Custo Med custo cardio 400 BT User manual

Operating Manual
Resting and Stress ECG
Part 2: Hardware, description of device
for custo cardio 400 BT and custo cardio 400 accu
1234
Safety Hardware Software Hygiene
Operating characteristics:
12-channel PC ECG,
Resting & stress ECG
MHW 0012 – DK 1713
Version 004 – 20/04/2020

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© 2020 custo med GmbH
This Operating Manual may not be copied in its entirety or in part, duplicated in any
form or by any means or translated into another language without the prior written
consent of custo med GmbH.
The manufacturer reserves the right to change the information in this Operating
Manual without prior notice. The current version can be downloaded from our web-
site: www.customed.de.
CAUTION:
This Operating Manual is part of a modular system, consisting of four parts. All
four parts must be downloaded from the Internet or from a CD to ensure the
Operating Manual is complete.

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Table of contents
2.1 Symbols on the devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
2.2 Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2.3 Part names, components for the recording
2.3.1 custo cardio 400 BT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
2.3.2 custo cardio 400 accu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
2.4 Assembly, preparing the custo cardio 400 device
2.4.1 custo cardio 400 BT and telescopic boom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
2.4.2 custo cardio 400 accu and custo move extension arm . . . . . . . . . . . . . . . . 10
2.4.3 Attaching patient leads to the custo cardio 400 BT/
custo cardio 400 accu device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
2.5 Handling the device
2.5.1 Charging custo cardio 400 accu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
2.5.2 custo cardio 400 display and operating elements. . . . . . . . . . . . . . . . . . . . . . . 14
2.5.3 custo cardio 400 device states in standard operation . . . . . . . . . . . . . . . . . 15
2.5.4 custo cardio 400 further states and special functions. . . . . . . . . . . . . . . . . 16
2.5.5 custo cardio 400 troubleshooting (both device variants) . . . . . . . . . . . . .17
2.6 Examination procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
2.7 Attaching the device to the patient
2.7.1 Electrode application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
2.7.2 Instructions for the stress ECG with treadmill. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.8 Technical data and system requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.9 Manufacturer’s declaration regarding EMC
(electromagnetic compatibility) according to DIN EN 60601-1-2:2016 . . . .24
2.10 EC Declaration of Conformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
2.11 List of product components and accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Operating Manual
Resting and Stress ECG
Part 2: Hardware, description of device
for custo cardio 400 BT and custo cardio 400 accu
1234
Safety Hardware Software Hygiene

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Resting and Stress ECG
Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
[2] Resting and Stress ECG Hardware, custo cardio 400 devices | page 4
2.1 Symbols on the devices
Manufacturer:
custo med GmbH, Maria-Merian-Str. 6, 85521 Ottobrunn, Germany
Production date (YYYY-MM, e.g. 2018-01)
CE mark, notified body
Serial number
Follow the Operating Manual
Medical electrical equipment classification
according to DIN EN 60601-1 (Type CF)
Non-ionising electromagnetic radiation,
Device contains a RF transmitter
Separate collection of electrical and electronic equipment,
do not dispose with domestic waste
Hygiene seal of the German Society
of Hospital Hygiene

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2.2 Intended use
custo cardio 400 BT / custo cardio 400 accu is a 12-channel electrocardiograph
with integrated electrode application system which is used professionally as a rest-
ing or stress ECG. The electrode application system is used to attach the electrodes
to the patient‘s body using underpressure. R, L and F according to Einthoven and C1
to C6 according to Wilson are used as derivations.
Intracardiac application is not intended.
The unit has no protection against possible influences of
high-frequency surgery devices.
The custo cardio 400 devices can be used safely for patients with pacemakers. ECG
recording is not affected by pacemaker pulses.
Users are trained specialists in medical practices, laboratories, rehabilitation facilities
or hospitals. These include in particular doctors and medical-technical assistants.
Use at home, especially by laypersons, is not part of the intended use.

