-13 Algorithm Version Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16 Speed and Sensitivity Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16 Device Identification Number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-17 12-Lead ECG Report Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18 Extended Measurements Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-25 Rhythm Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-25 Disclose Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-28
Troubleshooting
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1 Troubleshooting Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1 Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-2 Barcode Reader. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-6 Battery and AC Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-6 LAN and Modem Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8 Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-9 Magnetic Card Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-10 Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-10 Signal Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-14 System Freeze . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-16 Resetting the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-17
Contents-6
Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4 Tips for changing printer paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4 Battery Maintenance and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6 Charging the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7 Battery Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7 Replacing the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8 Replacing the AC Fuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9 Replacing the Lead Wires on the PIM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10 Maintenance Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 PIM Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13 Barcode Reader Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13 Magnetic Card Reader Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14 Printer Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14 Network Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-17 Important Patient and Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18 Supplies and Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-21 Ordering Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-21 PageWriter Trim Cardiograph Supply Part Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Patient Interface Module (PIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Replacement Fuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Complete Lead Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Replacement Lead Sets and Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22 Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Optional Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23 Contacting a Philips Response Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-24 North America Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-24 South America Response Centers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25 Europe Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25 Asia Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-26 Africa and Middle East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27
Specifications
Technical Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Keyboard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Screen Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Interface Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PageWriter Trim Cardiograph Instructions for Use
Contents-7
Signal Processing/Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sampling Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Auto Frequency Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhythm Frequency Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printer Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Report Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Battery Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recharge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Network Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FAX Capability (optional). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Modem (optional for USA and Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barcode Reader (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Magnetic Card Reader (optional). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ECG Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ECG File Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power and Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Environmental Operating Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Environmental Storage Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Shipping Container Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Shipping Container Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Cart Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Cart Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Cart Shipping Container Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cardiograph Cart Container Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Safety and Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Electromagnetic Compatibility (EMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reducing Electromagnetic Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B-2 B-2 B-2 B-2 B-2 B-2 B-2 B-2 B-3 B-3 B-3 B-3 B-3 B-3 B-3 B-3 B-3 B-3 B-4 B-4 B-4 B-4 B-4 B-4 B-4 B-4 B-4 B-4 B-5 B-5 B-5 B-5 B-5
Contents-8
Warning statements describe conditions or actions that may result in a potentially serious outcome, adverse event, or a safety hazard. Failure to follow a Warning may result in death or serious injury to the user or to the patient.
CAUTION
Caution statements describe when special care is necessary for the safe and effective use of the product. Failure to follow a caution may result in minor to moderate personal injury or damage to the product or other property, a remote risk of more serious injury, or may cause environmental pollution.
NOTE TIP
Notes contain additional important information about a topic. A Tip contains suggested information on using a particular feature.
Menu items and button names appear in bold no-serif font. Example: Touch the Config button.
Safety Summary
Safety and Regulatory Symbols Marked on the Cardiograph
Symbol Name Description
Attention
Type CF
ECG physio isolation is type CF, defibrillator proof. Electrical leakage current is suitable for all patient applications including direct cardiac application. Pressing the button with this symbol on it turns on the cardiograph, turns off the cardiograph, or puts the cardiograph into Standby (power saving mode).
On/Standby or On/Off
i-i
Safety Summary
Equipotential grounding post used for establishing common ground between instruments. Cardiograph contains a 1.5 amp (250V) time-delay fuse.
Input
The number next to this symbol is the serial number of the cardiograph. The number next to this symbol is the product model number of the cardiograph. The PIM (Patient Interface Module) is protected against splashing water. Water splashed against the PIM from any direction shall have no harmful effect. When lit, indicates that AC power is on. The battery is charging when inserted into the cardiograph. Dispose of in accordance with the requirements of your country.
Keep dry.
Ambient temperature range of 0 oC (32o.F) to 50 oC (122o F) (non-condensing) for transport and storage.
i-ii
Safety Summary
Relative humidity range of 15% to 90% (non-condensing) for transport and storage.
Fragile.
Sealed lead acid battery. Do not dispose of in trash. Follow local regulations for disposing of as small chemical waste.
i-iii
Failure to follow these warnings could affect both patient and operator safety.
When operating the cardiograph on AC power, ensure that the cardiograph and all other electrical equipment connected to or near the patient are effectively grounded. Use only grounded power cords (three-wire power cords with grounded plugs) and grounded electrical outlets. Never adapt a grounded plug to fit an ungrounded outlet by removing the ground prong. Use the equipotential post when redundant earth ground is necessary according to IEC 60601-1-1. If a safe ground connection is not ensured, operate the cardiograph on battery power only. The use of equipment that applies high frequency voltages to the patient (including electrosurgical equipment and some respiration transducers) is not supported and may produce undesired results. Disconnect the patient data cable from the cardiograph, or detach the leads from the patient prior to performing any procedure that uses high frequency surgical equipment. Do not perform ST analysis on the R/T ECG screen display or on Rhythm reports when the 0.5 Hz Baseline Wander filter is applied. If abnormal ECG data appears on the printed report, and the abnormal data does not have a physiological origin, perform the printer diagnostic test to assess printer performance. When printing a Rhythm report, there may be a slight delay before the Rhythm report begins to print on the cardiograph. Rhythm printing is not completed in real-time. Pace pulse tick marks will not print on an Auto ECG that uses simultaneous acquisition.
WARNING
Do not touch accessible connector pins and the patient simultaneously. Electrical shock hazard. Keep cardiograph, Patient Interface Module (PIM) and all cardiograph accessories away from liquids. Do not immerse cardiograph, PIM, or other accessories in any liquids.
Periodically inspect the patient data cable, lead wires, and AC power cord for any worn or cracked insulation to ensure that no inner conductive material is exposed. Discard worn accessories and replace them only with Philips Medical Systems accessories (see page 135). Keep the patient data cable away from power cords and any other electrical equipment. Failure to do so can result in AC power line frequency interference on the ECG trace.
i-iv
The Philips Medical Systems patient data cable (supplied with cardiograph) is an integral part of the cardiograph safety features. Use of any other patient data cable may compromise defibrillation protection, degrade cardiograph performance, and may result in distorted ECG data. Only qualified personnel may service the cardiograph or may open the cardiograph housing to access internal cardiograph components. Do not open any covers on the cardiograph. There are no internal cardiograph components that are serviced by the operator. Do not use this cardiograph near flammable anesthetics. It is not intended for use in explosive environments or in operating rooms. Do not touch the patient, the patient data cable, any unused patient leads, or the cardiograph during defibrillation. Death or injury may occur from the electrical shock delivered by the defibrillator. Always use electrode gel with reusable electrodes during defibrillation as ECG recovery will be greater than 10 seconds. Philips Medical Systems recommends the use of disposable electrodes at all times. Ensure that the electrodes or lead wires do not come in contact with any other conductive materials (including earth-grounded materials) especially when connecting or disconnecting electrodes to or from a patient. Connecting multiple medical electrical equipment to the same patient may pose a safety hazard due to the summation of leakage currents. Any combination of instruments should be evaluated by local safety personnel before being put into service. Portable medical equipment such as X-rays and MRI may produce electromagnetic interference that produces noise in the ECG signal. Move the cardiograph away from these potential sources of electromagnetic interference. Do not pull on the paper while an ECG report is being printed. This can cause distortion of the waveform and can lead to potential misdiagnosis. Only use the Philips Medical Systems AC power cord supplied with the cardiograph. Periodically inspect the AC power cord and AC power connector (rear of cardiograph, see page 1-9) to ensure that both are in a safe and operable condition. If the AC power cord or AC power connector is not in a safe or operable condition, operate the cardiograph on battery power and contact Philips Medical Systems for service. The cardiograph has been safety tested with the recommended accessories, peripherals, and leads, and no hazard was found when the cardiograph is operated with cardiac pacemakers or other stimulators. Do not connect any equipment or accessories to the cardiograph that are not manufactured or approved by Philips Medical Systems or that are not IEC 60601-1 approved. The operation or use of non-approved equipment or accessories with the cardiograph is not tested or supported, and cardiograph operation and safety are not guaranteed.
i-v
The list of cables and other accessories with which Philips claims compliance with the emissions and immunity requirements of IEC standard 60601-1-2 are listed in Supplies and Ordering Information on page 1-35.
WARNING
When using additional peripheral equipment powered from an electrical source other than the cardiograph, the combination is considered to be a medical system. It is the responsibility of the operator to comply with IEC 60601-1-1 and test the medical system according to the requirements. For additional information contact Philips Medical Systems.
WARNING
Do not use non-medical peripherals within 1.83 meters or 6 feet of a patient unless the non-medical peripherals receive power from the cardiograph or from an isolation transformer that meets medical safety standards.
Only install Philips Medical Systems software on the cardiograph. The installation or use of software not approved by Philips Medical Systems is strictly prohibited and cardiograph safety and performance are not guaranteed. Only use Philips Medical Systems replacement parts and supplies with the cardiograph. The use of non-approved replacement parts and supplies with the cardiograph is strictly prohibited. Cardiograph safety and performance are not guaranteed when non-approved replacement parts and supplies are used with the cardiograph. Manual measurements of ECG intervals and magnitudes should be performed on printed ECG reports only. Do not make manual measurements of ECG intervals and magnitudes on the R/T ECG display since these ECG representations are scaled. Only use patient electrodes that are approved by Philips Medical Systems. The use of nonapproved patient electrodes may degrade cardiograph performance. The Philips Medical Systems warranty is applicable only if you use Philips Medical Systems approved accessories and replacement parts. See Supplies and Ordering Information on page 1-35 for more information. Before using the Patient Cable Arm with the cardiograph cart, properly install the counter weight on the cardiograph base. Only use the shielded LAN cable provided with the PageWriter Trim cardiograph, Philips Part Number 989803138021. Do not use any other LAN cables with the PageWriter Trim cardiograph. Use of unapproved LAN cables may result in radiated emissions that exceed the limit specified by CISPR11 Class B. The combined maximum weight that can be placed on the cardiograph cart shelf and the top surface of the cart cannot exceed 20 kg (44 lbs). Do not place more than the specified weight on the cardiograph top surface and shelf. Do not connect any device to the RS-232 port on the rear of the cardiograph when the patient data cable is connected to a patient. There are no cardiograph parts that can be sterilized.
i-vi PageWriter Trim Cardiograph Instructions for Use
Intended Use
The cardiograph is not intended for direct, or invasive cardiac monitoring purposes. Excessive, repetitive use of the cardiograph keyboard and the cardiograph Trim Knob may result in a risk of developing carpal tunnel syndrome. Ensure that the patient data cable is tucked away from the cardiograph cart wheels when transporting the cardiograph. Ensure that the patient data cable does not present a hazard when pushing the cardiograph cart. For information on the standard IEC 60601-2-51, please go to the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Intended Use
The intended use of the cardiograph is to acquire multi-channel ECG signals from adult and pediatric patients from body surface ECG electrodes and to record, display, analyze, and store these ECG signals for review by the user. The cardiograph is to be used in healthcare facilities by trained healthcare professionals. Analysis of the ECG signals is accomplished with algorithms that provide measurements, data presentations, graphical presentations, and interpretations for review by the user. The interpreted ECG with measurements and interpretive statements is offered to the clinician on an advisory basis only. It is to be used in conjunction with the clinician's knowledge of the patient, the results of the physical examination, the ECG tracings, and other clinical findings. A qualified physician is asked to overread and validate (or change) the computer-generated ECG interpretation.
i-vii
Intended Use
12-lead Reports may include or exclude ECG measurements, reasons, or analysis statements.
Intended Use
The intended use of the Philips 12-Lead Algorithm is to analyze multi-channel ECG signals from adult and pediatric patients with algorithms that provide measurements, data presentations, graphical presentations, and interpretations for review by the user. The interpreted ECG with measurements and interpretive statements is offered to the clinician on an advisory basis only. It is to be used in conjunction with the clinician's knowledge of the patient, the results of the physical examination, the ECG tracings, and other clinical findings. A qualified physician is asked to overread and validate (or change) the computer-generated ECG interpretation.
i-viii
1
1
Getting Started
Welcome to the PageWriter Trim cardiograph! With its fast and simple operation, clearly labeled PIM and lead wires, and convenient cart, it is the ideal cardiograph for processing large volumes of ECGs quickly and easily. The PageWriter Trim supports multiple ECG acquisition modes, display settings, and report formats. Signal quality indicators provide instant feedback to the user to help ensure a quality ECG each and every time. This PageWriter Trim Cardiograph Instructions for Use includes an overview of the cardiograph and all of its components, setup and assembly instructions, care and maintenance information, and information on troubleshooting. It is intended to be used with the other materials included in the PageWriter Trim Cardiograph Learning Kit.
NOTE Read and complete the materials included in the PageWriter Trim Cardiograph Learning Kit before using the cardiograph. Pay close attention to all warnings and cautions.
1-1
Getting Started
1-2
Getting Started
PageWriter Trim I, II, III Quick Help Card A PDF version of the fold-out Quick Help Card provided in the Learning Kit. PageWriter Trim Cart Assembly Instructions This instruction sheet describes how to assemble the optional PageWriter Trim cart. PageWriter Trim Wireless LAN Installation Instructions This instruction sheet describes how to install and configure the wireless LAN option for the cardiograph.
Insert the CD into a PC CD-ROM drive. The CD only works on PCs with a Windows operating system. The user documentation CD main menu opens automatically. Click on a blue button or the file name to view the file. If the menu does not automatically appear, open the CD in Windows Explorer. Double-click the file menu.pdf. The main menu appears. Any of the files on the CD may be printed or saved to a PC hard drive.
If files from the CD are saved to a PC hard drive, Acrobat Reader 7.0 will need to be installed on the PC in order to view the files. For a free install go to: www.adobe.com.
2 3
NOTE
PageWriter Trim Cardiograph Interactive Training Program CD (D) The interactive training CD contains a computer-based training program that describes how to properly record an ECG and how to operate the cardiograph. Use this program to train the entire ECG staff in the proper operation of the cardiograph.
To run the interactive training program: 1
Insert the CD into a CD-ROM drive. The CD only works on PCs with a Windows operating system. The interactive training program starts automatically. If the interactive training program does not automatically start, open the CD in Windows Explorer. Double-click the file pwtrim.exe. The interactive training program file may be saved to any PC hard drive and does not require any special software to operate.
2 3
1-3
Getting Started
Exit Acrobat Professional (if open). Start Acrobat Reader 7.0. Open Internet Explorer, and go to the Philips InCenter site. Keep Acrobat Reader 7.0 open the entire time while accessing the InCenter site.
1-4
Getting Started
Follow the procedure below to ensure that the cardiograph is securely fastened to the cart before use.
Align the front feet of the cardiograph with the front locking holes on the cart. Align the rear feet of the cardiograph with the rear screw holes on the cart. Lower the cardiograph onto the cart.
Slide the cardiograph back to lock the front and rear feet into place. Insert the screws through the bottom of the cart and through the screw holes. Tighten the screws with a Phillips head screwdriver.
1-5
Getting Started
A G
H B
D E F
A B C D
CAUTION
Patient Interface Module (PIM) Printer paper/report storage slot Storage shelf AC power cord
E F G H
Always lock the wheel brake (F) when the cart is not in use. Press down on the wheel brake to set or to release the wheel brake.
1-6
Getting Started
Figure 1-4
I J
L M
K Fuse door
WARNING
Do not connect a LAN cable connector to the PIM connector. Do not plug a telephone connector into the PIM connector.
1-7
Getting Started
C D E F
A B C D E
CAUTION
Patient Interface Module (PIM) Printer paper/report storage slot Storage shelf AC power cord PIM leads
F G H I J
Wheel brake Control panel Keyboard Trim knob Printer paper drawer
Always lock the wheel brake (F) when the cart is not in use. Press down on the wheel brake to set or to release the wheel brake.
1-8
Getting Started
Figure 1-6
K
Q Battery door R PIM connector S SmartCard reader or USB memory stick connector
WARNING
Do not connect the LAN cable connector into the PIM connector. Do not plug a telephone connector into the PIM connector.
1-9
Getting Started
Figure 1-8
1-10
Getting Started
Figure 1-9
1-11
Getting Started
Figure 1-10
Locate the lead wires in the cardiograph packaging. Match the lead wire to the correct lead wire connector on the PIM. Insert each lead wire into the correct lead wire connector on the PIM. Push down on the lead wire to ensure that there is no gap between the lead wire and the connector.
1-12
Getting Started
Connect the patient data cable to the PIM connector port on the rear of the cardiograph.
WARNING
To ensure safety and prevent damage to the system, only connect the patient data cable to the PIM connector port on the rear of the cardiograph.
CAUTION
Ensure that the PIM patient data cable and lead wires do not drag on the ground or become tangled in the cart wheels.
1-13
Getting Started
Open the battery door on the rear of the cardiograph. Push the recessed tab in and pull it down to open the battery door. Insert the battery into the compartment with the connector facing down and the pull tab facing out. Push in the pull tab to lock it. Reattach and close the battery door. Attach the AC power cord to the rear of the cardiograph.
1-14
Getting Started
6 7
Plug the AC power cord into a grounded electrical outlet. Check that the green AC power indicator light is on (front of cardiograph). Charge the battery for at least twenty-four hours before mobile use.
Battery Level
1-15
Getting Started
Table 1-1
PageWriter Trim II and III Battery Level Indicator (continued) Status Indicator
Battery Level
Low Battery Alert; alternate icons flashing, cardiograph beeps until the unit is plugged into AC power
No or Dead Battery
Battery Level
1-16
Getting Started
Table 1-2
Battery Level
No or Dead Battery
Battery is charging
A On/Standby button (PageWriter Trim II/III) or B AC Power Indicator Light On/Off button (PageWriter Trim I)
To turn on the cardiograph: 1 2
Plug the AC power cord into the AC power connector on the rear of the cardiograph. Plug the AC power cord into a grounded electrical outlet with appropriate electrical ratings. The AC power indicator light on the front panel of the cardiograph illuminates when the cardiograph is plugged into AC power. Press the On/Standby or On/Off button on the front of the cardiograph.
1-17
Getting Started
Use between brief periods of inactivity to save battery power The cardiograph is in a sleep mode The display screen is black Patient ID information is not saved when the cardiograph is put into Standby Temporary report settings are saved when the cardiograph is put into Standby The battery charges when the cardiograph is plugged into AC power The green Standby indicator light (front of cardiograph) is lit Press any key on the keyboard to return the cardiograph to active use The cardiograph returns to the previously viewed screen when taken out of Standby
Shut Down
Use for extended periods of cardiograph inactivity The cardiograph is shut down The display screen is black The battery charges when the cardiograph is plugged into AC power Press the On/Standby button to restart the cardiograph
TIP
There are configurable features on the cardiograph that can be used to help prolong battery life (see page 2-25). Proper battery care and maintenance (including frequent and full charging of the battery) will also help to prolong battery life. Plug the cardiograph into AC power whenever possible to help prolong battery life. To put the cardiograph into Standby:
TIP
Press the On/Standby button. A message appears that the cardiograph is entering Standby. The green Standby indicator light (front of cardiograph) illuminates. The battery charges when the cardiograph is plugged into AC power.
NOTE The cardiograph cannot be put into Standby if the Patient ID screen is open or if the cardiograph is printing an ECG.
1-18
Getting Started
To exit Standby:
Press the On/Standby button. The splash screen appears. The R/T (real-time) ECG screen appears.
To shut down the cardiograph:
Press and hold the On/Standby button for three seconds then release it. A message appears that the cardiograph is shutting down.
To turn on the cardiograph:
Press the On/Standby button. The cardiograph displays a series of startup screens and then the R/T (real-time) ECG screen displays.
Open the paper drawer on the front of the cardiograph and lift up the bar.
1-19
Getting Started
Insert a new pack of printer paper as shown. Ensure that no more than 100 sheets are being inserted into the paper tray.
Drape the entire first sheet over the roller. Ensure that the perforated edge of the paper aligns with the edge of the paper drawer. Lower the bar onto the paper and close the drawer.
1-20
Getting Started
1-21
Getting Started
Figure 1-15
The PC card
A B
A PC card adapter
Only use wireless LAN cards with the PageWriter Trim cardiograph that have been purchased from Philips Medical Systems. The use of non-approved wireless LAN cards with the PageWriter Trim cardiograph is not tested or supported, and Philips Medical Systems does not guarantee cardiograph operation or wireless LAN connectivity.
Figure 1-16
1-22
Getting Started
Only use the shielded LAN cable provided with the PageWriter Trim cardiograph. Do not use LAN cables with the cardiograph that have not been approved by Philips Medical Systems.
Figure 1-17
1-23
Getting Started
Insert the card into the PC card slot (rear of cardiograph) and gently push it in. Push the PC card eject button to the left of the card slot to eject the card. Pull out the card.
1-24
Getting Started
Figure 1-20
1-25
Getting Started
1-26
Getting Started
Turn the Trim Knob left or right to scroll through the selections in a menu list. Push the Trim Knob to select an item on the menu.
Navigation Tips
PageWriter Trim II and III only
In addition to the Trim Knob, individual keys on the keyboard may be used to navigate on the software screens.
) to close any screen or window and save the information. ) to exit any screen without saving information.
Figure 1-25
1-27
Getting Started
Navigation Tips
Figure 1-26
3 4
Press the space bar to select an item and to close the drop-down menu.
Selecting Tabs
Figure 1-27 Tabs on Patient ID screen
A
Tabs
To select a tab: 1 2
) on keyboard.
Press the letter key in parenthesis on the tab. For example, to select the Rhythm tab, press the Alt key ( ) and the R ( ) key.
Field
) to go to the next field (white square) on any screen. ) at the same time to go to the previous
Press the Tab key and the Shift key ( field (white square) on any screen.
1-28
Getting Started
Press the Tab key ( Press the space bar ( appears in the box. Press the Enter key ( Press the Esc key (
) to highlight the text next to the check box. ) to select the check box. A check mark ( ) to save the information and to exit the screen. ) to close the screen without saving the information. )
1-29
Getting Started
Control Panel
The control panel contains all of the main functions on the cardiograph. For more information on any feature, see The Patient Session" on page 3-1.
Figure 1-30 PageWriter Trim I Control Panel
A B C
LCD Display
The LCD display shows the current settings on the cardiograph.
Figure 1-31 PageWriter Trim I LCD Display
A B C D
1-30
Getting Started
Battery Level Indicator Waveform Speed (mm/sec) Waveform Size (mm/mV) Filter Settings Rhythm Lead Report Format
Function Buttons
All of the functions on the PageWriter Trim I cardiograph are controlled by the function buttons located on the main panel of the cardiograph.
Figure 1-32 Function Buttons on PageWriter Trim I cardiograph
Button
Enter Patient ID information (age, gender) Take a 3x4, 1R or 6x2 Auto ECG Print out a continuous Rhythm report (3 or 6 leads) until the Stop button (F) is pressed Print out a copy of the last recorded Auto 12-lead ECG Advance the printer paper to the beginning of the next page Stop the printing of a Rhythm report Return to the previous screen on the LCD display
1-31
Getting Started
D A
G H
B E C I J K F L
Push to turn on the cardiograph or to put the cardiograph into Standby (power save) when the cardiograph is not in use. Push and hold for three seconds, then release to shut down the cardiograph for extended periods of inactivity. When lit, the cardiograph is in Standby (power save) mode and the screen is black. When lit, the cardiograph is plugged into AC power and the battery is charging. Displays current cardiograph settings including: leads off, battery level indicator, patient heart rate, filter settings, pacing detection settings, and patient name and ID. Displays real-time waveforms (waveforms are colorcoded to indicate signal quality on the PageWriter Trim III). Press the up or down arrow key to change the lead format displayed on the screen Available lead formats include: 6x2, 3x4 1R, 3x4, and 3 lead formats
B C D
Waveform Display
Command Toolbar
Buttons contain the major functions of the cardiograph, with the current date and time at the right.
1-32
Getting Started
Press button to enter Patient ID information at the beginning of a patient session. Press button to print out an Auto 12-lead ECG. Press button twice to print a STAT 12-lead ECG.
I J K L
Press button to print out a continuous Rhythm report (up to 12 leads) until the Stop button (L) is touched. Press button to print out a copy of the last recorded Auto 12lead ECG. Press button to advance the printer paper to the beginning of the next page. Press button to stop the printing of a Rhythm report or any other printing function.
Status Bar
B C D E ID: F
RL
P? NAME:
Status Bar Description Feature Name Leads Off Indicator Heart Rate Indicator Battery Level Indicator Filter Settings Pacing Detection Settings Patient Name and ID Description
Displays the name of any loose or disconnected leads or electrodes. Displays the current patient heart rate in beats per minute. Displays the current battery level and if the batteries are charging. Displays the filter settings for the current patient session. Displays the Pacing Detection Setting used for the current patient session. Displays the patient name and ID for the current patient session.
1-33
Getting Started
REPORT
CONFIG
HELP
REPORT
Change Auto ECG settings Change pacing detection settings Change Rhythm report settings Change the lead on a Disclose report Turn on or turn off optional filters (Baseline Wander, Artifact)
FILTER
Print a report of one minute of continuous waveform data for one selected lead
DISCLOSE
Load Orders on the cardiograph from a PC card or a USB memory stick Enter an Order using the keyboard, or edit or delete Orders
ORDERS
Review, edit, or print saved 12-lead ECGs Transfer 12-lead ECGs to a TraceMasterVue ECG Management System
ARCHIVE
Download ECGs from a TraceMasterVue Remote Site and view and print ECGs on the cardiograph Configure the cardiograph or change configured settings Change the access passwords for features on the cardiograph Save all cardiograph configured settings to a PC card or to a USB memory stick in case of system failure Save all cardiograph configured settings to a PC card or to a USB memory stick in order to upload the settings to multiple cardiographs Get Help when using the cardiograph
CONFIG
Help
1-34
Getting Started
Ordering Supplies
All supplies may be ordered on the web at:
http://shop.medical.philips.com
Use the part numbers listed below for reference to ensure that the correct supplies are ordered.
