Avalon fm20 руководство

• Page 1
  In stru ctio ns fo r Use Avalon Fetal Monitor FM20/30, FM40/50 Rel ease G.0 with Software Rev ision G.02.x x Patient Monitori ng…

• Page 3: Table Of Contents

  Safety Tests 3 Basic Operation Supported Measurements Avalon FM20 and FM30 Avalon FM40 and FM50 Cordless Monitoring Getting to Know Your Avalon FM20/FM30 Getting to Know Your Avalon FM40/FM50 Operating and Navigating Operating Modes Automatic Screen Layouts Settings Checking Your Monitor Revision…

• Page 4
  5 Alarms Alarm Mode Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms Acknowledging Disconnect INOPs Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at Power On 6 Patient Alarms and INOPs Alarm Messages Technical Alarm Messages (INOPs) 7 Admitting and Discharging Admit/Discharge on the Monitor…
• Page 5
  Fetal Movement Profile Troubleshooting Additional Information Testing Ultrasound Transducers 11 Monitoring Twin FHRs Important Considerations Monitoring Twins Externally Monitoring Twins Internally Cross-Channel Verification Separating FHR Traces Troubleshooting 12 Monitoring Triple FHRs Important Considerations Monitoring Triplets Cross-Channel Verification Separating FHR Traces «Standard»…
• Page 6
  Testing DECG Mode 17 Monitoring Noninvasive Blood Pressure Introducing the Oscillometric Noninvasive Blood Pressure Measurement Preparing to Measure Noninvasive Blood Pressure Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Choosing the Alarm Source Assisting Venous Puncture Calibration Troubleshooting 18 Monitoring SpO2 Selecting an SpO2 Sensor…
• Page 7
  Cleaning and Disinfecting Cleaning and Disinfecting Monitoring Accessories Sterilizing 24 Maintenance Inspecting the Equipment and Accessories Inspecting the Cables and Cords Maintenance Task and Test Schedule Storing Recorder Paper Cleaning the Printhead Disposing of the Monitor 25 Accessories and Supplies Information on Latex Transducers Fetal Accessories…

• Page 9: Introduction

  Introduction Who this Book is For This book is for trained healthcare professionals using the Avalon FM20, FM30, FM40 and FM50 fetal/maternal monitors. It describes how to set up and use the monitor and transducers. Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about application and care and cleaning that is not repeated in this book.

• Page 10: Confirm Fetal Life Before Using The Monitor

  1 Introduction Confirm Fetal Life Before Using the Monitor Fetal monitoring technology available today is not always able to differentiate a fetal heart rate (FHR) signal source from a maternal heart rate (MHR) source in all situations. Therefore, you should confirm fetal life by independent means before starting to use the fetal monitor, for example, by palpation of fetal movement or auscultation of fetal heart sounds using a fetoscope, stethoscope, or Pinard stethoscope.

• Page 11: Introducing The Avalon Family Of Fetal Monitors

  1 Introduction Introducing the Avalon Family of Fetal Monitors The Avalon family of fetal monitors consists of the Avalon FM20, FM30, FM40 and FM50. While the FM20/FM30 and the FM40/FM50 have different form factors, the method of operation is very similar for all monitors.

• Page 12
  1 Introduction Indications for Use Avalon Fetal/Maternal Monitor FM20: Indicated for use by trained health care professionals whenever there is a need for monitoring of the physiological parameters uterine activity, heart rate, oxygen saturation, non-invasive blood pressure, pulse rate of pregnant women and the fetal heart rates of single fetuses, twins, and triplets in labor and delivery rooms, in antepartum testing areas, in private households and during transports in healthcare facilities.

• Page 13: Installation

  For a list of conventions used in this guide, see “Basic Operation” on page 19. Not all accessories and supplies may be available in all geographies. Please contact your local Philips sales representative for details of availability. Installation Checklist Use this checklist to document your installation.

• Page 14: Unpacking And Checking The Shipment

  2 Installation Step Task Check Box when Task Done Check/set paper speed (see “Choosing Paper Speed” on page 48) Perform System Test as necessary (see the Service Guide) For monitors with the battery option (#E25) chosen, confirm that the battery can be charged, and that the monitor can be powered by the battery.

• Page 15: Mounting The Monitor

  2 Installation Claims for Damage If the shipping cartons are damaged, contact the carrier. If any of the equipment is damaged, contact both the carrier and your local Philips service organization for repair or replacement arrangements. Repacking Retain the original packing carton and material, in case you need to return equipment to Philips for service.

• Page 16: Connecting The Monitor To Ac Mains

  2 Installation Connecting the Monitor to AC Mains FM20/30 The monitor is an electrical Class II device in which the protection against electric shock does not rely on basic insulation and a protective earth conductor but on double and/or reinforced insulation. FM40/50 The monitor is an electrical Class I device.

• Page 17: How And When To Carry Out The Test Blocks

  2 Installation How and When to Carry Out the Test Blocks The following table defines which test and inspection blocks need to be performed, and when they are required. Test Block Test or Inspection to be Performed Test Block Required for Which Events? Visual Inspect the monitor, transducers and cables for any…

• Page 18: Safety Tests

  2 Installation Safety Tests Details of the safety tests and procedures required after an installation or an exchange of system components are described in your monitor’s Service Guide. These safety tests are derived from international standards but may not be sufficient to meet local requirements. WARNING •…

• Page 19: Basic Operation

  Basic Operation This chapter gives you an overview of the monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on, changing some monitor settings, and setting up the recorder). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.

• Page 20: Avalon Fm20 And Fm30

  This section outlines the capabilities of your monitor. Avalon FM20 The Avalon FM20 fetal/maternal monitor provides a solution for external fetal monitoring applications, and optional non-invasive maternal vital signs. You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity and maternal pulse using an external Toco transducer, and the maternal heart rate (MHR) via maternal ECG electrodes, and optionally, non-invasive blood pressure.

• Page 21: Avalon Fm40 And Fm50

  The Avalon FM30 fetal/maternal monitor offers a solution for both external and internal fetal monitoring applications, and optional non-invasive maternal vital signs. The Avalon FM30 shares all the features and capabilities of the Avalon FM20. In addition, you can monitor one FHR internally via direct fetal electrocardiogram (DECG), uterine activity internally using…

• Page 22: Cordless Monitoring

  3 Basic Operation Avalon FM50 The Avalon FM50 fetal/maternal monitor offers a solution for both external and internal fetal monitoring applications, and non-invasive maternal vital signs. The Avalon FM50 shares all the features and capabilities of the Avalon FM40. In addition, you can monitor one FHR internally via direct fetal electrocardiogram (DECG), and uterine activity internally using an intra-uterine pressure (IUP) catheter together with a Toco transducer or patient module.

• Page 23: Getting To Know Your Avalon Fm20/Fm30

  3 Basic Operation Getting to Know Your Avalon FM20/FM30 Overview Touchscreen Display (tilt and fold) Power LED Paper Drawer Paper Drawer release Connectors (see Left Side view) Right Side On/Off Switch Power Connector with Battery Option On/Standby Switch MSL Connector…

• Page 24: Getting To Know Your Avalon Fm40/Fm50

  3 Basic Operation Rear 10 Display Release 11 Carrying Handle 12 Built-in Stand Left Side 13 SpO Socket (optional) 14 Noninvasive Blood Pressure Socket (optional) 15 Fetal Sensor Sockets — each socket accepts any fetal transducer, an Avalon CTS Cordless Fetal Transducer System base station (connected via the interface cable M2731- 60001), or event marker…

• Page 25
  3 Basic Operation Rear Reserved for future use: protective earth intended for use in system installations. Equipotential Grounding Point Power Cord Connector Loudspeaker Slot 01 for optional LAN / RS232 system interface (for connection to an obstetrical information and surveillance system) Slot 02 for optional interfaces: Either dual PS/2 system…
• Page 26
  3 Basic Operation Ultrasound Transducer (M2736A) Cable — connects to any of the four Fetal Sensor Sockets on the monitor Note that the The M2736AA US transducer is identical to the M2736A US transducer, including all specifications. Toco Transducer with ECG/IUP capability (M2735A) transducer only) Connector — for connecting ECG/IUP adapter cables (M2735A Toco Butterfly Belt Clip (shown…

• Page 27: Operating And Navigating

  3 Basic Operation Patient Module for ECG/IUP (M2738A) Connector — for connecting ECG/IUP adapter cables (same as for Toco transducer) 10 Cable — connects to any of the four Fetal Sensor Sockets on the monitor Operating and Navigating Your monitor has a touchscreen. Everything you need to operate the monitor, other than to turn it on and off, is contained on its screen.

