Basic Patient Monitoring Knobology

Regina Yap
Patient Care & Clinical Informatics
June, 2013
 The Monitor

•  1 Color coded alarm lamps

•  2 Alarms Off lamp
•  3 Power on/Standby switch with
•  integrated LED: Green - On/
•  Standby, Red - Error
•  4 AC power LED
•  5 Mounting quick-release lever
•  (when this is pressed the
•  monitor is not fixed on the
•  mounting)
•  6 Part number and serial number

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 Devices for Acquiring Measurements

•  Flexible Module Rack (M8048A)

•  The FMS lets you use up to eight plug-in
physiological measurement modules.
•  The maximum number of specific module
types that can be used simultaneously in an
FMS is: 5 pressure modules, 4 temperature
modules, 4 VueLink or IntelliBridge modules
(any combination).

–  1 X1 Multi-Measurement Module
–  2 Multi-Measurement Module mount
–  3 Flexible Module Rack
–  4 Power on LED
–  5 Interruption indicator

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 Devices for Acquiring Measurements

•  X1 Multi-Measurement Module
(M3001A)
•  The X1 MMS can simultaneously
monitor 3-, 5-, 6- or 10-lead ECG
•  (including arrhythmia and ST
monitoring), respiration, SpO2,
NBP and either invasive pressure
or temperature.
•  Connect it to the monitor via a
cable or mount it on the left side
of the FMS.

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 Devices for Acquiring Measurements

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 1. Disabling Touchscreen Operation? (If Applicable)
• To temporarily disable the touchscreen operation of the monitor,
press and
Hold the Main Screen key for 5 seconds. A padlock will appear
(blinking)

• Press and hold the Main Screen permanent key again for 5
seconds to
Re-enable the touch screen

2. Cleaning Your Monitor?

• Clean with lint free cloth, moistened with warm water (40
degrees Celcius) and soap,
diluted non-caustic detergent, ammonia or alchohol based
cleaning agent.
• Do not use strong solvents such as acetone or trichloroethylene.

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 3. Multi Measurement Server (MMS) storing data?
• The MMS can store up to 8 hours of patient data at one minute resolution
• It stores patient information and measurement settings

4. Patient MisMatch where data is not the same at the

Central Station and Bedside Monitor?
Continue Central : to continue
With patient data from Central
Discharge patient in monitor

Continue Monitor: to continue

With patient in the monitor and
Discharge patient at the Central
Permaently deleting all data at the
Central

New Patient

Same Patient
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 5. CareGroups – viewing of other patient data from your monitor?
• View patient data, be notified of Yellow & Red alarms and see alarm status of all beds

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 6. ECG Lead Display showing the Pacing Spikes & ECG Defib Sync?

Pace pulse markers: The white spikes are shown if the Pace Mode
Is switched ON and if the patient has a pace signal

Defib Sync Marks: If the monitor is connected to a HP/Agilent/Philips

Defibrillator, the white vertical lines are shown on the ECG

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 7. The 20 configurable screens that can be loaded on your monitor
• The monitor comes with a set of preconfigured screens

• You can easily switch between different screens.

• Screens do NOT affect change alarm settings or

patient category

• When you switch from 8 wave to 6 wave screen,

some measurements may not be visible but it is still
monitored in the background.

• An asterisk will appear when you make changes

to a default screen. Changes made can only be stored
In the Config Mode.

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 8. The Calculator and Keyboard within your monitor?

On-Screen Calculator
You can use the on screen calculator to perform any
Standard operations.
• To access calculator, select Main Setup--Calculations--
--Calculator

On-Screen Keyboard
You can use the on-screen keyboard to Enter information,
Admit/Discharge patient, Hemodynamic calculations,
Height, Weight etc

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9. Label (ABP, ART, Temp) Conflicts and How to Resolve these conflicts?

To resolve a label conflict,

• Select Measurement Selection Key (Caterpillar) to display the measurement
Selection window
• Select device/port whose label you want to correct
Select either:-
--Change Label to assign different label
--Deactivate to disable the conflicting device, as though it has been unplugged

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 10. Viewing All Alarm Limits?