989803130091 989803130101
Replacement Fuse
Part Number Description
453564000371
989803129161 989803129191
989803129141
Getting Started
Chest Lead Set, 61 cm/24 in (AAMI) Limb Lead Set, 99 cm/39 in (IEC) Chest Lead Set, 61 cm/24 in (IEC) Long Limb Lead Set, 137 cm/54 in (IEC) Long Chest Lead Set, 99 cm/39 in (IEC) Long Complete Lead Set (IEC)
Electrodes
Part Number Description
13943B M2253A 40420A 13944B 989803129231 989803129241 M2254A 40431B 40498E 40475A 40490E 40421A 40494E 40491E 40424A 14030A
Disposable cardiography electrode, resting diagnostic ECG Disposable electrode, adult, resting ECG (not available in Japan) Disposable electrode, diagnostic, pre-gelled Wet Gel Foam Electrode, resting ECG Alligator Clips for Disposable Tab Electrodes (AAMI) Alligator Clips for Disposable Tab Electrodes (IEC) Tab electrode adapter Alligator Clip Adapter for 1/8 post Snap Lead Electrode (IEC) Snap Lead Electrode Adapter 15mm Suction Electrode Push-in Connect Welsh Electrode Limb Clamp Electrode C400 (4 per box) Limb Plate Electrode C400 (4 per bag) Limb Plate Electrode (4 pack) Strap Electrode, 14 inch limb (4 per pack)
1-36
Getting Started
Printer Paper
Part Number Description
M3707A
M3708A
Thermal Paper (100 sheets) A4 size (8.27 x 11.69 in/21 x 29.69 cm)
Battery
Part Number Description
989803130151
Cardiograph Accessories
For more information on optional cardiograph accessories or to place an order, contact your Philips Sales Representative the Philips Response Center nearest you, see page 1-38.
989803129931 989803129941 989803127331 989803129961 989803130131 989803142041 989803129951 989803145331 989803144601 989803130111 989803130121 989803127441 989803127461 989803138021
Barcode Reader Magnetic Card Reader PC card (128 MB storage) SmartCard Reader Patient Cable Arm Wireless LAN Card LAN PCMCIA Network Card USB Memory Stick PageWriter Trim Cardiograph User Documentation CD (additional copies) PageWriter Trim Cardiograph Cart PageWriter Trim Cardiograph Cart Additional Shelf Optional Locking Drawer for Cardiograph Cart Modem Card (USA and Canada only) LAN Cable
1-37
Getting Started
(800) 323 2280 01 800 710 8128 1 787 754 6811 (800) 722 9377
54 11 4546 7698 0800 701 7789 0800 22 3003 01 8000 11 10 10 51 1 620 6440
United Kingdom
Austria Belgium
Czech Republic MCR Response Center (located in The Netherlands) Denmark Finland
1-38 PageWriter Trim Cardiograph Instructions for Use
31 40 2781619
Getting Started
France Germany Greece MCR Response Center (located in The Netherlands) Hungary MCR Response Center (located in The Netherlands) Italy Netherlands Norway Poland MCR Response Center (located in The Netherlands) Rumania MCR Response Center (located in The Netherlands) Russia MCR Response Center (located in The Netherlands) Slovak Republic MCR Response Center (located in The Netherlands) Spain Sweden Switzerland
31 40 2781619
31 40 2781619
31 40 2781619
31 40 2781619
Australia China
1-39
Getting Started
Hong Kong India Indonesia Japan Korea Malaysia New Zealand Philippines Singapore Taiwan Thailand
852 2876 7578 1600 112 444 62 21 7910040, ext 8610 81 (0)120 095 205 82 (0)2 3445 9010 1800 886 188 0800 251 400 63 2 8162617 ext. 875 1800 Philips 0800 005 616 66 (0)2 614 3569
31 40 2781619
1-40
2
1
Introduction
Settings on the PageWriter Trim II and III cardiographs are configurable to meet the needs of any clinical environment. The cardiograph is shipped with factory default settings, and any of these settings may be changed. There are no configurable features on the PageWriter Trim I cardiograph. Please see "The Patient Session" on page 3-1, and complete the Interactive Training Program on CD to learn how to use the features of the cardiograph. These files may also be downloaded from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Password Access
Access to all configuration options on the cardiograph may be set to be password access controlled. It is recommended that the Password screen be configured first, see page 2-40.
2-1
Press the space bar ( ) or the Trim Knob to select the button. The Configuration screen appears. A series of tabs appear at the top of the screen. Under each tab are a set of configurable features.
The Configuration Screen Profiles (P) System (S) Orders (Q) Rhythm (V)
Figure 2-1
(page 2-8)
(page 2-17)
(page 2-30)
2-2
Analysis Settings
To select a tab: 1 2
) on the keyboard.
Press the letter shown in parenthesis on the tab. For example, to select the Analysis tab, press and hold down the Alt key, and then press the A key on the keyboard.
After making all changes to the cardiograph configuration screens, press the Enter key ( ) on the keyboard to save the settings and to exit the screen.
To exit the configuration screens without saving changes:
Analysis Settings
This section is used to configure the settings used with the Philips 12-Lead Algorithm, including selecting the algorithm version, setting the default pacing detection setting, the adult bradycardia limit, and configuring the statement that appears on the printed 12-lead ECG indicating that the ECG has not been overread by a qualified physician.
2-3
Analysis Settings
RL
P? NAME:
ID:
2-4
Analysis Settings
There are four pacing detection settings that are available as the default setting on the cardiograph. These settings are described in Table 2-1. The pacing detection setting may be changed for an individual patient session when necessary.
Table 2-1 Setting Pacing Detection Setting Description Description Symbol on Status Bar and printed ECG P?
This is the default setting and normally is used for both paced and non-paced patients Pacemaker pulse detection is on and is at normal sensitivity Occasional false pacemaker pulse detections may occur in ECGs with excessive noise False detections may result in an incorrect interpretive statement appearing on the report Small amplitude pacemaker pulses may not be detected using this setting
Non-paced
Pacemaker pulse detection is off Use this setting if there are false pacemaker pulse detections from noise, or if incorrect interpretive statements or inappropriate paced ECG complexes appear on the report Pacemaker pulse detection is on and is set at a higher sensitivity Use this setting if small amplitude pacemaker pulses are not being detected at the default (Not Known if Paced) setting False pacemaker pulse detections may occur if the ECG is noisy
Paced
2-5
Analysis Settings
Pacing Detection Setting Description (continued) Description Symbol on Status Bar and printed ECG PM
Paced (magnet)
Use this setting if the ECG is acquired with an active pacemaker magnet or programmer in place Pacemaker pulse detection is on and is at a higher sensitivity Magnets or programmers often put the pacemaker into a fixed-rate, non-sensing mode The statement ECG ACQUIRED WITH MAGNET IN PLACE is printed on the 12lead ECG notifying the overreader that a magnet or programmer was used and would explain the fixed rate behavior of the pacer
Press and hold down the Alt key ( Press the A key on the keyboard.
) on the keyboard.
The Analysis screen appears. Under Pacer Detect, Not Known if Paced (recommended setting) is selected. To select another setting, turn the Trim Knob or press the Tab key ( setting. ) to highlight the
Press the space bar (on keyboard) or the Trim Knob to select the setting.
Press the space bar (on keyboard) to delete the statement. No statement will appear on the printed ECG report. Or, type in a customized statement to appear on the ECG report.
2-6
Analysis Settings
Press the space bar (on keyboard) or the Trim Knob. The drop-down list of available settings appears. Press the up or down arrow keys ( ) or turn the Trim Knob to highlight a setting.
Press the space bar (on keyboard) or the Trim Knob to select the setting.
Press the Tab key ( ) or turn the Trim Knob until the algorithm version (PH080A or PH090A) is highlighted. Press the space bar or the Trim Knob to select the algorithm version. If version PH090A is selected, a group of configurable options appear on the screen.
Algorithm version PH090A is only compatible with TraceMasterVue ECG Management System version A.02.01 and higher, and is not compatible with the PageWriterTouch cardiograph.
Press the Tab key or turn the Trim Knob to highlight the Check Lead Placement setting. Press the space bar to select the check box. This option enables the automatic lead reversal detection feature for limb leads RA and LA, and the precordial leads. When the algorithm detects that leads have been reversed, a statement will appear on the ECG report.
2-7
Patient ID Settings
For a complete listing of all borderline interpretive statements that are suppressed using this feature, see Appendix A, Suppressed Borderline Interpretive Statements.
Table 2-2 Borderline Statement Suppression Settings Description Description
This setting turns off all borderline statement suppression; no statements are suppressed. All borderline or otherwise normal interpretive statements will appear on the printed ECG report.
Level 1 - few
This setting will suppress certain borderline interpretive statements. See Appendix A, Suppressed Borderline Interpretive Statements for a complete listing of the interpretive statements that are suppressed using this setting. This setting will suppress the maximum number of borderline or otherwise normal interpretive statements. See Appendix A, Suppressed Borderline Interpretive Statements for a complete listing of the interpretive statements that are suppressed using this setting.
Level 2 - many
Press the space bar to select the radio button. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Patient ID Settings
The Patient ID settings are used to configure the amount and type of information that appears on the Patient ID screen when the Patient ID button (right side of the cardiograph) is pressed. The Patient ID screen is used during a patient session to enter patient information.
CAUTION
Age and Gender Patient ID information are required if using the Philips 12-Lead Algorithm for ECG interpretation. For more information, see the Philips 12-Lead Algorithm Physicians Guide on the PageWriter Trim User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com). To open the Patient ID configuration screen: 1 2
) on the keyboard.
Press the I key on the keyboard to open the Patient ID configuration screen.
2-8
Patient ID Settings
Three tabs appear at the top of the screen. These tabs contain the three types of configurable Patient ID information available on the cardiograph. The Patient Info. tab is selected.
Patient ID Configurable Settings Clinical Info. (X) Order Info. (O)
Figure 2-3
(page 2-9)
(page 2-12)
(page 2-17)
Select this check box to make this type of Patient ID information appear on the Patient ID screen. This information is transferred with the ECG to a TraceMasterVue ECG Management System.
Required
Select this check box to require that this type of Patient ID information be complete before the ECG is transferred to a Philips TraceMasterVue ECG Management System. Select this check box to make this type of Patient ID information appear as a column on the Archive or Orders screen. Select this check box to include this type of Patient ID information on the printed ECG report.
Indexed Printed
Press the space bar (on keyboard) or the Trim Knob to select the check box. A check mark appears and the feature is enabled.
2-9
Patient ID Settings
There are two optional and configurable text entry fields available labeled <User Field 1> and <User Field 2>. These optional text entry fields may be configured to appear on the Patient ID screen during a patient session. Each type of Patient Information can be configured using four different settings: Enabled, Required, Indexed, and Printed (see Table 2-3 on page 2-9).
Table 2-4 Patient Information Description Description
Patient Information
Patient First Name Patient Last Name Patient Additional Name Race (Ethnicity)
Up to 40 characters in length Up to 40 characters in length Up to 40 characters in length Drop-down list selection Pre-defined drop-down list
Patient Age
Patient age is configurable and can be entered by: Configurable units (years, hours, days, weeks, months) Date of birth (month, day, year)
A default age is specified for ECG interpretation when no patient age is entered Patient Gender User Defined text entry field Radio button selection (male, female, unknown) Text entry field label up to sixteen characters in length Text entry field is free text entry up to thirty-two characters in length
) on the keyboard.
2-10
Patient ID Settings
3 4 5 6 7 8 9
Press and hold down the Alt key on the keyboard. Press the T key to select the Patient Info. tab (if not selected). Press the Tab key ( ) or turn the Trim Knob to highlight the ON text next to a check box of a feature to be enabled. Press the space bar (on keyboard) or the Trim Knob to select a check box. A check mark appears in the selected check box and enables the patient information field. Press the Tab key or turn the Trim Knob to select the drop-down list next to Age/DOB. Press the space bar (on keyboard) or the Trim Knob to display the drop-down list. Press the up or down arrow keys to scroll through the list and to highlight a default age unit (DOB-date of birth, Years, Days, Weeks, Hours).
10 Press the space bar or the Trim Knob to select the age unit. 11 Press the Tab key or turn the Trim Knob to highlight the age displayed under Default Age (Years). The Default Age (Years) selection sets the default age that is used for ECG
interpretation when no patient age is entered. The factory default age setting is 50 years.
12 Type in the default age (using keyboard). 13 Press the Tab key or turn the Trim Knob to highlight the drop-down list next to Weight or Height. 14 Press the space bar or the Trim Knob to display the drop-down list. 15 Press the up or down arrow key (
16 Press the space bar or the Trim Knob to select the weight or height unit.
Ensure that <User Field 1> and <User Field 2> check boxes for Enabled, Required, Indexed, or Printed are selected. If these check boxes are not selected, the user defined fields will not appear on the Patient ID screen. Turn the Trim Knob or press the Tab key ( ) to select the field next to <User Field 1> or <User Field 2>. The cursor appears in the field. Type in any sixteen letters or numbers with the keyboard to create the text field label. This label appears on the Patient ID screen. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
2 3
2-11
Patient ID Settings
Each type of Clinical Information can be configured using four different settings: Enabled,
Required, Indexed, and Printed (see Table 2-3 on page 2-9).
Table 2-5
Clinical Information
Sx (Symptoms)
Configurable drop-down list Selections from drop-down list can be up to thirty-two characters in length
Hx (History)
Configurable drop-down list Selections from drop-down list can be up to thirty-two characters in length
Rx (Prescriptions)
Configurable drop-down list Selections from drop-down list can be up to thirty-two characters in length
2-12
Patient ID Settings
Table 2-5
Clinical Information
Dx (Diagnoses)
Configurable drop-down list Selections from drop-down list can be up to thirty-two characters in length
Configurable drop-down list Selections from drop-down list can be up to thirty-two characters in length Numeric entry Systolic, diastolic
Blood Pressure
Drop-down list label up to sixteen characters in length Text field is free text entry up to thirty-two characters in length
) on the keyboard.
Press the I key. The Patient ID screens appear. Press and hold down the Alt key on the keyboard. Press the X key to select the Clinical Info. tab. Press the Tab key ( ) or turn the Trim Knob to highlight the ON text next to a check box of a feature to be enabled. Press the space bar (on keyboard) or the Trim Knob to select a check box. A check mark ( ) appears in the selected check box and enables the clinical information field. Press the Tab key or turn the Trim Knob to highlight the drop-down list next to Sx (Symptoms). Press the space bar or the Trim Knob to review the available selections in the drop-down list. To add a new entry, press the Tab key or turn the Trim Knob to highlight the + button.
10 Press the space bar or the Trim Knob. The Please input data window appears. 11 Type in the new symptom (up to thirty-two characters in length). 12 Press the Tab key or turn the Trim Knob to highlight the OK button. 13 Press the space bar or Trim Knob to add the symptom. The new symptom appears in the
drop-down list. Follow the same procedure to add drop-down list entries for Hx (History), Rx (Prescriptions), Dx (Diagnosis), and DRG (Diagnostic Related Group)
2-13
Patient ID Settings
Press the Tab key or turn the Trim Knob to highlight the - button. Press the space bar or the Trim Knob. The Delete Sx Label window appears. Press the space bar or the Trim Knob to select the OK button. The user- defined symptom is deleted from the drop-down list. Follow the same procedure to delete drop-down list entries for Hx (History), Rx (Prescriptions), Dx (Diagnosis), and DRG (Diagnostic Related Group).
Ensure that the <User Field 3> and <User Field 4> check boxes for Enabled, Required, Indexed, or Printed are selected. If these check boxes are not selected, the user defined fields will not appear on the Patient ID screen or on the printed ECG. Turn the Trim Knob to select the field next to <User Field 3> or <User Field 4>. The cursor appears in the field. Type in any sixteen letters or numbers with the keyboard to specify a text label for the field. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
2 3
Patient ID Settings
Encounter ID STAT ECG There are two optional and configurable text entry fields available labeled <User Field 5> and <User Field 6>. These optional text entry fields appear on the Patient ID screen during a patient session. Each type of Order Information can be configured using four different settings: Enabled,
Required, Indexed, and Printed (see Table 2-3 on page 2-9).
Table 2-6
Order Information
Physician Name and UPIN (Universal Physician Identification Number) Department Number
Configurable drop-down list Drop-down list selections up to thirty-two characters in length Configurable drop-down list Drop-down list selections up to thirty-two characters in length
Operator ID
Room Number
Order Number
Encounter ID
2-15
Patient ID Settings
Table 2-6
Order Information
STAT ECG
Selectable drop-down list on Patient ID screen STAT label printed on Auto ECG
Text entry field label up to sixteen characters in length Free text entry up to thirty-two characters in length
) on the keyboard.
Press the I key. The Patient ID screens appear. Press and hold down the Alt key on the keyboard. Press the O key to select the Order Info. tab. Press the Tab key ( ) or turn the Trim Knob to highlight the ON text next to a check box of a feature to be enabled. Press the space bar or the Trim Knob to select a check box. A check mark ( the selected check box and enables the Order information field. ) appears in
Press the Tab key or turn the Trim Knob to highlight the + button next to Reason for Order. Press the space bar (on keyboard) or the Trim Knob. The Please input data window appears. Type in a reason for order (up to thirty-two characters in length).
10 Press the Tab key or turn the Trim Knob to highlight the OK button. 11 Press the space bar or the Trim Knob to add the reason for order. The new reason for order
Select the reason for order to be deleted from the drop-down list. Press the Tab key ( ) or turn the Trim Knob to highlight the - button.
Press the space bar (on keyboard) or the Trim Knob. The Delete Reasons window appears. Press the space bar or the Trim Knob to select the OK button. The reason for order is deleted from the drop-down list. Follow the same procedure to add or to delete drop-down list entries for Physician Name and UPIN, Department, and Operator ID.
2-16
Ensure that the <User Field 5> and <User Field 6> check boxes for Enabled, Required, Indexed, or Printed are selected. If these check boxes are not selected, the user defined fields will not appear on the Patient ID screen or on the printed ECG. Turn the Trim Knob or press the Tab key ( ) to select the field next to <User Field 5> or <User Field 6>. The cursor appears in the field. Type in any sixteen letters or numbers with the keyboard. The text field label is entered and will appear on the Patient ID screen. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
2 3
A profile is a group of settings applied to Auto ECGs and to copies of Auto ECGs. A profile defines how the Auto ECG or ECG copy appears when printed. The Auto ECG or ECG copy is generated when the Auto or Copy buttons (right side of cardiograph) are pressed during a patient session.
2-17
Figure 2-4
The Profile
Speed (mm/sec) and Size (mm/mV) of waveforms Lead Sequence: Standard or Cabrera ECG Signal Acquisition: Time-Sequential or Simultaneous Lead Configuration on printed report (3x4, 3x4 1R, 3x4 3R, 6x2, 12x1, Pan-12) Extended Measurements Report: enabled or not enabled Level of ECG interpretation using the Philips 12-Lead Algorithm (Measurements, Interpretive and Reason Statements, Severity Codes) There is one factory default report profile (Default Main) and one factory default copy report profile (Default Copy). The factory default report and copy profile may be edited, or new, customized profiles may be created.
NOTE The factory default report profile (Default Main) and copy profile (Default Copy) may not be deleted. Figure 2-5 The Factory Default Report Profile (Default Main)
Default Main
Speed: 25 mm/sec Size: 10 mm/mV Chest Leads: Full Scale Lead Configuration: 3x4, 1R Lead Sequence: Standard Acquisition: Time-Sequential Interpretation Level: None
2-18
Figure 2-6
Default Copy
Speed: 25 mm/sec Size: 10 mm/mV Chest Leads: Full Scale Lead Configuration: 3x4, 1R (Rhythm Lead: II) Lead Sequence: Standard Acquisition: Time-Sequential Interpretation Level: None Number of report copies printed: 1
To open the profile screens: 1 2
) on the keyboard.
Press the P Key on the keyboard. The Profile screen appears. Under Profiles List (left side of screen) Default Main is highlighted. Default Main is the factory default Auto 12-lead ECG report profile. This profile may be edited or new profiles may be created. Four tabs appear on the left side of the Profiles screen. Under each tab are ECG report settings that may be edited.
The Profile tabs Interps (G) Scale (J) Type (K)
Figure 2-7
Format (M)
(page 2-20)
(page 2-21)
(page 2-21)
The Interps (G) and Type (K) tabs only appear if the Philips 12-Lead Algorithm is enabled on the cardiograph. To edit a factory default or existing profile: 1
Under Profiles List (left side of screen) an Auto ECG report profile is highlighted. This is the profile selected to be edited. The settings for this profile are displayed on the screen. To select a different profile for editing, press the space bar or the Trim Knob to display the drop-down list. Press the up or down arrow key ( profile to be edited. ) to scroll through the list and to highlight a
2 3
Press the space bar (on keyboard) or the Trim Knob to select a the report profile for editing. The drop-down list closes and the selected report profile appears highlighted under Profiles List.
2-19
If the Format (M) tab is not selected, press and hold down the Alt key ( Press the M key. The Format screen appears. Press the Tab key (
Configuration is highlighted.
) on keyboard.
) or turn the Trim Knob until the drop-down list under Lead
Press the space bar (on keyboard) or the Trim Knob to display the list of available report formats. Press the up or down arrow keys ( ) to scroll through the list. Press the space bar or the Trim Knob to select a report format. The selected report format appears highlighted under Lead Configuration. If the selected report format includes rhythm strips, the default rhythm leads are displayed under Rhythm. Press the Tab key or turn the Trim Knob to highlight the Lead Groups>>> button (3x4, 3R only). Press the space bar or the Trim Knob to display pre-defined groups of three rhythm leads. Or, turn the Trim Knob or press the Tab key to highlight the drop-down list next to R1 (R2, R3) and select the rhythm leads individually. Under Lead Sequence, the default settings for the selected report format are displayed. Press the Tab key or turn the Trim Knob to highlight the lead sequence drop-down list (Standard, Cabrera).
The Pan-12 report format is only available with Cabrera lead sequence and Time-Sequential acquisition. The 12x1 report format is only available with Simultaneous acquisition.
NOTE NOTE 7 8 9
Press the space bar or the Trim Knob to display the drop-down list. Press the up or down arrow key to highlight a lead sequence. Press the space bar to select a lead sequence.
10 Follow the same procedure to select an ECG acquisition type (Simultaneous, TimeSequential) for the report profile.
).
Press the G key on the keyboard. The Interpretation screen appears. Under Interpretations, the different levels of interpretive information available with the Philips 12-lead Algorithm are displayed.
2-20
3 NOTE 4
Selecting None will have no interpretive information (including Basic Measurements) appear on the printed Auto ECG.
Press the space bar (on keyboard) or the Trim Knob to select the interpretive setting.
) on the keyboard.
Press the J key. The Scale screen appears. Press the Tab key ( Chest Leads. ) or turn the Trim Knob to select settings under Speed, Size, and
NOTE 4
Chest Leads sets the precordial leads to full or half the scale of the limb and augmented leads.
Press the space bar (on keyboard) or the Trim Knob to select a setting.
) on the keyboard.
Press the K key. The Type screen appears. Press the Tab key ( ) or turn the Trim Knob to highlight Extended Measurements.
Press the space bar (on keyboard) to select the check box. With the check box selected, the full Extended Measurements report is included with each Auto ECG.
2-21
Press the Tab key ( ) or turn the Trim Knob until the Save button (top of screen) is highlighted. The new settings will be saved to the profile displayed under Profiles List.
To select a different profile, press the Tab key or turn the Trim Knob until the drop-down list under Profiles List is highlighted. Press the space bar or the Trim Knob to open the drop-down list. Press the up or down arrow key to highlight a profile. Press the space bar or the Trim Knob to select the profile.
Press the space bar or the Trim Knob to apply the new settings to the selected profile. The new settings are saved to the selected profile. Press the Tab key ( ) or turn the Trim Knob until the Add button (top of screen) is highlighted. Press the space bar or the Trim Knob. The Please input data window appears. Type in the name of the new profile (up to thirtytwo characters in length). Press the Tab key to highlight the OK button.
Highlight the Cancel button and push the space bar or Trim Knob to exit without saving the profile name.
Press the space bar (on keyboard) or the Trim Knob to save the new profile. The new profile appears in the Profiles List drop-down list.
) or turn the Trim Knob until the drop-down list under Select
Press the space bar (on keyboard) or the Trim Knob to display the drop-down list of available Auto ECG report profiles. Press the up or down arrow key ( report profile. Press the space bar to select the profile. Press the Tab key or turn the Trim Knob to highlight the drop-down list under Copy. Press the space bar or the Trim Knob to display the drop-down list of available Copy profiles. Press the up or down arrow key to highlight a profile. ) to highlight a profile as the default Auto ECG
2-22
System Settings
8 9
Press the space bar or the Trim Knob to select the profile as the default Copy profile. Press the Tab key or turn the Trim Knob to highlight the drop-down list next to Number
of Copies.
10 Press the space bar or the Trim Knob to display the drop-down list. 11 Press the up or down arrow key to select the number of Auto ECG report copies (1-5) printed each time the Copy button (right side of cardiograph) is pressed.
System. ECGs that are not saved to the Archive are deleted. The Second ID Label option prints the patient name and ID at the top and the bottom of the ECG report. The Print Immediately option automatically prints each ECG when the Auto button (right side of cardiograph) is pressed. If this option is not selected, the Auto ECG appears on the Preview screen. The user can assess the quality of the ECG directly on the Preview screen, and then print it by pressing the Enter key ( ) on the keyboard.
TIP Previewing the Auto ECG before printing it saves printer paper and helps to ensure a quality report. To select other print options: 1 2
) or turn the Trim Knob until the option is highlighted (lower right
Press the space bar (on keyboard) to select the check box. A selected check box enables the feature. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
System Settings
The configurable cardiograph settings in this section include: paper size keyboard caps lock feature lead standard setting for printed ECGs (AAMI or IEC) battery power saving modes default display format notification messages
2-23
System Settings
simulated waveform feature This section also includes tools under Configuration Management (see page 2-46) and other maintenance and diagnostic tools under Diagnostics. For information on Diagnostic tools, see page 7-11. The Software Option Upgrade feature is used when installing a software or an accessory upgrade on the cardiograph. For information, see the PageWriter Trim Cardiograph Upgrade Instructions provided with the upgrade kit.
) on the keyboard.