• Page 28
  3 Basic Operation Date and time Bed label (when connected to a Philips OB TraceVue system) Fetal heart sound volume adjust/indicator Alarm volume adjust/indicator Numeric/measurement values Fetal Trace Recorder — status indicator Fetal recorder is On Fetal recorder is Off (when Paper Save Mode is off )
• Page 29
  3 Basic Operation Status line — shows status and prompt messages Signal quality indicator Good / full acceptable / medium Poor / no signal Measurement label (a cordless measurement from a connected Avalon CTS system is indicated by symbol) NST timer, if configured (default is Off) Keys The monitor has three different types of keys.
• Page 30
  3 Basic Operation SmartKeys SmartKeys are configurable graphical keys, located at the bottom of the main screen. They give you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. Main Setup Start/ Stop — enter main setup…
• Page 31
  3 Basic Operation Start/ Stop Stop All — stop all noninvasive blood pressure measurements — start/stop manual noninvasive blood pressure measurement — start auto series — stop current automatic measurement within series Start NBP Stop NBP — start manual noninvasive blood — stop manual noninvasive blood pressure measurement pressure measurement…

• Page 32: Operating Modes

  3 Basic Operation Selecting Screen Elements Select a screen element to tell the monitor to carry out the actions linked to the element. You access most screen elements by touching that element directly. For example, select the FHR1 Setup FHR1 Start/ Stop numeric to call up the menu, or select the…

• Page 33: Automatic Screen Layouts

  3 Basic Operation Automatic Screen Layouts Your monitor’s preconfigured screen layouts define how measurement information is arranged on screen. The monitor automatically applies the correct screen layout for the measurements you are monitoring. No user action is required. Connecting or disconnecting transducers, or switching the noninvasive blood pressure measurement on or off, results in an automatic adjustment of the screen layout.

• Page 34
  3 Basic Operation CAUTION This resets all settings to factory defined values, but be aware that some values will differ from those with which the monitor was originally shipped from the factory (recorder speed and paper scale type will need to be corrected, for instance). After loading the Factory Default, please check the settings and, if necessary, change them to the settings you normally use.

• Page 35: Checking Your Monitor Revision

  Store Date, Time Select to change the date and time. If connected to a Philips OB TraceVue system, the monitor uses the OB TraceVue system date and time, including daylight saving time changes. WARNING Changing the date and time while the monitor is connected to an OB TraceVue system can result in a mismatch in the time and date between the monitor and the OB TraceVue system.

• Page 36
  3 Basic Operation Switching On: FM20/FM30 FM20/30 • Connect the monitor to AC mains and switch the monitor on. • The green power-on LED comes on. Selftest: OK • The monitor performs a self-test as it starts up. , the serial number, and revisions for Auto Start the software and firmware are printed on the fetal trace paper (if recorder is configured…
• Page 37
  3 Basic Operation Lift the display forwards. You hear a click as the first position engages. If you want to tilt the display further, lift the display further forwards until you reach the desired angle. To fold the display: Pull the display forwards as far as it will go. Then push it all the way back until it clicks shut.
• Page 38
  3 Basic Operation Fastening Belts and Transducers You can use more than one belt if, for example, you are monitoring uterine activity and FHR simultaneously. There are two basic ways to fasten belts and transducers: • Belts with button fixings. •…
• Page 39
  3 Basic Operation Using Belt with Velcro Fixings Insert one end of the belt between the belt guides on one side of the butterfly belt clip, and secure with the velcro fixing. Insert the other end of the belt between the belt guides on the other side of the butterfly belt clip, adjust for the correct tension, then secure with the velcro fixing.
• Page 40
  3 Basic Operation Connecting a Transducer to the Monitor socket Noninvasive blood pressure socket Fetal sensor sockets You can plug a fetal transducer, a ECG/IUP patient module, an Avalon CTS Cordless Fetal Transducer System interface cable (M2731-60001, red connector), or an external event marker into any of the four fetal sensor sockets marked or «Fetal Sensors»…
• Page 41
  3 Basic Operation When you connect a transducer or sensor: • The appropriate measurement is shown on the display. For fetal measurements using an Avalon CTS system, the symbol appears additionally next to the measurement label, indicating that the measurement is being made by a cordless transducer. Measurement label Cordless measurement symbol •…
• Page 42
  3 Basic Operation • The recorder prints an annotation showing the date, time, paper speed, and monitoring mode. It repeats this every 10 minutes. Checking/Setting Paper Scale Scale Type Internat’l Fetal You can check the paper for USA, or for other geographies) in the Recorder menu.
• Page 43
  3 Basic Operation A — Protrusion holds paper guide in closed position Release the paper guide from one side of the holder..then remove the paper guide.
• Page 44
  Refitting is a reversal of the removal procedure. Loading Paper: FM20/FM30 CAUTION Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty. FM20/30…
• Page 45
  Off ” on page 49 for details). Loading Paper: FM40/FM50 CAUTION Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty. FM40/50…
• Page 46
  3 Basic Operation A — Protrusion holds paper guide in closed position Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is indicated by the word STOP printed on the final page of the new pack. Unfold the top page of the pack and position the uterine activity scale on the right.
• Page 47
  3 Basic Operation Now close the paper guide. Start/ Stop Start Recordng Press the recorder SmartKey or the SmartKey to switch on the recorder. Annotations of trace information are printed on the trace paper (see “Switching the Recorder On and Off ” on page 49 for details). Paper-Out Indication Each pack of paper has 150 pages.
• Page 48
  3 Basic Operation Choosing Paper Speed You can choose a paper speed of 1, 2, or 3 centimeters per minute (cm/min). The default setting is 3 cm/min. The ACOG technical bulletin on FHR monitoring states that «accurate pattern recognition is difficult if not impossible at 1 cm/min and that 1 cm/min is only recommended for more economic screening.
• Page 49
  3 Basic Operation Using the Paper Guide To tear off the trace paper after monitoring using the paper guide: If the recorder is running (the «recorder on» status indicator is displayed), turn off the Start/ Stop Stop Recordng recorder by selecting the fetal recorder SmartKey or the SmartKey.
• Page 50
  3 Basic Operation When you switch on: • The «recorder on» status indicator is displayed in the bottom right-hand corner of the screen. • The paper advances quickly for 2 cm and then returns to the set speed. • Whenever the recorder is switched on, a trace header is printed vertically on the trace paper, containing the following: Selftest: OK –…
• Page 51
  3 Basic Operation The monitor prints the time, date, paper speed and monitoring modes in the trace header when first switched on, in a periodic time stamp every ten minutes after, and if the monitoring modes change. The time stamp begins with the symbol.
• Page 52
  3 Basic Operation To mark an event on the trace paper you can: Set Marker • Either select the SmartKey • Or press the button on the remote event marker. The remote event marker is connected to the monitor via any fetal transducer socket. A small arrow is printed on the heart rate scale on the trace paper.

• Page 53: Starting Monitoring

  3 Basic Operation MD Notified Sitting On Back Left Lateral Ambulating Tocolytic Given Membranes Ruptured Amniotomy Amniotic Fluid Clear Amniotic Fluid Not Clear Oxytocin Urinary Catheter Micro Blood Analysis Up to two notes can be printed directly, and the monitor can temporarily store up to a further two notes, and these are printed after the first two have been recorded.

• Page 54: Switching The Monitor To Standby

  3 Basic Operation Switching the Monitor to Standby To switch the monitor to Standby: Either Monitor Standby Select the SmartKey Main Setup Enter the menu using the SmartKey Monitor Standby Select Pressing any key or selecting any field on the screen will resume monitoring. After Monitoring Discharge the patient.