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2.3 Part names, components for the recording
2.3.1 custo cardio 400 BT
custo cardio 400 BT ECG application system
6 thoracic wall leads (1.20 m) and
4 extremity leads (1.45 m)
Electrode “hair”, other versions optional
Spacer 2-fold
Spacer 3-fold
Telescopic boom for custo cardio 400 BT
Bracket for telescopic boom with mounting material
Cable hook for telescopic boom
Bluetooth 4.0 USB adapter
USB extension cable 1.8 m, Plug A – Socket A
Power supply unit for custo cardio 400
Power cable 1 m for power supply unit
USB cable 3 m for custo cardio 400 BT
For assembly and mounting see 2.4.1 custo cardio 400 BT and telescopic boom.

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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2.3.2 custo cardio 400 accu
custo cardio 400 accu ECG application system
6 thoracic wall leads (1.20 m) and
4 extremity leads (1.45 m)
Electrode “hair”, other versions optional
Spacer 2-fold
Spacer 3-fold
Extension arm custo move for custo cardio 400 accu incl. USB cable
(Fixture for the extension arm included in the custo easy plus equipment cart)
Cable hook for extension arm custo move
Bluetooth 4.0 USB adapter
USB extension cable 1.8 m, Plug A – Socket A
Power supply unit for custo cardio 400
Power cable 1 m for power supply unit
For assembly and mounting see
2.4.2 custo cardio 400 accu and extension arm custo move.

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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2.4 Assembly, preparing the custo cardio 400 device
2.4.1 custo cardio 400 BT and telescopic boom
Operating elements on the telescopic boom
Anti-rotation lock for fixing the boom,
open during operation (swivel range 270°)
Continuous height adjustment with gas pressure spring
Gas pressure spring
Extraction lock to extend and pull in the boom arm
Bracket for custo cardio 400 BT with safety bar
Adjust telescopic boom
Put the clamps and in position
and secure them with an Allen key
(size 5 mm).
Mount the clamps straight (aligned)
to keep the gas pressure spring from
jamming.
Mounting the telescopic boom
on the equipment cart
Use the screw set to fix the bracket
to the equipment cart , place
the boom and protective plastic ring
in the bracket, set the swivel range
of the boom and then fasten
the boom in the bracket .
400 mm
160 mm

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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Insert custo cardio 400 BT into
the telescopic boom
Push custo cardio 400 BT from above into the bracket
on the boom . To do this, pull the safety bar back
and push the device into the bracket until it clicks into
place so that the safety bar is moved back to the front.
Plug in the USB cable
To do this, pull the arm of the boom out until it reaches
the maximum length (extraction lock ). Connect the
supplied USB cable to the USB port of the custo cardio
400 BT device , route it along the boom and fix it
with the Velcro fasteners.
IMPORTANT: Do not connect the USB cable to the PC
until after the software installation.
Operating the telescope boom safely
Follow the instructions below to safely move the
equipment cart with the telescopic boom:
Fasten the telescope boom:
Tighten the anti-rotation lock .
Set the angle of the boom arm
to 90 degrees:
Height adjustment : Press the lever and
simultaneously move the boom arm into
the desired position by moving the end of the
boom arm up or down.
Do NOT pull the device.
Pull the boom arm in completely:
extraction lock .
custo cardio 400 BT
power supply line
for connection to
the power supply
unit 1)
1) Note on the power supply:
Use only the power supply unit delivered with the device
(item number 85023)

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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2.4.2 custo cardio 400 accu and custo move extension arm
custo move operating elements
Bracket for custo cardio 400 accu
with safety bar
Anti-rotation lock for fixing the extension arm,
open during operation, swivel range 270°
USB connection
Power cable
Mount the cable hook
(for holding the patient leads)
Attach the cable hook to the custo move extension
arm in the desired position with the screws supplied.
Mounting the fixture for custo move extension arm
The fixture for the custo move extension arm is inclu-
ded as standard in the custo easy plus equipment cart.
For older versions of the custo easy plus equipment
cart, the fixture for custo move must be ordered se-
parately. custo move may only be mounted in the new
fixture (from 2020 with radial groove, see ).
Screw the fixture onto the equipment cart with the
groove facing backwards. Use the supplied screws.
Then attach the cover plate. To do this, slide the
round opening of the cover plate over the fixture so
that the column of the equipment cart is closed at the
top.
Then insert the inset for the custo move extensi-
on arm into the fixture from above. The groove of the
inset is also aligned to the rear, corresponding to the
groove in the fixture.
Insert custo move extension arm into the fixture
Insert the USB and power cable of the custo move ex-
tension arm into the column of the equipment cart via
the opening of the fixture. Align the custo move ex-
tension arm so that the anti-rotation lock is located
above the groove of the fixture and inset. Insert the
custo move extension arm. The anti-rotation lock is
located on the transverse groove of the holder.
Fixture for
extension arm
Equipment cart
custo easy plus
Inset, groove
to the back!
Cover plate