Press the S key. The System screen appears. Press the Tab key ( is highlighted. ) or turn the Trim Knob until the A or A4 setting under Paper Size
NOTE 4
A4 paper requires a special paper drawer modification. Contact the nearest Philips Response Center for more information, see page 1-38.
Press the space bar (on keyboard) or the Trim Knob to select a default paper setting.
2-24
System Settings
Press the space bar (on keyboard) to select the check box. With the check box selected ( ), the keyboard will type in all capital letters.
) or turn the Trim Knob until the AAMI or IEC lead standard is
Press the space bar (on keyboard) or the Trim Knob to set the default print lead standard.
The lead format on the R/T ECG screen can be changed at any time during a patient session by pressing the up or down arrow key. For more information on using the R/T ECG screen, see page 1-34, or see Chapter 3 The Patient Session of the PageWriter Trim Cardiograph Instructions for Use on the User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com).
To set the default display format setting: 1 2
) or turn the Trim Knob until the 6x2 or 3x4, 1R lead format is
System Settings
The Shutdown feature is used to automatically shut down all cardiograph power if the cardiograph is not used for a pre-set number of minutes after entering Standby. The green Standby indicator light is not lit when the cardiograph is shut down. Press the On/Standby button to turn on the cardiograph. The cardiograph will restart and display a series of information screens before the R/T ECG screen appears.
NOTE The Shutdown feature may be disabled. To set the battery power saving features: 1 2 3
Press the Tab key ( ) or turn the Trim Knob until the Idle Timeout (Minutes) field next to Standby is highlighted. Enter the number of minutes (5-60) that elapse before the cardiograph enters Standby. Press the Tab key or turn the Trim Knob until the Idle Timeout (Minutes) field next to Shutdown is highlighted.
To disable the Shutdown feature, press the Tab key or turn the Trim Knob until Shutdown is highlighted. Press the space bar (on keyboard) to clear the check box. The Shutdown feature is disabled.
NOTE
Enter the number of minutes (10-3000) that pass after the cardiograph enters Standby that it automatically shuts down.
Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Press the Tab key ( ) or turn the Trim Knob until the Add button under Notification Messages is highlighted. Press the space bar (on keyboard) or the Trim Knob to select the button. The Please input data window appears. Type in the first line of text to appear on the notification message screen. The information can be up to fifty characters in length.
2-26
System Settings
4 5 6
Press the Tab key or turn the Trim Knob until the OK button is highlighted. Press the space bar or the Trim Knob to enter the line of text into the notification message. Continue to add up to five total lines of text in the order that they should appear on the notification message window. Press the Tab key ( ) or turn the Trim Knob until the drop-down list under Notification Messages is highlighted (in blue). Press the space bar (on keyboard) or the Trim Knob to open the drop-down list. Press the up or down arrow key to scroll through the lines of text. Highlight the line of text to be deleted. Press the space bar or the Trim Knob to close the drop-down menu. Press the Tab key or turn the Trim Knob to highlight the Delete button.
The line of text is automatically deleted once the Delete button is selected. No confirmation message to delete is provided.
3 4 NOTE 5
Press the space bar or the Trim Knob to delete the selected line of text from the notification message.
From any configuration screen, press down and hold the Alt key ( Press the S key. The System screen appears. Press the Tab key ( Data is highlighted.
on the keyboard.
) or turn the Trim Knob until the ON check box under Simulated
Press the space bar (on keyboard) or the Trim Knob to select the check box. The simulated waveform feature is enabled. To use the simulated waveform data feature immediately, press the Enter key ( the new configured setting. ) to save
Press and hold the On/Standby button for three seconds and then release it to shut down the cardiograph.
2-27
Order Settings
7 8
Remove the PIM from the PIM connector port on the rear of the cardiograph (see page 110). Press the On/Standby button to restart the cardiograph. Simulated waveforms appears on the R/T ECG screen. From any configuration screen, press down and hold the Alt key ( Press the S key. The System screen appears. Press the Tab key ( Data is highlighted. ) or turn the Trim Knob until the ON check box under Simulated ) on the keyboard.
Press the space bar (on keyboard) or the Trim Knob to clear the check box. The simulated waveform feature is disabled. Press the Enter key ( ) to save the new configured setting.
Press and hold the On/Standby button for three seconds and then release it to shut down the cardiograph. Attach the PIM to the PIM connector port on the rear of the cardiograph (see page 1-10). Press the On/Standby button to restart the cardiograph. The cardiograph returns to normal operation.
Order Settings
The Order settings are used with the Orders feature on the cardiograph. The Quick Search Fields feature is used on the Patient ID entry screen. This feature is used to automatically
ORDERS
locate a Pending Order from the Pending Orders list based on information entered into one searchable field. The field that is used to search for Pending Orders information is configurable. The Delete After Selection feature is used to automatically delete an order after it is selected from the Pending Orders list on the Patient ID screen. Disabling this feature will allow an order to be selected multiple times from the Patient ID screen.
To configure the Order settings: 1 2 3
) on the keyboard.
Press the Q key. The Orders screen appears. Under Quick Search Fields, the Patient ID field is selected as the searchable field. To select another field as the searchable field, press the down arrow key ( ) until the field is highlighted.
Ensure that the field enabled as the Quick Search Field is also enabled as an active Patient ID field on the cardiograph (see page 2-9).
NOTE 4
) or turn the Trim Knob until the Delete After Selection text is
2-28
Rhythm Settings
Press the space bar (on keyboard) or the Trim Knob to select or to clear the check box. With the check box selected, an order will be deleted from the Pending Orders list when it is selected during a patient session. With the check box cleared, the order may be selected multiple times from the Patient ID screen.
Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Rhythm Settings
The Rhythm settings specify the default Rhythm report settings on the cardiograph. These settings include the size and the speed of the waveforms, and the individual leads that appear on the printed Rhythm report. Any of the default settings may be changed during an individual patient session by selecting the Report button on the Command Toolbar and manually changing the Rhythm report REPORT settings.
NOTE To set Rhythm filter settings, see the next section Filter Settings. To set default Rhythm settings: 1 2 3 4 5 6 7 NOTE 8
) on the keyboard.
Press the V key. The Rhythm screen appears. Press the Tab key ( ) or turn the Trim Knob until the drop-down list next to Speed
(mm/s) is highlighted (in blue).
Press the space bar (on keyboard) or the Trim Knob to open the drop-down list. Press the up or down arrow key ( ) to scroll through the available settings.
Press the space bar or the Trim Knob to select a setting. Repeat the procedure to set the Size (mm/mv) and Size (V Leads) settings.
The Size (V Leads) setting scales the size of the precordial leads to one-half or to the same (full) size as the limb leads.
Press the Tab key or turn the Trim Knob to highlight the Select All check box to select all twelve leads to print on the Rhythm report. Or, press the Tab key or turn the Trim Knob to highlight the I lead check box. Press the up or down arrow key or turn the Trim Knob to select individual leads from the list. Press the space bar or the Trim Knob to select an individual lead check box.
Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
2-29
Rhythm Settings
Filter Settings
The filter settings specify the default filter settings that are used for each patient session. The configurable filter settings include: AC filter Artifact filter Baseline Wander filter High and Low Pass Frequency filters
Figure 2-9
A B
A B C D
Artifact Filter Baseline Wander Filter AC Filter High and Low Pass Frequency Filters
2-30
Rhythm Settings
The Baseline Wander filter helps to suppress the slow drifting of the ECG signal during ECG recording. Baseline wander may result from patient respiration or from other sources.
Table 2-7 Artifact and Baseline Wander Filter Settings Artifact and Baseline Wander Filters Disabled
2-31
Rhythm Settings
To configure filters: 1 2 3 4
) on the keyboard.
Press the F key. The Filter screen appears. Press the Tab key ( ) or turn the Trim Knob to highlight the Filter On setting.
Press the space bar (on keyboard) or the Trim Knob to select the check box (if not selected). Selecting this check box turns on the optional filters (Artifact, Baseline Wander or both) for all patient sessions. The Main Settings section specifies the optional filters and high and low pass frequency filter settings used for all Auto ECGs. Press the Tab key or turn the Trim Knob to highlight the optional filters (Artifact, Wander, or both) that are turned on for all patient sessions. Press the space bar or the Trim Knob to select the filter setting. Press the Tab key or turn the Trim Knob to highlight a High Pass and Low Pass frequency setting that is used for all patient sessions.
The High and Low Pass frequency settings of 0.15 and 150 Hz are recommended for most ECGs.
6 7
TIP 8 9
Press the space bar or the Trim Knob to select a setting. Press the Tab key or turn the Trim Knob to highlight the On check box under AC Filter (Hz) (bottom of screen).
10 Press the space bar or the Trim Knob to select the On check box. NOTE Clear the On check box to turn off the AC filter.
) or turn the Trim Knob to highlight a High Pass (Hz) and Low
Press the space bar or the Trim Knob to select the setting. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
2-32
2-33
TraceMasterVue Remote Sites that are defined in Configuration appear in the Selected Archive drop-down list in the Archive. The Archive is used to transmit ECGs to and from the cardiograph, and to search the Remote Site for ECGs to print on the cardiograph using the
ARCHIVE Query feature.
Remote Site Fax and Modem Connection (USA and Canada only)
The cardiograph supports fax transmission of hard copy (non-editable) ECGs and modem transmission of ECG data to a TraceMasterVue ECG Management System. The cardiograph uses a PCMCIA Card modem (optional feature, see page 1-23) that supports printing to Group 3 Fax machines, and supports Class 1 or 2 Fax modem protocol (USA and Canada only). For information on compatible PCMCIA card modems used outside of the USA and Canada, contact the nearest Philips Response Center (see page 1-38) or your local distributor.
WARNING
Never connect the PC card modem to a phone line when the cardiograph is connected to a patient.
Insert the PC card modem into the PC card slot on the rear of the cardiograph before configuring the fax or modem connection (see page 1-21) Press and hold down the Alt key ( ) on the keyboard. Press the R key. The Remote Sites screen appears. Press the Tab key ( LAN). ) or turn the Trim Knob to highlight Fax or Network (modem,
Press the space bar (on keyboard) or the Trim Knob to select the setting.
For Fax:
1 2 3 4 5 6
) or turn the Trim Knob to highlight the Name: field. The cursor
Type in up to forty numbers or letters to represent the name of the sender of each fax transmission. Press the Tab key or turn the Trim Knob to highlight the Station ID field. The cursor appears in the field. Type in up to forty numbers or letters. Press the Tab key or turn the Trim Knob to highlight the Name field. The cursor appears in the field. Type in up to forty numbers or letters to represent the name of the recipient of each fax transmission.
2-34
7 8 9
Press the Tab key or turn the Trim Knob to highlight the Fax Number field. The cursor appears in the field. Type in the receiving fax number. Press the Tab key or turn the Trim Knob to highlight the drop-down list under Dialing Devices.
10 Press the space bar (on keyboard) or the Trim Knob to display the drop-down list. 11 Press the up or down arrow key ( NOTE
If the installed modem card does not appear on the drop-down list, ensure that the modem card is fully inserted into the PC card slot on the rear of the cardiograph. If the card is not installed, or was not fully inserted into the slot, press and hold down the On/Standby button for three seconds, then release it. The cardiograph shuts down. Push the On/Standby button again. After the R/T ECG screen appears, follow the procedure Opening the Configuration Screen on page 2-2 and then return to this procedure. 12 Press the space bar to select the modem card. 13 Press the Tab key or turn the Trim Knob to highlight the Memo: field. The cursor appears
in the field.
14 Type in optional memo text to appear on the fax cover sheet.
A new Remote Site can be created using these settings, or any existing Remote Site may be saved with the new settings. Follow steps 15 to 18 to create a new Remote Site, or see the next procedure to edit an existing Remote Site.
15 At the top of the screen a check mark and the word Modified appears. Press the Tab key or turn the Trim Knob to highlight the Add New button. 16 Press the space bar or the Trim Knob. The Add New Remote Site window appears. 17 Type in a name for the Remote Site configured with these fax settings. 18 Press the Tab key or turn the Trim Knob to highlight the OK button. 19 Press the space bar or the Trim Knob. The new Remote Site with fax transmission is
created. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
To change remote site fax settings: 1 2 3 4 5
Press the Tab key ( ) or turn the Trim Knob until the Remote Sites Archive dropdown list is highlighted. Press the space bar (on keyboard) or the Trim Knob to display the drop-down list. Press the up or down arrow key ( ) to scroll through the drop-down list.
Press the space bar or the Trim Knob to select a Remote Site. Make all changes to the selected Remote Site on the screen.
2-35
6 7 8
When all changes are complete, a check mark and the word Modified appears at the top of the screen. Press the Tab key or turn the Trim Knob until the Save button is highlighted. Press the space bar or the Trim Knob to save the new settings to the selected Remote Site. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
) on the keyboard.
Press the R key. The Remote Sites screen appears. Press the Tab key ( ) or turn the Trim Knob to highlight Network (modem, LAN).
Press the space bar (on keyboard) or the Trim Knob to select the setting. Press the Tab key or turn the Trim Knob to highlight the settings Receive (Query) and Copy/Transfer (left side of screen).
Selecting the Receive (Query) check box enables the user to search the Remote Site (in the Archive) for ECG files to print on the cardiograph. Selecting the Copy/Transfer check box enables the user to transfer ECGs from the Archive to a TraceMasterVue ECG Management System.
NOTE
6 7
Under the Network tab (right of screen), press the Tab key or turn the Trim Knob to highlight the Server URL field. The cursor appears in the field. Type in the URL address of the Remote Site server. The Server URL is the TraceMasterVue file server URL. The Server URL must be entered in the following format: http://computername/EMSCOMM/ Computername is the TraceMaster file server computer name or IP address. Examples of valid URLs include: http://tracemaster/EMSCOMM/ or http://10.101.2.42/EMSCOMM/. Press the Tab key or turn the Trim Knob to highlight the User Name field. The cursor appears in the field.
2-36
10 Press the Tab key or turn the Trim Knob to highlight the Password field. The cursor 11 Type in the Password for the TraceMasterVue User Name. 12 Press and hold down the Alt key on keyboard. 13 Press the Z key. The Net Connect screen appears. 14 Press the Tab key or turn the Trim Knob to highlight Always Connected or Dial-up
(modem) connection.
15 Press the space bar or the Trim Knob the select the setting.
Press the space bar (on keyboard) or the Trim Knob to display the drop-down list. Select the installed modem card.
If the installed modem card does not appear on the drop-down list, ensure that the modem card is fully inserted into the PC card slot on the rear of the cardiograph. If the card is not installed, or was not fully inserted into the slot, press and hold down the On/Standby button for three seconds, then release it. The cardiograph shuts down. Push the On/Standby button again. After the R/T ECG screen appears, follow the procedure Opening the Configuration Screen on page 2-2 and then return to this procedure.
4 5 6 7 8 9
Press the Tab key or turn the Trim Knob to highlight the Phone field. The cursor appears in the field. Type in the dial-up modem telephone number. Press the Tab key or turn the Trim Knob to highlight the User Name field. The cursor appears in the white box. Type in the TraceMasterVue User Name for the dial-up modem connection. Press the Tab key or turn the Trim Knob to highlight the Password field. The cursor appears in the field. Type in the password for the TraceMasterVue user name. in the white box.
10 Press the Tab key or turn the Trim Knob to highlight the Domain field. The cursor appears 11 Type in the Domain name (optional). 12 At the top of the screen a check mark and the word Modified appears. Press the Tab key or turn the Trim Knob to highlight the Add New button. 13 Press the space bar or the Trim Knob. The Add New Remote Site window appears. 14 Type in a name for this Remote Site. 15 Press the Tab key or turn the Trim Knob to highlight the OK button.
2-37
Network Settings
The Remote Site appears in the Remote Sites Archive drop-down list (top of screen) and may be selected in the Archive. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Network Settings
The settings in this section include network protocol settings used with the wireless LAN or the Ethernet LAN connection. The cardiograph supports the following network connections: 10/100-Base T Ethernet using a PCMCIA network card (see page 1-23) wireless LAN card (see page 1-22) The network configuration settings support TCP/IP using a static IP address or a DNS or WINS server. For more information on configuring network settings, see your Network Administrator. For information on configuring the wireless LAN card option with the PageWriter Trim Cardiograph, see the PageWriter Trim Cardiograph Wireless LAN Installation Instructions on the User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com). For detailed information on configuring the PageWriter Trim cardiograph with a TraceMasterVue ECG Management System, see the Configuring Cardiograph and TraceMasterVue Communication Guide available for download from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4
Figure 2-11 Connecting the LAN card
2-38
Network Settings
Networking Overview
The PageWriter Trim cardiograph communicates with the TraceMasterVue ECG Management System through a network connection. In the cardiograph network configuration settings, all TCP/IP settings are configurable based on the specific needs of the clinical environment. Both DHCP (Dynamic Host Configuration Protocol) and fixed IP (Internet Protocol) address settings are available.
DHCP
With DHCP, the LAN automatically provides a dynamic IP address to the cardiograph. The LAN logs the cardiographs unique MAC (Media Access Control) address and provides a temporary DHCP IP address for the cardiograph. If the cardiograph is connected to different LAN servers within the same facility, it may have to be reset in order to be recognized and assigned a DHCP IP address. Or, if the cardiograph has not been connected to the network for a specified period of time (defined by the LAN), the network may not recognize the cardiograph. In this case, the cardiograph may also have to be reset. Resetting the cardiograph at multiple locations on the LAN may be time consuming. If the cardiograph is going to be connected to multiple sites within a facility, or to different LAN servers within a facility, it may be more efficient to assign the cardiograph a fixed IP address.
Fixed IP Address
Fixed IP addresses allow the cardiograph to be recognized throughout a network. With a fixed IP address, the cardiograph will be recognized at multiple locations throughout a LAN and will not require a full reset in order to be recognized. Using fixed IP addresses will also avoid the problem of having multiple IP addresses assigned to a single cardiograph.
Auto Negotiation
When the cardiograph is connected to a LAN, it automatically configures the correct settings for Ethernet speed and mode (half or full duplex). If the auto-negotiation fails, it may be necessary to lock a specific switch or router port to a fixed setting (for example, 100BaseT Full Duplex) in order to obtain a connection. Issues with the timing of the PageWriter Trim auto negotiation have been reported with certain CISCO switches (such as the CISCO 4506). To obtain a LAN connection with these switches, the specific LAN port may have to be locked down with fixed Ethernet port settings. The cardiograph should only be connected to these locked down ports. For more information on networking options or to troubleshoot specific networking issues, consult your network administrator.
To configure cardiograph network settings: 1 2 3
) on the keyboard.
Press the N key. The Network screen appears. Under Network ID, press the Tab key ( ) or turn the Trim Knob to highlight the text field next to Computer Name (if not highlighted).
PageWriter Trim Cardiograph Instructions for Use 2-39
Password Settings
4 NOTE 5
Type in the computer name for the cardiograph (up to sixteen letters or numbers).
The Computer Name may not contain spaces.
Press the Tab key or turn the Trim Knob to highlight the Obtain IP Address Automatically (DNS) or Specify IP Address (fixed IP address) setting depending on your network requirements. Press the space bar or the Trim Knob to select the setting.
Press the Tab key ( ) or turn the Trim Knob to select the IP Address, Subnet Mask, and Default Gateway fields. A cursor appears in the white box. Type in the IP address information for each field. Press the Tab key or turn the Trim Knob to select the Primary DNS Server or Primary
WINS fields. The cursor appears in the white box.
2 3 4 5 6 7 8
Type in the server information. Press the Tab key or turn the Trim Knob to select the Secondary DNS or Secondary WINS fields (if necessary). Type in the server information. To apply the new network settings the cardiograph must restart. Press the Enter key ( on keyboard to save the settings. )
Press and hold the On/Standby button for three seconds and then release the button. The message PageWriter Trim is shutting down... appears. The cardiograph shuts off. Press the On/Standby button to restart the cardiograph. The cardiograph restarts and the new network settings are applied.
Password Settings
The following cardiograph features can be configured to be password access controlled: Archive Configuration Passwords can be up to six letters or numbers in length and are case-sensitive (capital and lower case letters can be used). The Password Configuration System password must be configured first. This password controls access to all password settings on the Configuration screens. Entering a correct password allows the user to change all password settings on the cardiograph. The Archive password must be entered to open the Archive screen. The Configuration password must be entered to open the Configuration screens.
To configure passwords: 1 2
) on keyboard.
Press the W key. The Passwords screen appears. The Password Configuration System password needs to be configured first.
2-40
Locale Settings
Press the Tab key ( ) or turn the Trim Knob until the first field to the right of Password Configuration System (under the Enter Password column) is highlighted. The cursor appears in the field. Type in a password (up to six letters or numbers in length). Press the Tab key or turn the Trim Knob until the cursor appears in the second field (under the Confirm Password column). Re-enter the password.
If the password is re-entered incorrectly, the message Invalid Password Entered appears. Push the Trim Knob to select OK. Re-enter the password.
4 5 6 NOTE 7 8
Press the Tab key or turn the Trim Knob to highlight the On check box to the right of Password Configuration System (under the Enabled column). Follow the same procedure to configure passwords for the Archive and Configuration features on the cardiograph. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Lost Passwords
If a cardiograph password is lost and cannot be retrieved, contact the nearest Philips Response Center for assistance, see page 1-38.
Locale Settings
The settings in this section include setting time format, date format, numerical, and unit measurements for specific countries or regions.
To change the date and time: 1 2 3 4 5 6
) on the keyboard.
Press the L key. The Locale screen appears. The Region: drop-down list is highlighted. Press the space bar (on keyboard) or the Trim Knob to display the drop-down list. Press the up or down arrow key ( selections. ) to scroll through the language and country
Press the space bar to select a language and country setting. The settings for the specified language and country appear on the screen. Any of the settings on the screen may be edited, if necessary. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and exit the Configuration screen. The new changes are applied.
2-41
Cardiograph Settings
Cardiograph Settings
The optional settings in this section provide information about a specific cardiograph including: Location Code (LOC), Device ID (identification number to track a specific cardiograph), Institution Label, Institution Number, Facility Label, Facility Number, Department Label and Department Number. Each of these fields may be customized with any thirty-two letters or numbers. Location Code (LOC) is limited to five numbers only. Each of these configured information fields appear on the printed Auto ECG and are transferred with the ECG to a TraceMasterVue ECG Management System. To view examples of these information fields on the printed ECG report, see "Reading the Printed ECG Report" on page 5-1. The table below describes each cardiograph identification information field.
Table 2-8 Cardiograph Identification Information Fields Description
Only used with a TraceMaster ECG Management System (version A.04.02 or higher) Limited to five numbers in length Does not appear on the printed ECG Configuring this information field disables the Institution Number and Department Number fields
Device ID
Institution Label
Institution Number
Facility Label
Facility Number
Department Label
Department Number
2-42
Cardiograph Settings
Under Identification, press the Tab key ( ) or turn the Trim Knob until the field next to Location Code is selected. The cursor appears in the field.
The Location Code (LOC) is only used with the Philips TraceMaster ECG Management System (version A.04.02 or higher) and does not appear on the printed 12-lead ECG. Configuring the LOC disables the Institution Number and Department Number fields. For more information see the Configuring TraceMasterVue and Cardiograph Communication Guide on the User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com).
2 NOTE
3 4 5 6 7 8 9
Press the Tab key or turn the Trim Knob to select the field next to Device ID. The cursor appears in the field. Enter the number. Press the Tab key or turn the Trim Knob to select the field next to Institution Label. The cursor appears in the field. Enter the text. Press the Tab key or turn the Trim Knob to select the field next to Institution Number. The cursor appears in the field. Enter the number. Press the Tab key or turn the Trim Knob to select the field next to Facility Label. The cursor appears in the field.
10 Enter the text. 11 Press the Tab key or turn the Trim Knob to select the field next to Facility Number. The
2-43
Cardiograph Settings
13 Press the Tab key or turn the Trim Knob to select the field next to Department Label. The
Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
Metronome Settings
This section is also used to configure the Metronome feature. The Metronome is used with the Auto ECG function to perform exercise stress tests such as the Masters Two Step. Using this feature, the patient exercises at a rate indicated by the metronome chime, and an Auto ECG is taken after the patient stops exercising. The default settings for the Metronome are set in Configuration, but these settings may be changed by the user during a patient session. For more information on using the Metronome feature during a patient session, see "Using the Metronome with Auto ECG" on page 3-27.
) or turn the Trim Knob until the ON check box under Metronome
Press the space bar (on keyboard) or the Trim Knob to select the check box. Selecting the ON check box enables the Metronome feature. Each time the Auto button is pressed, the Metronome window appears on the screen. Press the Tab key or turn the Trim Knob to highlight the field to the right of Number of Steps (under Speed). Type in the number of default steps (16-70) to be used with the Metronome feature during a typical stress test. This setting can be changed by the user during a patient session.
2-44
Cardiograph Settings
Press the Tab key or turn the Trim Knob to highlight a setting under Stress Test Protocol. This setting sets the default Masters Two Step stress test used with the Metronome. This setting can be changed by the user during a patient session.
Masters Two Step Stress Test Settings Description
Press the Tab key or the Trim Knob to select a Masters Two Step Stress Test setting. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
The magnetic card reader supports the following standards: ISO 7810, 7811-1, -2, -3, -4, -5 JIS X 6301 and X 6302
) or turn the Trim Knob until the Field 1 drop-down list under
Press the space bar (on keyboard) or the Trim Knob to display the drop-down list of available Patient ID information fields. Press the up or down arrow key ( ) to scroll through the drop-down list.
Press the space bar or the Trim Knob to select a Patient ID field.
2-45
Repeat the procedure for Fields 2-4. Select another tab (top of screen) to continue making changes. If done making changes, press the Enter key ( ) to save the changes and to exit the Configuration screen. The new changes are applied.
TIP
Select all cardiograph configured settings to be saved to the configuration settings file. Insert the PC card into the PC card slot, or insert the USB memory stick into the USB port on the rear of the cardiograph. Press the Tab key ( Command Toolbar. ) or turn the Trim Knob to highlight the Config button on the
Press the space bar (on keyboard) or the Trim Knob to select the button. The Configuration screen appears. Press and hold down the Alt key ( ) on the keyboard.
