laerdal VitalsBridge Manual

VitalsBridge
Directions for Use
MODEL VB2.0 for US Government Customers
TM

VitalsBridge Directions for Use (for US Government Customers)
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Table of Contents
Regulatory Information..........................................................................................................2
Support .................................................................................................................................3
Warnings and Caution............................................................................................................4
Requirements Checklists ........................................................................................................6
VitalsBridge Overview............................................................................................................7
Powering the VitalsBridge ......................................................................................................8
External Power.................................................................................................................... 8
Internal Battery................................................................................................................... 8
Internal Fan......................................................................................................................... 8
Network Connections.............................................................................................................9
Overview............................................................................................................................. 9
Installation of the VitalsBridge Software...............................................................................11
Cables, Tubing, and Regulator Setup/Configuration ..............................................................14
Pulse Oximetry (SpO2).......................................................................................................14
Configuration of a Compressed CO2Source .....................................................................16
Capnography (Side-stream End Tidal CO2) .......................................................................19
Non-invasive Blood Pressure (NIBP) .................................................................................19
Invasive Blood Pressure (IBP)............................................................................................21
Temperature .....................................................................................................................22
Respiration Impedance via Electrocardiogram (ECG).......................................................23
Running the VitalsBridge......................................................................................................24
VitalsBridge Software Features ............................................................................................27
SpO2Calibration................................................................................................................ 27
Enabling CO2Simulation ...................................................................................................29
CO2Calibration..................................................................................................................30
Zeroing the Invasive Blood Pressure(s).............................................................................32
Pulmonary Artery Capillary Pressure and Invasive Blood Pressure Offsets .....................33
Network Configuration Tool Software ..................................................................................34
VitalsBridge Frequently Asked Questions..............................................................................37

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Regulatory Information
Use statement: The VitalsBridge is for use in the United States and Canada only.
Federal Communications Commission Statement: This device complies with part 15 Subpart B of the
FCC rules.
Caution: Only use cables supplied with the VitalsBridge and accessories approved for use
with the VitalsBridge. Changes or modifications not expressly approved by the party
responsible for compliance could void the user's authority to operate the equipment.
Disposal/Recycling: Recycle and dispose of in accordance with all governing requirements and
regulations. The VitalsBridge contains a Li-ion battery, which should be recycled.
The VitalsBridge instrumentation and its associated cables are latex free.
LATEX

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Support
For technical assistance, contact your local Laerdal Technical Service Center.
Disclaimer
Use of the VitalsBridge to train personnel should be undertaken under supervision of suitably trained
medical personnel with an understanding of clinical monitoring, patient simulation educational
principles, and recognized medical protocols. As with all simulation training devices, there may be
approximations, variations, and inaccuracies in the information being presented.
Global Warranty
See the Laerdal Global Warranty, www.laerdal.com.
Manufacturer
The VitalsBridgeTM is made in the USA and is manufactured for Laerdal Medical AS by:
Dynasthetics LLC.
3487 W. 2100 S. #300
Salt Lake City, Utah, 84119
USA

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Warnings and Caution
Follow all cautions and warnings outlined in the SimMan 3G or SimMan Essential Directions for Use.
The VitalsBridge is intended solely for use during patient simulation. It is not a medical device.
Warning: Never connect the VitalsBridge to a patient.
Warning: Never connect the VitalsBridge to a Vital Signs monitor that is connected to a patient.
Warning: The VitalsBridge is not waterproof. Protect the VitalsBridge in damp conditions and
keep away from liquids.
Warning: The VitalsBridge contains a lithium ion battery, which if damaged, could cause risk of
fire or explosion.
Compressed Gases and Regulators
Use only sources of compressed CO2with the VitalsBridge. Adequate training and expertise is required
to work with compressed gases.
The VitalsBridge is supplied with a portable CO2regulator that uses cartridges of highly pressurized CO2
gas. Take care when handling these cartridges as they pose a potential risk of injury if used improperly.
Cartridges should be stored and operated at temperatures below 120oF (49oC) and punctures should be
prevented. They should not be heated. They should not be used or stored ate temperatures above 120o
F or 49oC. Do not inhale the CO2gas.
Warning: Do not use compressed oxygen (fire hazard) or any other flammable substance with or
near the VitalsBridge.
Warning: CO2cartridges may become extremely cold when discharging. Protect eyes and hands
when installing and handling CO2handling CO2cartridges.
Warning: Mishandled CO2cartridges may become a projectile.
Caution: CO2 cartridges may not be transported by air.

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Defibrillation Hazards:
During defibrillation the defibrillator and VitalsBridge may present a shock hazard. All standard safety
precautions must be taken when using a defibrillator with the SimMan 3G/Essential and VitalsBridge.
The respiration cable connector on the manikin is designed exclusively for respiration monitoring via
ECG impedance signals.
Warning: Defibrillation on the ECG connectors will damage the internal electronics of the
VitalsBridge and may cause personal injury.
Warning: Never connect any cables from the VitalsBridge to the designated defibrillator
connectors on the SimMan 3G/Essential manikin.

