Cardioline AR 600 User manual

ar600
user manual
English

2
This User Manual is prepared with the objective of providing the user with all of the
information necessary to obtain the best use of the CARDIOLINE® ar600. Together
with a description of the equipment's functions the following documentation will be
found:
- Certificate of Guarantee
General information
CARDIOLINE
®
is a registered trade mark et medical devices SpA
All rights reserved © et medical devices SpA ITALY.
et medical devices SpA, in its continual pursuit of technological improvement and
customer satisfaction, reserves the right to modify this publication without notice at
any time.
um_ar600_cardioline_01_eng1.doc Rev. 01/sr/GZ 07/09/2005 Ref: 36519094

3
Index
1 Introduction .....................................................................................5
1.1 How to read the manual ...............................................................6
1.2 Information and recommendations related to safe use .....................7
1.3 The electrocardiograph.................................................................9
Front view .....................................................................................9
Side view and bottom .....................................................................9
Parts, symbols and commands ....................................................... 10
2 Installation and initial preparation ..................................................... 12
2.1 Selecting the installation site ...................................................... 12
2.2 Loading the heat-sensitive paper................................................. 12
If using rolls of paper: .................................................................. 13
If using packs of paper: ................................................................ 13
2.3 Power supply; control and management of the internal batteries..... 13
Recharging the batteries ............................................................... 14
Battery charger: precautions for use............................................... 15
2.4 How to switch on the electrocardiograph ...................................... 15
2.5 How to switch off the electrocardiograph ...................................... 15
Auto power off ............................................................................. 15
2.6 Setup of the electrocardiograph .................................................. 16
How to access the "Setup Menu" .................................................... 16
How to change the setup............................................................... 16
Selections available ...................................................................... 16
How to quit the "Setup Menu" ........................................................ 18
3 Preparing for an ECG recording......................................................... 19
3.1 Connecting the patient cable....................................................... 19
3.2 Preparing the patient and applying the electrodes.......................... 19
3.3 Selection of recording characteristics: speed, sensitivity, filters ....... 20
Speed of recording on paper.......................................................... 20
Sensitivity of recording on paper .................................................... 21
Recording filters........................................................................... 21
4 Recording a resting ECG .................................................................. 22
4.1 Recording in manual mode ......................................................... 22
4.2 Recording in automatic mode ...................................................... 22
Automatic calculation of the ECG parameters 5 ........................ 23
Copy of an automatic ECG recording ........................................ 23
Saving an automatic ECG recording to archive on a Personal Computer
5 ........................................................................................ 24
4.3 Recording in "PC ECG" mode 5 ............................................ 24
4.4 Defibrillation ............................................................................. 24
5 Management and control of the functions of the electrocardiograph....... 26
5.1 Disconnected electrodes, potential presence of defibrillation ........... 26

4
Stop phase ................................................................................. 26
Manual recording phase................................................................ 26
Automatic recording phase ........................................................... 26
Defibrillation ............................................................................... 26
5.2 Batteries low on energy or no charge .......................................... 26
5.3 Print system control. Out of paper............................................... 27
5.4 Status messages & errors indication: description and related event. 27
5.5 Troubleshooting........................................................................ 28
6 Maintenance .................................................................................. 29
6.1 Self-test .................................................................................. 29
6.2 Replacement of the heat-sensitive paper ..................................... 29
6.3 How to clean the device and the electrodes.................................. 30
6.4 How to replace the batteries....................................................... 30
6.5 Periodic checks ......................................................................... 31
Technical information ................................................................... 31
7 Technical Specifications................................................................... 32
Basic accessories supplied ............................................................ 33