Press the S key. The System screen appears. Press the Tab key or turn the Trim Knob until the Save Configuration File button under Configuration Management is highlighted. Press the space bar or the Trim Knob. The Save Configuration File window appears. The Select Destination Media drop-down list is highlighted. Press the up or down arrow key to select the output media.
10 Press the Tab key or turn the Trim Knob to select the Input file name: field. 11 Type in a name for the configuration settings file. 12 Press the Tab key or turn the Trim Knob until the OK button is highlighted.
2-46
13 Press the space bar or the Trim Knob to select the button.
A message appears that the configuration settings file is saved to the selected media. The Configuration screen automatically closes. The configuration settings file may be uploaded to additional cardiographs using the following procedure.
Insert the PC card or the USB memory stick that contains the configuration settings file into the PC card slot or the USB port on the rear of the cardiograph. From the R/T ECG screen, press the Tab key ( Config button on the Command Toolbar. ) or turn the Trim Knob to select the
Press the space bar (on keyboard) or the Trim Knob to select the button. The Configuration screen appears. Press and hold down the Alt key ( ) on the keyboard.
Press the S key. The System screen appears. Press the Tab key or turn the Trim Knob until the Load Configuration File button under Configuration Management is highlighted. Press the space bar or the Trim Knob. The Load Configuration File window appears. The Select Input Source pull-down list is highlighted. Press the up or down arrow key ( ) to select the input media. Press the space bar to select the input media. The configuration settings file(s) saved to the input media display under Profiles List. Press the Tab key or turn the Trim Knob to highlight a profile under Profiles List. Press the space bar or the Trim Knob to select the configuration settings file. the Trim Knob to select the button. The configuration settings file is loaded onto the cardiograph. The new settings are applied.
10 Press the Tab key or turn the Trim Knob to highlight the OK button. Press the space bar or
2-47
From the R/T ECG screen, press the Tab key ( Config button on the Command Toolbar.
Press the space bar (on keyboard) or the Trim Knob to select the button. The Configuration screen appears. Press and hold down the Alt key ( ) on the keyboard.
Press the S key. The System screen appears. Press the Tab key or turn the Trim Knob until the Reset to Default button under Configuration Management is highlighted. Press the space bar or the Trim Knob. The Configuration Management window appears with the message Are you sure you want to reset to factory settings? Press the space bar or the Trim Knob to select the Yes button.
Select the No button to not apply the factory default settings and to exit the window.
NOTE 7
The message System reset to factory default settings appears. The factory default configuration settings are loaded onto the cardiograph.
From the R/T ECG screen, press the Tab key ( Config button on the Command Toolbar.
Press the space bar (on keyboard) or the Trim Knob to select the button. The Configuration screen appears. Press and hold down the Alt key ( ) on the keyboard.
Press the S key. The System screen appears. Press the Tab key or turn the Trim Knob until the Print Configuration File button under Configuration Management is highlighted. Press the space bar or the Trim Knob to select the button. The Configuration Print Setup window appears. Press the Tab key or turn the Trim Knob until the Select Configuration Item drop-down list is highlighted. Press the space bar to open the drop-down list.
2-48
Press the up or down arrow key ( ) to select an individual item to print on the report, or specify Select All to print out all configured settings information. Press the space bar to select the printed report settings and to close the drop-down list. Press the Tab key or the Trim Knob to highlight the OK button. Press the space bar or the Trim Knob to select the button. The configuration settings report prints.
2-49
3
1
Introduction
A patient session is the period of time when waveform data is acquired and processed from a single patient. A patient session begins by entering accurate Patient ID information. Patient ID information is linked with all waveform data acquired during the patient session.
CAUTION
Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to generate ECG interpretation. For more information see the Philips 12-lead Algorithm Physicians Guide on the PageWriter Trim User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Description
Prepare the patient for the procedure. Prepare the electrode sites and attach the electrodes. Attach the lead wires.
Description
Press the On/Standby button. Enter Patient ID information for the patient.
Description
Check the signal quality to ensure a quality ECG.
3-1
Patient Preparation
Table 3-1
Description
Do any of the following: Print an Auto 12-lead ECG Print a Rhythm report PageWriter Trim II and III only: Print a 1-minute continuous report of one selected lead
Taking an Auto ECG on page 3-25. Rhythm ECG Acquisition on page 3-28. Disclose ECG Acquisition on page 3-30.
Description
Disconnect the patient and replace the PIM in its holder with the lead wires facing down.
The patient session ends when: The On/Standby button is pressed New Patient ID information is entered The patient is disconnected or leads are off for more than 10 seconds
Patient Preparation
For complete information on patient preparation, proper electrode placement, and other patient preparation issues, see Lesson 2 of the PageWriter Trim Cardiograph Interactive Training Program on CD.
TIP Good ECG technique is very important to achieve the best quality results.
3-2
Patient Preparation
Make sure the patient is lying down and is comfortable. The patients arms and hands must be relaxed. If the table is too narrow, place the patients hands under the buttocks to prevent muscle tension in the arms. Once the electrodes and lead wires are attached, instruct the patient to: Remain still and do not talk Breathe normally Try not to shiver Do not chew or clench teeth The more relaxed the patient, the less the ECG will be affected by noise.
Shave hair from electrode sites if necessary (excessive hair prevents a good connection). Wash thoroughly with soap and water. Dry the skin vigorously to increase capillary blood flow to the tissues and to remove the dead, dry skin cells and oil.
TIP
Do not use alcohol to clean the skin because it dries the skin. If there is no time to follow the
procedure above, rub the site with gauze to remove dead, dry skin and to increase capillary flow.
Do not use disposable electrodes on more than one patient. Using disposable electrodes on multiple patients may cause infectious materials to be transferred between patients. Always discard disposable electrodes after patient use.
WARNING
Always clean and disinfect reusable electrodes before patient use. See Reusable Electrode Cleaning on page 7-2 for information on cleaning and disinfecting reusable electrodes. Failure to properly clean and disinfect reusable electrodes may cause infectious materials to be transferred between patients.
3-3
Patient Preparation
Review the following lead wire labeling and electrode placement information to ensure a quality ECG.
Table 3-2 AAMI Lead AAMI and IEC Lead Labeling and Electrode Placement IEC Lead Electrode Position
On the right leg (inside calf, midway between knee and ankle) On the left leg (inside calf, midway between knee and ankle) On the right arm (on the inside)
Left midclavicular line in the 5th intercostal space Anterior axillary line at the same level as V4, midway between V4 and V6 Left midaxillary line at the same level as V4
3-4
Patient Preparation
Figure 3-1
V2/C2 V1/C1
RA/R
LA/L
RL/N
LL/F
3-5
Patient Preparation
Figure 3-2
V2/C2 V1/C1
RA/R
LA/L
RL/N
LL/F
Expose the arms and legs of the patient (to place the limb electrodes). Place the electrodes on flat, fleshy parts of the arms and legs. Place the electrodes on the inside of each arm (between the wrists and elbows). Place the electrodes on the inside of each calf (between the knee and the ankle). Place the limb electrodes equal distance from the heart. Position the electrodes at the same place on each limb.
3-6
6 7 8
For female patients, place the precordial electrodes on top of the breast (not underneath the breast tissue). If a limb site is not available (amputation, injury) place the electrodes closer to the torso. Attach the electrodes to the skin. A good test for firm electrode contact is to try to move it. If it moves easily, the electrode connection is too loose. Do not allow the electrodes to move in any way.
3-7
The RL or N electrode or lead wire are loose or disconnected RL or N is the only lead wire or electrode connected All twelve leads or electrodes are loose or disconnected Two limb leads (I, II, III) are loose or disconnected
LL or F electrode or lead wire are loose or disconnected RA or R electrode or lead wire are loose or disconnected LA or L electrode or lead wire are loose or disconnected One or more chest electrodes or lead wires are loose or disconnected V13 or C13 indicates that electrodes or lead wires V1 and V3, or C1and C3 are loose
A good connection Slight noise or interference in signal Moderate noise or interference in signal Extreme noise or interference Lead wires or electrodes are disconnected
3-8
RL
P? ID: NAME:
A Leads off indicator The leads off indicator displays the name of any loose or disconnected leads or electrodes.
Table 3-5 Leads Off Indicators Indicates...
The RL or N electrode or lead wire are loose or disconnected RL or N is the only lead wire or electrode connected All twelve leads or electrodes are loose or disconnected Two limb leads (I, II, III) are loose or disconnected
LL or F electrode or lead wire are loose or disconnected RA or R electrode or lead wire are loose or disconnected LA or L electrode or lead wire are loose or disconnected
3-9
Table 3-5
One or more chest electrodes or lead wires are loose or disconnected V13 or C13 indicates that electrodes or lead wires V1 and V3, or C1and C3 are loose
Good connection Moderate noise level, artifact, electrical interference, or a poor electrode connection 12-lead ECG report quality will be affected Inadequate patient preparation Electrical interference from another device Moderate patient movement, tense patient Improperly gelled electrode (dried gel) Inadequate patient preparation Significant electrical interference from another device Severe patient movement Very poorly gelled electrode (dried gel) Inoperative electrode, electrode that has fallen off the patient Defibrillation has been performed too recently to take ECG measurements Other cause that renders waveform data useless
Orange Waveform
Severe noise, artifact, electrical interference, or a very poor electrode connection 12-lead ECG report quality will be significantly affected
3-10
Using Filters
Using Filters
Filter settings may be configured on all models of the PageWriter Trim cardiograph. Filters can be used when all other troubleshooting methods to reduce signal quality problems are not successful. Before using filters: Check patient and skin preparation techniques. Ensure that the patient is comfortable, lying still, and breathing normally. Check that the electrodes are correctly placed on the patient and are adhering to the skin. Check if any surrounding devices are causing electrical interference. Switch any surrounding devices to battery power. Filters should be applied only after all other potential causes of interference do not resolve a signal quality problem. The filter settings are displayed on the cardiograph and are also printed on the bottom of the ECG report inside the Filter Box.
Figure 3-5 The Filter Box on the printed 12-lead ECG report
A Filter Box
Table 3-7 Filter Symbols Description
Filter symbol
F 60 ~
3-11
Using Filters
Table 3-7
Filter symbol
0.05 150
Artifact Filter
The Artifact filter removes skeletal muscle artifact. This noise source is the most difficult to eliminate because it contains the same frequencies as ECG signals. The Artifact filter eliminates skeletal muscle artifact, but also reduces all high frequency components of the ECG signal.
Figure 3-6 Artifact Filter symbol on the printed ECG report
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Using Filters
A Filter settings
Table 3-8 Filter symbols on the LCD Display Description
Filter symbol
F ~ 0.05 150
Artifact Filter AC Filter High Pass Frequency Filter Low Pass Filter Setting
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Using Filters
Turn the Trim Knob until the ~ symbol is highlighted. Press the Trim Knob. A new screen appears with the current AC filter setting (50Hz, 60Hz, 0) highlighted. Push the Trim Knob to change the setting.
Press the Stop button on the Control Panel to exit the screen without changing the AC filter setting.
Press the Trim Knob to select the setting. Turn the Trim Knob to highlight the arrow ( ).
Press the Trim Knob to save the setting and to exit the screen. The new setting is applied. Turn the Trim Knob until the filter setting to be changed is highlighted. Push the Trim Knob. Turn the Trim Knob to scroll through the available filter settings. Push the Trim Knob to select a setting. Turn the Trim Knob to change additional filter settings.
The Artifact filter (F) may be turned on or turned off. No symbol appears on the LCD display when the Artifact filter is turned off. When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically turned on.
3-14
Using Filters
Figure 3-10 RL
Filter settings on the Status Bar F W 60~ ID: 0.15 - 150 Hz P? NAME:
A Filter settings
Table 3-9 Filter symbols on the Status Bar Description
Filter symbol
Artifact Filter Baseline Wander Filter AC Filter High Pass Frequency Filter Low Pass Filter Setting
There are two sets of configured filters available on the PageWriter Trim II and III cardiographs: Main Settings and Rhythm Settings. These filters are applied to both the printed ECG report and to the real-time waveforms that display on the R/T ECG screen. These filter settings may only be changed in Configuration, see page 2-30 for more information. The table below describes these filter settings.
Table 3-10 Filter Settings Description
Filter Setting
Main Settings
These filter settings are applied to all Auto and Disclose Reports These filter settings may only be changed in Configuration These filter settings include: High and Low Pass Frequency, Artifact, and Baseline Wander The Artifact and Baseline Wander filters may be turned on or turned off for individual patient sessions; the High and Low Pass Frequency filters are turned on for all patient sessions These filter settings can be applied to the real-time waveform display on the R/T ECG screen
3-15
Using Filters
Table 3-10
Filter Setting
Rhythm Settings
These filter settings are used for all Rhythm reports These filter settings may only be changed in Configuration These filter settings include Artifact, and High and Low Pass Frequency The Artifact filter may be turned on or turned off for individual patient sessions These filter settings may be applied to the real-time waveform display on the R/T ECG screen
The AC filter may be configured to be turned on or turned off for all patient sessions. The AC frequency Hertz is also set in Configuration (see page 2-30).
Press the space bar or the Trim Knob. The Filter window appears.
Press the Esc key on keyboard to exit the Filter window without changing filter settings.
Press the Tab key or turn the Trim Knob to highlight the Filter On text under Report Filter. Press the space bar or the Trim Knob to select the setting. With the check box selected, the Artifact and Baseline Wander filters are enabled. Clear the check box to turn off the Artifact and Baseline Wander filters. Press the Enter key ( ) on keyboard to save the filter settings and to exit the window. The Artifact Filter (F) or Baseline Wander (W) symbol appear on the Status Bar, and the new filter settings are applied.
When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically turned on.
NOTE
3-16
The Display Filter settings do not affect printed ECGs. The Main Settings are applied to printed Auto ECGs, and the configured Rhythm Settings are applied to printed Rhythm reports.
To change the display filter settings: 1 FILTER 2 NOTE 3 4 5
Turn the Trim Knob to highlight Main Settings or Rhythm Settings under Display Filter. Push the Trim Knob to select the setting. Press the Enter key ( ) on keyboard to save the filter settings and to exit the window. The new filter settings appear on the Status Bar and are applied to the real-time waveforms on the R/T ECG screen.
The Rhythm Settings Low Pass Frequency filter setting will not appear on the R/T ECG screen. The Main Settings Low Pass Frequency setting will be applied. When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically turned on.
NOTE NOTE
Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to generate ECG interpretation. For more information see the Philips 12-lead Algorithm Physicians Guide on the PageWriter Trim User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Press the Patient ID button on the Control Panel. The Patient ID entry screen appears. The default age of 50 (years) is highlighted. Push the Trim Knob to change the patient age.
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3 4 5
Turn the Trim Knob to highlight an age. Push the Trim Knob to select the age. Turn the Trim Knob to highlight the age unit, if necessary. The following age units are available.
PageWriter Trim I Age Units Description
Y M W D H
6 7 8 9 NOTE
Years Months Weeks Days Hours Push the Trim Knob to select an age unit. Turn the Trim Knob to highlight a patient gender icon ( Push the Trim Knob to select the patient gender. Turn the Trim Knob to highlight the arrow ( ).
Push the Stop button on the Control Panel to exit the Patient ID screen without saving the settings.
female or
male).
10 Push the Trim Knob to save the Patient ID settings and to exit the screen.
Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to generate ECG interpretation. For more information see the Philips 12-lead Algorithm Physicians Guide on the PageWriter Trim User Documentation CD, or download the file from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
The amount and type of Patient ID information that appears on the Patient ID screen is configurable, see page 2-8 for more information. There are three main types of Patient ID information: patient information, clinical information, and order information. Patient ID information that is required to be complete before an Auto ECG can be transferred to a TraceMasterVue ECG Management System is also configurable, see page 2-9. Required Patient ID information appears in underlined type on the Patient ID screen.
3-18
Patient ID information is entered by: Keyboard Selecting a Pending Order Barcode reader (optional) Magnetic card reader (optional) SmartCard reader (optional)
Press the Patient ID button on the right side of the cardiograph. The Patient ID screen appears with the Patient Info. tab (top of screen) selected. The ID field is selected. Enter the Patient ID number.
Patient ID information that is required to be complete in order to transfer an ECG to a TraceMasterVue ECG Management System is indicated in underlined type.
) or turn the Trim Knob to select the next field on the screen. Enter
For Gender, press the Tab key or turn the Trim Knob to highlight the text. Press the space bar or the Trim Knob to select the patient gender. If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key, and then press the C key on the keyboard. Continue to enter information on the screen. When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
6 7
NOTE
ORDERS
3-19
Press the Patient ID button on the right side of the cardiograph. The Patient ID screen appears. Press the Tab key ( screen). ) or turn the Trim Knob to highlight the Orders button (top left of
Press the space bar or the Trim Knob to select the button. The Select Pending Order window appears.
The Orders button only appears on the Patient ID screen when there are Pending Orders loaded on the cardiograph.
NOTE 4 5
The available Pending Orders appear on the screen as a list. Press the up ( ( ) arrow key to highlight a Pending Order on the list.
) or down
The Select button (bottom of screen) is highlighted. Press the space bar or the Trim Knob to select the highlighted Pending Order. The Pending Order window closes and the Patient ID screen appears. The information from this Pending Order appears on the Patient ID screen.
A selected Pending Order may be configured to be deleted from the Pending Orders list, see page 2-28 for more information.
NOTE 6 7
Enter any missing Patient ID information with the keyboard. Press the Tab key or turn the Trim Knob move between the different fields. If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key, and then press the C key on the keyboard. When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
NOTE
Enter information into the Patient ID field that is specified as the searchable field.
Only one Patient ID field can be specified as the searchable field, see page 2-28.
Press the Page button (right side of cardiograph). The Select Pending Order window appears with the retrieved Pending Order(s).
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3 4
The available Pending Orders appear on the screen as a list. Press the up ( ( ) arrow key to highlight a Pending Order on the list.
) or down
The Select button (bottom of screen) is highlighted. Press the space bar or the Trim Knob to select the highlighted Pending Order. The Pending Order window closes and the Patient ID screen appears. The information from this Pending Order appears on the Patient ID screen. Enter any missing Patient ID information with the keyboard. Press the Tab key ( turn the Trim Knob scroll through the different fields. ) or
5 6
If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key, and then press the C key on the keyboard. When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
NOTE
Press the Patient ID button on the right side of the cardiograph. The Patient ID screen appears. The ID field is highlighted. Hold the barcode reader at a 45o angle over the barcode. The barcode automatically scans the information and it appears in the ID field. If the barcode does not automatically scan, press the button on the top of the scanner.
The barcode reader will only operate when held at a 45o angle.
NOTE 3 4 5 6
Hold the barcode reader at a 45o angle over the barcode. The barcode automatically scans. The information appears in the field. Enter any missing information with the keyboard. If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key and then press the C key on the keyboard.
PageWriter Trim Cardiograph Instructions for Use 3-21
When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
NOTE
Press the Patient ID button on the right side of the cardiograph. The Patient ID screen appears. Press the Tab key ( of screen). ) or turn the Trim Knob to highlight the MagCard button (top left
Press the space bar or the Trim Knob to select the button. The Magnetic Card Reader window appears. Insert the magnetic card all the way into the slot. Leave the card in the slot for five seconds before removing it. The information scanned from the magnetic card appears on the screen. The OK button (bottom of window) is highlighted. Press the space bar or the Trim Knob to select the OK button and to save the displayed Patient ID information. Press the Tab key ( ) or turn the Trim Knob to highlight the Cancel button if the Patient ID information did not scan correctly. Press the space bar or the Trim Knob to close the window. Repeat steps 2 through 5. Enter any missing information with the keyboard. If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key and then press the C key on the keyboard. When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
6 7
NOTE
3-22
Press the Patient ID button on the right side of the cardiograph. The Patient ID screen appears. Press the Tab key ( left of screen). ) or turn the Trim Knob to highlight the Smart Card button (top
Press the space bar or the Trim Knob to select the button. The Smart Card Reader window appears. Insert the SmartCard all the way into the slot. The scanned information appears on the screen in the ID: and Name: fields. The OK button (bottom of window) is highlighted. Press the space bar or the Trim Knob to select the OK button and to save the displayed Patient ID information. Press the Tab key or turn the Trim Knob to highlight the Cancel button if the Patient ID information did not scan correctly. Press the space bar or the Trim Knob to close the window. Repeat steps 2 through 5. Enter any missing information with the keyboard. If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab, press and hold down the Alt key and then press the C key on the keyboard. When all Patient ID information has been entered, press the Enter key ( ) on the keyboard to save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.
A message appears if the Patient ID screen is exited before completing the required Patient ID information.
6 7
NOTE
3-23
NOTE
The magnetic card reader or Pending Orders cannot be used to edit existing Patient ID information. These buttons will not appear on the top of the Patient ID screen when editing existing Patient ID information. To edit Patient ID information during the patient session: 1 2 3 4 5
Press the Patient ID button (right side of cardiograph). The message Is this a New Patient? appears. Press the Tab key ( Knob to highlight the No button. ) or turn the Trim
Press the space bar or the Trim Knob to select the button. The Patient ID screen appears. Edit the Patient ID information. Press the Enter key ( ) on the keyboard to save the edits. Press the Esc key on keyboard to exit the screen without saving the edits.
Press the Auto button twice. The ECG prints. Press the Auto button twice at any time to take another STAT ECG.
If interpretation is enabled on the cardiograph, and no Patient ID information is entered, a statement is included on the Auto ECG that interpretation used a default age (50 years) and gender (male).
Press the Auto button twice (right side of cardiograph). The Auto ECG appears on the Preview screen. The ECG prints if the cardiograph is configured to automatically print Auto ECGs. If the Auto ECG does not automatically print, check the quality of the ECG on the Preview screen. If the quality is good, press the Enter key ( ) to print the ECG. Press the Copy button to print out an additional copy of the Auto ECG. Press the Esc key on keyboard to exit the Preview screen without printing
3-24
the ECG. Press the up ( ) or down ( ) arrow key to view the ECG in different report formats. Any of the displayed report formats may be printed by pressing the Enter key ( ).
3
On the R/T ECG screen, press the Auto button twice at any time to take another STAT ECG.
If no Patient ID information is entered, a statement is included on the Auto ECG that interpretation used a default age (50 years) and gender (male). The default age for interpretation is configurable (see page 2-9). Patient ID information is required to transmit an Auto ECG from the Archive to a TraceMasterVue ECG Management System, see page 4-9 for more information.
NOTE
NOTE
Turn the Trim Knob to highlight the displayed ECG report format in the Format field. Push the Trim Knob. Turn the Trim Knob to highlight the 3x4 1R or 6x2 ECG format. Push the Trim Knob to select the ECG format.
The 6x2 ECG format is only available in Cabrera lead sequence.
NOTE 2 3 4 5
To change the Rhythm lead for the 3x4, 1R format, turn the Trim Knob to highlight the Rhythm lead selected in the Leads field. Push the Trim Knob. Turn the Trim Knob to highlight the Rhythm lead to be selected for the ECG. Push the Trim Knob to select the Rhythm lead. Press the Auto button on the Control Panel. The Patient ID entry screen appears. Follow the procedure to enter Patient ID information, see page 3-17. The Auto ECG progress bar appears ( ) on the LCD display under the Leads-off field. The Auto ECG prints.
3-25
Only the waveforms shown on the preview screen are an accurate representation of what is printed on the actual ECG. Interpretation, Patient ID, or other information may appear truncated or not appear at all on the ECG preview, but will appear on the printed ECG.
For information on ECG quality indicators, see Lesson 4 of the PageWriter Trim Interactive Training Program on CD.
TIP Reviewing Auto ECGs on the Preview screen before printing saves printer paper and ensures a quality ECG. To take an Auto ECG: 1 2
On the R/T ECG screen, press the Auto button (right side of cardiograph). The Auto ECG displays on the Preview screen and prints (if the cardiograph is configured to do so). Review the quality of the Auto ECG on the Preview screen. If the ECG quality is good, press the Enter key ( ) to print the ECG. If the ECG quality is poor, press the Esc key on keyboard to exit the Preview screen and not print the ECG. Press the Copy button (right side of cardiograph) to print out a copy of the Auto ECG.
Press the space bar or the Trim Knob to display the Report settings window. The Auto tab (top of screen) is selected and the current Auto ECG report settings are displayed on the screen. The Format: drop-down list is highlighted. Press the space bar or the Trim Knob to display the drop-down list of available Auto ECG formats.
The Pan-12 ECG format prints with Cabrera lead sequence and Time-Sequential acquisition. For more information, see page 5-24. The 12x1 ECG format prints with Simultaneous acquisition. For more information, see page 522.
NOTE NOTE
3-26
WARNING
Pace pulse tick marks do not appear on any PageWriter Trim II and III report that include simultaneous (not time-sequential) acquisition settings. For information on simultaneous acquisition, see page 5-13.
4 5 6 NOTE
) or down (
Press the space bar or the Trim Knob to select an Auto ECG format. Continue to select Auto ECG settings by following the same procedure.
The Size (VLeads) selection sets the precordial leads to full or half the scale of the limb and augmented leads, see page 5-11.
To save the new Auto ECG settings, press the Enter key ( ) on the keyboard. To exit the Auto ECG settings screen without saving the new settings, press the Esc key on the keyboard.
Using the Metronome with Auto ECG PageWriter Trim II and III only
The cardiograph can be configured to automatically display the Metronome each time the Auto button is pressed. For more information, see page 2-42. A typical use of the Metronome is during a Masters Two-Step stress test: the patient exercises at a rate indicated by the metronome chime for a specified period of time, and then the cardiograph records an Auto ECG after the exercise session is complete. The Metronome feature must be enabled in Configuration before it can be used with the Auto ECG feature. The procedure below is a recommend example of how to use the Metronome.