• Page 55: Troubleshooting

  3 Basic Operation Troubleshooting Problem Possible Causes Solutions Light or no trace. Wrong paper. Use recommended paper. Dirty printhead. Clean printhead. See “Cleaning the Printhead” on page 177. FM20/30 only: Paper misaligned due to Shut the drawer fully, pushing evenly with drawer not being correctly shut.

• Page 56
  3 Basic Operation…

• Page 57: Using Batteries (With Fm20/30 Battery Option)

  Using Batteries (with FM20/30 Battery Option) You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. The monitor is connected to the AC mains power via the external power supply. NOTE The Battery Option is not available for the FM40/FM50.

• Page 58: External Power Supply M8023A

  4 Using Batteries (with FM20/30 Battery Option) External Power Supply M8023A The external power supply M8023A (option #E25) allows you to operate the fetal monitor from an AC (alternating current) power source of 100 V to 240 V (± 10%) and 50/60 Hz (± 5%). If this option is used, then the M8023A (option #E25) power supply is included for FM20/30.

• Page 59
  4 Using Batteries (with FM20/30 Battery Option) Battery LED Colors If the monitor is connected to If the monitor is running on mains power, this means battery power, this means battery power is > 90% Green battery charging (battery power Yellow <…

• Page 60: Battery Status Window

  4 Using Batteries (with FM20/30 Battery Option) Battery Status Indicator Battery Malfunction Indicator Alternates with the battery gauge on the The red ! flashes. Critical battery Main Screen. situation or malfunction. Check in the Battery Statuswindow Check in the Battery Status window to see which malfunction to see which status symbol is displayed to indicator is displayed, or refer to…

• Page 61: Optimizing Battery Performance

  4 Using Batteries (with FM20/30 Battery Option) Battery status symbols Battery malfunction symbols battery is empty (red) incompatible battery battery not charging as the temperature (red) battery malfunction is above or below the specified range battery requires maintenance (red) battery has no power left charging stopped to protect the battery (red) battery temperature too high (red) battery is missing, insert battery…

• Page 62
  Battery Safety Information WARNING Use only Philips batteries part number M4605A. Use of a different battery may present a risk of fire or explosion. Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.

• Page 63: Alarms

  Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is contained in the sections on individual measurements. The fetal monitor has three alarm levels: red, yellow, and INOP. Red and yellow alarms are patient alarms. A red alarm indicates high priority, such as a potentially life threatening situation (for example, SpO below the desaturation alarm limit).

• Page 64: Visual Alarm Indicators

  The audible alarm indicators of your monitor are configurable. In the monitor’s Configuration Mode, you can change the alarm sound to suit the different alarm standards valid in different countries. Standard Philips Alarms • Red alarms: A high pitched sound is repeated once a second.

• Page 65
  5 Alarms • Yellow alarms: A lower pitched sound is repeated every two seconds. • INOPs: an INOP tone is repeated every two seconds. ISO/IEC Standard 9703-2 Audible Alarms • Red alarms: A high pitched tone is repeated five times, followed by a pause. •…

• Page 66: Acknowledging Alarms

  5 Alarms Acknowledging Alarms Silence To acknowledge all active alarms and INOPs, select the . This switches off the audible alarm indicators. A check mark beside the alarm message indicates that the alarm has been acknowledged. If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it.

• Page 67
  5 Alarms Alarms Off Select the SmartKey. Main Setup Select Alarms Select Alarms Off Select To Switch Individual Measurement Alarms On or Off This applies to alarm mode Select the measurement numeric to enter its setup menu. Alarms Select to toggle between The alarms off symbol is shown beside the measurement numeric.

• Page 68: Alarm Limits

  5 Alarms Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different scenarios. Always check that the alarm settings are appropriate before you start monitoring. Viewing Individual Alarm Limits (Alarm Mode «All»…

• Page 69: Latching Alarms

  5 Alarms Review Alarms Window Alarms On SpO₂ NON-PULSAT. Alarms Silenced ** FHR1 HIGH ** SpO₂ LOW Review Alarms window contains a list of up to 300 of the most recent alarms and INOPs with date and time information. If configured to do so, each alarm is shown with the alarm limit active Review Alarms when the alarm was triggered and the maximum value measured beyond this limit.

• Page 70
  5 Alarms then audible latching can only be set to . The following table shows the possible combinations for latching settings: Possible Combinations for Alarm Latching Settings Visual Latching Setting Audible Latching Setting Red and Yellow Red and Yellow Red and Yellow Red and Yellow Alarm Latching Behavior Alarm Condition…

• Page 71: Testing Alarms

  5 Alarms Testing Alarms In general, to test the functioning of visible and audible alarms, do the following: Enable the alarm. Set the alarm limits. Measure or simulate the parameter that is out of range, or signal loss. Verify that the visible and audible alarms are working. As an example, to test the FHR alarms: Connect the US transducer to a fetal sensor socket.

• Page 72
  5 Alarms…

• Page 73: Patient Alarms And Inops

  Patient Alarms and INOPs This chapter lists alarms and technical alarms (INOPs) for the fetal monitors, alphabetically, irrespective of their priority. INOPs start “Technical Alarm Messages (INOPs)” on page 76. Alarm Messages Fetal alarms are identified by either «FHR» or «DFHR». All other alarms without these identifiers refer to maternal parameters.

• Page 74
  6 Patient Alarms and INOPs Alarm Message From Condition Indication *** EXTREME BRADY MECG The maternal heart rate obtained Numeric flashes, red alarm from the maternal ECG has fallen message, alarm tone. ***BRADY xxx < yyy below the extreme bradycardia limit. xxx denotes the lowest measured value, and yyy is the extreme bradycardia limit.
• Page 75
  6 Patient Alarms and INOPs Alarm Message From Condition Indication ** Pulse HIGH The pulse rate has exceeded the high Numeric flashes and high alarm limit. limit is highlighted, yellow alarm message, alarm tone. ** Pulse LOW The pulse rate has dropped below Numeric flashes and low limit the low alarm limit.

• Page 76: Technical Alarm Messages (Inops)

  Check that there is no paper jam, that the print drawer is properly shut, that the paper is loaded with the grid facing INOP tone upwards, and that the correct Philips paper is being used. Check Settings Monitor If this INOP appears, check the monitor and patient settings before you resume monitoring.

• Page 77
  6 Patient Alarms and INOPs INOP Message, Indication Source What to do CHECK TI CONFIG Monitor If this INOP appears, the monitor can be used normally, except for the Trace Interpretation feature. Contact your service personnel. Check Touch Input Monitor Perform a visual and functional check of the touch input device.
• Page 78
  6 Patient Alarms and INOPs INOP Message, Indication Source What to do FetRec CHK CONF. Recorder Speed Scale Type Recorder and/or settings are set to «Unknown» and need to be set to the correct values in INOP tone Configuration Mode before the recorder can be operated. FHR1 EQUIP MALF There is a problem with the FHR hardware.
• Page 79
  6 Patient Alarms and INOPs INOP Message, Indication Source What to do NBP MEASURE FAILED Noninvasive Check that you are using the correct cuff size and placement, blood pressure and that the correct patient category is selected. Try restarting Numeric is replaced by a -?- the measurement.
• Page 80
  6 Patient Alarms and INOPs INOP Message, Indication Source What to do SpO₂ NOISY SIGN. Excessive patient movement or electrical interference is causing Numeric is replaced by a -?- irregular pulse patterns. Try to reduce patient movement or to INOP tone. relieve the cable strain on the sensor.
• Page 81
  6 Patient Alarms and INOPs INOP Message, Indication Source What to do Toco UNPLUGGED Toco Reconnect the Toco transducer to the monitor. Check all connections are sound. INOP tone Unsupported LAN Monitor There is a problem with the communication to the network and central monitoring is currently not possible.
• Page 82
  6 Patient Alarms and INOPs…

• Page 83: Admitting And Discharging

  Admitting and Discharging The fetal monitor can store basic patient demographic information used to identify patients. Admit/Discharge on the Monitor This section describes how you admit and discharge patients when using the monitor as a stand-alone device (that is, when not used with a obstetrical information and surveillance system such as OB TraceVue).