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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Fasten custo move extension arm in the fixture
Viewed from above, turn custo move clockwise until
the stop of the fixture. Then fasten the inset in the
fixture with the supplied screw (on the left side of the
fixture when viewed from the front). The extension
arm is now completely mounted.
Inserting custo cardio 400 accu
into the custo move extension arm
Insert custo cardio 400 accu from above into the
bracket on the extension arm. To do this, pull the safe-
ty bar to the rear and press the device into the bracket
until it engages, so that the safety bar folds forward
again.
IMPORTANT: Only connect the USB cable to the PC
after the software installation.
Using the swivel range
Open the quick-release fastener of the anti-rotation
lock to the left and turn custo move to the desired
position.
To move custo move safely from one place to anoth-
er, align the extension arm straight forward. The an-
ti-rotation lock is located centrally on the back of the
bracket. Close the quick-release fastener of the an-
ti-rotation lock (press the handle to the right).
Disassembly,
remove custo move from the fixture
Remove custo cardio 400 accu from the custo move
bracket. To do this, disconnect the USB cable and ex-
ternal power supply if necessary, pull the safety bar
backwards and remove the device from the top. Loosen
the screw that fixes the custo move extension arm (on
the left side of the fixture, seen from the front).
Position the removal tool on the stop in the right-hand
side of the transverse groove of the inset (viewed from
behind). Open the anti-rotation lock (fold the quick-re-
lease fastener to the left). Turn custo move extension
arm to the stop against the tool (anti-clockwise).
The groove of the inset is again flush with the groove
of the fixture. Align the anti-rotation lock again so
that it is in the vertical groove. The custo move exten-
sion arm can be pulled upwards.
pull the safety bar
to the rear

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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Attach the coding labels to the ends of the patient
leads.
The labels “C1 to C6” are glued to the chest wall leads
(length: 1.20 m) .
The labels “R, L, F and N” are glued to the longer
extremity leads (length: 1.45 m).
Connect the patient leads according to the coding on
the device .
Press the electrodes onto the ends of the electrode
leads, until you hear a click .
C3 C2 C1
2.4.3 Attaching patient leads to the custo cardio 400 BT/custo cardio 400 accu device

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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2.5 Handling the device
2.5.1 Charging custo cardio 400 accu
The custo cardio 400 accu device type has a lithium polymer battery that is located
on the top of the housing. The battery is firmly mounted and cannot be removed. To
exchange the battery, please contact your authorised custo med dealer.
Observe the operating and storage conditions and only use the power supply unit
supplied for charging.
Commissioning (exit shipping mode) and charging in normal operation
Upon delivery custo cardio 400 accu is in shipping mode to protect the battery (no
LEDs, all keys inactive). To cancel the shipping mode and charge the device, connect
custo cardio 400 accu to a power supply. Either directly via the supplied power
supply unit or via the power supply of the extension arm (if it is connected to
the mains via the supplied power supply unit).
The device is then in standby mode (On/Off button is constantly illuminated in blue).
When inactive, the device is put into energy-saving mode after one minute – the
On/Off button flashes blue and the battery charge status is indicated by a light
indicator in the middle of the front of the housing (purple below 20 %, blue 20 %
to 80 %, green above 80 %).
custo cardio 400 accu is charged as soon as the device is connected to a power
supply.
Charging time approx. 4.5 hours at 1.5 A charging current in standby,
extended charging time with simultaneous operation,
e.g. cleaning
Running time approx. 9 hours (at suction level 3),
depending on the suction level and leakages
the running time varies!
Fully charge custo cardio 400 accu before using it for the first time.
Safety mode
If the custo cardio 400 accu device is not used for a longer period of time and the
battery is discharged, the device may be put into safety mode to protect the battery.
All keys are inactive and no LEDs are displayed. To use custo cardio 400 accu again,
connect it to a power supply. If a mobile use of the device is planned, make sure that
the battery is sufficiently charged.
To ensure availability for mobile use, we recommend connecting custo cardio 400
accu to a power supply when not in use (e.g. overnight or at weekends).