To use the Metronome feature: 1 2 3
Prepare the patient for the procedure. Press the Patient ID button (right side of cardiograph) and enter the Patient ID information (see page 3-18). Press the Auto button (right side of cardiograph). The Metronome window appears. The default Metronome settings appear on the screen. The displayed settings may be changed. The Number of Steps field is highlighted. Type in the number of steps (16-70) that the patient will complete during the test. Press the Tab key ( ) or turn the Trim Knob to select a setting under Stress Test Protocol. Highlight the Master Single (90 seconds) or Master Double (180 seconds) test. Press the space bar or the Trim Knob to select a test setting. Press the Tab key or turn the Trim Knob to highlight the Start button.
4 5 6 7
3-27
When the patient is ready, press the space bar or the Trim Knob to start the Metronome. The Metronome beeps and the icon moves to indicate each time that the patient should take a step. The Metronome window displays the number of steps completed. A long beep indicates that the metronome cycle is complete. The message Timed ECG Test Completed appears at the top of the Metronome window. To adjust the volume of the Metronome, press the Tab key or turn the Trim Knob to highlight the << or >> buttons. Press the space bar or the Trim Knob to lower or to raise the volume. securely attached.
10 Connect the electrodes on the patient to the lead wires. Ensure that the lead wires are 11 Press the Tab key or turn the Trim Knob to highlight Cancel button. 12 Press the space bar or the Trim Knob to close the Metronome window.
The R/T ECG screen appears. The Auto ECG is acquired and appears on the Preview screen.
13 Review the quality of the Auto ECG on the Preview screen. If the ECG quality is good,
press the Enter key ( ) to print the ECG. If the ECG quality is poor, press the Esc key on the keyboard to exit the Preview screen and not print the ECG. Press the Copy button to print out a copy of the last recorded ECG.
Turn the Trim Knob to highlight the displayed report format above Format (on the LCD display). Push the Trim Knob to display the available report formats. Turn the Trim Knob to highlight 3 (three lead) or 6 (six lead) Rhythm report. Push the Trim Knob to select the Rhythm report format. Turn the Trim Knob to highlight the displayed Rhythm leads above Leads.
3-28
Push the Trim Knob to display the available preconfigured Rhythm lead groups.
Preconfigured Rhythm Lead Selections Lead selections II-aVF-V2 (C2) I-II-III aVR-L-F (aVR, aVL, aVF)
Table 3-12
Rhythm report
3 lead report
6 lead report
7 8
Turn the Trim Knob to highlight a Rhythm lead group. Push the Trim Knob to select the Rhythm lead group. Press the Rhythm button on the Control Panel. The Patient ID entry screen appears. Enter the Patient ID information for the patient (see page 3-18). The Rhythm report progress bar appears ( ) on the LCD display under the Leadsoff field. The Rhythm report prints. Press the Stop button on the Control Panel to stop printing the Rhythm report. Press the Page button on the Control Panel to advance the paper to the top of the next page.
3 4
Press the space bar or the Trim Knob to display the Report settings window. Three tabs appear at the top of the screen. To select the Rhythm tab, press and hold down the Alt key on the keyboard. Press the R key. The Rhythm screen appears. Press the Tab key or turn the Trim Knob to highlight the Lead Groups button to select a preconfigured group of three or six leads. Press the space bar or the Trim Knob to display the lead group list.
3-29
6 7 8 9
) or down (
Press the space bar or the Trim Knob to select a lead group. The selected leads appear on the screen under the Lead Groups button. To select leads individually, press the up ( ) or down ( Knob until the I lead on the lead list is highlighted. ) arrow key or turn the Trim
Press the space bar or the Trim Knob to select the individual lead. The check box for that lead is selected.
10 Continue to select leads individually, or press the Tab key or turn the Trim Knob to highlight the Select All check box. Press the space bar or the Trim Knob to select all
twelve leads.
To set the size and speed of waveforms: 1 2 3 4 5 NOTE 6
On the Rhythm settings screen, press the Tab key or turn the Trim Knob to highlight the drop-down list under Speed. Press the space bar or the Trim Knob to display the drop-down list. Press the up ( setting. ) or down ( ) arrow key or turn the Trim Knob to highlight a speed
Press the space bar or the Trim Knob to select the speed setting. Follow the same procedure to set the Size (mm/mV) and Size (V Leads) settings.
Size (V leads) sets the precordial leads to full or half the scale of the limb and augmented leads.
Press the Enter key ( ) on keyboard to save the Rhythm lead settings and to exit the screen. Press the Esc key to exit the screen without saving the settings. Press the Patient ID button (right side of cardiograph). Enter the Patient ID information for the patient. Press the Rhythm button (right side of cardiograph). The Printing Rhythm Report progress window appears. The Rhythm report prints. Press the Stop button (right side of cardiograph) to stop printing the Rhythm report. Press the Page button (right side of cardiograph) to advance the paper to the top of the next page.
3-30
Press the space bar or the Trim Knob to select the button. The Report settings window appears. Three tabs appear at the top of the screen. To select the Disclose tab, press and hold down the Alt key on the keyboard and then press the D key. The Disclose screen appears. The Lead drop-down list is highlighted. Press the space bar or the Trim Knob to display the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight a lead.
Press the space bar or the Trim Knob to select the lead for the Disclose report. Press the Tab key ( Command Toolbar. ) or turn the Trim Knob to highlight the Disclose button on the
1 2 3
Press the space bar or the Trim Knob to select the button. The Printing Disclose Report progress window appears. The Disclose report prints.
RL
P?
ID: NAME:
3-31
Pacemaker pulses that are detected by the cardiograph are marked on the Auto ECG with small vertical tick marks. These marks enable the overreader to identify false pacemaker pulse detections, or if true pulses are not being detected.
Table 3-13 Setting Not known if paced Pacing Detection Settings Description Symbol on Status Bar P?
This is the default setting and normally is used for both paced and non-paced patients Pacemaker pulse detection is on and is at normal sensitivity Occasional false pacemaker pulse detections may occur in ECGs with excessive noise False detections may result in an incorrect interpretive statement appearing on the ECG Small amplitude pacemaker pulses may not be detected using this setting
Non-paced
Pacemaker pulse detection is off Use this setting if there are false pacemaker pulse detections from noise, or if incorrect interpretive statements or inappropriate paced ECG complexes appear on the ECG Pacemaker pulse detection is on and is set at a higher sensitivity Use this setting if small amplitude pacemaker pulses are not being detected at the default (Not Known if Paced) setting False pacemaker pulse detections may occur if the ECG is noisy
Paced
3-32
Paced (magnet)
Use this setting if the ECG is acquired with an active pacemaker magnet or programmer in place Pacemaker pulse detection is on and is at a higher sensitivity Magnets or programmers often put the pacemaker into a fixed-rate, non-sensing mode The statement ECG ACQUIRED WITH MAGNET IN PLACE is printed on the 12-lead ECG notifying the overreader that a magnet or programmer was used and would explain the fixed rate behavior of the pacer
Press the space bar or the Trim Knob to select the button. The Report settings window appears. Three tabs appear on the top of the screen. The Auto tab is selected. Press the Tab key ( ) or turn the Trim Knob until the Not Known if Paced (recommended setting) is highlighted under Pacer Detect. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight a setting.
Press the space bar or the Trim Knob to select the setting. Press the Enter key ( ) to save the Pacing Detection Setting and to exit the screen. Press the Esc key to exit the screen and without saving the new setting. The new pacing detection setting is applied and appears on the Status Bar. After the patient session ends, the default pacing detection setting (set in Configuration) is restored and will appear on the Status Bar.
3-33
Press the space bar or the Trim Knob to select the button. The Help screen appears. Press the left ( ) or right ( ) arrow keys or turn the Trim Knob to go forward or backward through the screens. Press the Esc key on keyboard to exit the Help.
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4
1PageWriter Trim II and III Orders and Archive
About Orders
The Order screen is used to pre-load Patient ID information onto the cardiograph. Orders are loaded onto the cardiograph using a PC card or a USB memory stick, or may be entered directly on the cardiograph using the keyboard. Once the Patient ID information is loaded onto the cardiograph, it becomes a Pending Order that may be selected on the Patient ID screen during a patient session. For more information, see page 3-19.
ORDER
ECG Management System by modem or by an Ethernet or wireless LAN network connection. Auto ECGs may also be transferred to any external ECG management system that accepts XML (Extensible Markup Language) files. For more information on the PageWriter Trim XML Schema, see page 1-3. The Archive can also be used to search a configured TraceMasterVue Remote Site for stored 12-lead ECGs to view and print on the PageWriter Trim cardiograph. For information on configuring the cardiograph to work with Remote Sites, see page 2-33.
4-1
Press the Tab key ( ) or turn the Trim Knob until the Order button on the Command Toolbar is highlighted. Press the space bar or the Trim Knob to select the button. The Order screen appears.
The Order Screen
Figure 4-1
A B C
D F
The number of tabs that appear on the screen depends on the amount and type of Patient ID information configured for the cardiograph. For information on configuring Patient ID information, see page 2-9. To select a tab, press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info. tab, press and hold down the Alt key and then press the C key.
Patient ID columns
These column headers list the Patient ID fields that are contained under each tab.
4-2
This check box indicates that all required Patient ID information fields for the Order are complete. Required Patient ID information is set in Configuration. For more information, see page 2-9.
Displays the number of loaded (pending) Orders on the cardiograph along with the number of Orders that may be loaded in the available space remaining on the cardiograph. Lists all the pending Orders loaded onto the cardiograph. These Orders have not yet been selected on the Patient ID screen during a patient session.
Order List
Buttons that are used to navigate on the Order screen or are used to perform functions on the screen (see Table 4-2 below).
Table 4-2 Button Select Select All Add Order Edit Order
Select an Order on the Order List Select all Orders displayed on the Order List Manually add an Order to the Order List using the cardiograph keyboard Edit an Order on the Order List Delete an Order from the Order List Load Orders onto the cardiograph using a PC card or a USB memory stick
4-3
Press the space bar or the Trim Knob to select the button. The Please input data Patient ID window appears. The ID: field at the top of the screen is selected. The cursor appears in the field. Type in the Patient ID information. Press the Tab key or turn the Trim Knob to select the next field on the screen. Type in the information. Repeat the procedure to complete all the Patient ID fields on the screen. If additional tabs appear at the top of the screen, press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info. tab, press and hold down the Alt key and then press the C key. Enter the information on the additional tabs as required. Press the Tab key or turn the Trim Knob to move to the next field. Repeat to complete all the fields on the screens. To open a drop-down list, press the space bar or the Trim Knob. Press the up ( ) or down ( ) arrow key to highlight an item on the drop-down list, then press the space bar or Trim Knob to select it. Press the Enter key ( ) to save the Order and to exit the screen. Press the Esc key to exit the screen without saving the Order. The Order screen appears. The new Order appears on the Order List and may be selected during a patient session (see page 3-19).
3 4 5 6
Deleting an Order
Orders may be deleted at any time from the Order screen. One Order may be deleted, or multiple Orders may be deleted at the same time.
NOTE Deleted Orders may not be retrieved. To delete an order: 1
Press the up ( ) or down ( ) arrow key to scroll through the Order list and to highlight an Order to be deleted. To select multiple Orders, press and hold down the Shift key ( ) and then press the up and down arrow key. Once all Orders to be deleted have been selected on the list, press the Tab key ( ) or turn the Trim Knob to highlight the Select button (bottom of screen). Press the space bar or the Trim Knob. The Order(s) selected for deletion appear in dark gray on the Orders List.
4-4
Editing an Order
Continue to select Orders to be deleted, or to delete all Orders from the list, turn the Trim Knob to highlight the Select All button. Push the Trim Knob to select the Select All button. Press the Tab key or turn the Trim Knob to highlight the Delete Order button. Press the space bar or the Trim Knob to select the button. A message appears to confirm the deletion of the selected Orders. The OK button is highlighted. Press the space bar or the Trim Knob to confirm the deletion of the selected Order(s). Select the Cancel button to exit the window and not delete the selected Orders. To remove Orders from the list to be deleted, press the up or down arrow key to highlight an Order. Press the Tab key or turn the Trim Knob to highlight the Unselect button. Press the space bar or the Trim Knob to select the button. Or, select the Unselect All button to deselect all orders.
Editing an Order
An Order may be edited at any time from the Order screen.
NOTE Only one Order may be edited at a time. To edit an order: 1
The Order to be edited must be highlighted in dark blue (or in dark gray) on the Order List. To highlight a different Order to be edited, press the up ( ) or down ( ) arrow key or turn the Trim Knob to scroll through the Order List. Once the Order to be edited is highlighted in dark blue, press the Tab key ( the Trim Knob to highlight the Edit Order button. Press the space bar or the Trim Knob to select the button. The Patient ID information for the Order appears on the screen. Edit the Patient ID information. If additional tabs appear at the top of the screen, press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info. tab, press and hold down the Alt key and then press the C key. Press the Enter key ( ) to save the edits to the Order and to exit the screen. Press the Esc key to exit the screen without saving the edits. The edited Order appears on the Orders list. ) or turn
2 3 4
Loading Orders
Orders may be loaded onto the cardiograph using a PC card or a USB memory stick. For information on the PC card and USB memory stick, see page 1-21.
To load orders: 1 2
) or turn the Trim Knob to highlight the Load New Orders button.
Press the space bar or the Trim Knob to select the button.
4-5
3 4 5 6 7
The Load New Orders window appears. Press the Tab key or turn the Trim Knob to highlight the Select Input Source drop-down list. Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key to highlight an input source.
Press the space bar or Trim Knob to select the input source. Press the Tab key or turn the Trim Knob to select the dir\...\Filename.ext field. The cursor appears in the field. Type in the name of the Orders file contained on the PC card or USB memory stick. Press the Tab key or turn the Trim Knob to highlight the OK button. Press the space bar or the Trim Knob to select the button. The Order(s) appear on the Orders List.
4-6
There are two categories of Auto ECGs saved to the Main Archive: ID Complete and ID
Incomplete. Table 4-3 ID Complete and ID Incomplete Auto ECGs ID Incomplete
ID Complete
All required Patient ID fields are complete The Auto ECG can be transferred by modem, LAN, or wireless LAN to a or TraceMasterVue ECG Management System, or to a PC card or USB memory stick
Required Patient ID information is not complete The Auto ECG cannot be transferred by modem, LAN, or wireless LAN to a or TraceMasterVue ECG Management System, or to a PC card or USB memory stick
Turn the Trim Knob until the Archive button on the Command Toolbar is highlighted. Push the Trim Knob to select the button. The Archive screen appears.
The Archive Screen
Figure 4-2
A B
NOTE
4-7
The number of tabs that appear on the screen are dependent upon the amount and type of Patient ID information configured for the cardiograph. For information on configuring Patient ID information, see page 2-9. To select a tab, press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info. tab, press and hold down the Alt key and then press the C key.
B C
These column headers list the Patient ID fields that are contained under each tab. Displays the number of Auto ECGs in the Archive, along with the number of remaining Auto ECGs that may be saved in the available space left in the Archive. This drop-down list displays all of the available Archives. The Main Archive is the internal cardiograph Archive.
Selected Archive
E F
Displays all of the reports saved to the Selected Archive. Buttons that are used to navigate on the Archive screen or are used to perform functions on the Archive screen (see Table 4-5 below).
Select a report Select all displayed reports Edit the Patient ID Information on the selected report Delete the selected report View the selected Auto ECG on the Preview screen and to print the Auto ECG
Print/Preview
4-8
Transfer the selected report to a TraceMasterVue ECG Management System, or to a PC card or USB memory stick Fax the selected report Print out a list of all reports in the selected Archive Enter LEAP login name and password to access a configured wireless LAN network
Do not connect the modem card to a phone line when the cardiograph is connected to a patient.
4-9
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom left of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight Main
Archive-ID Complete.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs that can be transferred are displayed on the screen. Press the up or down arrow key to scroll through the ECG list. To select multiple ECGs, press and hold down the Shift key ( ) and then press the up and down arrow key. Once all ECGs to be transferred have been highlighted on the list, press the Tab key or turn the Trim Knob to highlight the Select button (bottom of screen). Press the space bar or the Trim Knob to select the button. The ECG(s) selected to be transferred appear in dark gray. Continue to select ECGs to be transferred, or to transfer all ECGs on the list, press the Tab key or turn the Trim Knob to highlight the Select All button. Press the space bar or the Trim Knob to select the button. Press the Tab key or turn the Trim Knob to highlight the Transfer button. Press the space bar or the Trim Knob to select the button. The Transfer Selected ECGs window appears. Press the Tab key or turn the Trim Knob to highlight the drop-down list under Select
Transfer Destination.
8 9
10 Press the space bar or the Trim Knob to display the drop-down list. NOTE If selecting PC Card or USB Memory Stick, ensure that the media is fully inserted into the PC card slot or the USB port on the rear of the cardiograph. For more information, see page 1-21. 11 Press the up or down arrow key or turn the Trim Knob to highlight a transfer destination. 12 Press the space bar or the Trim Knob to select the transfer destination. 13 Press the Tab key or turn the Trim Knob to highlight the Delete Selected ECGs text. Selecting this option deletes the Auto ECG from the Main Archive and Main Archive-ID Complete archive after it is successfully transferred. Press the space bar or the Trim Knob
The Transfer Selected ECGs window appears and the Auto ECG(s) are transferred.
4-10
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom left of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight an Archive.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. The Auto ECG selected to be viewed or printed appears highlighted in dark blue (or in dark gray) on the Report List. To select a different Auto ECG to be printed, press the up or down arrow key to highlight an ECG. To select multiple ECGs, press and hold down the Shift key ( ) and then press the up and down arrow key. Once the Auto ECG(s) to be viewed and printed is highlighted, press the Tab key or turn the Trim Knob to highlight the Select button. Or, press the Tab key or turn the Trim Knob to highlight the Select All button to view and print all Auto ECGs in the Archive. Press the space bar or the Trim Knob to select the button. The Auto ECG(s) to be printed are selected and appear on the Report List in light gray. To deselect an Auto ECG to be viewed and printed, press the up or down arrow key to highlight the ECG. To deselect multiple ECGs, press and hold down the Shift key and then press the up and down arrow key. Press the Tab key or turn the Trim Knob to highlight the Unselect button. Press the space bar or the Trim Knob to select the button. The Auto ECG is deselected and appears highlighted in dark blue (or in dark gray). Once all Auto ECGs have been selected to be viewed and printed, press the Tab key or turn the Trim Knob to highlight the Print/Preview button. Press the space bar or the Trim Knob to select the button. The Print Selected ECGs progress bar window appears. If the cardiograph is configured to automatically print, the ECG prints out. If the cardiograph is not configured to automatically print, the Auto ECG appears on the Preview screen. Press the up ( ) or down ( ) arrow key to change the report format of the displayed ECG. Press the Enter key ( ) to print out the ECG. Press the Esc key to exit the Preview screen and not print the ECG. If multiple Auto ECGs are have been selected, the next selected Auto ECG appears on the Preview screen.
For information on automatic print features, see page 2-23.
8 9
NOTE
4-11
NOTE
No guarantee is made as to the suitability of the faxed 12-lead ECG for any particular purpose, due to the variability inherent in fax technology. Do not connect the modem card to a phone line when the cardiograph is connected to a patient.
WARNING
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom left of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight an Archive.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. The Auto ECG selected to be faxed appears highlighted in dark blue (or in dark gray) on the Report List. To select a different Auto ECG to be faxed, press the up or down arrow key to highlight an ECG. To select multiple ECGs, press and hold down the Shift key ( ) and then press the up and down arrow key. Once the Auto ECG(s) to be faxed is highlighted, press the Tab key or turn the Trim Knob to highlight the Select button. Or, press the Tab key or turn the Trim Knob to highlight the Select All button to fax all Auto ECGs in the Archive. A selected Auto ECG appears highlighted in light gray. To deselect an Auto ECG to be faxed, press the up or down arrow key to highlight the ECG. To deselect multiple ECGs, press and hold down the Shift key and then press the up and down arrow key. Press the Tab key or turn the Trim Knob to highlight the Unselect button. Press the space bar or the Trim Knob to select the button. The Auto ECG is deselected and appears highlighted in dark blue (or in dark gray). Once all Auto ECGs have been selected to be faxed, press the Tab key or turn the Trim Knob to highlight the Fax button. The Fax Selected ECGs window appears. Press the Tab key or turn the Trim Knob to highlight the drop-down list under Select Fax
Destination.
8 9
10 Press the space bar or the Trim Knob to display the drop-down list. 11 Press the up or down arrow key or turn the Trim Knob to highlight the desired configured
fax destination.
NOTE For information on configuring a Remote Site fax destination, see page 2-34. 12 Press the space bar or push the Trim Knob to select the highlighted fax destination. 13 Press the Tab key or turn the Trim Knob to highlight the OK button. 14 Press the space bar or the Trim Knob to fax the selected Auto ECG(s).
The Fax Selected ECGs window appears and the Auto ECG(s) are faxed to the Remote Site.
4-12 PageWriter Trim Cardiograph Instructions for Use
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight an Archive.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. The Auto ECG selected to be edited appears highlighted in dark blue (or in dark gray) on the Report List. To select a different Auto ECG to be edited, press the up or down arrow key to highlight an ECG. Press the Tab key or turn the Trim Knob to highlight the Edit button. Press the space bar or the Trim Knob to select the button. The Get Selected ECGs progress bar window appears, and then the Patient ID screen appears for the selected Auto ECG. The ID field is selected. Edit the Patient ID information as required. Press the Tab key or turn the Trim Knob to move between the different Patient ID fields. If additional tabs appear at the top of the screen, press and hold down the Alt key on the keyboard. Press the letter key in parenthesis on the tab. For example, to select the Clinical Info. tab, press and hold down the Alt key and then press the C key. ) to save the edited Patient ID information and to exit the screen. Press the Esc key to exit the screen without saving the edits to the Patient ID information.
6 7
8 9
11 If patient age (date of birth), gender, or clinical information is edited, the message Patient Data Changes will cause ECG to be reinterpreted appears. Press the space bar or the Trim Knob to select the OK button. The new Patient ID information is saved with the
Auto ECG, and the interpretive, reason, and severity statements (if configured) may change.
4-13
The PageWriter Trim cardiograph only supports the importing of XML files from the PageWriter Trim or PageWriterTouch cardiographs. Do not import XML files from other devices.
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight an Archive.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. Press the Tab key or turn the Trim Knob to highlight the Archive Listing button (bottom of screen). Press the space bar or the Trim Knob to select the button. The message Printing Archive
Report appears and the report prints.
4-14
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight the
Remote Site Archive.
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. Press the Tab key or turn the Trim Knob to highlight the Get ECGs (Query) button (bottom of screen). Press the space bar or the Trim Knob to select the button. The Remote Sites Query window appears. Press the Tab key or turn the Trim Knob to highlight the Selected Remote Site dropdown list. Press the space bar or the Trim Knob to display the drop-down list. Press the up or down arrow key or turn the Trim Knob to highlight a configured Remote Site.
10 Press the space bar or the Trim Knob to select the Remote Site. 11 Press the Tab key or turn the Trim Knob to select the OK button. 12 Press the space bar or the Trim Knob to select the button. The Search screen appears. 13 Press the Tab key or turn the Trim Knob to highlight the fields under Query (Wildcard = %) at the bottom of the screen. Type in the search information using as many fields as necessary. The wildcard character (%) may be used. NOTE NOTE If only the wildcard character is entered into a search field, all 12-lead ECGs saved to the Remote Site will be retrieved. Up to 100 ECGs may display in the Results window. If no information is entered into a search field, that field will not be used to search the Remote Site. 14 Press the Tab key or turn the Trim Knob to highlight the Search button. 15 Press the space bar or the Trim Knob to select the button. The Remote Site Search
progress bar window appears. After the search is complete, the ECGs that match the entered search information appear on the screen under Search Results.
16 To scroll through the list, press the up or down arrow key.
4-15
17 To select an Auto ECG to be saved to the cardiograph, press the Tab key or turn the Trim Knob and highlight the Select button. To select all of the Auto ECGs on the list, highlight the Select All button. 18 Press the space bar or the Trim Knob to select the Auto ECG(s). 19 Press the Tab key or turn the Trim Knob to highlight the Get Selected ECG(s) button. 20 Press the space bar or the Trim Knob to select the button and to save the selected Auto
Press the Tab key ( ) or turn the Trim Knob to highlight the drop-down list under Selected Archive (bottom of screen). Press the space bar or the Trim Knob to open the drop-down list. Press the up ( Archive. ) or down ( ) arrow key or turn the Trim Knob to highlight the
Press the space bar or the Trim Knob to select the Archive. The Auto ECGs contained in the selected Archive appear on the screen. The selected Auto ECG appears highlighted (in dark blue or in dark gray) on the Report List. To select a different Auto ECG to be deleted, press the up or down arrow key. To select multiple ECGs, press and hold down the Shift key ( ) and then press the up and down arrow key. To delete all of the Auto ECGs in the Archive, turn the Trim Knob to highlight the Select All button. Press the space bar or the Trim Knob to select the button. When the ECG to be deleted is highlighted, press the Tab key or turn Trim Knob to highlight the Delete button. Press the space bar or the Trim Knob to select the button. The Delete Selected ECGs window appears. The OK button is highlighted.
7 8
4-16
Press the space bar or the Trim Knob to select the button and to delete the selected Auto ECGs. To not delete the Auto ECGs, select the Cancel button. The Delete Selected ECGs progress bar window appears and the selected Auto ECGs are deleted from the Archive.
4-17
5
Reading the Printed ECG Report
The following chapter describes the printed report formats available on the PageWriter Trim I, II and III cardiographs. Figure 3-1 describes the 3x4 1R report format that is available on all cardiograph models. For information on additional report formats, see page 5-18.
Figure 5-1 A 12-Lead 3x4, 1R Report (page one)
D C B
E F G H I
J K
P A B C D E F G H I
N J K L M N O P Q
Interpretive, Reason, and Severity Statements (see page 5-2) Basic Measurements (see page 5-4) Patient ID Clinical Information (see page 5-5) Patient ID Information (see page 5-6) Institution Information (see page 5-7) Configurable Clinical Information (see page 5-8) ECG Order Information (see page 5-9) Physician Information (see page 5-10) Report Information (see page 5-10)
Calibration Information (see page 5-11) Time Separator (see page 5-13) Pacing Detection Setting (see page 5-13) Algorithm Version (see page 5-16) Speed and Sensitivity Settings (see page 5-16) Patient Name (see page 5-7) Patient ID Number (see page 5-7) Device Identification Number (page 5-17)
5-1
Additional Patient ID Clinical Information may appear on the top of a second page of the ECG report if more than two clinical fields (Rx, Dx, Sx, Hx) are entered with the Patient ID information. Additional Configurable Clinical Information may also appear on the top of a second page of the ECG report if more than two fields are entered.