5
1 Introduction
ar600 embodies the features of reliability, modularity, versatility and
upgradability that characterize the latest generation of CARDIOLINE®
electrocardiographs.
ar600 is a portable electrocardiograph with dual power supply, (mains and
rechargeable internal batteries), which in the basic configuration allows:
 recording of an ECG in either automatic or manual mode;
 printing the ECG on 60 mm single channel format paper using a high-
resolution thermal print;
 storing the most recent ECG recording in automatic mode and printing
additional copies of the ECG as required.
Thanks to the flexibility of the software used and to the infrared interface,
the ar600 can be adapted at any given moment to suit your individual
requirements. The range of "options" offered is particularly generous and
there are no restrictions or constraints, as the selection can be made either
at the moment of purchase or later on at your clinic or surgery without
having to interrupt day-to-day activity.
In just a few minutes your ar600 can be equipped with:
- "multi-channel option": for printing the ECG signal in 1, 2 and 3 channel
format;
- "ECG measurement option": automatic ECG parameter measurement
program;
- PC archive option: Archival storage of the ECG in a personal computer
running the CARDIOLINE® software for the ECG computerised
management .The data upload to the PC is made by use of the wireless
“IR” interface; no direct connection to the PC is required.
- PC ECG option: real time display of the 12 ECG leads on a personal
computer screen endowed with CARDIOLINE® software for the ECG
computerised management. The software can offer an optional module
for automatic interpretation of the ECG signal.
CONGRATULATIONS ON YOUR PURCHASE. Your new computerised
electrocardiograph CARDIOLINE® has been designed and built in
compliance with the applicable regulations in force at the time when et
medical devices SpA, Cavareno (Trento) - ITALY drew up this manual. et
medical devices operates in accordance with the requirements for quality
management systems defined by EN ISO 9001: 2000 and EN ISO 13485:
2003 standards. The system is covered by a Nemko Certification AS (Cert.
N. 800278). Your new electrocardiograph has also been built in compliance
with the Medical Device Directive 93/42/EEC and is therefore marked by the
relevant CE0470 mark.

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1.1 How to read the manual
In order to ensure the ® ar600 is operated in a safe and correct manner,
and to appreciate its ease of use and high reliability the user instructions
must be read carefully.
This documentation describes the functions of your electrocardiograph
including those provided by all the possible "options" available. It is
therefore possible that some of the functions described may not be present
in the model you have purchased. For details of the options, consult the
"firmware configuration" chart which accompanies each individual appliance.
5 This symbol allows you to identify the functions not provided on all
models, which must be requested specifically at the time of purchase.
This symbol allows you to identify the functional, behavioral and
operational aspects that may be programmed by the type of configuration
selected during the step of "Installation and initial preparation: setup of the
electrocardiograph".
...
When a given key is depicted in the body of a sentence or a
paragraph, press the corresponding key on the appliance to perform the
action.
The structure of this manual allows you to approach the use of the
electrocardiograph according to your own level of experience. If you are
already familiar with CARDIOLINE® equipment, the initial fast-track part
of each paragraph will allow you to begin working immediately. If you
continue reading the paragraph, however, you will see that the individual
aspects of the operation are discussed in more detail.
The manual gives detailed information on the use of the model ar600 for
typical ECG procedures, and an introduction to the use of particular
functionalities involving interaction with software and a Personal Computer.
For instructions on the use of the software applications for Personal
Computer, consult the special online guides.
The quick guide to the electrocardiograph (
?
to obtain the printout)
sums up the operations linked to the single commands presented in the
manual.
Further information and clarifications can be requested directly from:
CARDIOLINE® - Product Support
Strada Rivoltana Nuova, 53, I - 20060 Vignate (MI) ITALIA
e-mail: et.se[email protected]
tel. [phone] fax: [phone]

7
1.2 Information and recommendations related to
safe use
- Always use the device according to the instructions in this manual.
- The device is equipped with a set of standard accessories. For reasons
of safety, reliability and conformity with the Medical Devices Directive
93/42/EEC, use only original accessories or accessories approved by the
manufacturer.
- The device is equipped with a special long-life thermal print head writing
system, which allows maximum writing precision. To avoid frequent and
costly replacements and repairs, always use the original paper or paper
approved by the manufacturer. The manufacturer does not accept
responsibility for any damage to the device or any other effect on it,
caused by the use of unsuitable paper.
- Do not subject the device to impact or excessive vibrations.
- Do not allow liquids to penetrate inside the device. If this should
accidentally occur, have the functional efficiency of the device tested by
a Qualified Assistance Centre before using it again.
- Make sure that the value of the supply voltage corresponds to that
indicated on the data plate of the device.
- If you are using the device in connection with others, ensure that: all
connections are made by skilled persons; all connections comply with
safety regulations; all other devices connected respond likewise to
regulations. Non-compliance with regulations can cause physical harm to
the patient connected and to the person operating the device. Should it
be difficult to obtain the necessary information for assessing the risk of
the individual connections, apply directly to the manufacturers
concerned or avoid making the connections.
- If other equipment is used, connected directly or indirectly to the
patient, check the possible risks caused by the sum of the leakage
currents on the body of the patient.
- The device is protected against defibrillation discharges according to
standards IEC 601-1-25; to ensure that the signal is restored, use only
original electrodes or electrodes responding to IEC and AAMI standards.
- If an electrosurgical scalpel is in use, the patient cable should be
disconnected from the device.
- At all events, when defibrillators or high-frequency surgical devices are
being used at the same time, it is essential to take the greatest care. If
there is any doubt concerning their use, disconnect the ECG patient
cable temporarily.
- The device recognizes the impulses generated by a pacemaker and does
not interfere with its operation, as prescribed by standards in use at the
time of drafting this manual.
- Periodically check the efficiency of all accessories and of the device
itself. Use the built-in test function to make a first check of the
equipment's efficiency. Contact the Authorized Technical Assistance
Center whenever the equipment appears to be malfunctioning.

