A&D TM-2657P User manual

TM-2657P
Automatic Blood Pressure Monitor
Instruction Manual
1WMPD4002893 1505
English
(
Original
)

© 2015 A&D Company, Limited. All rights reserved.
No part of this publication may be reproduced, transmitted, transcribed or translated into any language
in any form by any means without the express written consent of A&D Company, Limited.
The contents of this manual and the specifications of the instruments covered by this manual are
subject to change without notice.
Windows is a registered trademark of the Microsoft Corporation.

i
WARNING DEFINITIONS
To prevent accidents due to inappropriate handling, this product and its manual contain the following
warning signs and marks. The meaning of these warning signs and marks are as follows.
Warning Definitions
An imminently hazardous situation which, if not avoided, will result in death
or serious injury.
Apotentially hazardous situation which, if not avoided, could result in death
or serious injury.
A potentially hazardous situation which, if not avoided, may result in minor
or moderate injury. It may also be used to alert against unsafe practice.
Symbol Examples
The symbol indicates “Caution.”
The nature of the caution required is described inside or near the symbol,
using text or a picture.
The example on the left indicates caution against electrical shock.
The symbol indicates “Do not.”
The prohibited action is described inside or near the symbol, using text or a
picture.
The example on the left indicates “Do not disassemble.”
The symbol indicates Mandatory action.
The mandatory action is described inside or near the symbol, using text or a
picture.
The example on the left indicates General mandatory action.
Other
Note Provides information useful for the user to operate the device.
Precautions for each operation are described in the instruction manual. Read the instruction
manual before using the device.
Danger
Warning
Caution

ii
PRECAUTIONS FOR USE
In order to use the TM-2657P Automatic Blood Pressure Monitor safely and correctly, carefully read
the following precautions before using the monitor. The following content summarizes general matters
regarding the safety of patients and operators, in addition to safe handling of the monitor.
1. When installing and storing the monitor.
Keep the monitor away from areas where flammable anesthetics or flammable gases
are present, high-pressure oxygen chambers, and oxygen tents. Using the monitor in
these areas may cause an explosion.
Consider the following when using and storing the monitor. If the monitor is stored in an
environment beyond the specified temperature or humidity, it may not perform to its
capabilities.
Avoid locations where the monitor may be splashed by water.
Avoid locations with high temperature, high humidity, direct sunlight, dust, salt and
sulfur in the air.
Avoid locations where the monitor may be tilted, vibrated, or impacted (including
during transportation).
Avoid locations where chemicals are stored or gas occurs.
Installation site: A location with a temperature between +10°C and +40°C and a
humidity between 15% RH and 85% RH (no condensation).
Storage site: A location with a temperature between -20°C and +60°C and a humidity
between 10% RH and 95% RH.
Alocation with an electrical outlet that can supply sufficient power (frequency,
voltage, current) for the monitor.
Note
Please be aware that the rubber feet may discolor the top of the stand.
Danger
Caution

iii
2. Before using the monitor.
Make sure that the electrical outlet is properly grounded and supplies the specified
voltage and frequency (100-240V~ 50-60 Hz, more than 85VA).
Connect the monitor to a grounded, 3-prong outlet.
If a grounded, hospital-grade, 3-prong outlet is not available, connect the ground
wire to an outlet with a contact terminal and ground it. Using the monitor with an
incorrect outlet may cause an electrical shock.
Use the monitor safely and correctly.
Connect all cables correctly and securely.
Do not place objects on the monitor or power cable.
Ensure cuff cover is fitted before use.
Using other devices in conjunction with this monitor may cause incorrect diagnosis or
safety problems. When used, check for safety.
Always use accessories and consumables approved byA&D.
Carefully read the instruction manuals provided with optional items.
The precautions for these items are not listed in this manual.
For safe and correct use of this monitor, always perform a pre-inspection (an
inspection before use).
If the monitor is covered with condensation, allow it to dry before switching the power
on.
If the monitor has not been used for an extended period, check that the monitor
operates normally and safely before using it.
The pressure of the cuff may cause a patient’s arm to become numb.
3. When using the monitor.
Do not use a mobile phone near the monitor. It may cause a malfunction.
Do not use the monitor in a moving vehicle as this may result in inaccurate
measurements.
Always check the conditions of the monitor, its parts and the patient for safety.
If a problem is found with the monitor, its parts or the patient, stop using the monitor,
check the status of the patient and take appropriate actions.
Do not use the monitor near a strong magnetic or electric field.
Do not use the monitor on a patient using a heart-lung machine.
Warning
Caution
Warning