Figure 5-2 A 12-Lead 3x4, 1R Report (page two)
R S
R Additional Patient ID Clinical Information (see page 5-5) S Additional Configurable Clinical Information (see page 5-8)
Severity Statement
Interpretive statements may include a reason statement that summarizes the criteria that generated the interpretive statement.
5-2 PageWriter Trim Cardiograph Instructions for Use
NOTE
The interpretive statements may include quality statements that describe a signal quality problem that occurred during recording, such as ARTIFACT IN LEAD(S) I, III, aVL.
For a complete listing (in alphabetical order and by diagnostic category) of all of the criteria included in the Philips 12-lead Algorithm, see Appendices B and C of the Philips 12-lead Algorithm Physicians Guide on the User Documentation CD, or download the file from the Philips InCenter site (incenter.medical.philips.com). For information on using the Philips InCenter site, see page 1-4.
Severity Statement
Each interpretive statement included on the ECG report has an associated severity. Severities that are more abnormal override lesser severities. The severities of all selected interpretive statements are combined to determine the overall severity of the ECG. This severity code is printed on the front page of the ECG report.
Table 5-1 Severity Overall ECG Severity with Code Code
No Severity Normal ECG Otherwise Normal ECG Borderline ECG Abnormal ECG Defective ECG
NS NO ON BO AB DE
5-3
Basic Measurements
Basic Measurements
These measurements provide standard interval and duration measurements in milliseconds, and limb lead axis measurements in degrees. These are the values measured from the representative beat pattern in the ECG. This feature is only available on the PageWriter Trim II and III.
Figure 5-4 Basic Measurements on the ECG Report
Heart rate PR interval QRS duration QT interval QT interval corrected for rate Frontal P axis Frontal QRS axis Frontal T axis
beats per minute milliseconds milliseconds milliseconds milliseconds degrees degrees degrees
5-4
If more than two Patient ID Clinical Information fields are entered, the third and subsequent fields appear at the top of a second page of the report.
Figure 5-6 Patient ID Clinical Information on the ECG Report (page two)
5-5
Patient ID Information
Patient ID Information
This section contains patient identification information. This block of information is configurable (see page 2-8). The example below is for informational purposes only.
Figure 5-7 Patient ID Information on the ECG Report
Patient identification number Date and time of ECG acquisition Cannot be edited
Doe, John T. Born 1936 Male 247 lbs, 70 in. BP: 133/90
Patient name Patient date of birth (may be configured to display patient age) Patient gender Patient weight and height Patient blood pressure (mm/Hg)
5-6
Institution Information
Institution Information
This block of identification information is optional and is fully configurable (see page 2-42). The example below is for informational purposes only. This feature is only available on the PageWriter Trim II and III.
Figure 5-9 Institution Information on the ECG Report
5-7
Room number of patient or room number where ECG was acquired Operator identification Name and ID number of facility or other unit within an institution
Figure 5-11
5-8
Institution-defined order number, part of order management system Institution-defined encounter number, part of order management system The reason for acquiring the ECG, may be part of an order management system
5-9
Physician Information
Physician Information
This information block is configurable (see page 2-14) and contains physician identification information, including the name of the ordering physician and UPIN (Universal Physician Identification Number). This feature is only available on the PageWriter Trim II and III.
Figure 5-13 Physician Information on the ECG report
Report Information
Information about the status of the ECG report is included in this section. The statement indicating that the ECG report has not been overread by a physician is configurable (see page 2-3). This feature is only available on the PageWriter Trim II and III.
Figure 5-14 Report Information on the ECG Report
Indicates that the ECG report has not been overread by a qualified physician The ECG report is a printed copy of an original The ECG report is designated as STAT
Calibration Information
The limb leads or precordial leads were recorded at a gain other than the standard 10mm/mV See "Calibration Information" on page 5-11
Calibration Information
The calibration pulse is the rectangular waveform shown in each line of ECG trace. It shows the hypothetical deflection of the trace in response to a 1 mV calibration pulse applied to the acquisition circuitry.
Figure 5-15 Calibration Pulse on the ECG Report
Calibration Pulse
The shape of the calibration pulse reflects the scaling of the trace. If the calibration pulse is square the same scale. If the calibration pulse is stepped of the limb leads.
Table 5-5 Calibration Pulse Shapes Limb (mm/mV) Precordial (mm/mV)
the precordial leads and limb leads were recorded at the precordial leads were recorded at half the scale
2.5
10
10
5-11
Calibration Information
Table 5-5
10
20
20
20
10
NOTE
For ECG recordings where the precordial leads or limb leads were recorded at a gain other than 10mm/mV, the statement Non-standard lead gains appears in the Report Information section on the printed report. Figure 5-16 Calibration information on the ECG report
5-12
Time Separator
Time Separator
The time separator marks indicate whether the ECG data is displayed simultaneously or time-sequentially. These settings are configured as part of a report or copy profile (see page 217). The data for each lead is always acquired simultaneously.
Figure 5-17 Simultaneous time separator on ECG report
The double line indicates that the ECG data for each lead is displayed simultaneously. The starting point of each lead is the same time even though they may appear to start at different times on the printed report.
Figure 5-18 Time sequential separator on ECG report
The single line indicates that the ECG data for each lead is displayed over a continuous period of time. For example, on a 3x4 grid all signals start at 0 in the first column, 2.5 seconds in the second column, 5.0 seconds in the third column, and 7.5 seconds in the fourth column.
5-13
WARNING
Pace pulse tick marks do not appear on any PageWriter Trim II and III report that include simultaneous (not time-sequential) acquisition settings. For information on simultaneous acquisition, see page 5-13. For information on report settings, see page 326.
Figure 5-19
The table below describes the available Pacing Detection Settings with the pacing detection code that appears on the printed ECG report.
Table 5-6 Setting Pacing Detection Settings Description ECG Report Code
This is the default setting and normally is used for both paced and non-paced patients. Pacemaker pulse detection is on and is at normal sensitivity. Occasional false pacemaker pulse detections may occur in ECGs with excessive noise. False detections may result in an incorrect interpretive statement appearing on the report. Small amplitude pacemaker pulses may not be detected using this setting.
P?
Non-paced
Pacemaker pulse detection is off. Use this setting if there are false pacemaker pulse detections from noise, or if incorrect interpretive statements or inappropriate paced ECG complexes appear on the report.
5-14
Paced
Pacemaker pulse detection is on and is set at a higher sensitivity. Use this setting if small amplitude pacemaker pulses are not being detected at the default (Not Known if Paced) setting. False pacemaker pulse detections may occur if the ECG is noisy.
Paced (magnet)
Use this setting if the ECG is acquired with an active pacemaker magnet or programmer in place. Pacemaker pulse detection is on and is at a higher sensitivity. Magnets or programmers often put the pacemaker in a fixedrate, non-sensing mode. On the PageWriter Trim I and III, the statement ECG ACQUIRED WITH MAGNET IN PLACE is printed on the ECG report. This statement notifies the overreader that a magnet or programmer was used and would explain the fixed rate behavior of the pacer.
PM
5-15
Table 5-7
PH080A or PH090A
PH refers to Philips 08 or 09 refers to the version of the measurement program 0A refers to the criteria version installed on the cardiograph
Speed
The speed at which the ECG was printed Available settings: 25mm/sec 50 mm/sec
5-16
Limb
Chest
NOTE
For ECG recordings where the precordial leads or limb leads were recorded at a gain other than 10mm/mV, the statement Non-standard lead gains appears in the Report Information section on the printed report.
5-17
5-18
Figure 5-23
5-19
Figure 5-24
5-20
Figure 5-25
5-21
Figure 5-26
5-22
Figure 5-27
5-23
Figure 5-28
NOTE
Leads are displayed in Cabrera sequence on the Panoramic (Pan-12) Report regardless of the selected lead standard on the cardiograph.
5-24
Rhythm Report
Rhythm reports show up to 12 leads of continuous waveform data. The amount of report information that is included on the report is dependent upon the number of leads selected for recording. Information on the report may include: Patient ID information Date and time of recording Settings information (scale and sensitivity, filter settings) Rhythm reports are not analyzed, so they do not provide measurement information or interpretive statements, and they are not saved to the Archive. The calibration pulse appears at the beginning of the ECG trace.
5-25
Rhythm Report
Figure 5-29
5-26
Rhythm Report
Figure 5-30
5-27
Disclose Report
Disclose Report
PageWriter Trim II and III only
The Disclose report displays up to one minute of continuous ECG waveform data for one selected lead. Disclose reports are not analyzed, so they do not provide measurement information or interpretive statements, and they are not saved to the Archive. Each 10-second waveform segment on the report is labeled next to the lead name.
Figure 5-31 1 Minute Disclose Report
5-28
6
1Troubleshooting
Introduction
Common troubleshooting topics are discussed in this chapter. If additional assistance is required, contact the nearest Philips Response Center (see page 7-24).
Troubleshooting Topics
The following table lists all of the Troubleshooting topics included in this chapter.
Table 6-1 Topic Troubleshooting Topics Page Number
Archive Barcode Reader Battery and AC Power LAN and Modem card Leads Off Magnetic Card Reader Printer Signal Quality (bad electrode connection, interference or noise in ECG signal) System Freeze
see page 6-2 see page 6-6 see page 6-6 see page 6-8 see page 6-9 see page 6-10 see page 6-10 see page 6-14
6-1
Troubleshooting
Archive
Archive
The following table includes common error messages that may appear when using the Archive and common problems that may occur when using the Archive to transmit ECGs to a TraceMasterVue ECG Management System.
Table 6-2 Archive Troubleshooting Possible Cause Solution
The TraceMasterVue ECG Management system is busy at the receiving end. The analog phone line is disconnected or was interrupted while an ECG is being transferred to a TraceMasterVue Remote Site. The Selected Archive is a PC card and there is no PC card inserted into the PC card slot (rear of cardiograph) or the PC card is not fully inserted into the PC card slot. The connection between the TraceMasterVue server and the PageWriter Trim cardiograph is not established, or is not configured properly.
Check that the phone connector is properly inserted into the modem card and the modem has a dial tone. Check that the PC card is correctly orientated in the PC card slot and that the PC card is fully inserted into the slot.
Check the cardiograph Network settings, and the Remote Site settings in Configuration (see page 233). Check with your System Administrator regarding TraceMasterVue network permission and access. Check that the LAN card or modem card is correctly orientated in the PC card slot and that the card is fully inserted.
6-2
Archive
Troubleshooting
Table 6-2
ECG files have been corrupted during the transfer or retrieval from a TraceMasterVue server. XML files from an unknown device are being transferred to the cardiograph.
Try transferring or retrieving the ECG again. If the error message is received a second or subsequent time, contact the nearest Philips Response Center for further assistance (see page 7-24). The PageWriter Trim cardiograph only supports the importing of XML files from the PageWriterTouch and other PageWriter Trim cardiographs.
There are unspecified errors on the PC card inserted into the PC card slot on the rear of the cardiograph, or on the internal cardiograph CompactFlash card. There is an unspecified error with the USB memory stick that is inserted into the USB connector on the rear of the cardiograph.
Try accessing the Archive again. If the error message is received a second or subsequent time, contact the nearest Philips Response Center for further assistance (see page 7-24).
An unsupported Auto ECG format is being transferred to a TraceMasterVue ECG Management System.
Pan-12 and 12x1 reports may not be transferred to a TraceMasterVue ECG Management System.
6-3
Troubleshooting
Archive
Table 6-2
When multiple ECGs are being transferred from the cardiograph to a TraceMasterVue Remote Site, not all ECGs transfer and are not deleted from the Archive. After selecting the
Archive button on the
Transfer the ECGs again. If the ECGs do not transfer after a second or subsequent time, contact the nearest Philips Response Center for assistance (see page 7-24). Transmit and delete ECGs from the Main Archive (see page 4-9).
Command Toolbar, it takes longer than 40 seconds for the Archive Report List to display on the screen. An ECG cannot be transferred to a PC card or to a USB memory stick when there are less than 100 ECGs on the PC card or on the USB memory stick.
The Main Archive (internal cardiograph archive) contains more than 150 ECGs and is full.
There are other non-ECG files on the PC card or on the USB memory stick that are taking up space.
Delete files from the PC card or from the USB memory stick and attempt to transfer the ECG(s) again.
6-4
Archive
Troubleshooting
Table 6-2
The ECG retrieved from a TraceMasterVue ECG Management System does not print as expected or appear as expected on the Preview screen.
The ECG was not originally generated on a PageWriter Trim or PageWriterTouch cardiograph.
Retrieving and printing ECGs that were not generated on a PageWriter Trim or a PageWriterTouch cardiograph may result in the following: The algorithm version number appears as HPxx on the TraceMasterVue ECG Management System, but will appear as PH on the PageWriter Trim (see page 5-16). Pacer tick marks do not appear on the ECG report printed on the PageWriter Trim. If the ECG was originally generated using the Frank lead system, the PageWriter Trim will print the report with three flat Rhythm strips with no lead information. Custom lead names will not appear on a report printed on a PageWriter Trim.
CAUTION
Do not pull the PC card out of the PC card slot, or pull the USB memory stick out of the USB connector while the cardiograph is accessing ECG files from either type of removable media.
6-5
Troubleshooting
Barcode Reader
Barcode Reader
The following table describes a potential problem with the barcode reader.
Table 6-3 Problem Barcode Reader Troubleshooting Possible Cause Solution
The barcode reader has been unplugged or plugged into the cardiograph when the cardiograph is in use.
Shut down all power to the cardiograph. Press and hold the On/Standby button for three seconds and then release. Securely attach the barcode reader to the barcode reader port ( ) on the rear of the cardiograph. Press the On/Standby button.
The AC power indicator light on the front of the cardiograph does not illuminate when the cardiograph is plugged into AC power.
6-6
Troubleshooting
No battery detected.
The battery is completely depleted of power and requires a full recharge. The battery is damaged. The battery has been removed from the cardiograph.
Check that the battery is properly inserted (see page 1-14). Recharge the battery. Plug the cardiograph into AC power and press the On/ Standby button. Charge the battery until the Battery Power Indicator on the Status Bar displays that the battery is fully charged (see page 1-33). Replace the battery (see page 7-8). Only use the PageWriter Trim replacement battery with Philips part number 989803130151.
6-7
Troubleshooting
The LAN cable or phone cable is not connected to the card. The configured settings for the TraceMasterVue Remote Site are incorrect.
Check that the LAN cable or phone cable are correctly and securely attached to the card. Only use the shielded LAN cable supplied with the PageWriter Trim cardiograph with Philips part number 989803138021. Do not use any other LAN cable with the cardiograph. Check the configured settings for the Remote Site (see page 2-33).
The modem card is not fully inserted into the PC card slot, or was removed and replaced while the cardiograph was in operation.
Ensure that the modem card is fully inserted into the PC card slot on the rear of the cardiograph. Reset the cardiograph (see page 6-17) and attempt to use the modem card again. If the modem card fails to respond a second or subsequent time, contact the nearest Philips Response Center for assistance (see page 7-24).
6-8
Leads Off
Troubleshooting
Leads Off
The following table lists some common problems with leads off.
Table 6-6 Leads Off Troubleshooting Possible Cause Solution
RL or N
The PIM (Patient Interface Module) patient data cable is not securely attached to the PIM connector port on the rear of the cardiograph. The RL or N electrode or lead wire are lose or disconnected. More than two of the following leads: LA or L, LL or F, or RA or R are loose or disconnected.
Check that the patient data cable is securely attached to the PIM connector port ( ) on the rear of the cardiograph. Check that the RL or N electrodes or lead wires are securely attached. Check that the electrodes and lead wires are correctly positioned on the patient (see page 3-3). Ensure that there are at least two limb lead wires securely connected.
LL or F
LL or F (left leg) electrode and lead wire are loose or disconnected. LA or L (left arm) electrode and lead wire are loose or disconnected. RA or R (right arm) electrode and lead wire are loose or disconnected. V1-V6 (C1-C6) precordial electrodes and lead wires are loose or disconnected.
Check LL or F lead wire and electrode are securely attached. Check LA or L electrode and lead wire are securely attached. Check RA or R electrode and lead wire are securely attached. Check the V1-V6 (C1-C6) electrodes and lead wires are securely attached.
LA or L
RA or R
V1-V6 or C1-C6
6-9
Troubleshooting
The magnetic card reader does not correctly read the magnetic card data.
The magnetic card reader has been connected or disconnected from the cardiograph while the cardiograph is in use.
Shut down all power to the cardiograph. Press and hold the On/Standby button for three seconds and then release. Securely attach the magnetic card reader to the magnetic card reader port ( ) on the rear of the cardiograph. Press the On/ Standby button.
Printer
The following table contains a list of common error messages and other problems that may occur when using the cardiograph printer.
Table 6-8 Printer Troubleshooting Possible Cause Solution
The paper drawer is open. There is an unknown problem with the printer.
Open and close the printer drawer and ensure that it is securely closed. If the problem persists, contact the nearest Philips Response Center for further assistance (see page 7-24).
PageWriter Trim I:
0203
PageWriter Trim I:
0204
6-10
Printer
Troubleshooting
Table 6-8
Pull out the paper drawer and fix the paper jam.
PageWriter Trim I:
0204
PageWriter Trim I:
0202
The cardiograph is configured for a particular paper size (A or A4), and the paper drawer is loaded with a different size paper. The battery charge level is at low power. The paper drawer was opened while the cardiograph was printing a report.
Check that the paper size setting in configuration is correct (see page 2-23). Plug the cardiograph into AC power and fully charge the battery, or replace the battery with a new fully charged battery (see page 7-8). Reset the cardiograph (see page 6-17).
6-11
Troubleshooting
Printer
Table 6-8
The battery power level is too low to print a report. The printer is not responding.
PageWriter Trim I:
0201
Plug the cardiograph into AC power and fully charge the battery, or replace the battery with a new fully charged battery (see page 7-8). Open the paper drawer and securely close it. If all other methods fail to resolve the error message, press and hold the On/ Standby button for three seconds then release it to shut down the cardiograph. Push the On/ Standby button again to restart the cardiograph. The cardiograph will fully reboot. For further assistance, contact the nearest Philips Response Center (see page 7-24).
Open and securely close the paper drawer and then reset the cardiograph (see page 6-17). For further assistance, contact the nearest Philips Response Center (see page 7-24).
PageWriter Trim I:
0207
6-12
Printer
Troubleshooting
Table 6-8
Follow the cardiograph reset procedure (see page 6-17). If the problem persists, contact the nearest Philips Response Center for further assistance (see page 7-24).
The cardiograph prints out a blank ECG report and will not stop printing.
The cardiograph is configured for a particular paper size (A or A4), and the paper drawer is loaded with a different size paper.
Press the Stop button on the cardiograph to stop the printer. Press the On/Standby button for three seconds then release it to shut down the cardiograph. Press the On/Standby button again to restart the cardiograph. Configure the cardiograph for the correct paper size (see page 2-23).
The printer paper does not advance to the correct position at the top of the next sheet. The perforated edge does not appear at the end of the report.
The cardiograph is configured for a particular paper size (A or A4), and the paper drawer is loaded with a different size paper. The printer paper is being torn off incorrectly.
Configure the correct paper size in Configuration (see page 223). Review the correct procedure to tear off the printer paper (see page 74). Plug the cardiograph into AC power. If the cardiograph prints reports normally, fully charge the battery or replace it. If the problem persists, contact the nearest Philips Response Center (see page 7-24).
6-13
Troubleshooting
Signal Quality
Table 6-8
The cardiograph is configured for a particular paper size (A or A4), and the paper drawer is loaded with a different size paper.
Signal Quality
The following section describes common signal quality problems with suggested solutions.
Figure 6-1 AC interference
Table 6-9
Possible Cause
An improperly gelled electrode (dried gel) Electrical interference from another device (IV pump, microwave oven, cellular phone, wireless device) An electrical device near the cardiograph that is improperly grounded
Check that the electrodes are firmly attached. Check for devices that could be causing electrical interference. Unplug the devices or switch to battery power. Lay the lead wires alongside the limbs and away from any electrical devices. Turn on the AC filter (see page 311).
6-14
Signal Quality
Troubleshooting
Figure 6-2
Wandering Baseline
Table 6-10
Possible Cause
Inadequate patient preparation, or a sweaty patient Moderate patient movement, tense patient Very poor electrode contact, dry electrodes Patient respiratory interference
Reassure the patient and make sure that the patient is comfortable. If the patient has tremors, attach the limb electrodes higher on the patient (closer to torso). Ensure that the lead wires are not pulling on the electrodes. Check that the electrodes are firmly attached or reapply new electrodes if the gel is dry. Turn on the Baseline Wander filter (see page 3-11).
Figure 6-3
Somatic Tremors
6-15
Troubleshooting
System Freeze
Table 6-11
Possible Cause
Place a blanket on the patient to warm the patient Assist with limiting patient movement
Figure 6-4
Loose Electrode
Table 6-12
Possible Cause
An electrode is loose or is not adhering to the skin An electrode has fallen off A lead wire is disconnected
Check all electrodes Replace dry electrodes Check all lead wires
System Freeze
If the cardiograph freezes on any screen and cannot be used, follow the procedure below to reset the cardiograph. For further assistance with system freeze issues, contact the nearest Philips Response Center (see page 7-24).
6-16
System Freeze
Troubleshooting
The cardiograph cannot perform any function. The cardiograph does not respond when the Trim Knob is turned or pressed, or when a key on the keyboard is pressed.
Continue with normal cardiograph operation after the reset is complete. If the cardiograph continues to reset automatically, contact the nearest Philips Response Center for assistance (see page 7-24).
cardiograph does not shut down, follow the next step in this procedure.
2 Press and hold the On/Standby button for five seconds, then release it. Press the On/Standby
button again. If the cardiograph does not shut down, perform the following steps in this procedure.
3 Using a paper clip or other item with a small tip, gently press the Reset button on the rear of
the cardiograph.
Figure 6-5 Pressing the Reset button on the PageWriter Trim I
6-17
Troubleshooting
System Freeze
Figure 6-6
cord from the cardiograph. Ensure that the AC power indicator light on the front of the cardiograph is not lit. Open the battery door and remove the battery from the cardiograph (see page 7-8). Reinsert the battery and connect the AC power cord to the AC power connector on the rear of the cardiograph. Press the On/Standby button. After the cardiograph is reset, a series of screens appear. At the end of the restart sequence, the R/T ECG screen appears and the cardiograph can be returned to normal use.
6-18
7
1
The following chapter contains information on basic cardiograph care and periodic maintenance. If further technical assistance is required, contact the nearest Philips Response Center (see page 7-24).
Cardiograph Cleaning
To clean the cardiograph: 1 2
Unplug the AC power cord. Wipe the external surfaces of the cardiograph with a soft cloth dampened in any of the approved cleaning solutions listed below.
CAUTION
When cleaning, avoid the lead wire connectors and the connectors on the rear panel.
Do not spill liquids on the surface of the cardiograph. Do not use any of the following to clean the cardiograph: Acetone Iodine-based cleaners Phenol-based cleaners Ethylene oxide sterilization Chlorine bleach Ammonia-based cleaners The cardiograph or PIM should not be autoclaved, ultrasonically cleaned, or immersed.
7-1
Dampen a soft cloth with one of the disinfectants or cleaning agents listed below. Clean the patient data cable and lead wires with any of the following: Cidex Ortho Phthaladehyde Cetylcide Vesphene 2 Aqueous Phenolic Germicidal Agent
CAUTION
Do not: Use isopropyl alcohol Autoclave the PIM, patient data cable or lead wires or use ultrasonic cleaners Immerse Use abrasive materials Wet the connectors 2
Dampen a soft cloth with one of the disinfectants or cleaning agents listed below. Cidex Ortho Phthaladehyde Cetylcide Vesphene 2 Aqueous Phenolic Germicidal Agent
CAUTION
Do not: Use isopropyl alcohol Autoclave the reusable electrodes or use ultrasonic cleaners Use abrasive materials 2
7-2
Turn the Trim Knob until the date on the LCD display is highlighted. Push the Trim Knob. A screen appears showing the current date and time settings. Turn the Trim Knob until the field to be changed is highlighted. Push the Trim Knob to select the field. Turn the Trim Knob to scroll through the options for that field. Push the Trim Knob to select a setting. Repeat the procedure to set the current Month, Day, Year, Hour, Minute, and Second. When all settings are complete, turn the Trim Knob to highlight the arrow icon Push the Trim Knob to save the settings and to exit the screen. .
Changing the Date and Time on the PageWriter Trim II and III
The following procedure changes the current displayed date and time. For information on changing the format of the displayed date and time (12 hour or 24 hour clock, or other date settings), see page 2-41.
To change the date and time: 1 2 3 4 5 6
Press the Tab key ( ) or turn the Trim Knob to highlight the displayed date and time on the Command Toolbar. Press the space bar or the Trim Knob to select it. The Date and Time Settings window appears. The month drop-down list is highlighted. Press the space bar or the Trim Knob to display the drop-down list. Press the up ( ) or down ( ) arrow key or turn the Trim Knob to highlight the current month. Press the space bar or the Trim Knob to select it. Repeat the procedure to select the current year, date and time. When done, press the Enter key ( ) to save the new date and time settings. The new date and time appears on the Command Toolbar.
7-3
Printer Paper
Printer Paper
Replace the printer paper when a red stripe appears on the printed ECG report. Only use Philips Medical Systems replacement printer paper. For part number and ordering information, see page 7-21.
Open the paper drawer on the front of the cardiograph and lift up the bar.
Insert a new pack of printer paper as shown. Ensure that no more than 100 sheets are being inserted into the paper tray.
7-4
Printer Paper
Drape the entire first sheet over the roller. Ensure that the perforated edge of the paper aligns with the edge of the paper drawer. Lower the bar onto the paper and close the drawer.