• To open the Alarm Limits

window, either select any alarm
field to open the Alarm Message
Window

• Select Alarm Limits pop up key

• OR select Alarm Limits Smartkey

if configured

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 11. Veni Puncture?

• You can use the NBP cuff to cause sub-diastolic pressure.

• The cuff deflates automatically after a set time
• Adults / peads – 170 seconds
• Neonates – 85 seconds

• Select Veni Puncture Smartkey

• Puncture vein and draw sample
• Reselect Veni Puncture to deflate cuff

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 12. Vital Trends & Graph Trends?

• To open a tabular trends window over the current Screen,

Select the Vital Trend Smartkey

• To open the Graphic trends window over the current screen
• Select the Graph Trends Smartkey

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 ALARMS

•  Red – 3 star •  Alarm Silence

•  Yellow – 2 star bed •  Alarm Pause
•  Yellow – 2 star
arrhythmia
•  Blue – 1 star

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 Finding a measurement….

•  If you have connected a patient to the monitor

and one of the measurements does not begin to
monitor straight away follow these steps
1.  Press measurement selection icon
2.  Press the set up pop up key
3.  Turn measurement ON
4.  Or use the Main set up key
(note: don’t get confused with alarm on/off)

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 Measurement Selection

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 Admitting
Select the Admit/Discharge Smart Key
ê
Select the Admit pop up key
ê
Type in patients last name
ê
Press enter
ê
Continue as prompted
ê
When all the details are entered press the CONFIRM key at the
bottom of the screen
ê
The patients details should now appear at the top left hand side of
the screen

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 Discharging

Select the Admit/Discharge Smart Key

ê
Select the Discharge Pop up Key
ê
Press CONFIRM
ê
All the data is now erased from the monitor and
information centre

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 ECG Waves – leads on the monitor

•  P wave = atrial depolarization

•  QRS complex = ventricular

depolarization

•  T wave = ventricular
repolarization
R

P T

Q S

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 Frontal Plane Leads for bedside monitor ECG

Limb Leads

Eindhoven’s Triangle

Augmented Limb Leads

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 EASI LEAD PLACEMENT

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 ECG

•  Review the essentials of skin preparation

•  Demonstrate how to enlarge a waveform
•  Demonstrate how to change the lead view
•  Review of arrhythmia set up
•  Review when and why you would use the relearn
key
•  Demonstrate how to turn arrhythmia alarms on/off

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 ECG Morphology Measurements

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 Pacing

•  Demonstrate how to turn pacing mode on/off

•  Review implications for respiratory monitoring

•  Identify key problem solving methods

– Positive/negative QRS
– Height of QRS complex

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 Respiratory review

•  Review where the measurement come from

–  whiteà red dot

•  Identify and demonstrate how to problem solve respiratory

monitoring
–  Ensure leads are on the chest
–  Increasing the waveform size
–  Auto vs. manual mode

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 SpO2 Monitoring

•  Review the key principles

•  Think about the correct sensor and location

•  Define Perf

•  Desaturation alarm

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 Non Invasive Blood Pressure

•  Review cuff size

•  Demonstrate how to initiate a reading

•  Demonstrate changing repeat time

•  Define to difference of auto/manual, demonstrate how to

change between the 2

•  Highlight venipuncture function and define what it does

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 Invasive Pressure Monitoring

•  Demonstrate how to zero

•  Demonstrate how to changing scale

•  Demonstrate how to changing labels

•  Review and demonstrate how to identify and resolve

pressure module conflicts

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 Monitoring Invasive Pressure
•  Selecting a Pressure for Monitoring
•  Tell the monitor which pressure you want
by selecting its pressure label.
•  The label is a unique identifier for each
type of pressure.
•  When you choose a label, the monitor
uses that label‘s stored settings, for
example colour, wave scale and alarm
settings.
•  The label also determines which algorithm
is used to process the pressure signal, so
an incorrect label can lead to incorrect
pressure values

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 Monitoring Invasive Pressure

Confidential Patient Care & Clinical Informatics, April, 2013

 Monitoring Invasive Pressure

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 Invasive pressure monitoring