• Page 84: New Patient Check

  7 Admitting and Discharging Editing Patient Information To edit the patient information after a patient has been admitted, select the patient name field on the Patient Demographics main screen of the fetal monitor to open the window, and make the required changes.

• Page 85: Ob Tracevue: Via Lan

  7 Admitting and Discharging OB TraceVue: via LAN Both the monitor from which you are transferring a patient and the monitor to which you are transferring her must be switched on and connected to the OB TraceVue network during the patient transfer.

• Page 86
  7 Admitting and Discharging…

• Page 87: Non-Stress Test Timer

  Non-Stress Test Timer The non-stress test ( ) timer shows the elapsed time for the non-stress test. The timer counts up to the time you set for the NST. Setting NST Autostart/Autostop NST Autostart You can set the recorder so that it starts automatically ( ) when the NST timer is started, NST Autostop and stops automatically (…

• Page 88: Accessing The Nst Setup Pop-Up Keys

  8 Non-Stress Test Timer Accessing the NST Setup Pop-up Keys You control and set up the NST timer (for example, start, stop, or clear the timer, and set the run time) using a selection of pop-up keys that you access via any one of three possible routes: Timer •…

• Page 89
  8 Non-Stress Test Timer Run Time Setup The run time can be set from 10 to 60 minutes. To set the run time, you first need to enter the menu: Setup NST To enter the menu: Either Main Setup a. Enter the menu using the SmartKey .
• Page 90
  8 Non-Stress Test Timer…

• Page 91: Non-Stress Test Report

  Non-Stress Test Report It is generally accepted that a non stress test ( ) allows you to assess fetal well-being. The monitor’s NST report process uses fetal ultrasound (but not DECG) heart rate traces and the Maternal Toco Trace, generating a printed report when criteria are met and the test can be considered reassuring. The American term Non Stress Test (NST) is used for antepartum testing.

• Page 92: Nst Report Status Window

  9 Non-Stress Test Report Report Recording • . Choose from: Manual Record Report – — press the pop up key to trigger a manual request. After Recorder Stop – — report is recorded as soon as recorder becomes idle Immediately –…

• Page 93
  9 Non-Stress Test Report Example NST Report Field Field Content Report Title, with FHR NST Report for FHR1 on 12 Oct 2009 label and date Product Information Product DE53102345 G.01.70, OB A.04.24, Toco DE52401090, FHR1 DE00002345 A.05.26 Patient Information Rogers, Alice Age: 27 Gestational Age: Week 34, Day 5 Start time, end time,…

• Page 94: Nst Reassurance Criteria

  9 Non-Stress Test Report NST Reassurance Criteria The patient is monitored for a user-definable period of time (10 — 60 minutes in steps of 5 minutes). The test is considered reassuring when the following criteria are met: • The fetal heart rate is valid at least 90% (this is configurable) of the specified time span. •…

• Page 95: Monitoring Fhr And Fmp Using Ultrasound

  Monitoring FHR and FMP Using Ultrasound To monitor a single FHR externally, you use an ultrasound transducer attached to a belt around the mother’s abdomen.The ultrasound transducer directs a low-energy ultrasound beam towards the fetal heart and detects the reflected signal. Your monitor can also detect fetal movements and print the fetal movement profile ( ) on the trace.

• Page 96: Limitations Of The Technology

  10 Monitoring FHR and FMP Using Ultrasound Limitations of the Technology All tissues moving towards or away from the transducer generate Doppler echoes. Therefore, the resulting signal that is provided to the monitor’s speaker, and for further fetal heart signal processing, can contain components of the beating fetal heart wall or valves, fetal movements, fetal breathing or hiccup, maternal movements such as breathing or position changes, and pulsating maternal arteries.

• Page 97: Cross-Channel Verification

  10 Monitoring FHR and FMP Using Ultrasound Cross-Channel Verification To reduce the possibility of mistaking the MHR for FHR, it is recommended that you monitor both maternal and fetal heart rates (see “Monitoring Maternal Heart / Pulse Rate” on page 155). The monitor’s cross-channel verification (CCV) facility can help by automatically detecting when the same heart rate is being recorded by different transducers.

• Page 98: Preparing To Monitor

  Apply a thin layer of ultrasound gel to the underside of the transducer. CAUTION Using ultrasound gel not approved by Philips may reduce signal quality and may damage the transducer. This type of damage is not covered by warranty. •…

• Page 99: Selecting Fetal Heart Sound

  10 Monitoring FHR and FMP Using Ultrasound WARNING Periodically compare the mother’s pulse with the signal coming from the monitor’s loudspeaker to ensure that you are monitoring fetal heart rate. Do not mistake a doubled or elevated MHR for FHR. Note that when applied to the patient, the ultrasound transducer may warm slightly (less than 1°C/ 1.8°F above ambient temperature).

• Page 100: Fetal Movement Profile

  10 Monitoring FHR and FMP Using Ultrasound Select the required volume from the volume scale. Alarm Volume Fetal Movement Profile The Fetal Movement Profile (FMP) parameter detects fetal movements via an ultrasound transducer connected to the monitor. Only the fetus monitored on the FHR1 channel is monitored for FMP. Once you have enabled FMP (see “Switching FMP On and Off”…

• Page 101
  10 Monitoring FHR and FMP Using Ultrasound FMP Statistics FMP statistics are printed every ten minutes. FMP started here FMP enabled The FMP statistics are presented as two percentage figures: • The first figure shows the percentage of detected fetal movements in the previous ten minutes (see B above).

• Page 102: Troubleshooting

  10 Monitoring FHR and FMP Using Ultrasound Troubleshooting Problem Possible Causes Solutions Erratic trace. Fetal arrhythmia. Consider monitoring FHR using DECG after the rupture of membranes. Obese patient. Erratic display. Transducer position not optimal. Reposition transducer until signal quality indicator shows a good signal (at least half- full).

• Page 103: Additional Information

  10 Monitoring FHR and FMP Using Ultrasound Problem Possible Causes Solutions FHR1 EQUIP MALF FHR2 EQUIP MALF FHR3 EQUIP MALF INOP (see “Patient Alarms and INOPs” on displayed. page 73). FHR1 SIGNAL LOSS FHR2 SIGNAL LOSS FHR3 SIGNAL LOSS INOP displayed. FHR1 UNPLUGGED FHR2 UNPLUGGED FHR3 UNPLUGGED…

• Page 104
  It is strongly recommended that the maternal pulse oximeter or maternal ECG be employed to make use of the monitor’s Cross-Channel Verification (CCV) feature, especially during the second stage of labor or when the maternal pulse is elevated over 100 bpm. The Philips Avalon fetal monitor offers maternal pulse oximetry (SpO ) and maternal ECG for maternal pulse detection and the creation of a maternal heart rate pattern plotted on the same recorder as the FHR pattern.
• Page 105
  10 Monitoring FHR and FMP Using Ultrasound “Noisy/Erratic” signals: With mixed or weak signals the tracing may reveal very brief episodes of erratic recorded traces. These represent the autocorrelation algorithm finding brief sequences of apparent and persistent heartbeats amidst a mixed or weak signal. These erratic recorded traces are commonplace, especially in association with fetal or maternal movement.
• Page 106
  10 Monitoring FHR and FMP Using Ultrasound Audio Output The audio output from the device is an aural representation of movement that, in most cases, permits accurate auscultation of the FHR corresponding to the FHR displayed on the monitor and rate pattern depicted on the trace recording.
• Page 107
  10 Monitoring FHR and FMP Using Ultrasound fetuses are monitored, the Avalon will identify and label apparent CCV between either two fetuses or a fetus and the mother. FHR1 Pulse FHR1 Pulse Avalon CCV numeric display and recorded trace showing coincident alerts When monitoring the maternal ECG, a beat-to-beat maternal heart rate trace is printed alongside the FHR recorded trace.
• Page 108
  10 Monitoring FHR and FMP Using Ultrasound Half-Counting Baseline Rate Baseline Variability Moderate Accelerations Present Decelerations Not apparent Contractions Minimal Artifact Half-counting, noise, drop out Comment Reassuring tracing. The half-count at 4-5 minutes into the tracing may simulate a fetal deceleration, but the abruptness and the lack of any compensatory changes when the normal rate returns suggests that this is half-counting.
• Page 109
  10 Monitoring FHR and FMP Using Ultrasound Maternal-Switching (Maternal Insertion) Baseline Rate 170 — Tachycardia Baseline Variability Moderate Accelerations Unable to determine Decelerations Absent Contractions Absent Artifact Maternal insertion, noise Comment The fetus has an elevated baseline rate of about 170 bpm with minimal to moderate variability.
• Page 110
  10 Monitoring FHR and FMP Using Ultrasound Noisy/Erratic Signal and Dropout Contractions Minimal Artifact Noisy signal, drop-out Comment Reassuring tracing. Note that there is episodic drop out of the signal with discontinuity of the fetal tracing. Remediation Either improving the position of the transducer or the application of a fetal scalp electrode will reduce the amount of artifact in the tracing.
• Page 111
  10 Monitoring FHR and FMP Using Ultrasound Selection of Literature References on Artifacts ___________________________________________________________ Fetal Monitoring, A Multidisciplinary Approach, Sixth edition Susan M. Tucker, Lisa A. Miller, David A. Miller Mosby Inc. 2009, ISBN 978-0-323-05670-0 ___________________________________________________________ Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring By Duncan R.