iv
4.After using the monitor.
Use the specified procedure to return switches to their state before usage, and then
switch the power off.
Do not forcibly pull out the cables. Hold the connector with your hand when disconnecting
the cables.
Clean the accessories and arrange them before storage.
Keep the monitor clean and in proper operating condition so that it can be used without
problem for the next operation.
5. If you suspect there is a problem with the monitor, perform the following actions.
Ensure the safety of the patient.
Stop the operation of the monitor, switch the power off, and then disconnect the
power cable from the outlet.
In an emergency, such as when the air in the cuff is not released by pressing the
START/STOP switch, press the FAST STOP switch.
Label the monitor with a sign that says “Out of order” or “Do not use” and then
contact A&D immediately.
6. When performing a maintenance inspection.
For your safety, before performing a maintenance inspection, switch the power off
and disconnect the power cable from the outlet.
If the monitor has not been used for an extended period, check that the monitor
operates normally and safely before using it.
Always perform a pre-inspection and maintenance inspection to ensure safe and
correct operation. The organization that installs the monitor (hospital, clinic) is
responsible for use, maintenance, and management of medical electrical devices.
Neglecting pre-inspection and maintenance inspection can result in accidents.
Never disassemble or modify the monitor (medical electrical device).
When maintaining the monitor, use a dry, soft cloth. Do not use rags soaked in
volatile liquids such as thinner and benzene.
Caution
Warning
Warning
Caution

v
7. Be aware that strong electromagnetic waves can cause malfunctions.
This monitor complies with EMC-standard IEC60601-1-2:2007. However, to prevent
electromagnetic interference with other devices, do not use mobile phones near the
monitor.
If this monitor is located near strong electromagnetic waves, noise may enter in
waveforms and malfunctions may occur. If unexpected operations occur during use
of this monitor, check the electromagnetic environment and take appropriate actions.
The following are examples of general causes and countermeasures.
Use of mobile phones
Radio waves may cause unexpected malfunctions.
Instruct visitors to rooms or buildings with medical electrical devices not to use mobile
phones or small wireless devices.
High frequency noise is being introduced from other devices via the electrical outlet.
Check for the source of noise, and then perform countermeasures, such as using a
noise cancellation device on this line.
If the noise source is a device that can be stopped, stop using it.
Use another electrical outlet.
Effects from static electricity are suspected (discharges from devices or the
surrounding area)
Before using the monitor, ensure that the operator and patient have discharged static
electricity.
Humidify the room.
If lightning is occurring nearby, the monitor may receive excessive voltage. In such
cases, power the monitor using the following method.
Use an uninterruptible power supply.
8. Environmental considerations
Before disposing of this monitor, remove the lithium battery from the monitor.
Caution
Caution