8
- To ensure a longer life of your device, it is necessary to have it checked
periodically by an Authorized Assistance Center.
- Caution: do not use the electrocardiograph for intracardiac applications
or for monitoring activities in the operating theatre!
- Caution: do not use the device in the presence of anaesthetics or
inflammable gases!
- Caution: devices for medical applications must be used only by persons
who by virtue of training or practical experience are able to ensure
maximum safety and effectiveness in operation. Every operator must
become familiar with the instrument before using it on a patient.
- Caution: the indications obtained using automatic interpreting
programs or other diagnostic aids must be passed and countersigned by
a qualified medical person!
- Caution: use only original "battery chargers" as indicated alongside the
connector and in the paragraph "Accessories supplied".The original
"battery chargers" ensure the electrical isolation of the patient and the
operator, guaranteeing essential conditions of safety. Do not use
replacement accessories that have not been approved by the
manufacturer.
- Caution: the device is provided with an IR interface for the transfer of
data to other devices. The IR interface must not be masked, even
accidentally, as this will adversely affect its capability and its operation,
interrupting and preventing the correct flow of data.
- The manufacturer will be responsible for the safety and correct use of
the devices only if:
o modifications and repairs are performed by the manufacturer or by
an Authorized Assistance Center;
o the a.c. power supply of the building responds to current
regulations;
o the device is operated in accordance with user instructions;
o the accessories used are those approved by the manufacturer.

9
1.3 The electrocardiograph
In order to simplify the installation and the use of your electrocardiograph,
it is recommended that you become familiar with the component parts and
method of operation.
Front view
Side view and bottom
REF: 63 08.
1
2
3
4
4
5
2
6
7
8

10
Parts, symbols and commands
1. The keyboard
Function
key
Associated
LEDs
- LED on: device connected to
a.c. power supply; internal
batteries charging
On / Off
- LED off: batteries charged
- LED blinking: charge level of
batteries lower than 30%
- LED on: internal batteries; the
device must be connected to
the a.c. supply for recharging.
- ECG recording in "manual
mode"
- ECG recording in "automatic
mode"
- "setup mode"; access to
configuration menu
selection of
operating
mode
- ECG recording in "PC ECG
mode"
- automatic sensitivity: the
device optimizes the ratio
between n° channels and
available space
5
- sensitivity 5 mm/mV
10
- sensitivity 10 mm/mV
Selection of
recording
sensitivity
20
- sensitivity 20 mm/mV
mains and
muscle
interference
filter
- LED on: filter on
25
- paper speed 25 mm/s
selection of
paper speed
50
paper speed 50 mm/s
start selected
operating
mode
- LED on: electrodes not
connected or insufficient
contact; saturation
interrupt
current
operation;
stop

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2. Paper compartment cover
3. IR interface
4. Connector for the CF type patient cable protected from defibrillation as
indicated by the symbol
5. "Reset" key : allows normal operating conditions to be restored in
the event of an error that cannot be managed using the other keys
6. "Battery charger" connector
7. Data plate. In the event of communicating with Authorized Assistance
Centers, refer to the data indicated
8. Battery compartment cover