• Page 112: Testing Ultrasound Transducers

  If any of the following tests fail, repeat the test using another transducer. If the second transducer passes the tests, confirming that the first transducer is defective, contact your service personnel. If the second transducer also fails the tests, contact your Philips Service Engineer or Response Center. To test an ultrasound transducer: Switch on the monitor and the recorder.

• Page 113: Monitoring Twin Fhrs

  Monitoring Twin FHRs You can monitor twin FHRs externally using two ultrasound transducers. It is not possible to monitor twins externally using cordless ultrasound transducers. Additionally, you can monitor twin FHRs throughout labor and delivery after rupture of the FM30/50 membranes by monitoring one twin externally using ultrasound and the other internally using DECG.

• Page 114: Monitoring Twins Externally

  11 Monitoring Twin FHRs for FM40/50. • The trace recorded for FHR1 is thicker (darker) than that recorded for FHR2. This ensures that the two heart rates are easily distinguishable. The thickness of the recorded trace can be changed in Configuration Mode.

• Page 115: Monitoring Twins Internally

  11 Monitoring Twin FHRs Monitoring Twins Internally FM30/50 Monitor one twin using the procedures described in the Chapter “Monitoring FHR and FMP Using Ultrasound” on page 95. Monitor the second twin using the procedures described in the Chapter “Monitoring FHR Using DECG” on page 137. Example of a screen showing twin monitoring using a combination of US and DECG (The fetal heart rate monitored via DECG is labeled «DFHR1″/»DFHR2″/»DFHR3″…

• Page 116: Separating Fhr Traces

  11 Monitoring Twin FHRs Separating FHR Traces To help you to interpret traces with similar baselines, you can separate the baselines by an offset of 20 bpm by switching trace separation on. For details of the offset, see “Determining the Separation Order”…

• Page 117
  11 Monitoring Twin FHRs When Trace Separation is On When trace separation is turned on, the recorder prints a dotted line labeled with the two FHRs at the top, and at the bottom. Examples of the two methods (Standard, Classic) for determining the trace separation order are provided here.
• Page 118
  11 Monitoring Twin FHRs Only the FHR1 trace is offset. The numerical FHR value displayed on the monitor remains unchanged. Subtract 20 from the recorded trace for FHR1 to obtain the true FHR1 value. For example, if the recorded trace shows 160, then the true FHR is 140. Switching Trace Separation On and Off Connect three ultrasound transducers to the monitor to measure FHR.

• Page 119: Troubleshooting

  11 Monitoring Twin FHRs Troubleshooting Common problems that may occur when monitoring FHR using ultrasound are listed in “Monitoring FHR and FMP Using Ultrasound” on page 95. See also “Monitoring FHR Using DECG” on page 137 for common problems you might encounter when monitoring FHR directly. The following problem may occur when monitoring twins.

• Page 120
  11 Monitoring Twin FHRs…

• Page 121: Monitoring Triple Fhrs

  Monitoring Triple FHRs If your monitor is equipped with the triplets option, it carries the label. You can monitor triple FHRs externally using three ultrasound transducers. Triplets monitoring is not possible using the Avalon CTS Cordless Fetal Transducer System. Refer to the appropriate preceding chapters for contra-indications and other information about the measurement methods you have chosen.

• Page 122: Monitoring Triplets

  12 Monitoring Triple FHRs for FM40/50. • The trace recorded for the FHR3 is thicker (darker) than that recorded for FHR1, which is thicker than that for FHR2. This ensures that the three heart rates are easily distinguishable. The thickness of the recorded trace can be changed in Configuration Mode.

• Page 123: Separating Fhr Traces

  12 Monitoring Triple FHRs Separating FHR Traces To help you to interpret traces with similar baselines, you can separate the baselines by an offset of 20 bpm by switching trace separation on. For details of the offset, see “Determining the Separation Order”…

• Page 124: When Trace Separation Is Off

  12 Monitoring Triple FHRs • The label for FHR1 is annotated with and the FHR3 label is annotated with Trace Separation Classic The following trace shows triplets with on, and using separation order. The traces for FHR1 and FHR3 are offset. The numerical FHR values displayed on the monitor remain unchanged.

• Page 125: Troubleshooting

  12 Monitoring Triple FHRs Troubleshooting Common problems that may occur when monitoring FHR using ultrasound are listed in “Monitoring FHR and FMP Using Ultrasound” on page 95. The following problem may occur when monitoring triplets. Problem Possible Cause Solution More than one transducer is recording Reposition one or more ultrasound is printed repeatedly.

• Page 126
  12 Monitoring Triple FHRs…

• Page 127: Fetal Heart Rate Alarms

  Fetal Heart Rate Alarms Fetal heart rate (FHR) alerting can give both audible and visual warning of a non-reassuring fetal condition. Your monitor must be configured to alarm mode to enable the FHR alerting (see “Alarms” on page 63). Changing Alarm Settings When you do any of the following actions for any FHR measurement channel, this applies for all active FHR measurements, both ultrasound and DECG: •…

• Page 128: Changing Signal Loss Delay

  13 Fetal Heart Rate Alarms Changing Alarm Delays You can change the alarm delays in Configuration Mode. Connect either an ultrasound or a DECG transducer to a free socket on the monitor. Enter the Setup Menu for a connected FHR measurement. High Delay To change the high alarm limit delay time, select and select the delay time (in seconds)

• Page 129: Monitoring Uterine Activity Externally

  Monitoring Uterine Activity Externally You can measure uterine activity externally using a Toco transducer. You can also use a Toco Toco MP transducer for the same purpose, although they also have wider (ECG/IUP and Pulse) capabilities. The external Toco transducer measures the frequency, duration and relative strength of contractions, but not their absolute intensity.

• Page 130: External Toco Monitoring

  14 Monitoring Uterine Activity Externally External Toco Monitoring Prepare for Toco monitoring using the list below. The standard procedures in use in your facility determine the sequence of actions. • Fasten the abdominal transducer belt around the patient. • Connect the Toco transducer to a free socket on the monitor. The Toco baseline is automatically reset.

• Page 131: Troubleshooting

  14 Monitoring Uterine Activity Externally Troubleshooting External Toco Monitoring Problem Possible Causes Solutions Quality of the trace deteriorates The belt is incorrectly fastened and is The belt must be tight enough to ensure or the Toco baseline varies. too slack or too tight or the belt has lost good contact between the patient’s skin its elasticity.

• Page 132: Testing Toco Transducers

  If any of the following tests fail, repeat the test using another transducer. If the second transducer passes the tests, confirming that the first transducer is defective, contact your service personnel. If the second transducer also fails the tests, contact your Philips Service Engineer or Response Center. To test a Toco transducer: Switch on the monitor and the recorder.