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2.5.2 custo cardio 400 display and control elements
IMPORTANT - Prerequisite for the use of the device:
Correct installation, configuration and commissioning of the system
by your authorised custo med dealer
The device types custo cardio 400 BT and custo cardio 400 accu have the same
display and operating elements. These are located in the front area of the bottom
of the housing. The display and operating elements provide feedback on the device
status with different light states.
On/Off button
Suction level and status display (for operating mode and battery, if necessary)
Suction level control: regulates how firmly the electrodes are placed on the skin
of the patient (manually adjustable level 1 to 6)
Cleaning button: for manually blowing out the lines
States of the suction level and status display
During operation, when performing an ECG recording, the suction level and status
display provides information about the current operating mode.
With custo cardio 400 accu the suction level and status display also shows the
battery charging status.
Operating modes and states of the suction level and status display
/
Turquoise = USB operation
Blue = Bluetooth-/WLAN operation
Orange = Manual recording by keystroke
Green = Blowing out the leads
Yellow = Warning
Red = Error, service case
Charging status display in energy saving mode
Green = Battery charging level over 80 %
Blue = Battery charging level between 20 % and 80 %
Purple = Battery charging level below 20 %
Charging level warning during operation
If the charging level is below 20 %, the suction level indicator lights up purple
during operation at the level of the set suction level instead of the colour of the
present operating mode (e.g. turquoise for USB). Even during the release time (short
blow-out of the electrode leads after completion of an ECG recording), the suction
level display lights up purple instead of green in this case.

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Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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2.5.3 custo cardio 400 device states in standard operation
Energy saving mode
:The On/Off button flashes blue and the suction level
and status display show the charging status (middle LEDs flash green, blue or
purple, see chapter 2.5.2 custo cardio 400 display and control elements).
Briefly pressing the On/Off button puts the custo cardio 400 accu into standby, see
next paragraph. The device can also be activated directly via custo diagnostic by
calling up the ECG interface. custo cardio 400 accu is put back into energy saving
mode after one minute of inactivity.
Standby
/ : The On/Off button lights up
constantly blue. The device functions are active. The suction level control can be
activated by briefly pressing the On/Off button , e.g. to put the electrode leads
on the patient. Otherwise, the suction level control is automatically activated when
the ECG interface is called up, see next paragraph. The cleaning can be started by
pressing the cleaning button (longer blowing out of the electrode leads, e.g. for
30 minutes).
Monitoring, status before an ECG recording
/ : When the ECG interface is called
up in custo diagnostic, the suction level control is activated and the electrode leads
can be applied to the patient. The patient‘s ECG signal is displayed on the screen. In
this state, the On/Off button as well as the suction level control light up blue
and the suction level and status display shows the preset suction level in the co-
lour of the operating mode. The suction level can be adjusted manually by pressing
the buttons (in this case the automatic suction level control is deactivated, see
chapter 2.5.4).
ECG recording
/ :The recording is triggered in custo
diagnostic with the Start or Autostart button. Manual start by pressing the button
on the device is also possible, see chapter 2.5.4. The indicator lights during a recor-
ding corresponds to the display during the monitoring.
: If the charging level is below 20 %, the suction level and
status display lights up purple during operation at the set suction level instead of
the colour of the current operating mode. Charge the device promptly!
State when the ECG recording ended
/ : When the ECG recording is ended,
the electrodes are discarded and the electrode leads are briefly blown out. The On/
Off button and the cleaning button light up blue, the suction level and status
display lights up green for the duration of the blow-out. The green suction level
and status display will decrease in accordance with the detachment time that
has already elapsed (if the total duration of the detachment time is less than one
minute).
and