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2 Installation and initial preparation
This section describes the operations to be performed prior to using your
new CARDIOLINE® ar600 electrocardiograph. Suggestions are given for
"selecting the installation site" and "recommendations for safe use in
conformity with current statutory regulations" are indicated. Also introduced
are the operations involved in preparing the electrocardiograph for use,
such as "loading the heat-sensitive paper", "power supply; control and
management of the internal batteries", "switching on and off", "setup".
2.1 Selecting the installation site
The ar600 electrocardiograph complies with European directives on
electromagnetic compatibility. The absence of emissions damaging to radio
and telecommunications transmissions is therefore assured, as also is
protection from interference emitted by other systems and equipment.
Nevertheless, in order to protect your device from other equipment not in
conformity with the aforementioned directives:
- avoid the use of mobile phones in the vicinity;
- place the electrocardiograph as far as possible from electrical power
lines or from sources of static electricity. The ECG signal can in fact be
disturbed if the electrocardiograph is situated in proximity to sources of
high voltage or electrical lines;
- avoid placing the electrocardiograph close to other diagnostic or
therapeutic equipment (e.g. X-ray machines, ultrasound machines,
electrically operated beds, etc.) that could be a source of excessive
interference and ECG signal distortion;
- if it is impossible to position the electrocardiograph away from other
electrical equipment, switch off such equipment when recording an ECG.
Also, observe the ambient operating conditions when recording ECGs:
- record in a room where the temperature is between 20 and 25 degrees
Centigrade. This precaution prevents the patient from feeling cold, which
could increase shivering and contribute to muscle tremor;
- Avoid exposing the equipment to extreme temperatures, excessive dust
or dirt, and very salty or humid environments; refer to the ambient
conditions described in detail under the "Technical characteristics"
heading.
2.2 Loading the heat-sensitive paper
CARDIOLINE® ar600 is able to reproduce the ECG signal both on heat-
sensitive paper in rolls and on heat-sensitive paper in packs. No special
setup procedure is required for either. This sections gives the instructions
for the correct loading of both types of paper.

13
1
1
2
2
33
If using rolls of paper:
a. Using a coin or similar instrument, open the paper compartment and
remove the "roll guide" hub. If replacing a depleted roll, recover the hub
before throwing away the core of the previous roll.
b. Slot the hub into a new roll of paper (1) and locate in the paper
compartment, positioning the pins in the sockets (2). Ensure that the
black mark on the paper is on the lower part of the roll.
c. Close the cover, positioning the paper between the rubber roller and the
casing of the device (3).
If using packs of paper:
a. Using a coin or similar instrument, open the paper compartment and
remove the "roll guide" hub. To avoid accidentally losing the hub, store
it in a safe place.
b. Prepare a new pack (1) and position it in the compartment (2). Ensure
that the black mark on the paper is on the lower part of the pack.
c. Close the cover, positioning the paper between the rubber roller and the
casing of the device (3).
Warning: use only original heat-sensitive paper or paper approved by the
manufacturer. The use of paper that does not respond to the manufacturer's
specifications could jeopardize the correct operation of the device.
2.3 Power supply; control and management of the
internal batteries
Your electrocardiograph uses a dual power supply system: a.c. mains and
NiMh rechargeable internal batteries.

14
The rechargeable batteries come as a pack of 4+4 elements housed in the
battery compartment on the bottom of the device, and are protected
against short circuits.
Caution: before using the device, it is necessary to go through a complete cycle of
recharging of the batteries! However, it is advisable to connect the appliance to the
mains during the installation procedures.
To connect the electrocardiograph to the mains, connect the "battery
charger" (provided) to the connector
REF: 6308.
on the back of the device. The
"battery charger" is protected against short circuits by an internal fuse (not
replaceable) and against overheating.
Caution: the battery charger is a class II power supply and does not require earthling
of the electrical system.
Caution: when the device is connected to the mains, the internal batteries are
recharged automatically, even during use.
To gain maximum benefit from the characteristics of the dual power supply
system, follow the indications given below.
Recharging the batteries
The batteries must be recharged when the LED begins to blink,
signifying that the reserve charge is lower than 30%.
Connect the electrocardiograph to the mains: LED
turns on. Complete
recharging of the batteries requires about 14 hours.
The batteries can be recharged in part, or the device can be kept connected
permanently to the mains. For longer life, the batteries should be allowed to
run down and recharged completely at least every two months.
A complete recharge allows the recording of up to 500 complete ECGs
(automatic recording mode, 3 channel print format, speed 25 mm/s. When
recording with single channel print format, the number is reduced to 250).
If the batteries have completely run down (LED
lit), it is still possible to
make an ECG recording by connecting the device to the mains.
The average life of the batteries is more than 300 complete
discharge/recharge cycles.
Caution: do not dispose of spent batteries as ordinary refuse or litter. Use only
original batteries provide from the manufacturer. The battery lifetime is
approximately one year.