• Page 133: Monitoring Uterine Activity Internally

  Monitoring Uterine Activity Internally FM30/50 You can monitor intrauterine pressure (IUP) using an intrauterine catheter together with a patient module or a Toco transducer, after rupture of the membranes and the cervix is sufficiently dilated. What You Need Illustration 1 shows the complete connection chain from the IUP catheter to the fetal monitor using the patient module: A Disposable Koala IUP Catheter B Reusable Koala IUP Adapter Cable (9898 031 43931)

• Page 134: Internal (Iup) Monitoring

  15 Monitoring Uterine Activity Internally C Toco Transducer (M2735A) Internal (IUP) Monitoring Read the instructions that accompany the intrauterine catheter and the adapter cable before you start monitoring. Zero the monitor when instructed. WARNING Do not catheterize if placenta previa is diagnosed or if uterine bleeding from an undetermined source is present.

• Page 135: Troubleshooting

  15 Monitoring Uterine Activity Internally Troubleshooting Internal (IUP) Monitoring Problem Possible Causes Solutions No change in pressure during Dry environment or possible extra- Please refer to catheter Instructions for Use. contraction. ovular placement of sensor tip. Only pressure peaks can be Zero adjustment is incorrect.

• Page 136
  15 Monitoring Uterine Activity Internally…

• Page 137: Monitoring Fhr Using Decg

  Monitoring FHR Using DECG FM30/50 This chapter describes how to monitor a single fetal heart rate via direct ECG (DECG), using a spiral fetal scalp electrode in the intrapartum period. Read and adhere to the instructions that accompany the fetal scalp electrode, the DECG adapter cable, and the attachment electrode.

• Page 138
  16 Monitoring FHR Using DECG Illustration 1 shows the complete connection chain from the fetal scalp electrode to the fetal monitor using the Toco transducer. A Fetal Scalp Electrode, single spiral (9898 031 37631) B Fetal Scalp Electrode, double spiral, Europe only, not for USA (9898 031 37641) C DECG Adapter Cable (9898 031 37651) D Pre-gelled Attachment Electrode (9898 031 39771) E Toco+ Transducer (M2735A)

• Page 139: Making Connections

  16 Monitoring FHR Using DECG Making Connections WARNING Follow the instructions supplied with each of the monitoring accessories you are using. Prepare for DECG monitoring using the list below. The standard procedures in use in your facility determine the sequence of actions. •…

• Page 140: Suppressing Artifacts

  16 Monitoring FHR Using DECG being monitored, both waves are displayed, with the DECG wave above the MECG wave. The MECG MECG wave is labeled Check the artifact suppression setting and change it if necessary (see “Suppressing Artifacts” on page 140). Measurement label (DFHR1) Measurement label (Toco) Additional measurement label…

• Page 141: Troubleshooting

  16 Monitoring FHR Using DECG Troubleshooting Problem Possible Cause Solutions DFHR1 EQUIP MALF See “Patient Alarms and INOPs” on DFHR2 EQUIP MALF page 73. DFHR3 EQUIP MALF DFHR1 LEADS OFF Spiral electrode detached at connector. Reconnect the fetal scalp electrode. DFHR2 LEADS OFF DFHR3 LEADS OFF Poor or no contact between leg…

• Page 142: Testing Decg Mode

  16 Monitoring FHR Using DECG Testing DECG Mode Refer to the monitor’s Service Guide.

• Page 143: Monitoring Noninvasive Blood Pressure

  Monitoring Noninvasive Blood Pressure This fetal monitor uses the oscillometric method for the noninvasive blood pressure measurement. In adult mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative sample population.

• Page 144: Preparing To Measure Noninvasive Blood Pressure

  Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.

• Page 145
  17 Monitoring Noninvasive Blood Pressure A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.

• Page 146: Starting And Stopping Measurements

  17 Monitoring Noninvasive Blood Pressure The NBP timestamp will normally show the completion time of the NBP measurement. Only under the following conditions the timestamp shows the beginning of the measurement: Auto Sequence • when in mode, and • the monitor is configured to synchronize the measurements in a measurement series to an «easy- Repeat Time to-document»…

• Page 147: Choosing The Alarm Source

  17 Monitoring Noninvasive Blood Pressure NOTE Be aware that a combination of a recorder speed of less than 3 cm/min and a repetition time of less than five minutes can result in not all noninvasive blood pressure measurements being recorded on the fetal trace.

• Page 148: Calibration

  17 Monitoring Noninvasive Blood Pressure Calibration NBP is not user-calibrated. Cuff-pressure transducers must be verified at least once every two years by a qualified service professional, and calibrated, if necessary. See the Service Guide for details. Troubleshooting Problem Possible Causes Solutions Cuff will not inflate.

• Page 149: Monitoring Spo2

  FM30/40/50 The pulse oximetry measurement (SpO ) is intended for use with maternal patients. Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier Artifact Suppression Technology (FAST). It provides two measurements: • Oxygen saturation of arterial blood (SpO ) — percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

• Page 150: Connecting Spo2 Cables

  CAUTION Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates «long» cable version). Electrical Interference: Position the sensor cable and connector away from power cables, to avoid…

• Page 151: Measuring Spo2

  18 Monitoring SpO2 Measuring SpO2 During measurement, ensure that the application site: – has a pulsatile flow, ideally with a signal quality indicator of at least medium. – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.

• Page 152: Spo2 Signal Quality Indicator

  18 Monitoring SpO2 SpO2 Signal Quality Indicator The SpO numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the displayed values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled.

• Page 153: Setting Up Tone Modulation

  18 Monitoring SpO2 Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components: • The general system delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values.

• Page 154
  18 Monitoring SpO2…

• Page 155: Monitoring Maternal Heart / Pulse Rate

  Monitoring Maternal Heart / Pulse Rate You can monitor the maternal heart/pulse rate using one of four sources: • Maternal heart rate (MHR) via MECG electrodes • (pulse rate) • Maternal pulse from Toco MP transducer (pulse rate) • NBP (pulse rate) Maternal heart / pulse rates derived from MECG, SpO and Toco MP are continuous measurements, and are compared against the FHR for cross-channel verification.

• Page 156: Mhr From Mecg Electrodes

  19 Monitoring Maternal Heart / Pulse Rate beat MECG heart rate trace or an ultrasound heart rate trace calculation, having switched to the maternal rate with no significant delay. Note that Maternal Pulse from Toco has an averaging of 4 seconds and an overall delay of between 6 and 8 seconds.

• Page 157
  19 Monitoring Maternal Heart / Pulse Rate Applying Electrodes To derive the MHR (when you do not want to view the MECG waveform), you can place the electrodes just below the outer end of the clavicle near each shoulder. 1 MECG Electrodes Making Connections WARNING Follow the instructions supplied with each of the monitoring accessories you are using.

• Page 158: Monitoring Mecg Wave

  19 Monitoring Maternal Heart / Pulse Rate Monitoring MECG Wave WARNING The fetal/maternal monitor is not a diagnostic ECG device. In particular, the display of fetal/maternal ECG is intended only for evaluating signal quality for fetal/maternal heart rate as derived from the ECG waveform.

• Page 159: Pulse Rate From Spo2

  19 Monitoring Maternal Heart / Pulse Rate Viewing the Waveform on the Screen DFHR1 parameter Toco parameter FHR2 parameter Numeric/measurement values For the FM30/50, the MECG wave is displayed automatically on the screen, labeled MECG. If DECG is also being monitored (FM30/50), and the DECG wave is configured to On, both waves are displayed, with the…

• Page 160: Adjusting The Heart Rate / Pulse Alarm Limits

  19 Monitoring Maternal Heart / Pulse Rate Adjusting the Heart Rate / Pulse Alarm Limits To adjust the pulse alarm limits: Setup SpO₂ Pulse (SpO₂) Setup Pulse (SpO₂) In the menu, select . This opens the menu. Pulse (SpO₂) Pulse (SpO₂) Ensure .