vi
PRECUATIONS FOR SAFETY MEASUREMENT
The following lists precautions related to measurement. Always consult with a doctor for evaluation of
the results and treatment. Self-diagnosis and self-treatment from results can be dangerous.
Do not measure on an arm receiving an intravenous drip or blood transfusion. This
may cause an accident.
If the arm cuff cover is soiled with blood, dispose of the cover. There is a risk of
spreading communicable disease.
Items that may be contaminated must be disposed of as medical waste.
Do not perform measurement if the arm has external injuries. Not only will the wound
worsen, there is a risk of communicable disease from a hygiene perspective.
Measurement cannot be performed in the following cases.
The patient who has thin or thick arms.
・ Measurement is intended for arms with circumferences of 18 to 35 cm.
The arm of the patient is wet.
・ Wet arms may cause accidents or electrical shock.
Note
Blood pressure measurement may cause subcutaneous bleeding. This subcutaneous bleeding
is temporary and disappears with time.
If thick clothing is worn, correct measurement is not possible. Measure when the patient is
wearing a sleeveless or thin shirt.
If the patient rolls up their sleeve and this pinches their arm, correct measurement is not possible.
Measurement is not possible with patients with peripheral hypoperfusion, very low blood
pressure, or low body temperature (since blood flow to the measurement location is low).
Measurement is not possible with patients with frequent arrhythmia recurrences
Measurementlocationsarerestrictedtotherightandleftupperarms.Otherlocationscannotbemeasured.
Insert the arm into the arm insertion section up to the top of the shoulder.
Ifthepatientdoesnotfeelwell,stopmeasurementimmediatelyandtakeappropriateactions.
Measurement cannot be performed with the following patients.
Patients who have just exercised
・ Blood pressure after exercise is higher than normal.
Measure after the patient has rested for several minutes and has taken deep breaths.
Patients with shaking arms
・ If the patient’s body moves, correct measurement is not possible. Wait until the shaking
stops, and then perform measurement. (This includes shaking fromthe cold or muscle
movements after moving heavy objects.)
Consult the doctor for any of the following situations.
The application of the cuff on any limb with intravascular access or therapy, or an
arterio-venous (A-V) shunt.
The application of the cuff on the arm on the side of a mastectomy.
Simultaneous use with other medical monitoring equipment on the same limb.
The blood circulation of the patient needs to be checked.
Warning
Caution

vii
UNPACKING
This monitor is a precision device and must be handled carefully. If it receives a strong
impact, it may be damaged.
Note
This monitor has been shipped in specially designed packaging to preventdamageduring shipping.
Check the monitor for damage when unpacking it.
Before using the monitor, ensure that everything is included and then check the main unit and each
standard accessory for damage.
For optional items, see “13.ACCESSORIES AND OPTIONS LIST”.
Main unit........................................................................1
Standard accessories
Power cable ........................................1
Arm cuff cover.......................................1 (One already installed on the main unit)
Printer paper .......................................1
Instruction manual (this manual) ........1
Instruction panel..................................1
Caution

viii
[Blank page]

1
TABLE OF CONTENTS
1. INTRODUCTION........................................................................................................................................ 3
2. FEATURES................................................................................................................................................ 3
3. ABBREVIATIONS AND SYMBOLS............................................................................................................ 4
4. SPECIFICATIONS...................................................................................................................................... 6
4.1. MODEL CONFIGURATION....................................................................................................................... 6
4.2. PERFORMANCE SPECIFICATIONS........................................................................................................... 6
4.3. EXTERNAL DIMENSIONS........................................................................................................................ 7
4.4. OPERATION PRINCIPLES ....................................................................................................................... 7
4.5. STANDARDS AND COMPLIANCES............................................................................................................ 7
5. PART NAMES............................................................................................................................................ 8
Front.......................................................................................................................................................... 8
Rear........................................................................................................................................................... 9
External input/output unit (option)........................................................................................................... 10
6. BEFORE USE...........................................................................................................................................11
6.1. MONITOR INSTALLATION.......................................................................................................................11
6.2. POWER CONNECTION..........................................................................................................................11
6.3. SECURITY SLOT ..................................................................................................................................11
6.4. ATTACHING THE INSTRUCTION PANEL................................................................................................... 12
6.5. PRE-INSPECTION ............................................................................................................................... 13
6.5.1. Introduction .............................................................................................................................. 13
6.5.2. Before switching the power on.................................................................................................13
6.5.3. After switching the power on....................................................................................................13
7. BLOOD PRESSURE MEASUREMENT.................................................................................................... 14
8. SETTING THE CLOCK ............................................................................................................................ 15
9. PRINTER ................................................................................................................................................. 16
9.1. INSTALLING THE PRINTER PAPER ......................................................................................................... 16
9.2. SELECTING THE PRINT FORMAT........................................................................................................... 18
10. CHANGING FUNCTIONS..................................................................................................................... 20
10.1. CHANGING PROCEDURE ................................................................................................................. 20
10.2. DISPLAY TIME................................................................................................................................. 22
10.3. APPLIED PRESSURE ....................................................................................................................... 22
10.4. IHB............................................................................................................................................... 22
10.5. PRINT QUALITY............................................................................................................................... 23