7-5
Repeated undercharging of the battery will damage the battery and will reduce battery life.
If the battery has been fully charged and requires recharging after only a few ECGs, consider replacement. Charging the battery at temperatures above 45 oC (113o F) can damage the battery and can reduce overall battery life. Check the battery power indicator on the Status Bar to ensure that the battery is fully charged, see "PageWriter Trim II and III Status Bar" on page 1-33. For the PageWriter Trim II and III, configure and turn on the Battery Power Saving Modes (Standby, Shutdown) feature in Configuration, see page 2-23. For the PageWriter Trim II and III, put the cardiograph into Standby mode when not in use. Push the On/Standby button to put the cardiograph into Standby. For the PageWriter Trim I, push the On/Off button to turn off the cardiograph when not in use. Always charge the battery when the cardiograph is not in use. Plug the cardiograph into AC power. Ensure that green AC power indicator light is on. The battery will charge while the cardiograph is in use, but will charge at a slower rate. The use of cardiograph accessories (barcode reader, magnetic card reader, SmartCard Reader, PC card, modem and LAN card) will deplete battery power at a faster rate. The battery will require more frequent charging if these accessories are used with the cardiograph. Operate the cardiograph, charge the battery, and store the battery at a temperature of 40 oC (104o F) or lower. Exposure to higher temperatures may reduce battery life, damage the battery, and degrade overall cardiograph performance. For optimal battery performance store the battery at a cooler temperature, but not below freezing (0 oC/32oF).
7-6
If the cardiograph will be stored for more than thirty days without use, unplug the cardiograph from AC power and remove the battery. See Battery Storage on page 7-7 for more information. A fully charged battery stored outside the cardiograph will need to be recharged every six months. If the battery is not charged every six months it will be damaged. See Battery Storage on page 7-7 for more information.
Repeated undercharging of the battery will degrade battery performance and reduce overall battery life.
For the PageWriter Trim I, check the Battery Level Indicator on the LCD display ( ) to confirm that the battery is fully charged, see "LCD Display" on page 1-30. For the PageWriter Trim II and III, check the Battery Level Indicator on the Status Bar ( ) to confirm that the battery is fully charged, see "PageWriter Trim II and III Status Bar" on page 1-33.
Battery Storage
Remove the battery from the cardiograph if it will be stored for more than 30 days without use. While in storage, the battery will require a full recharge every 6 months. Charge the battery for at least 16 hours. This will ensure that the battery does not completely discharge while in storage. The battery life will be prolonged when stored in cooler temperatures, but will be damaged if stored below freezing (0 oC/32oF). Store the battery at a temperature of 40 oC (104o F) or lower.
To store the battery: 1
Charge the battery for 16 hours before removing it from the cardiograph. Ensure that the AC power cord is connected to the cardiograph and is plugged into a grounded AC power outlet. Check that the green AC power indicator light on the front of the cardiograph is lit. Remove the battery from the cardiograph and store in a cool, dry location. For information on removing the battery, see Replacing the Battery on page 7-8. Recharge the battery for 16 hours for every 6 months that the battery is in storage.
2 3
7-7
Properly dispose of or recycle the depleted battery according to local regulations. Do not disassemble, puncture, or incinerate the disposed battery.
How often battery needs to be replaced depends on how well the battery is maintained and how much it is used. If the battery is fully charged but loses significant power after only a few ECGs, consider replacement.
Figure 7-1 Replacing the Battery
Unplug the cardiograph from AC power and ensure that the green AC power indicator light on the front of the cardiograph is not lit. Open the battery door on the rear of the cardiograph. Push the recessed tab in and pull it down to open the battery door.
7-8
3 4 5 6 7 8 9
Remove the battery. Insert the replacement battery into the compartment with the connector facing down and the pull tab facing out. Push in the pull tab to lock it. Reattach and close the battery door. Attach the AC power cord to the rear of the cardiograph. Plug the AC power cord into a grounded electrical outlet. Check that the green AC power indicator light on the front of the cardiograph is illuminated. Charge the battery for at least 16 hours before mobile use. The cardiograph can operate on AC power while the battery is charging but it will charge at a slower rate.
Unplug the cardiograph from AC power. Pull out the AC power cord from the AC power connector on the rear of the cardiograph. Locate the AC fuse, which is directly below the AC power connector. Push down on the center tab on the fuse and pull out the fuse from the fuse holder slot. Insert the new fuse using the same orientation, with the center tab facing up. Push the fuse all the way into the fuse holder slot. The fuse snaps into place.
7-9
Match the lead wire labeling (on lead) with the same lead wire connector on the PIM. Replace the lead wire by snapping it into the connector.
7-10
Maintenance Tests
WARNING
To ensure safety and prevent damage to the system, only connect the patient data cable to the correct PIM connector on the rear of the cardiograph.
Maintenance Tests
PageWriter Trim II and III only
Maintenance tests and diagnostic utilities are included in Configuration. These tests are used to verify or to optimize cardiograph performance. They can be used as a first step to identify a technical problem with the cardiograph. For more information about these tests contact the nearest Philips Response Center (see page 7-24).
To open the Maintenance Test screen: CONFIG NOTE 2 3 1
Turn the Trim Knob to highlight the Config button on the Command Toolbar.
Access to the Configuration screens may be password controlled (see page 2-40).
Push the Trim Knob to select the button. The Configuration screen appears. Press and hold down the Alt key on the keyboard. Press the S key to select the System tab. The System screen appears.The five available tests appear as buttons under Diagnostics (right side of screen).
7-11
Maintenance Tests
Figure 7-3
Diagnostic Tests
PIM Test
(page 7-13)
Barcode Test
(page 7-13)
Magcard Test
(page 7-14)
Printer Test
(page 7-14)
Network
(page 7-17)
7-12
Maintenance Tests
PIM Test
This test is used to confirm that the Patient Interface Module (PIM) is communicating with the cardiograph. This test can be performed when the cardiograph displays Patient Interface Module error messages, or when the cardiograph is unable to acquire data from the PIM when the PIM patient data cable is securely attached to the PIM connector ( ) on the rear of the cardiograph. If this test fails, it may indicate a problem with the PIM or with the PIM patient data cable. For further assistance, contact the nearest Philips Response Center (see page 7-24).
To perform the PIM Test: 1 2
Turn the Trim Knob to highlight the PIM Test button under Diagnostics. Push the Trim Knob to select the button. The message Accessing PIM... appears. The PIM Test Result window appears and indicates that the PIM Test has passed, or that the cardiograph is unable to communicate with the PIM. If the message PIM Test Passed appears, the PIM is communicating properly with the cardiograph. The OK button is highlighted. Push the Trim Knob to close the window. If the message Please Check the Patient Interface Module appears, check that the PIM patient data cable is securely attached to the PIM connector on the rear of the cardiograph. If the patient data cable is securely attached to the PIM connector, but still fails the PIM Test, contact the nearest Philips Response Center for further assistance (see page 7-24).
3 4
Ensure that the barcode reader is securely attached to the barcode reader connector ( ) on the rear of the cardiograph. If the barcode reader is not attached to the cardiograph, press and hold down the On/Standby button for 3 seconds, then release it. The cardiograph shuts down. Connect the barcode reader to the barcode reader connector ( ) on the rear of the cardiograph. Press the On/Standby button. Follow the procedure to open the Maintenance Test screen, see page 7-11. Turn the Trim Knob to highlight the Barcode Test button under Diagnostics. Push the Trim Knob to select the button. The Barcode Reader test window appears. Hold the barcode reader at a 45o angle and scan a test barcode. The barcode data appears next to the Patient ID field. Review the barcode data to ensure that it is accurate. The OK button is highlighted. If the barcode data is accurate, push the Trim Knob to select the OK button. Turn the Trim Knob to highlight the Cancel button if the barcode data is incorrect. Try the test again. If the test fails a second or subsequent time, contact the nearest Philips Response Center for further assistance (see page 7-24).
2 3 4 5
7-13
Maintenance Tests
Ensure that the magnetic card reader is securely attached to the magnetic card reader connector ( ) on the rear of the cardiograph. If the magnetic card reader is not attached to the cardiograph, press and hold down the On/Standby button for 3 seconds, then release it. The cardiograph shuts down. Connect the magnetic card reader to the magnetic card reader connector ( ) on the rear of the cardiograph. Press the On/Standby button. Follow the procedure to open the Maintenance Test screen, see page 7-11. Turn the Trim Knob to highlight the Magcard Test button. Push the Trim Knob to select the button. The Magnetic Card Reader window appears. Insert the magnetic card into the slot on the reader. Leave the magnetic card in the slot for five seconds and then pull it out. The magnetic card data appears next to the Patient ID field. Review the data to ensure that it is correct. The OK button is highlighted. If the magnetic card data is accurate, push the Trim Knob to select the OK button. Turn the Trim Knob to highlight the Cancel button if the magnetic card data is incorrect. Push the Trim Knob to select the button. Try the test again. If the test fails a second or subsequent time, contact the nearest Philips Response Center for further assistance (see page 7-24).
2 3 4 5 6 7
Printer Test
The Printer Test is used to verify that the cardiograph printer is able to correctly print out the test page. Use this test to verify proper printer performance or when reports appear to have print quality errors.
To perform the print test: 1 2 3
Turn the Trim Knob to highlight the Printer Test button under Diagnostics. Push the Trim Knob to select the button. The message Printing Test Page... appears and the test page prints out. Review the printer test page at points A, B, C, and D as seen on Figure 7-4, on page 7-16.
Printer Test Page Description Description
A B
The stepped bars are sharp edged and printed cleanly without distortion or missing segments The spacing between the vertical lines is 25 mm with a discrepancy of no more or less than 2%
7-14
Maintenance Tests
Table 7-1
C D
The diagonal lines should be straight and printed cleanly without distortion or breaks in the lines The character set is printed cleanly without distortion or missing characters, and all characters are clearly legible
7-15
Maintenance Tests
Figure 7-4
7-16
Maintenance Tests
If the printer test page matches the printer test points as described in Table 7-2, the cardiograph has passed the printer test. If the printer test page does not match the printer test points, the cardiograph has failed the print test. If the cardiograph fails the printer test, contact the nearest Philips Response Center for further assistance (see page 7-24).
Network Test
The Network Test displays the configured network information for the cardiograph. All cardiograph network configuration is completed on the Network screen. From any Configuration screen, press and hold down the Alt key on the keyboard, and then press the N key to select the Network tab and to open the Network screen. Before performing the Network test, ensure that the LAN card is fully inserted into the PC card slot on the rear of the cardiograph, and that the LAN cable is fully inserted into the cable connector on the card.
WARNING
Do not connect the LAN card to a network connector when the cardiograph is connected to a patient.
CAUTION
Only use the shielded LAN cable provided with the PageWriter Trim cardiograph (Philips Part Number 989803138021). Do not use LAN cables with the cardiograph that have not been approved by Philips Medical Systems. To perform the network test: 1 2 3
Turn the Trim Knob to highlight the Network button. Press the Trim Knob to select the button. The Network Connection window appears. The configured network information for the cardiograph appears on the window. Review the network data to ensure that it is correct. The Retry button is highlighted. If the network data does not display, push the Trim Knob. If the test fails a second or subsequent time, contact the nearest Philips Response Center for further assistance (see page 7-24). If the network data displays correctly, turn the Trim Knob to highlight the Close button. Push the Trim Knob to select the button.
7-17
Failure to follow these warnings could affect both patient and operator safety.
When operating the cardiograph on AC power, ensure that the cardiograph and all other electrical equipment connected to or near the patient are effectively grounded. Use only grounded power cords (three-wire power cords with grounded plugs) and grounded electrical outlets. Never adapt a grounded plug to fit an ungrounded outlet by removing the ground prong. Use the equipotential post when redundant earth ground is necessary according to IEC 60601-1-1. If a safe ground connection is not ensured, operate the cardiograph on battery power only. The use of equipment that applies high frequency voltages to the patient (including electrosurgical equipment and some respiration transducers) is not supported and may produce undesired results. Disconnect the patient data cable from the cardiograph, or detach the leads from the patient prior to performing any procedure that uses high frequency surgical equipment. Do not perform ST analysis on the R/T ECG screen display or on Rhythm reports when the 0.5 Hz Baseline Wander filter is applied. If abnormal ECG data appears on the printed report, and the abnormal data does not have a physiological origin, perform the printer diagnostic test to assess printer performance. When printing a Rhythm report, there may be a slight delay before the Rhythm report begins to print on the cardiograph. Rhythm printing is not completed in real-time. Pace pulse tick marks will not print on an Auto ECG that uses simultaneous acquisition.
WARNING
Do not touch accessible connector pins and the patient simultaneously. Electrical shock hazard. Keep cardiograph, Patient Interface Module (PIM) and all cardiograph accessories away from liquids. Do not immerse cardiograph, PIM, or other accessories in any liquids.
Periodically inspect the patient data cable, lead wires, and AC power cord for any worn or cracked insulation to ensure that no inner conductive material is exposed. Discard worn accessories and replace them only with Philips Medical Systems accessories (see page 135). Keep the patient data cable away from power cords and any other electrical equipment. Failure to do so can result in AC power line frequency interference on the ECG trace.
7-18
The Philips Medical Systems patient data cable (supplied with cardiograph) is an integral part of the cardiograph safety features. Use of any other patient data cable may compromise defibrillation protection, degrade cardiograph performance, and may result in distorted ECG data. Only qualified personnel may service the cardiograph or may open the cardiograph housing to access internal cardiograph components. Do not open any covers on the cardiograph. There are no internal cardiograph components that are serviced by the operator. Do not use this cardiograph near flammable anesthetics. It is not intended for use in explosive environments or in operating rooms. Do not touch the patient, the patient data cable, any unused patient leads, or the cardiograph during defibrillation. Death or injury may occur from the electrical shock delivered by the defibrillator. Always use electrode gel with reusable electrodes during defibrillation as ECG recovery will be greater than 10 seconds. Philips Medical Systems recommends the use of disposable electrodes at all times. Ensure that the electrodes or lead wires do not come in contact with any other conductive materials (including earth-grounded materials) especially when connecting or disconnecting electrodes to or from a patient. Connecting multiple medical electrical equipment to the same patient may pose a safety hazard due to the summation of leakage currents. Any combination of instruments should be evaluated by local safety personnel before being put into service. Portable medical equipment such as X-rays and MRI may produce electromagnetic interference that produces noise in the ECG signal. Move the cardiograph away from these potential sources of electromagnetic interference. Do not pull on the paper while an ECG report is being printed. This can cause distortion of the waveform and can lead to potential misdiagnosis. Only use the Philips Medical Systems AC power cord supplied with the cardiograph. Periodically inspect the AC power cord and AC power connector (rear of cardiograph, see page 1-9) to ensure that both are in a safe and operable condition. If the AC power cord or AC power connector is not in a safe or operable condition, operate the cardiograph on battery power and contact Philips Medical Systems for service. The cardiograph has been safety tested with the recommended accessories, peripherals, and leads, and no hazard was found when the cardiograph is operated with cardiac pacemakers or other stimulators. Do not connect any equipment or accessories to the cardiograph that are not manufactured or approved by Philips Medical Systems or that are not IEC 60601-1 approved. The operation or use of non-approved equipment or accessories with the cardiograph is not tested or supported, and cardiograph operation and safety are not guaranteed.
7-19
The list of cables and other accessories with which Philips claims compliance with the emissions and immunity requirements of IEC standard 60601-1-2 are listed in Supplies and Ordering Information on page 1-35.
WARNING
When using additional peripheral equipment powered from an electrical source other than the cardiograph, the combination is considered to be a medical system. It is the responsibility of the operator to comply with IEC 60601-1-1 and test the medical system according to the requirements. For additional information contact Philips Medical Systems.
WARNING
Do not use non-medical peripherals within 1.83 meters or 6 feet of a patient unless the non-medical peripherals receive power from the cardiograph or from an isolation transformer that meets medical safety standards.
Only install Philips Medical Systems software on the cardiograph. The installation or use of software not approved by Philips Medical Systems is strictly prohibited and cardiograph safety and performance are not guaranteed. Only use Philips Medical Systems replacement parts and supplies with the cardiograph. The use of non-approved replacement parts and supplies with the cardiograph is strictly prohibited. Cardiograph safety and performance are not guaranteed when non-approved replacement parts and supplies are used with the cardiograph. Manual measurements of ECG intervals and magnitudes should be performed on printed ECG reports only. Do not make manual measurements of ECG intervals and magnitudes on the R/T ECG display since these ECG representations are scaled. Only use patient electrodes that are approved by Philips Medical Systems. The use of nonapproved patient electrodes may degrade cardiograph performance. The Philips Medical Systems warranty is applicable only if you use Philips Medical Systems approved accessories and replacement parts. See Supplies and Ordering Information on page 1-35 for more information. Before using the Patient Cable Arm with the cardiograph cart, properly install the counter weight on the cardiograph base. Only use the shielded LAN cable provided with the PageWriter Trim cardiograph, Philips Part Number 989803138021. Do not use any other LAN cables with the PageWriter Trim cardiograph. Use of unapproved LAN cables may result in radiated emissions that exceed the limit specified by CISPR11 Class B. The combined maximum weight that can be placed on the cardiograph cart shelf and the top surface of the cart cannot exceed 20 kg (44 lbs). Do not place more than the specified weight on the cardiograph top surface and shelf. Do not connect any device to the RS-232 port on the rear of the cardiograph when the patient data cable is connected to a patient. There are no cardiograph parts that can be sterilized.
7-20 PageWriter Trim Cardiograph Instructions for Use
The cardiograph is not intended for direct, or invasive cardiac monitoring purposes. Excessive, repetitive use of the cardiograph keyboard and the cardiograph Trim Knob may result in a risk of developing carpal tunnel syndrome. Ensure that the patient data cable is tucked away from the cardiograph cart wheels when transporting the cardiograph. Ensure that the patient data cable does not present a hazard when pushing the cardiograph cart. For information on the standard IEC 60601-2-51, please go to the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Ordering Supplies
All supplies may be ordered on the web at:
http://shop.medical.philips.com
Use the part numbers listed below for reference to ensure that the correct supplies are ordered.
7-21
989803130091 989803130101
Replacement Fuse
Part Number Description
453564000371
989803129161 989803129191
Limb Lead Set, 99 cm/39 in (AAMI) Chest Lead Set, 61 cm/24 in (AAMI) Limb Lead Set, 99 cm/39 in (IEC) Chest Lead Set, 61 cm/24 in (IEC) Long Limb Lead Set, 137 cm/54 in (IEC) Long Chest Lead Set, 99 cm/39 in (IEC) Long Complete Lead Set (IEC)
Electrodes
Part Number Description
Disposable cardiography electrode, resting diagnostic ECG Disposable electrode, adult, resting ECG (not available in Japan) Disposable electrode, diagnostic, pre-gelled Wet Gel Foam Electrode, resting ECG
Electrodes (continued)
Part Number Description
989803129231 989803129241 M2254A 40431B 40498E 40475A 40490E 40421A 40494E 40491E 40424A 14030A
Alligator Clips for Disposable Tab Electrodes (AAMI) Alligator Clips for Disposable Tab Electrodes (IEC) Tab electrode adapter Alligator Clip Adapter for 1/8 post Snap Lead Electrode (IEC) Snap Lead Electrode Adapter 15mm Suction Electrode Push-in Connect Welsh Electrode Limb Clamp Electrode C400 (4 per box) Limb Plate Electrode C400 (4 per bag) Limb Plate Electrode (4 pack) Strap Electrode, 14 inch limb (4 per pack)
Printer Paper
Part Number Description
M3707A
M3708A
Thermal Paper (100 sheets) A4 size (8.27 x 11.69 in/21 x 29.69 cm)
Battery
Part Number Description
989803130151
Cardiograph Accessories
For more information on optional cardiograph accessories or to place an order, contact your Philips Sales Representative the Philips Response Center nearest you, see page 7-24.
989803129931
Barcode Reader
7-23
989803129941 989803127331 989803129961 989803130131 989803142041 989803129951 989803145331 989803144601 989803130111 989803130121 989803127441 989803127461 989803138021
Magnetic Card Reader PC card (128 MB storage) SmartCard Reader Patient Cable Arm Wireless LAN Card LAN PCMCIA Network Card USB Memory Stick PageWriter Trim Cardiograph User Documentation CD (additional copies) PageWriter Trim Cardiograph Cart PageWriter Trim Cardiograph Cart Additional Shelf Optional Locking Drawer for Cardiograph Cart Modem Card (USA and Canada only) LAN Cable
(800) 323 2280 01 800 710 8128 1 787 754 6811 (800) 722 9377
7-24
54 11 4546 7698 0800 701 7789 0800 22 3003 01 8000 11 10 10 51 1 620 6440
United Kingdom
Austria Belgium
Czech Republic MCR Response Center (located in The Netherlands) Denmark Finland France Germany Greece MCR Response Center (located in The Netherlands) Hungary MCR Response Center (located in The Netherlands) Italy Netherlands Norway
31 40 2781619
31 40 2781619
7-25
Poland MCR Response Center (located in The Netherlands) Rumania MCR Response Center (located in The Netherlands) Russia MCR Response Center (located in The Netherlands) Slovak Republic MCR Response Center (located in The Netherlands) Spain Sweden Switzerland
31 40 2781619
31 40 2781619
31 40 2781619
31 40 2781619
Australia China Hong Kong India Indonesia Japan Korea Malaysia New Zealand Philippines Singapore Taiwan
1800 251 400 800 810 0038 852 2876 7578 1600 112 444 62 21 7910040, ext 8610 81 (0)120 095 205 82 (0)2 3445 9010 1800 886 188 0800 251 400 63 2 8162617 ext. 875 1800 Philips 0800 005 616
7-26
Thailand
31 40 2781619
7-27
A
1Suppressed Borderline Interpretive Statements
Introduction
This Appendix includes a listing of all borderline interpretive statements that are suppressed using the Borderline Statement Suppression feature that is available with the Philips 12-Lead Algorithm version PH090A. This feature is not available with the algorithm version number PH080A. For more information on the Philips 12-Lead Algorithm, including a listing of all interpretive, reason, and severity statements included in the Philips 12-Lead Algorithm, please see the Philips 12-Lead Algorithm Physicians Guide on the User Documentation CD or download the file from the Philips InCenter web site (incenter.medical.philips.com). For information on using the Philips InCenter web site, see page 1-4.
Statement Code
BORDERLINE AV CONDUCTION DELAY BORDERLINE INTRAVENTRICULAR CONDUCTION DELAY CONSIDER LEFT ATRIAL ABNORMALITY CONSIDER RIGHT ATRIAL ABNORMALITY EARLY PRECORDIAL R/S TRANSITION RSR' IN V1 OR V2, RIGHT VCD OR RVH BORDERLINE T WAVE ABNORMALITIES LATE PRECORDIAL R/S TRANSITION
A-1
Table A-1
Statement Code
LVHQ LVOLFB NFAD NFRA QMAB QMART QMBW REPB RSR1 RSRNV SDALP SDANP SDCU SDINP SDJ SDM SEALP SEANP SEINP SPRB TAXAB TAXQT TTW1
CONSIDER LEFT VENTRICULAR HYPERTROPHY BORDERLINE LOW VOLTAGE IN FRONTAL LEADS NO FURTHER ANALYSIS ATTEMPTED DUE TO PACED RHYTHM NO FURTHER RHYTHM ANALYSIS ATTEMPTED DUE TO PACED RHYTHM ARTIFACT IN LEAD(S) AND BASELINE WANDER IN LEAD(S) ARTIFACT IN LEAD(S) BASELINE WANDER IN LEAD(S) BORDERLINE REPOLARIZATION ABNORMALITY RSR' IN V1 OR V2, PROBABLY NORMAL VARIANT RSR' IN V1, NORMAL VARIATION NONSPECIFIC ST DEPRESSION, ANTEROLATERAL LDS NONSPECIFIC ST DEPRESSION, ANTERIOR LEADS MINIMAL ST DEPRESSION NONSPECIFIC ST DEPRESSION, INFERIOR LEADS JUNCTIONAL ST DEPRESSION MINIMAL ST DEPRESSION T ELEVATION, PROB NORMAL VARIATION, ANT-LAT ST ELEV, PROBABLY NORMAL VARIATION, ANT LEADS T ELEVATION, PROBABLY NORMAL VARIATION, INF BORDERLINE SHORT PR INTERVAL BORDERLINE T WAVE ABNORMALITIES BORDERLINE T WAVE ABNORMALITIES TALL T, PROBABLY NORMAL VARIANT, ANT-LAT LDS
A-2
Statement Code
AMI1 AMI3 AXL AXR BIVCDL CRHPI CRHPIR CRPMI CRVH IMI3 IMI4 IMI18 IRBBRV LMI10 LMI49 LQTB LVHR56 LVHR6 LVHRS LVHRSI LVHS12 LVHTA LVHV MSTEA
BORDERLINE R WAVE PROGRESSION, ANTERIOR LEADS Q WAVE IN V1 BORDERLINE LEFT AXIS DEVIATION BORDERLINE RIGHT AXIS DEVIATION BORDERLINE IVCD WITH LAD CONSIDER RVH OR POSTERIOR INFARCT CONSIDER RVH OR PMI W/ SEC REPOL ABNORMALITY TALL R WAVE IN V2, CONSIDER RVH OR PMI CONSIDER RIGHT VENTRICULAR HYPERTROPHY BORDERLINE INFERIOR Q WAVES CONSIDER LAFB OR INFERIOR INFARCT INFERIOR Q WAVES, PROBABLY NORMAL VARIATION IRBBB, THE RSR' PATTERN MAY ALSO REFLECT RVH BORDERLINE LATERAL Q WAVES LATERAL Q WAVES, PROBABLY NORMAL VARIATION BORDERLINE PROLONGED QT INTERVAL LVH BY VOLTAGE LVH BY VOLTAGE CONSIDER LEFT VENTRICULAR HYPERTROPHY LVH BY VOLTAGE LVH BY VOLTAGE CONSIDER LEFT VENTRICULAR HYPERTROPHY LVH BY VOLTAGE MINIMAL ST ELEVATION, ANTERIOR LEADS
A-3
Table A-2
Statement Code
MSTEAL MSTEI MSTEL PLAA PQAL PQAN PQIN PQLA PRAA REPBAL REPBAN REPBIL REPBIN REPBLA RVHS5 RVHS6 SD0AL SD0AN SD0IN SD0LA SD0NS SPR SQT T0AL T0AN T0IN T0LA T0NS TTW30
A-4
MINIMAL ST ELEVATION, ANTEROLATERAL LEADS MINIMAL ST ELEVATION, INFERIOR LEADS MINIMAL ST ELEVATION, LATERAL LEADS PROBABLE LEFT ATRIAL ABNORMALITY BORDERLINE Q WAVE IN ANTEROLATERAL LEADS BORDERLINE Q WAVE IN ANTERIOR LEADS BORDERLINE Q WAVES IN INFERIOR LEADS BORDERLINE Q WAVES IN LATERAL LEADS PROBABLE RIGHT ATRIAL ABNORMALITY BORDERLINE REPOL ABNORMALITY, ANT-LAT LEADS BORDERLINE REPOL ABNORMALITY, ANT LEADS BORDERLINE REPOL ABNORMALITY, INF-LAT LEADS BORDERLINE REPOL ABNORMALITY, INFERIOR LEADS BORDERLINE REPOL ABNORMALITY, LATERAL LEADS CONSIDER RIGHT VENTRICULAR HYPERTROPHY CONSIDER RIGHT VENTRICULAR HYPERTROPHY MINIMAL ST DEPRESSION, ANTEROLATERAL LEADS MINIMAL ST DEPRESSION, ANTERIOR LEADS MINIMAL ST DEPRESSION, INFERIOR LEADS MINIMAL ST DEPRESSION, LATERAL LEADS MINIMAL ST DEPRESSION SHORT PR INTERVAL, ACCELERATED AV CONDUCTION SHORT QT INTERVAL BORDERLINE T ABNORMALITIES, ANT-LAT LEADS BORDERLINE T ABNORMALITIES, ANTERIOR LEADS BORDERLINE T ABNORMALITIES, INFERIOR LEADS BORDERLINE T ABNORMALITIES, LATERAL LEADS BORDERLINE T WAVE ABNORMALITIES TALL T WAVES, PROBABLY NORMAL VARIANT
B
1Specifications
Technical Specifications
ECG Acquisition
Auto (12 leads) Rhythm (up to 12 leads) Disclose (1 lead)
Keyboard
Full alphanumeric capability
Screen Display
640 x 480 pixel resolution Color TFT display
Cardiograph Cart
The cardiograph cart (optional accessory) has been tested for stability using the IEC 60601-1 test protocol. The IEC 60601-1 protocol calls for the cardiograph cart to not tip over using a 10 degree angle of incline in any direction. It is possible to exceed this amount of incline when the cardiograph and cart are moved over a roadside curb or some other small but steep incline. Use care when moving the cardiograph cart. Always remove the patient cable arm before transporting. Install the cart counterbalance prior to the installation of the Patient Cable Arm.