• Page 161: Printing The Ecg Waveform

  Printing the ECG Waveform FM30/50 You can print the ECG wave onto the trace paper. If you are monitoring both DECG and MECG, MECG both waves will be printed. The start of the wave recording is annotated above the wave with DECG 25 mm/sec for Maternal ECG, with…

• Page 162
  20 Printing the ECG Waveform DECG MECG Paper speed DECG and MECG waveforms When the recorder is on, there are two choices for printing the ECG wave: Separate • : This recording mode gives you a six-second ECG strip on the fetal trace paper in fast printout mode.
• Page 163
  20 Printing the ECG Waveform The following trace shows both the DECG and MECG waveforms: Paper speed Date To make your choice: Main Setup Enter the menu by selecting the SmartKey Fetal Recorder Fetal Recorder Select to enter the menu. ECG Wave Separate Overlap…
• Page 164
  20 Printing the ECG Waveform…

• Page 165: Paper Save Mode For Maternal Measurements

  Paper Save Mode for Maternal Measurements Your monitor’s recorder features a Paper Save Mode, where maternal vital signs are recorded using less paper than during a normal trace recording. When Paper Save Mode is enabled, and if the recorder is stopped, it will start automatically to print data from maternal measurements as they occur, and then stop again to save paper.

• Page 166
  21 Paper Save Mode for Maternal Measurements…

• Page 167: Recovering Data

  Note that the data in the memory is cleared when a software upgrade is performed. CAUTION Only use Philips paper. Using paper other than Philips paper may result in the failure to recover traces. Recovering Traces on Paper The monitor is able to recover traces by printing them out at a high speed from the monitor’s backup memory.

• Page 168: Recovering Traces On An Ob Tracevue System

  22 Recovering Data • The change back to a real-time recording from a trace recovery printout prompts the recording to restart. A new vertical trace header annotation consisting of the time, date and paper speed is printed, letting you see where the trace recovery printout ends, and where the real-time trace continues.

• Page 169
  22 Recovering Data The speed of the printout depends on the configured recorder speed and on the amount of trace data available. The fetal trace printed from the trace data contains all data from the real-time trace, with the exception of the maternal heart rate, the pulse numeric and the ECG wave. Information for scale type, trace separation and recorder speed are not stored in the trace memory, but is applied when the stored recording starts.
• Page 170
  22 Recovering Data…

• Page 171: Care And Cleaning

  Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to “Guideline for Disinfection and…