2
10.6. ID PRINTING................................................................................................................................... 23
10.7. MEAN ARTERIAL BLOOD PRESSURE (MAP) PRINTING........................................................................ 24
10.8. MEASUREMENT VALUE PRINTING..................................................................................................... 25
10.9. GRAPH PRINTING ........................................................................................................................... 26
10.10. BITMAP PRINTING........................................................................................................................... 26
10.11. BEEP SOUND ................................................................................................................................. 26
10.12. EXTERNAL INPUT/OUTPUT UNIT (OPTION)PROTOCOL........................................................................ 27
10.13. TRANSMISSION SPEED (MINI-DIN) .................................................................................................. 28
10.14. TRANSMISSION SPEED (D-SUB)...................................................................................................... 28
10.15. STOP BIT (MINI-DIN)...................................................................................................................... 28
10.16. STOP BIT (D-SUB).......................................................................................................................... 28
10.17. BLOOD PRESSURE RESULT OUTPUT................................................................................................. 28
10.18. DATE FORMAT................................................................................................................................ 29
10.19. TIME FORMAT................................................................................................................................. 29
10.20. ICT PRINTING ................................................................................................................................ 29
11. TRANSMISSION SPECIFICATIONS .................................................................................................... 30
11.1. EXTERNAL INPUT/OUTPUT UNIT ....................................................................................................... 30
12. MAINTENANCE................................................................................................................................... 35
12.1. INSPECTIONAND SAFETY MANAGEMENT........................................................................................... 35
12.2. CLEANING ..................................................................................................................................... 37
12.3. PERIODIC INSPECTION.................................................................................................................... 40
12.4. REPLACING THE ARM CUFF COVER .................................................................................................. 41
12.5. CHECKING THE NUMBER OF MEASUREMENTS................................................................................... 43
12.6. DISPOSING OF THE COMPONENT PARTS........................................................................................... 44
12.7. BEFORE REQUESTING SERVICE....................................................................................................... 45
12.8. ERROR CODES............................................................................................................................... 46
13. ACCESSORIES AND OPTIONS LIST .................................................................................................. 49
14. ABOUT BLOOD PRESSURE............................................................................................................... 49
15. SENDING BITMAP PATTERNS............................................................................................................ 50
15.1. SIZE OF ORIGINAL BITMAP PATTERNS............................................................................................... 50
15.2. SENDING BITMAPS.......................................................................................................................... 51
APPENDIX: EMC INFORMATION.................................................................................................................... 52
MEMO............................................................................................................................................................. 55

3
1. INTRODUCTION
This device conforms to the European Directive 93/42/EEC for Medical Products. This is
evidenced by the CE mark of conformity accompanied by the reference number of a designated
authority.
This device is a blood pressure monitor that measures systolic and diastolic blood pressure and
pulse rate for diagnosis and checkup. The intended users are general adults, or 13 and older, with
common knowledge about blood pressure measurement, who can perform a measurement on
either their right or left arm.
This device is designed to be used at outpatient clinics of general hospitals. It can also be used at
health facilities, fitness gyms and other public facilities for blood pressure management of the
visitors.
Notes
Do not attempt to evaluate the blood pressure measurement results. Always consult with a doctor
for evaluation of the results and treatment, especially when the results are greatly different from your
ordinary values. Self-diagnosis and self-treatment from such results can be dangerous.
Do not attempt to use this device on newborns or infants. Using this device on small children
could cause injury to them. This device is designed for measuring adults.
Facilities with the device installed should employ at least one person who has good knowledge of
blood pressure measurement and can give advice to users about how to pose for measurement or
general information about blood pressure. The person should also have basic knowledge about
maintenance of the monitorand know procedures to request training for maintenance if necessary.
2. FEATURES
Measurement can be performed using either the right or left arm.
The arm cuff is inflated around the arm by pressing the START/STOP button and deflation
speed is automatically controlled. No special adjustment is required. All you have to do is insert
your arm into the arm insertion section to the shoulder and press the START/STOP button. The
rest of the procedure is done automatically for a quick and easy measurement of blood
pressure.
The printer is equipped with a cutter to automatically cut the printed paper.
An optional external input/output unit can be connected to a computer for data management or
automation as necessary.
.