15
Battery charger: precautions for use
- The "battery charger" can be damaged if dropped, struck or tampered
with.
- Do not immerse the "battery charger" in water or other liquids. When
using it, do not place it on or near sources of heat.
- Do not damage or tamper with the cables for connection to the mains
and to the electrocardiograph.
- Connect the "battery charger" to the electrocardiograph only by means
of the connector provided.
- Use the "battery charger" only at the specified mains voltage. If the
"battery charger" provided is not compatible with your mains supply,
ask the nearest Authorized Assistance Center for a suitable model.
2.4 How to switch on the electrocardiograph
for at least two seconds.
The LEDs corresponding to the settings previously selected will light
up: you can proceed.
Caution: if the LED remains alight or blinking, internal power is insufficient and
the batteries must therefore be recharged, connecting the device to the mains (see
paragraph "Power supply; ..." ). The batteries are recharged even if the device is in
use.
2.5 How to switch off the electrocardiograph
.
The LEDs corresponding to the selected settings will extinguish. The
memorized ECG, if any, and the settings for the last recording, are
stored in the memory.
Caution: switching off is not enabled 1. during the transmission of an ECG to a PC; 2.
during the self-test routine; 3. if "setup" mode is active. In these cases, first stop the
device and then switch off.
Auto power off
To preserve the battery charge, the electrocardiograph is provided with an
auto power off function that will activate automatically, depending on the
amount of power still available and on the operating mode selected. The
procedure is activated only after the current operation has been completed.
- After 10 min. have elapsed without any key being pressed: reserve
power > 30%.

16
- After 1 min. has elapsed without any key being pressed: reserve power
between 15 and 30% (LED
blinking).
- After 10 sec. have elapsed without any key being pressed: reserve
power < 15% (LED
alight).
If the auto power off function is activated, the current ECG and settings (if
applicable), will be stored in memory.
Auto power off is inhibited if:
- a recording is in progress in PC-ECG mode.
- during the self-test routine;
- during "setup".
2.6 Setup of the electrocardiograph
Some of the characteristics of your electrocardiograph can be set according
to individual preference and convenience. The characteristics that can be
configured are listed in the "Setup Menu".
Within the menu, it is possible to activate the self-test function of the device
(see paragraph "Maintenance" ).
How to access the "Setup Menu"
to select "setup mode": LED on.
to print the menu and the active setup.
How to change the setup
Accessing the setup menu, a page is printed which shows the list of the
available setup options.
The active setup is highlighted by two square brackets […].
Press the key associated with each option to change the selection.
Selections available
Print format
Setup Option Status
(selections available) … change selection
5 No. channels [1] 2 3
?
Up to three print formats are available: [1] channel per page, [2] channels
per page, [3] channels per page. The appendix illustrates examples of
recordings in different formats (see "Print formats - examples").

17
The format selected will be applied to all the recordings in manual and
automatic mode.
Automatic calculation of ECG parameters (ECG measurements)
Setup Option Status
(selections available) … change selection
5 Calculate parameters Yes [No]
25
50
The program for automatic measurement of the ECG parameters allows a
report of the principal measurements calculated to be obtained at the end of
each automatic recording.
Selecting [Yes] the program will be performed automatically at the end of
acquisition; selecting [No], no measurements will be calculated.
PC ECG recording mode
Setup Option Status
(selections available) … change selection
5 PC ECG Yes [No]
5
20
10
The PC ECG function allows real time viewing of the twelve leads on the
screen of your Computer using "R.T.E." 4057 (Real Time ECG) software.
Selecting [Yes] it will be possible to select the PC ECG operating mode, from
the keyboard, in addition to the traditional automatic and manual modes;
selecting [No] this selection will not be possible.
Saving to Personal Computer archive
Setup Option Status
(selections available) … change selection
5 PC archive Yes [No]
Using the PC Archive function, in association with CARDIOLINE software, a
trace recorded and stored in automatic mode can be transferred to a
computer.
Selecting [Yes] the action "activate transmission to PC" is associated with
the key ; selecting [No] the associated action is "print copy of last
recording".