• Page 172
  Cleaning and Disinfecting Clean and disinfect the Avalon FM20, FM30, FM40 and FM50 fetal monitors and the transducers M2734A, M2734B, M2735A, M2736A, and M2738A (including ECG adapter cables) after each use. Clean equipment before disinfecting. For other accessories, see “Cleaning and Disinfecting Monitoring Accessories”…
• Page 173
  23 Care and Cleaning Recommended Cleaning Agents We recommend that you use one of the following disinfectants: Product Name Product Type Ingredients Isopropanol liquid Isopropanol 80% Bacillol® AF liquid, spray 100 g concentrate contains: Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 g. Bacillol®25 liquid Ethanol 100 mg/g…
• Page 174
  23 Care and Cleaning…
• Page 175
  In case of problems: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier. Electric shock hazard: Do not open the monitor housing. Refer all servicing to qualified service personnel.
• Page 176
  Ensure that these tasks are carried out as indicated by the monitor’s maintenance schedule, or as specified by local laws, whichever comes sooner. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.
• Page 177
  24 Maintenance – Products containing solvent-based adhesives such as (but not exclusively) laminating film, transparent film or labels sensitive to pressure. To ensure long lasting legibility and durability of thermal printouts, store your documents separately in an air-conditioned place and use: •…
• Page 178
  24 Maintenance Monitor: • There is no metal molded into the plastic parts and no metal sprays on the plastic. • All plastic parts with a weight greater than 10g (0.35 ounces) are marked with the ISO code for identification. •…
• Page 179
  All accessories listed for the fetal monitor may not be available in all geographies. You can order parts, accessories and supplies from Philips supplies at www.medical.philips.com or consult your local Philips representative for details. All accessories and supplies listed here are reusable, unless indicated otherwise.
• Page 180
  ECG reusable legplate adapter cable M1362B (QwikConnect Plus) QwikConnect Plus Solution ECG leg attachment electrode for DECG M1349A (NOT compatible with New Philips legplate adapter cable DECG Solution accessories) DECG fetal scalp electrode: single spiral, 15133E worldwide availability DECG fetal scalp electrode: double 15133D spiral, Europe only.
• Page 181
  25 Accessories and Supplies DECG Accessories: Component Compatibility Use the following pictorial guide to check component compatibility for DECG accessories. Do NOT mix accessories from the New Philips DECG Solution (marked ) with those from the QwikConnect Plus Solution (marked…
• Page 182
  25 Accessories and Supplies Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs Maternal Patient Limb Circumference Bladder Disposable Reusable cuff Tubing Category Width cuff Part No. Part No. Adult (Thigh) 42.0 — 54.0 cm 20.0 cm M1879A M1576A M1598B (1.5 m) Large Adult 34.0 — 43.0 cm 16.0 cm…
• Page 183
  Tyco Healthcare. Some sensors may not be available in all countries. Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates «Long» version).
• Page 184
  Use only on adult patients with FM30/40/50. M1194AN Special Edition (SE) Ear sensor (1.5 m cable) for patients more than 40 kg. Philips disposable sensors. Not available in the USA. M1904B Identical to OxiMax MAX-A Requires M1943A (1.0 m) or M1943AL (3.0 m) adapter cable…
• Page 185
  25 Accessories and Supplies Product Number Description Comments Philips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor (0.45 m cable) Requires M1943A (1.0 m) or M1943AL (3.0 m) adapter cable Use only on adult patients with FM30/40/50. M1133A Adult/Infant/Neonatal (0.9 m cable) for patients >…
• Page 186
  25 Accessories and Supplies Masimo SpO2 Accessories Product Description Philips Part Number Number MASIMO LNOP reusable sensors (No adaptor cable required) LNOP DC-I Adult Finger Sensor (> 30 kg) 989803140321 LNOP DC-IP Pediatric Finger Sensor (10 — 50 kg) 989803140331…
• Page 187
  Extension / Adapter Cables Product Description Comments Number M1941A Extension cable (2 m) For use with Philips reusable sensors and adapter cables. M1943A Adapter cable (1.1 m cable) Adapter cable for Philips/ Nellcor disposable sensors. M1943AL Adapter cable (3 m cable)
• Page 188
  25 Accessories and Supplies…
• Page 189
  Specifications and Standards Compliance The monitors are intended to monitor a mother and her fetus(es), which from an electrical safety point of view, are one person. Environmental Specifications The monitor may not meet the given performance specifications if stored and used outside the specified temperature and humidity ranges.
• Page 190
  26 Specifications and Standards Compliance Sensors Operating Temperature Range 0°C to 37°C (32°F to 98.6°F) WARNING Explosion Hazard: Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.
• Page 191
  26 Specifications and Standards Compliance Transducers (M2734A/M2734B/M2735A/M2736A/M2738A) Dimensions and M2734A&B/35/36A Size (diameter) 83 mm/3.27 in Weight Weight (without cable) < 220 g/7.8 oz. M2738A Maximum size mm/ 50 x 28 x 135 (2.0 x 1.1 x 5.3 in) (in): width x height x depth Cable length 2.5 m…
• Page 192
  26 Specifications and Standards Compliance Battery Specifications Performance Specifications Battery Operating Time Basic monitoring configuration: >2 hours (with new, fully charged (Display Brightness: 70%, Recorder: «On» at 3cm/ battery) min, NBP: Auto Mode at 15min, 2 US Transducers, 1 Toco+ with MECG, 1 Patient Module with DECG) Charge Time When monitor is off: approx.
• Page 193
  26 Specifications and Standards Compliance Fetal / Maternal Specifications Performance Specifications Ultrasound Measurement Method Ultrasound Pulse Doppler Measurement Range 50 to 240 bpm Resolution Display 1 bpm Printer 1/4 bpm Jitter @ 200 bpm ≤ 3 bpm Display Update Rate 1 / second US Intensity Average output power…
• Page 194
  26 Specifications and Standards Compliance Performance Specifications Auto Offset Correction 3 seconds after connecting the transducer, the Toco value is set to 20 units Auto Zero Adjust Toco value is set to zero following a negative measurement value for 5 seconds Maternal Pulse from Toco Emitted Light Energy ≤…
• Page 195
  26 Specifications and Standards Compliance Performance Specifications Filter Bandwidth 0.8 to 80 Hz Inop Auxiliary Current (Leads Off Detection) < 100 µA Input Signal Range DECG 20 µVpp to 6 mVpp MECG 150 µVpp to 6 mVpp Dielectric Strength 1500 Vrms Defibrillator Protection None ESU Protection…
• Page 196
  26 Specifications and Standards Compliance MECG Alarm Specifications Range Adjustment MECG Alarm Limits High Range: 31 to 240 1 bpm steps (30 to 40 bpm) 5 bpm steps (40 to 240 bpm) Default: 120 bpm Low Range: 30 to 235 Default: 50 bpm Tachycardia Difference to high limit: 0 to 50 bpm…
• Page 197
  26 Specifications and Standards Compliance Fetal / Maternal Defaults Settings FHR (Ultrasound/DECG) Alarms On/Off Default Default Color for FHR Numeric Orange Toco Default color for Toco numeric Green Default IUP Scale Unit mmHg Default color for IUP numeric Green Maternal Heart Rate Default Color for MECG Numeric (MHR) Measurement Noninvasive Blood Pressure…
• Page 198
  26 Specifications and Standards Compliance Measurement Validation: In adult mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 — 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative population.
• Page 199
  M1191T, M1192T, M1194A, M1194AN, M1196A, M1196T = 3% values and the reference (70% to 100%) values Philips Disposable Sensors with M1943A(L): M1131A, M1901B, M1903B, M1904B = 3% (70% to 100%) M1133A, M1134A = ±2% (70% to 100%) NellcorPB® Sensors with M1943A(L):…
• Page 200
  26 Specifications and Standards Compliance Alarm Specifications Range Adjustment Delay 50 to 100% 1% steps (0, 1, 2, 3,… 30) + 4 seconds Desat 50 to Low alarm limit 1% steps Pulse 30 to 300 bpm 1 bpm steps (30 to 40 bpm) max.
• Page 201
  26 Specifications and Standards Compliance Recorder Specifications Built-in Thermal Array Fetal Trace Recorder Mechanism Thermal Array Recorder Paper & Printing Type Standard Z-fold paper Standard Speeds (real-time traces) 3 cm/min, 2 cm/min, 1cm/min Fast Print Speed (stored traces) Max. 20 mm/s Print speed is variable and depends on the print load ECG Wave Print Speed…
• Page 202
  26 Specifications and Standards Compliance Recorder Default Settings Setting Choice Default Auto Start Confirmed Stop Bridge Paperout Paper Save Mode NST Autostart NST Autostop Trace Separation Separation Order Standard Classic Standard Intensity 1..5 Recorder Symbols Symbol Description Alarm is on (printed next to measurement label) Upper and lower alarm limit (printed next to measurement label) FMP detection is on Beginning of the date/time annotation…
• Page 203
  26 Specifications and Standards Compliance Recorder Symbols Symbol Description Trace separation -20 bpm (in label) Trace separation Off (in trace) Trace separation +20 bpm (in trace) Trace separation -20 bpm (in trace) Trace separation +20 bpm and -20 bpm (in trace) Coincidence of heart rates is detected Marker Special wave, with different speed and scale (for example, fast printout of…
• Page 204
  26 Specifications and Standards Compliance M4605A Battery Specifications Battery Type Smart Battery 10.8 V, 6000 mAh, Lithium Ion Safety complies with UL 2054 Electromagnetic Compatibility complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2 (EMC) Communication Standard complies with the SMBus specification v 1.1…
• Page 205
  Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com © Copyright 2003 — 2011. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement Oxisensor II, Oxi-Cliq , and OxiMax are trademarks of Tyco Healthcare Group LP, Nellcor Puritan Bennett Division.
• Page 206
  26 Specifications and Standards Compliance Electromagnetic Compatibility (EMC) The device and its accessories, listed in the accessories section, comply with the following EMC standards: • EN/IEC 60601-1-2: 2001+A1:2004 Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book.
• Page 207
  26 Specifications and Standards Compliance Reducing Electromagnetic Interference CAUTION The device should not be used adjacent to, or stacked with, other equipment unless otherwise specified. The product and associated accessories can be susceptible to interference from continuous, repetitive, power line bursts, and other RF energy sources, even if the other equipment is compliant with EN 60601-1-2 emission requirements.
• Page 208
  In the table below, the term «device» refers to the Avalon FM20/30/40/50 fetal monitor together with its accessories. The table gives details of the electromagnetic emissions, and how these are classified, for the device, and the electromagnetic environments in which the device is specified to technically function.
• Page 209
  26 Specifications and Standards Compliance Electromagnetic Immunity The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below. Table 2 — Guidance and Manufacturer’s Declaration: Electromagnetic Immunity Immunity Test IEC 60601-1-2 Compliance Level…
• Page 210
  26 Specifications and Standards Compliance Table 3 — Guidance and Manufacturer’s Declaration: Electromagnetic Immunity Conducted RF Immunity Test EN/IEC 61000-4-6 Electromagnetic Environment Guidance: Recommended Separation Distance IEC 60601-1-2 Test Level Compliance Level over 150 kHz to 80 MHz (in Meters, at Frequency Range Tested) for Ultrasound and ECG Measurements…
• Page 211
  These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. If you require further information or assistance, please contact Philips Support. Recommended Separation Distances from Other RF Equipment The device is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.
• Page 212
  26 Specifications and Standards Compliance Table 5 — Separation Distance (d) in Meters According to Frequency of Transmitter at IEC 60601-1-2 Test Compliance Level 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz Rated Maximum Output Power (P) of Transmitter (in Watts) 0.01 W…
• Page 213
  26 Specifications and Standards Compliance FM40/50 When power is lost — no power is available from the AC power source or from the battery — before the monitor is put into Standby, a beeper will sound. The tone can be silenced by pressing the On/Standby and FM20/ switch.
• Page 214
  26 Specifications and Standards Compliance Symbols on the System This caution/warning symbol indicates that you should consult the Instructions for Use (this document), and particularly any warning messages. This symbol indicates that you should consult the Instructions for Use (this document). Power-On/Off Switch — FM20/FM30 without Battery Option Power-On/StandBy Switch — FM40/FM50 and FM20/30 with Battery Option Power-On LED…
• Page 215
  26 Specifications and Standards Compliance Analog interface indicator for connection to any analog video display (VGA resolution). Video IP 67 Ingress Protection code according to IEC 60529. The IUP/ECG patient module (M2738A) is rated IP 67 (protection against dust, access to hazardous parts, and the effects of continuous immersion in water to a depth of 0.5 meter for 30 minutes).
• Page 216
  26 Specifications and Standards Compliance…
• Page 217
  SpO2 accessories cleaning monitor actions disposal of electronic waste Philips sensors (disposable) cleaning method disposal of monitor Philips sensors (reusable) cleaning monitoring accessories dyshemoglobins transducer accessories general cleaning requirements…
• Page 218
  interference from RF equipment Standby starting monitoring internal monitoring factory defaults switching on intrauterine pressure. See IUP noninvasive blood pressure factory monitoring mode intravascular dyshemoglobins defaults monitoring triplets and FHR intravascular dyshemoglobins effects on recorder factory defaults (SpO2) monitoring twins and FHR SpO2 factory defaults ISO/IEC standard 9703-2 mounting information…
• Page 219
  Philips sensors (reusable) signal quality reviewing alarms window paper SpO2 alarms default paper speed standards loading paper EMC standards safety paper out INOP safety standards maintenance interval paper speed standards compliance safety standards changing Standby default safety tests…
• Page 220
  fixing transducer to belt IUP, zeroing Toco transducer touch tone volume Toco+ transducer warnings transducer belt clip transducer specifications transducer testing Toco ultrasound triplets cross-channel verification external monitoring importance of monitoring MHR monitoring triplets offsetting baselines troubleshooting DECG MECG troubleshooting FHR twins cross-channel verification external monitoring…
• Page 221
  Part Number 453564290161 Printed in Germany 08/11 *453564290161*…

• page

  of
  221

  /
  221

• Contents

• Table of Contents

• Troubleshooting

• Bookmarks

Related Products for Philips Avalon FM20

This manual is also suitable for:

Avalon fm40Avalon fm30Avalon fm50

Table of Contents

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140