4
3. ABBREVIATIONS AND SYMBOLS
Abbreviation/
Symbol Meaning
Starts and stops a measurement
Alternating current
Fuse
mmHg Blood pressure unit
/min. Heartbeats per minute
--- Displayed when measurement is not possible
SYS Systolic blood pressure (Used for table printing)
MAP Mean arterial blood pressure
(Used for printing, depending on settings)
DIA Diastolic blood pressure (Used for table printing)
PUL Pulse (used for table printing)
Measurement time (used for table printing)
Irregular Heartbeat symbol (IHB)
Appears when an irregular heartbeat is detected. The mark is printed
when a very slight vibration like shivering or shaking is detected.
Read the description about irregular heartbeat on the next page.
Power off (disconnected from the power source)
Power on (connected to the power source)
Serial number
Date of manufacture
RS-232C serial interface
The medical device label by the EC directive
WEEE label
EU authorized representative
Manufacturer
Exx Error code display (xx=00 to 99)
Displays extent of electric shock protection; B-type applied part
Follow Instructions for use
Displays the measurement status. ”MEASUREMENT IN PROGRESS”.
Displays the measurement status. ”TAKE MEASUREMENT AGAIN“
“FAST STOP” for emergency use.
Caution：”Please do not pull printer paper during printing.”
Caution：”The printer paper is automatically cut.”
"POWER" switch.
Used to change functions.
Used to change function contents.
Used to display the number of measurements to date.
Described how to change a printer paper.

5
What is IHB (Irregular Heartbeat)?
The TM-2657P blood pressure monitor provides a blood
pressure and pulse rate measurement even when an
irregular heartbeat occurs. An irregular heartbeat is
defined as a heartbeat that varies by 25% from the
average of all heartbeats during the blood pressure
measurement. It is important that you are relaxed,
remain still and do not talk during measurement.
Note We recommend that the patient sees a doctor or clinician if the symbol ( ) frequently.
When is the IHB mark printed?
The IHB mark is printed in the measurement data in the following two cases.
●When a beat varies by ±25% from the average pulse interval during measurement.
●When the arm or monitor is moved during measurement.
25% or shorter than average
Beat Beat Beat Beat

6
4. SPECIFICATIONS
4.1. Model configuration
Model
Included functions
TM-2657P-EX TM-2657P-EG
Printer ○○
Measurement status LED ○○
Time,Date format 24hour,DD/month/YYYY
12hour,month/DD/YYYY
4.2. Performance specifications
General
AC Power supply 100-240V～50-60 Hz
Power consumption 50-80 VA
Safety standard IEC60601-1:2005
MDD Classification Class IIa
EMC compliance Complies with EMC standard IEC60601-1-2:2007.
Type of protection NIBP: type B Applied part
Type of protection against
electrical shock Class I
Blood pressure measurement
Measurement method Oscillometric measurement
Pressure display range 0-299 mmHg
Pressure display accuracy Pressure: ±3 mmHg
NIBP Measurement range SYS DIA
Pulse rate
40-270 mmHg
20-200 mmHg
30-240 bpm
NIBP Clinical test EN1060-4 :2004
Pulse rate accuracy ±5%
Cuff Winding mechanism operated by geared motor
Applicable arm circumference
18-35 cm
Cm 35 cm
Applied pressure Automatic inflation by air pump
Deflation Automatic deflation by mechanical exhaust
Exhaustion Automatic rapid exhaust by solenoid valve
Environment specifications
Operating environment Temperature: 10-40 °C
humidity: 30-85% RH (no condensation)
Storage environment Temperature: -20 to 60 °C
humidity: 10-95% RH (no condensation)
Atmospheric pressure range
70-106 kPa (both for operation and storage)
Physical specifications
External dimensions 241 (W) x 324 (H) x 390 (D) mm
Weight Approx. 5.5 kg
Functional specifications
Display method 3-digit display LED & LED lamp
Printer Thermal printing, paper width: 58 mm
Usable life
5 years from installation
According toA&D data (tested for use under recommended
environment, including maintenance inspection. Results may
be different under other conditions.)