18
ECG report length
Setup Option Status
(selections available) … change selection
No. pages auto [1] 2
25
50
It is possible to select the length of the signal to be represented on paper
during automatic recordings, indicating the number of pages to be used.
Two options are available: [1] page per lead or group of leads (if a multi
channel format has been selected); [2] pages per lead or group of leads (if
a multi channel format has been selected).
The option selected will be applied to all recordings in automatic mode.
Mains frequency
Setup Option Status
(selections available) … change selection
Mains frequency [50] 60
To ensure correct operation of the device, the program must be set to
recognize the mains frequency adopted in the area of use.
Two options are available: [50] Hz; [60] Hz.
The option selected will have an effect, both on the battery charging process
and on the operation of the filters used to reduce mains interference.
Self-test
Setup Option Status
(selections available) … change selection
Self-test
To verify correct operation of the electrocardiograph, the self-test routine
can be run by accessing the dedicated menu. For details, see "Maintenance
- Self-test".
How to quit the "Setup Menu"
to quit "setup mode". Select a new operating mode to
continue.

19
3 Preparing for an ECG recording
Below are described the operations to be performed prior to recording a
resting electrocardiogram with the CARDIOLINE® ar600
electrocardiograph. In particular, indications are given on "connecting the
patient cable", "suitably preparing the patient", "applying the electrodes".
Moreover, the necessary procedures for choosing the correct recording
parameters, such as "speed, sensitivity and inserting the filters", are
illustrated.
3.1 Connecting the patient cable
Connect the terminal plug of the patient cable to the connector
identified with the symbol , positioned on the right side of the device.
Note: to avoid breaking the patient cable, remove it from the connector without
tugging it, gripping it by the plug.
Warning: the device is internally protected against defibrillation discharges; in order
to guarantee the resetting of the signal, it is necessary to use protected electrodes.
To ensure that safety conditions are respected, use only original accessories.
3.2 Preparing the patient and applying the electrodes
A careful preparation of the patient and the correct positioning of the
electrodes are at the foundation of an ECG recording of high quality.
 First, make the patient comfortable, he should be warm and relaxed as
much as possible; he should lie on his back on an examination bed or
table of adequate size with his arms and hands relaxed along the sides
of his body: this will minimize the likelihood of trace interference
originating from muscle tremor.
 Thoroughly clean the skin where the electrodes will be placed with
alcohol or ether.
 Connect each unipolar plug of the patient cable (distinguished by colour
coding) to the respective electrodes, observing the colour-position
relationship indicated below:
Colour Symbol Electrode position
Red R right arm
Yellow L left arm
Green F left leg
Black N right leg
White - Red C1 V1
White - Yellow C2 V2
White - Green C3 V3
White - Brown C4 V4
White - Black C5 V5
White - Violet C6 V6

20
 Apply a small amount of® electrocardiograph conductive gel on the skin
area that will be in contact with the electrode, spreading it carefully
(this procedure is not necessary when using disposable electrodes with
built-in gel).
 The following figure shows the standard positioning of the electrodes.
Standard positioning of the
electrodes
V1: on the 4th intercostal space along
the right parasternal line;
V2: on the 4th intercostal space along
the left parasternal line;
V3: on the 5th rib, between V2 and
V4;
V4: on the 5th intercostal space, on
the left hemiclavicular region;
V5: on the left anterior axillary, at the
same level as V4 ;
V6: on the left mid-axillary at the
level of V4;
peripheral electrodes: generally a
few centimeters above ankles and
wrists.
Warning: make sure that the conductive portions of the electrodes are not touching
each other or other metallic parts. In any case, series original electrodes, of silver
and silver chloride, are designed and manufactured in order to minimize the likelihood
of accidental contact between conductive parts and external metal objects. Ensure
that the machine is not affected by disturbances originating from the power supply
network (see paragraph "Initial preparation").
3.3 Selection of recording characteristics: speed,
sensitivity, filters
Speed of recording on paper
25
50
to select the speed; corresponding LED on. The possible choices
are: 25 mm/s and 50 mm/s.
During printing, the speed of the paper flow is indicated by the width of the
calibration impulse that precedes each lead and is recorded in the
information line