•  ABP
–  Direct measure of blood pressure via catheter inserted into artery,
transduced into a digital signal in monitor
–  Normal : 120/60 (80)mmH
•  CVP
–  Direct measurement of right atrial pressure and reflects right sided
heart functioning
–  Normal : 3 -11 mmHg
•  PAP
–  Pulmonary artery pressure reflects right ventricular pressure and
thus right ventriacular function
–  Normal :20/10 (13) mmHg

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 Invasive Blood Pressure

•  PAWP
–  Pulmonary artery wedge pressure is obtained by inflating a balloon
at the tip of the PA catheter and results in an indirect measurement
of left ventricular pressure and thus LV function
–  The measurement must be calculated at the end of the respiratory
cycle to eliminate thoracic pressure influence
–  Normal; 6-12 mmHg
•  ICP
–  Intracranial pressure is a direct measurement of pressure on the
brain
–  Normal: 4-8 mmHg
–  CPP equals the difference between mean ABP and ICP

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Confidential Patient Care & Clinical Informatics, April, 2013
 Central Venous Pressure

•  Central Venous Pressure is a

direct measurement of the blood
pressure in the right Atrium and
vena cava.

•  •It is acquired by threading a CV

catheter into any large veins and
the tip of the catheter sits in the
lower third of the superior vena
cava.

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 •  The CVP catheter is an important
tool to asses right ventricular
function and systemic fluid status.
•  Normal CVP is 2-6mmHg
•  If CVP measurement is
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then insert it again. elevated, it could be due to:-
•  •Over hydration which increases
venous return
•  •Heart failure or PA stenosis–
limits venous outflow that leads to
venous congestion

•  If CVP measurement is
decreased, it could be due to:-
•  •Hypovolimicshock from
hemorrhage,dehydration
•  •Negative pressure breathing
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 Data Continuum
BASIC – Data in Monitor Only

What is Transferred?
-  8 Hours Data
(1 minute Resolution)
-  Alarm Limits
-  Demographics

Monitor Data
Central Data
External Data

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 Data Continuum
BASIC – Data in Monitor Only

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 Data Continuum
BASIC – Data in Monitor Only

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 Data Continuum
BASIC – in MMS Only

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 Data Continuum
NETWORKED – Data in Central and Monitor

What is Transferred?
Discharge and save data
Readmit patient into sector

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 Data Transfer
•  When moving from Monitor àMonitor Admit/Discharge Key
ê
Transfer Key
ê
Remove MMS
ê
Place into transport Monitor
ê
Move Patient
ê
Place the MMS into the new monitor
ê
When patient conflict appears continue with MMS
(the patient is then transferred on the monitor and the central station)

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 Patient Conflict

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 Resolving Patient Conflicts

•  4 Options
–  Continue Monitor- information from the monitor and
information centre will be used the information in the
MMS will be erased
–  Continue MMS- information from the MMS will be used
and the information in the monitor and information
centre will be erased
–  New Patient- all information on the monitor, information
centre and MMS will be erased
–  Same Patient- the information on the MMS, monitor and
information centre will be blended together

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Break out into groups and
perform a Lab exercise
 Hands On Time!

ü Admit yourself
ü Change the Primary ECG to Lead III
ü Adjust the ECG size
ü Turn Paced On/Off
ü Select the big numerics screen
ü Turn Off Irregular HR Arrhythmia Alarm
ü Turn On the QRS Volume & Adjust the QRS Volume
ü Review the Alarm Limits for NBP – what are the options?
ü Turn off all Alarms using Alarm Limits Smart keys- what happens &
what are the implications?
ü Find the System Pulse numeric- why is the alarm defaulted to off
when HR is the alarm source?

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 Hands On Time! continued….

ü Increase/Decrease the Alarm Volume

ü Adjust Alarm Limits per Measurement
ü Turn On/Off Alarms per Measurement
ü Change a Wave Position on the Screen
ü Turn On/Off Measurements ( Waves & Numerics)
ü Review Smart keys per row – find the Trends Smart key
ü Suspend Alarms for 2 minutes; then unsuspend. What is the difference
between Slience Alarms and Pause Alarms?
ü Adjust the Screen Brightness

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June