7
4.3. External dimensions
Unit:mm
4.4. Operation principles
The cuff pressure is raised to approximately 30 mmHg higher than the anticipated systolic
pressure and then gradually depressurized. Pulsations occur in the cuff pressure that matches
the heart rate. These pulsations have an undulating pattern. They start small and then gradually
increase with depressurization. After the maximum amplitude(MAP) is reached, they decrease.
An oscillometric blood pressure monitor analyzes the amplitude waveform data of these
pulsations to determine the systolic and diastolic blood pressures.
4.5. Standards and compliances
The TM-2657PAutomatic Blood Pressure Monitor corresponds to the following standards:
IEC 60601-1:2005 (Medical electrical equipment – Part 1: General requirements for safety and
essential performance);
IEC 60601-1-2:2007 (Medical electrical equipment – Part 1-2: General requirements for basic safety
and essential performance - Collateral Standard: Electromagnetic compatibility - Requirements and
tests);
EN ISO810601-1:2012(Non-invasive sphygmomanometers - Part 1: Requirements and test methods
for non-automated measurement type)
EN 1060-3: 1997 + A2: 2009 (Non-invasive sphygmomanometers - Part 3: Supplementary
requirements for electro-mechanical blood pressure measuring systems);
EN 1060-4: 2004 (Non-invasive sphygmomanometers - Part 4: Test procedures to determine the
overall system accuracy of automated non-invasive sphygmomanometers)
IEC 80601-2-30: 2009 + A1: 2013 (Medical electrical equipment –Part 2-30: Particular requirements
for the basic safety and essential performance of automated non-invasive sphygmomanometers).
The TM-2657P is not made with natural rubber latex.

8
5. PART NAMES
Front
No. Name Description
1 Open printer cover button
Opens the printer cover.
2 Printer paper opening Opening for printer paper to eject.
3 Printer cover Holds down the printer paper.
4 Power cable AC power cable.
5 Systolic blood pressure
display
Displays the systolic blood pressure measurement value.
When a measurement error occurs, the error code is
displayed.
6 Diastolic blood pressure
display Displays the diastolic blood pressure measurement value.
Displays the pressure during measurement.
7 Pulse display Displays the pulse measurement value.
8 Clock display Displays the current time.
(24hour :TM-2657P-EX, 12hour :TM-2657P-EG)
9 Measurement status LED
Displays the measurement status.
“MEASUREMENT IN PROGRESS”
“TAKE MEASUREMENT AGAIN“
10
START/STOP button
If this button is pressed in the standby mode, blood pressure
measurement is started.
If this button is pressed during blood pressure measurement,
blood pressure measurement is stopped.
11
Arm cuff cover Inner cover of the cuff.
12
Cuff section Holds the arm cuff cover.
13
FAST STOP button If this button is pressed during an emergency, the power is
switched off and measurement is stopped.

9
Rear
No.
Name Description
1 SELECT button Used to change functions.
2 ▲button If pressed when the number of measurements to date is
displayed, the number of measurements is printed.
Used to change functions.
3
COUNT button Displays the number of measurements to date. (See “12.5.
Checking the number of measurements”)
4
Bitmap SD socket cover Use for only maintenance.
5
Arm cuff cover Inner cover of the cuff.
6
Cuff section Holds the arm cuff cover.
7
Armrest Location to rest the arm during measurement.
8 External input/output unit The optional external input/output unit.
9 POWER switch Switches the power on and off.
Once the power is switched on, the monitor will be in the
standby mode.
10
Cover for pressure
inspection area Used to check pressure accuracy.
11 AC INPUT connector Insert the power cable.
12
Security slot Can be used with a security cable to secure the monitor to
a desk or pole. (For theft prevention)

10
External input/output unit (option)
TM-2657-01 External input/output unit RS 2ch（option）
No.
Name Description
1 Mini-DIN 8 pin female
RS-232C
2 D-Sub 9 pin male RS-232C
TM-2657-03 External input/output unit RS 1ch（option）
No.
Name Description
1 D-Sub 9 pin male RS-232C
TM-2657-05 External input/output unit RS+Bluetooth（option）
No.
Name Description
－ Bluetooth Bluetooth Ver.2.1 class1 SPP HDP correspondence
1 D-Sub 9 pin male RS-232C
NOTE
For details on EXTERNAL INPUT/OUTPUT UNIT (TM-2657-01, TM-2657-03, TM-2657-05),
contact the local A&D dealer.