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Resting and Stress ECG
Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
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Figure: USB connection, suction level
and status display changes from blue
(Bluetooth) on turquoise (USB connection)
Figure: Manual start of a recording,
suction level and status display orange
Figure: Display during cleaning
the device, On/Off button
and cleaning button light up blue
2.5.4 custo cardio 400 further states and special functions
Change of operating mode
If a USB connection is available, this will be prioritized over the wireless connection
due to the higher data rate. The connection can only be changed by the device (e.g.
from Bluetooth to USB) if there is no recording.
Manual start and stop
An ECG recording can be triggered not only via the custo diagnostic ECG interface,
but also by pressing the On/Off button on the device. To do this, open the ECG
interface in custo diagnostic and press the On/Off button on the device. The status
display lights up orange and the ECG recording takes place according to the custo
diagnostic configuration. In the case of recordings with no time limit, the On/Off
button must be pressed again to end the recording (e.g. with rhythm strips).
Automatic suction level control
For this function, the suction power in custo diagnostic must be at least set at level
3. With the automatic suction level control, the suction level is increased until the
system is tight or the electrodes are sufficiently tight against the patient‘s skin. If
the suction level is set manually, the automatic suction level control is deactivated.
Cleaning the electrode leads
The cleaning function should be used regularly, e.g. always at the end of a working
day. Pressing the cleaning button causes the moisture to be blown out
of the electrode leads for a longer period of time. Process according to settings in
custo diagnostic, factory setting: 30 minutes. After the cleaning time has elapsed,
the device switches to standby mode.
: With the custo cardio 400 accu device, it is recommended
to activate the cleaning function in mains operation when the device is connected
to a power supply via the supplied power supply unit. Cleaning in battery mode
leads to increased battery consumption.
Warning notices of the device
In the event of technical problems, the left LED of the suction level and status dis-
play lights up yellow or red. Some problems can be solved by the user, see chapter
2.5.5 custo cardio 400 troubleshooting. Otherwise, contact your authorized custo
med dealer.
Restart the device and reset the Bluetooth connection
When commissioning or when using the device on a mobile basis, the existing
Bluetooth connection may have to be reset (e.g. to enable a connection to another
workstation). To do this, press the „+“ and „-“ buttons simultaneously for approx.
3 seconds. The device switches off briefly and starts again.

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2.5.5 custo cardio 400 troubleshooting (both device variants)
In the event of an error, the custo cardio 400 suction level display lights up yellow
or red. The cause of a warning is saved in the custo cardio 400 error log file and
can be viewed there.
In order to open the error log file, the custo cardio 400 device must be connected to
the PC via USB. In this case, the device is displayed as custo cardio 400 mass stor-
age. Open the directory of the custo cardio 400 mass storage via Windows Explorer.
The file is called „error.log“ and can be opened with a text editor.
Warning indicator lights up yellow
The system is leaking
The device tries to gain the preset pressure for over five minutes, e.g. 280 mbar
(suction level 6). If this does not succeed, the device switches off and the warning
indicator lights up yellow.
Troubleshooting: Start the device without a patient (press the On/Off button). If
the device controls extremely often (engine noise), there is a mechanical problem:
one or more sealing rings on the leads are missing / stuck in the housing
the electrodes are not tight (dirt, e.g. from hair)
the device has an internal defect (service case)
If the device is tight without a patient,
check and correct the following points when used on patients:
Selection of the suitable electrode type (small, normal, hair)
Placing the electrodes on a less hairy part of skin / shave patient
Selection of a lower suction level which is more easily achieved.
Note: electrodes adhere less strongly, possibly reduced quality
of the derivations.
The pressure in the system is too high
The system may be clogged, e.g. too much moisture in the leads. Start a cleaning
cycle with the cleaning button (longer blowing out of the leads).
If this error still occurs or if the red light indicator appears during cleaning, con-
tact your authorised custo med dealer.
Warning indicator lights up red
Defect on the device
The device must be sent in for repair. Contact your authorised custo med dealer.