B-1
Specifications
Technical Specifications
Signal Processing/Acquisition
Sampling Rate
2,000 samples per second per electrode/lead 24 bit A/D conversion provides 5V resolution
Filters
AC noise Baseline Wander Artifact High and Low Pass Frequency
Printer
Printer Resolution
High-resolution, digital-array printer using thermal-sensitive paper 200 dpi at 25 mm/sec (voltage axis) by 500 dpi (time axis)
Report Formats
3x4 1R, 3R (Standard, Cabrera) 6x2 (Standard, Cabrera) Panoramic 12 (Cabrera) 12x1(Standard, Cabrera) Rhythm (up to 12 selected leads) 12-Lead Extended Measurements Disclose (1 minute of continuous waveform data for 1 selected lead)
B-2
Technical Specifications
Specifications
Battery Operation
Capacity
Typically 30 ECGs on a single charge or 30 minutes of continuous rhythm recording No fail operation during ECG printing
Recharge
Eight hours to full capacity
Network Connection
10 Base-T IEEE 802.3 Ethernet LAN
ECG Storage
150 ECGs typical for the optional 128 MB PC card PageWriter Trim II: 50 ECGs PageWriter Trim III: 150 ECGs
B-3
Specifications
Technical Specifications
Line Power
100-240 Vac, 50/60 Hz, 65 VA max
Cardiograph Dimensions
310 mm width x 388 mm depth x 176 mm height (12.2 x 15.3 x 6.9 inches)
Cardiograph Weight
7.38 Kilograms (16.3 pounds)
Specifications
B-5
Specifications
transmission. Should interference be encountered, as demonstrated by artifact on the ECG trace, attempt to locate the source by assessing: if the interference is intermittent or constant? does the interference occur only in certain locations? does the interference occur only when in close proximity to certain medical devices? does the ECG signal quality change dramatically when the AC power cord is unplugged? Once the source of the interference is located, attempt to attenuate the EMC coupling path by distancing the cardiograph from the source of the interference as much as possible. If further assistance is needed, contact the Philips Response Center nearest you.
Table B-1 Guidance and Manufacturers Declaration: Electromagentic Emissions
The PageWriter Trim cardiograph is intended for use in the electromagnetic environment specified in the table below. The customer or the user of the PageWriter Trim cardiograph should assure that it is used in such an environment.
Emissions Test Compliance Electromagnetic Environment: guidance
RF Emissions CISPR 11
Group 1
The PageWriter Trim cardiograph uses RF energy only for its internal function. Therefore, its RF emissions are very low are not likely to cause any interference in nearby electronic equipment. The PageWriter Trim cardiograph is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
RF Emissions CISPR 11 Harmonic Emissions IEC 61000-3-2 Voltage fluctuations/ flicker emissions IEC 61000-3-3
Table B-2
The PageWriter Trim cardiograph is intended for use in the electromagnetic environment specified below. The customer or the user of the PageWriter Trim cardiograph should assure that it is used in such an environment.
Emissions Test Compliance Compliance Level Electromagnetic Environment: guidance
Complies
Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.
B-6
Specifications
Table B-2
The PageWriter Trim cardiograph is intended for use in the electromagnetic environment specified below. The customer or the user of the PageWriter Trim cardiograph should assure that it is used in such an environment.
Emissions Test Compliance Compliance Level Electromagnetic Environment: guidance
+/- 2 kV for power supply line +/- 1 kV for input/output lines +/- 1 kV differential mode +/- 2 kV common mode
Complies
Complies
Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11
<5% UT (>95% dip in UT) for 0.5 cycle 40% UT (60% dip in UT) for 5 cycles 70% UT (>30% dip in UT) for 25 cycles <5% UT (>95% dip in UT) for 5 seconds
Complies
Mains power quality should be that of a typical commercial or hospital environment. If the user of the PageWriter Trim cardiograph required continued operation during power mains interruptions, it is recommended that the PageWriter Trim be powered from an uninterruptable power supply or a battery.
3 A/m
Complies
Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.
Note: UT is the a.c. mains voltage prior to application of the test level.
B-7
Specifications
Table B-3
The PageWriter Trim cardiograph is intended for use in the electromagnetic environment specified below. The customer or the user of the PageWriter Trim cardiograph should assure that it is used in such an environment.
Emissions Test IEC 60601 Test Level Compliance Level Electromagnetic Environment: guidance
Portable and mobile RF communications equipment should be used no closer to any part of the PageWriter Trim, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Conducted RF IEC 61000-4-6 3 Vrms 150 kHz to 80 MHz Complies Recommended separation distance
d =
3, 5 3Vrms
Complies
d =
3, 5 3V/m 7 3V/m
d =
Where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site surveya, should be less than the compliance level in each frequency rangeb. Interference may occur in the vicinity of equipment marked with the following symbol:
Note 1: At 80 MHz and 800 MHz, the higher frequency range applies. Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from surfaces, objects, and people.
B-8
Specifications
a.
b.
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radios, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the PageWriter Trim cardiograph is used exceeds the applicable RF compliance level above, the PageWriter Trim cardiograph should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the PageWriter Trim cardiograph. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [3] V/m. Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the PageWriter Trim Cardiograph: for equipment and systems that are not life-supporting
Table B-4
The PageWriter Trim cardiograph is intended for use in the electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the PageWriter Trim cardiograph can help to prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the PageWriter Trim cardiograph as recommended below, according to the maximum output power of the communications equipment.
Rated Maximum Output Power of Transmitter W Separation Distance According to Frequency of Transmitter (m)
150 KHz to 800 KHz d = 1.2 P 0,01 0,1 1 10 100 0.1 m 0.4 m 1.2 m 4.0 m 12.0 m
800 MHz to 2.5 GHz d = 2.3 P 0.2 m 0.7 m 2.3 m 7.0 m 23.0 m
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 frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. Note 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by the absorption and reflection from structures, objects, and people.
B-9
C
1
Overview
This appendix provides instructions on assembling the optional patient cable arm. The patient cable arm is used to hold the Patient Interface Module (PIM). For information on ordering the patient cable arm, see page 7-21.
NOTE Pay close attention to all of the cautions included in this appendix.
The patient cable arm ships with four Phillips head screws, a cart base counterweight with two hex bolts, four cable clips, one small Phillips head lock screw, three hex bolts, and two hex wrenches.
Figure C-1 Patient cable arm assembly kit
C-1
Assembly Instructions
Assembly Instructions
To assemble the patient cable arm: 1 2
Remove the cardiograph from the cart. For more information, see page 1-5. Flip the cart upside down and place onto a plastic sheet to prevent scratches on the cart surface.
CAUTION
Do not place pressure on the Patient Interface Module (PIM) holder when the cart is upside down.
Attach the cart base counterweight to either side of the cart base with the two hex bolts. The patient cable arm will be installed on the opposite side of the cart as the cart base counterweight.
CAUTION
The cart base counterweight must be installed to the cart base before installing the patient cable arm.
C-2
Assembly Instructions
Attach the patient cable arm base to the opposite side of the cart that the base counterweight is attached to.
CAUTION
Do not install the patient cable arm base to the same side of the cart that the cart base counterweight is attached to.
C-3
Assembly Instructions
Insert the small Phillips head lock screw into the base.
C-4
Assembly Instructions
Remove the four Phillips head screws and panel from the Patient Interface Module (PIM) holder and set it aside.
C-5
Assembly Instructions
11 Clip the PIM patient data cable to the patient cable arm in four places.
C-6
Assembly Instructions
Loosen the elbow hinge carefully. The patient cable arm will spring open suddenly.
13 Reattach the cardiograph to the cart. For more information, see page 1-5.
C-7
Index
#
1 minute Disclose report 5-28 12 lead Rhythm report 5-27 12-lead report 12x1 report with cabrera leads 5-22 3x4, 1R report 5-1 3x4, 1R report with cabrera leads and simultaneous acquisition 5-20 3x4, 3R report with standard leads 5-19 6x2 report with cabrera leads 5-21 algorithm version number 5-16 basic measurements 5-4 calibration information 5-11 configurable clinical information 5-8 deleting from the Archive 4-16 device identification number 5-17 examples 5-18 extended measurements 5-25 faxing 4-11 institution information 5-7 interpretive statements 5-2 non-standard lead gains 5-12 order information 5-9 overview 5-1 pacing detection settings 5-13 panoranic (Pan-12) 5-24 Patient ID clinical information 5-5 Patient ID information 5-6 PH080A 5-16 physician information 5-10 printing in the Archive 4-10 quality statements 5-3 report information 5-10 saving to the Archive 4-6 speed and sensitivity settings 5-16 time separator 5-13 12x1 report with cabrera leads 5-22 3x4, 1R report 5-1 cabrera leads and simultaneous acquisition 5-20 3x4, 3R report with standard leads
5-19
AC interference troubleshooting 6-14 AC power indicator light not working 6-6 troubleshooting 6-6 AC power indicator light location 1-17 troubleshooting 6-6 accessories ordering information 1-35, 7-21 part numbers 1-37, 7-23 acquisition time separator 5-13 algorithm version number 5-16 algorithm version 2-3 alligator clips part number 1-36, 7-23 Archive context toolbar 4-7 deleting 12-lead reports 4-16 exporting reports in XML format 4-14 faxing 12-lead report 4-11 functions available 4-6 opening the screen 4-7 printing 12-lead reports 4-10 saving 12-lead reports to 4-6 searching Remote Site with a wildcard character 4-15 artifact muscle 3-12 artifact filter 2-30, 3-12 symbol on printed report 3-12 attaching electrodes 3-3 attaching the lead wires to the electrodes 3-7 Auto ECG setting preview and print options 2-23 taking 3-25
battery battery charge indicator on PageWriter Trim I 1-15 battery charge indicator on PageWriter Trim II and III 1-16 charge time before initial use 1-15,
7-9
charging 7-7 inaccurate battery level reading 6-6 installing 1-14 maintenance and care 7-6 part numbers 1-37, 7-23 replacement 7-8 troubleshooting 6-6 borderline statement suppression feature 2-7
C
cables cleaning 7-2 cabrera leads 12x1 report 5-22 3x4 report example 5-20 6x2 report 5-21 panoramic (Pan-12) report 5-24 calibration pulse 5-11 non-standard lead gains 5-12 scaling 5-11 shapes 5-11 caps lock feature 2-24 cardiograph identification number on printed report 5-17 cardiograph cart cart assembly C-1 cart assembly C-1 installation instructions 1-3 cleaning approved cardiograph cleaning solutions 7-1 approved patient data cable cleaning solutions 7-2 cables 7-2 electrodes 7-2 lead wires 7-2 patient data cable 7-2 clinical information on the printed report 5-5 codes ethnicity 5-7 color-coded waveforms 3-10 computer based training program 1-3 configurable clinical information 5-8 configuration 2-2 connecting the Patient Interface Module to the cardiograph 1-12
Index-1
B
barcode reader diagnostic test 7-13 entering Patient ID information 321
6 lead Rhythm report 5-26 6x2 report with cabrera leads 5-21
A
AAMI electrode placement 3-3 female diagram 3-6 male diagram 3-5 AAMI leads part number 1-35, 7-22 AC fuse part number 1-35, 7-22 replacement 7-9
part number 1-37, 7-23 troubleshooting 6-6 using 1-25 baseline wander filter 2-30, 3-12 symbol on printed report 3-12 basic measurements 5-4 on ECG report 5-4
connector port location 1-7 context-sensitive Help using on the cardiograph 3-33 customer service telephone numbers 1-38, 7-24
D
date format setting 2-41 default display format setting 2-25 deleting 12-lead reports from the Archive 4-16 Device ID on printed report 5-17 diagnostic test barcode reader 7-13 magnetic card reader 7-14 Patient Interface Module (PIM) 7-13 printer 7-14 Disclose 1 minute report 5-28 overview 3-30 report examples 5-28 DNS configuring 2-38 Document Type Definition 4-14 DTD (Document Type Definition) 4-14
institution information 5-7 non-standard lead gains 5-12 order information 5-9 overview 5-1 pacing detection settings 5-13 panoramic (Pan-12) report 5-24 Patient ID information 5-6 clinical information 5-5 PH080A 5-16 physician information 5-10 printing in the Archive 4-10 report information 5-10 Rhythm 5-25 speed and sensitivity settings 5-16 STAT label 5-10 time separator 5-13 ECG reports saving to the Archive 4-6 editing Patient ID information 3-23 electrode placement female diagram 3-6 male diagram 3-5 electrodes attaching to the patient 3-3, 3-6 cleaning 7-2 disposable part number 1-36, 7-22, 723
frequency response filter 3-12 AHA recommendation 3-12 Fridericia rate corrected QT interval
2-3
G
green waveform 3-10
H
Help using on the cardiograph 3-33
I
ID information (Patient) editing 3-23 entering on cardiograph 3-17 on the printed report 5-6 IEC electrode placement 3-3 female diagram 3-6 male diagram 3-5 IEC leads part number 1-35, 7-22 InCenter web site errors opening PDF documents 1-4 using 1-4 institution information 5-7 instructing the patient 3-2 interactive training program 1-3 CD part number 1-37, 7-24 interpretive, reason, and severity statements overview 5-2
E
ECG quality 3-2 ECG acquisition concurrent 5-13 Disclose 3-30 Rhythm 3-28 simultaneous 5-13 taking an Auto ECG 3-25 ECG report 1 minute disclose 5-28 12 lead Rhythm report 5-27 12x1 report with cabrera leads 5-22 3x4, 1R report 5-1 3x4, 1R report with cabrera leads and simultaneous acquisition 5-20 3x4, 3R report with standard leads 5-19 6 lead Rhythm report 5-26 6x2 with cabrera leads 5-21 algorithm version number 5-16 basic measurements 5-4 calibration information 5-11 configurable clinical information
5-8
Emergency ECGs 3-24 entering Patient ID information 3-17 with keyboard 3-19 entering Patient ID information with the barcode reader 3-21 ethnicity codes 5-7 exporting reports XML 4-14 extended measurements report 5-25
K
keyboard entering Orders 4-4 entering Patient ID information 3-19
F
fax configuring for a TraceMaster Remote Site 2-34 faxing 12-lead reports (from the Archive) 4-11 filter artifact 3-12 frequency response 3-12 frequency response AHA recommendations 3-12 filter settings button 2-30 filters artifact symbol on printed report 3-12 as displayed on the printed report
3-11
L
LAN Card part number 1-37, 7-23 LAN connection configuring for a TraceMaster Remote Site 2-36 lead reversal detection feature 2-3 lead wires attaching 3-7 chest leads part number 1-35, 7-22 cleaning 7-2 limb leads part number 1-35, 7-22 replacing 7-10 leads part numbers 1-35, 7-22 leads off troubleshooting 6-9 limb leads axis measurements 5-4 limb plate electrode part number 1-36, 7-23
device identification number 5-17 Disclose 5-28 ECG order information 5-9 examples 5-18 exporting in XML format 4-14 extended measurements 5-25 faxing 4-11
baseline wander 3-12 symbol on printed report 3-12 overview 3-11 setting defaults 2-30 freeze resetting the cardiograph 6-17 troubleshooting 6-16
Index-2
loading configured cardiograph settings 2-47 loose electrode troubleshooting 6-16 lost password 2-41
M
magnet paced 5-15 magnetic card reader diagnostic test 7-14 entering Patient ID information 3-22,
3-23
part number 1-37, 7-23 using 1-26 maintenance battery 7-6 battery replacement 7-8 replacing AC fuses 7-9 tests 7-11 metric units configuring on cardiograph 2-41 modem configuring for a TraceMaster Remote Site 2-34 muscle artifact 3-12
pacing detection settings non-paced 5-15 not known if paced 5-14 on the printed report 5-13 overview 3-31 paced 5-15 paced (magnet) 5-15 PageWriter Trim I AC power cord connector location 1-7 equipotential port location 1-7 front view 1-6 rear view 1-7 PageWriter Trim II and III AC power cord location 1-9 barcode reader connector port location 1-9 configuration 2-1 configuring multiple cardiographs 2-1 opening the screen 2-2 configuration with a Philips TraceMasterVue ECG Management System 2-2 configuring Auto report profiles
2-17
entering on cardiograph 3-17 entering Orders at cardiograph 4-4 entering with keyboard 3-19 entering with magnetic card reader 3-22, 3-23 entering with the barcode reader
3-21
N
navigation tips 1-27 network connection configuring 2-38 configuring for a TraceMaster Remote Site 2-36 non-paced 5-14 non-standard lead gains 5-12 not known if paced 5-14 Notification Message Feature 2-26
O
On/Standby button how to use 1-18 location 1-17 order information 5-9 Order settings 2-28 ordering information supplies 1-35, 7-21 Orders configuring user defined information 2-17 deleting 4-4 entering with keyboard 4-4 information on printed report 5-9 using the Orders screen 4-2 using to enter Patient ID information 3-19 overreading 5-10
P
P? 5-14 paced 5-15 pacemaker and magnet 5-15
configuring default filters 2-30 configuring network settings 2-38 configuring password settings 2-40 configuring Patient ID settings 2-8 equipotential port location 1-9 front view 1-8 PC Card slot location 1-9 rear view 1-9 USB port location 1-9 panoramic (Pan-12) report 5-24 paper part number 1-37, 7-23 part numbers accessories 1-37, 7-23 supplies 1-35, 7-22 password settings configuring 2-40 lost password 2-41 patient cable arm part number 1-37, 7-23 patient data cable approved cleaning solutions 7-2 cleaning 7-2 diagnostic test 7-13 Patient ID clinical information 5-5 Patient ID Information on ECG report 5-5 Patient ID information changing 3-24 clinical codes 5-5 configurable clinical information
5-8
ethnicity codes 5-7 loading Orders 4-2 not entering to take STAT ECG 3-24 on the printed report 5-6 opening a Pending Order 3-19 reviewing 3-24 patient instructions before taking ECG 3-2 Patient Interface Module (PIM) assembly C-1 diagnostic test 7-13 how to connect to cardiograph 1-12 overview 1-10 part number 1-35, 7-22 placing in holder 1-13 replacing the lead wires 7-10 storage 1-13 patient preparation 3-2 skin preparation 3-3 patient session overview 3-1 steps 3-1 PC Card inserting into cardiograph 1-24 part number 1-37, 7-23 removing from cardiograph 1-24 using 1-21 Pending Order using to enter Patient ID information 3-19 PH080A 2-3, 5-16 PH090A 2-3 Philips 12-lead Algorithm borderline interpretive statement suppression 2-7 configuring default settings 2-3 interpretive, reason, and severity statements on printed report 5-2 severity codes 5-3 suppressed borderline interpretive statement listing A-1 version number on printed report
5-16
configuration options 2-8 configuring default settings 2-8 configuring user defined information 2-17 deleting Pending Orders 4-4 editing 3-23
Philips InCenter web site 1-4 errors opening PDF documents 1-4 using 1-4 Philips Response Center telephone numbers 1-38, 7-24 Philips TraceMaster ECG Management System searching a Remote Site 4-14 physician information on ECG report 5-10 physician name configuring option on Patient ID screen 2-14 PM 5-15
Index-3
power indicator light location 1-17 preparing the skin 3-3 printed ECG lead standard setting 2-25 printed report 3x4 report with standard leads 5-19 algorithm version number 5-16 basic measurements 5-4 calibration information
5-11
device identification number 5-17 Disclose report 5-28 examples 5-18 extended measurements 5-25 institution information 5-7 non-standard lead gains 5-12 order information 5-9 overview 5-1 pacing detection settings 5-13 Patient ID information 5-6 PH080A 5-16 physician information 5-10 quality statements 5-3 red stripe appears 1-19, 7-4 speed and sensitivity settings 5-16 time separator 5-13 printer diagnostic test 7-14 printer paper part number 1-37, 7-23 replacing 1-19, 7-4 printing the configuration settings report 2-48 pulse calibration 5-11
lead wires in the Patient Interface Module (PIM) 7-10 printer paper 1-19, 7-4 report format overview 5-1 report information 5-10 reports overview 5-1 resetting the cardiograph 6-17 restoring factory default settings 2-48 reviewing Patient ID information 3-24 Rhythm 3-28 12 lead report 5-27 6 lead report 5-26 using 3-28 Rhythm report 5-25 Rhythm strips recording 3-28
suppressed borderline interpretive statements listing A-1 system freeze resetting the cardiograph 6-17 troubleshooting 6-16
T
TCP/IP configuring 2-38 technical specifications B-1 tests diagnostic 7-11 maintenance 7-11 time format setting 2-41 time separator 5-13 token label 1-9 TraceMaster ECG Management System configuring network connection
2-38
S
saving configured cardiograph settings 2-46 serial number locating on cardiograph 1-4 severity statements 5-2 codes 5-3 signal quality checking 3-7 color-coded waveforms 3-10 indicators 3-7 troubleshooting 6-14 simulated waveform data feature 2-27 simultaneous acquisition report example 5-20 skeletal muscle artifact 3-12 skin preparation before taking ECG 3-3 SmartCard Reader part number 1-37, 7-23 using 1-26 software navigation tips 1-27 upgrade feature 2-24 somatic tremors troubleshooting 6-15 speed and sensitivity settings 5-16 ST segment distortion and Rhythm filter settings 2-32 Standby button location 1-17 configuring default settings 2-25 how to use 1-18 STAT ECG configuring Patient ID screen option 2-14 label on the printed report 5-10 taking 3-24 supplies ordering information 1-35, 7-21 part numbers 1-35, 7-22
Q
quality indicator green waveform 3-10 red dotted line 3-8, 3-10 yellow waveform 3-10 quality statements 5-3 query remote 4-14 Quick Search Fields feature 2-28
troubleshooting 6-2 TraceMasterVue ECG Management System configuring with cardiograph 2-2 training program 1-3 transferring reports XML 4-14 troubleshooting AC power 6-6 AC power indicator light 6-6 barcode reader 6-6 battery 6-6 leads off 6-9 loose electrode 6-16 Philips Response Center phone numbers 1-38, 7-24 red stripe on printed report 1-19, 7-4 signal quality 6-14 somatic tremors 6-15 system freeze 6-16 wandering baseline 6-15
U
Unconfirmed Diagnosis label on printed report 5-10 UPIN (Universal Physician Identification Number) on the printed report 5-10 USB memory stick 1-24 user documentation CD part number 1-37, 7-24
R
R/T ECG taking an Auto ECG 3-25 troubleshooting 6-16 reason statements 5-2 remote query 4-14 Remote Site searching on the cardiograph 4-14 searching with a wildcard character 4-15 replacing AC fuses 7-9 battery 7-8
W
wandering baseline troubleshooting 6-15 waveform green 3-10
Index-4
waveform size and sensitivity settings printed report 5-16 Welsh electrodes part number 1-36, 7-23 wildcard character search 4-15 WINS configuring 2-38 wireless LAN installation instructions 1-3 wireless LAN option 1-22 waveform yellow 3-10
X
XML exporting reports 4-14 XML information 1-3 XMT 4-7
Y
yellow waveform 3-10
Index-5
Philips Medical Systems 3000 Minuteman Road Andover, MA 01810 USA PageWriter Trim I, II, III Cardiograph Instructions For Use M4992-91150 Edition 4