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2.6 Examination procedure
IMPORTANT - Prerequisite for the use of the device:
Correct installation, configuration and commissioning of the system
by your authorised custo med dealer
Resting ECG
Make sure that the ECG device is connected to the PC
and the power supply of the device is guaranteed.
Check that your patient is lying comfortably and is not cold.
Start custo diagnostic and click:
Examination, Resting ECG, New Resting ECG see Software description... .
Spray the contact spray1) on the electrode application points.
Place the electrodes on the patient according to the placement diagram,
See
2.7.1 Electrode application.
Start the recording.
The patient must keep still during the recording process.
Stress ECG
Make sure that the ECG device is connected to the PC
and the power supply of the device is guaranteed.
: The battery charge should be > 20%
(charge status indicator blue or green, not purple).
Charge the device if necessary or use the mains!
When using an ergometer, make sure that the patient is in the optimal
seating position (the extended leg should be slightly bent).
When using a treadmill, make sure to follow the instructions
in 2.7.2 Instructions for stress ECG with treadmill.
Start custo diagnostic and click:
Examination, Stress ECG, New Stress ECG
see Software description... .
Spray the contact spray 1) on the electrode application points.
Place the electrodes on the patient according to the placement diagram,
See 2.7.1 Electrode application.
Wait a few minutes so that the contact between the skin
and the electrodes can develop optimally.
Apply the blood pressure cuff.
Start the recording.
1) Contact spray warning
Before each examination, make sure to spray contact spray on the electrode
application points. Never spray the contact spray onto the electrodes or into the
electrodes or leads. Do not use water or contact gel!
Recommended contact sprays from:
C+V Pharma Depot GmbH or GE Medical Systems
Only use recommended contact sprays.
Residues from other products can damage the electrodes.

MHW 0012 – DK 1713 | Version 004 – 20/04/2020 | custo med GmbH
2
Resting and Stress ECG
Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
[2] Resting and Stress ECG Hardware, custo cardio 400 devices | page 19
2.7 Attaching the device to the patient
2.7.1 Electrode application
Thoracic wall resting and stress ECG, standard according to Wilson
V1 (C1) red 4. Intercostal space at the right sternal border
V2 (C2) yellow 4. Intercostal space at the left sternal border
V3 (C3) green on left-hand side of the 5th rib between C2 and C4
V4 (C4) brown 5th intercostal space on the left midclavicular line
V5 (C5) black on the left-hand side of the anterior axillary line, at the same height as C4
V6 (C6) purple on the left-hand side of the midaxillary line, at the same height as C4
Extremities resting ECG
R red right arm
L yellow left arm
F green left leg
N black right leg
Stress ECG (lying or standing): extremities
R red on the right below the collarbone
L yellow on the left below the collarbone
F green on the left above the hip
N black on the right above the hip
Stress ECG (sitting position): extremities
R red attach to the deltoid muscle on the right
L yellow attach to the deltoid muscle on the left
F green 9. Left rib
N black 9. Right rib

MHW 0012 – DK 1713 | Version 004 – 20/04/2020 | custo med GmbH
2
Resting and Stress ECG
Hardware, description of device for custo cardio 400 BT and custo cardio 400 accu
[2] Resting and Stress ECG Hardware, custo cardio 400 devices | page 20
2.7.2 Instructions for stress ECG with treadmill
The patient should ideally be wearing running shoes or trainers.
The patient should not hold onto the handles of the treadmill during
the recording process. This will lead to muscle tension which will affect
the ECG signal.
Missing skin tension, in interaction with shoulder movement,
will increase artefacts in the ECG signal.
The extremity leads should if possible be applied on taut skin areas
in order to avoid excessive movement artefacts and therefore interference
in the other terminal lines.
During the ECG recording, the electrode leads must not come into contact
with the patient, the treadmill or other objects.
Normal electrode application
Artefact reduced electrode application
Artefact reduced electrode application results in
smaller amplitudes in the extremity leads.
Safe use of treadmills with stress ECG
Always set the treadmill so that the patient can safely move on the device. Ensure
that the acceleration, speed and inclination of the treadmill are adjusted to the
patient's physical constitution, stamina and skill. Observe the manufacturer's safety
instructions.
Always inform the patient before you change the acceleration, speed or inclination.
Otherwise, the patient may become injured, e.g. also due to an unexpected, abrupt
stopping or starting of the treadmill.