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Requirements Checklists
Checklist of Included Cables and Accessories:
Please verify the following has been included in your shipment; all of the following cables and
accessories are REQUIRED to properly operate the VitalsBridge. If you are missing any of these items, or
they are damaged, please contact Laerdal for replacements.
1. VitalsBridge power supply, 24V, with wall plug.
2. CO2Regulator with mounting bracket.
3. Non-Invasive blood pressure tubing (connects from VitalsBridge to blood pressure cuff).
4. Invasive blood pressure transducer cable (3 RJ11 cables, connects from VitalsBridge to monitor’s
blood pressure cable(s)).
5. Temperature transducer cable (2, connects from VitalsBridge to monitor’s temperature
cable(s)).
6. Respiration via ECG cable (connects from VitalsBridge to manikin).
7. SpO2Extension Cable (connects from VitalsBridge to manikin).
8. These directions for use.
Checklist of Required Cables and Accessories Not Included (Must be Purchased
Separately from Laerdal)
1. Non-Invasive Blood Pressure Cuff Kit.
2. Invasive Blood Pressure Monitor Cables.
Computer and Software Requirements
1. Windows operating system.
2. LLEAP or legacy SimMan 3G Instructor Application software.
3. Ethernet (LAN) or wireless (WLAN) communication capability.
4. VitalsBridge software (may be downloaded from laerdal.com).
Additional Requirements
1. VitalsBridge instrumentation.
2. SimMan 3G or SimMan Essential manikin, updated with SpO2-compatible hand and ECG-
respiration kit.
3. Commercially available vital signs monitor.
4. AC power source (i.e. a wall outlet).
5. Source of compressed CO2(either a disposable cartridge for use with included regulator, or
another external source).

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VitalsBridge™Overview
The VitalsBridge consists of a device that allows vital signs from the SimMan 3G or SimMan Essential to
be presented on a clinical vital signs monitor. It is intended to increase the fidelity of simulation for
users where they may view, interact, and control a vital signs monitor that is used in their clinical
practice. The VitalsBridge presents opportunities for high-fidelity simulations that involve critical care,
training and education on clinical monitoring, patient information systems testing, just to name a few.
The VitalsBridge is designed to function with commercially available vital signs monitors. It presents the
following vital signs on a clinical monitor: heart rate, respiration via Electrocardiogram (ECG)
impedance, plethysmography waveform, SpO2, capnography waveform, end-tidal CO2, non-invasive and
invasive blood pressure (arterial, central venous, pulmonary artery), and temperature. Vital signs cables
are usually connected to sensors attached to the patient. With the VitalsBridge, some of these cables
attach to the patient, and some are connected to the VitalsBridge device. Connectors for the respiration
via ECG impedance and SpO2have been pre-installed on the SimMan 3G/Essential manikin.
The VitalsBridge converts the digitized vital signs waveforms and numbers of the SimMan 3G/Essential
into signals that are compatible with a vital signs monitor. Compressed CO2gas is used for non-invasive
blood pressure and capnography to generate the signal. The vital signs created by the VitalsBridge are
controlled using the SimMan3G Instructor Application. Additional software is used to communicate vital
signs information between the SimMan 3G/Essential and the VitalsBridge.

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Powering the VitalsBridge™
External Power
To power the VitalsBridge via wall power, simply connect the external power adapter and plug into any
standard wall outlet.
Caution: Use only the included 24V power supply. Using an incorrect power supply may damage
the VitalsBridge and void the warranty.
Internal Battery
The VitalsBridge contains an internal, non-replaceable Lithium-Ion battery to allow for unplugged
operation of the unit. When fully charged, this will allow for at least 3 hours of use. To charge the
battery, connect the external power supply. The power supply will charge a fully depleted battery in 6-
12 hours. When the unit is switched on, the battery indicator on the top panel will flash when there is
less than 15% of battery life remaining; if you need to continue using the VitalsBridge, connect the
external power.
Internal Fan
The VitalsBridge contains an internal fan to keep the battery cool while charging and discharging during
use. The fan will be active under the following conditions:
1. Any time the VitalsBridge is connected to the external power supply.
2. When the VitalsBridge is switched on and not connected to the external power supply.

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Network Connections
Overview
The VitalsBridge communicates with the SimMan 3G/Essential using via the SimMan 3G’s internal
router. The VitalsBridge may be connected to the internal router by an Ethernet cable or by Wifi. In
addition to the information below, it is important to follow the procedure for running the VitalsBridge as
described on page 24. The VitalsBridge internal Wifi must also be configured to have the same SSID and
password as the SimMan 3G/Essential’s internal router using the VitalsBridge Network Configuration
Tool (see page 34).
Note: Do not connect the VitalsBridge directly to the SimMan 3G/Essential Instructor Application PC
with an Ethernet cable.
/Essential
/Essential
/Essential
/Essential
SimMan 3G/Essential

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When connecting the VitalsBridge to the SimMan 3G/Essential manikin using an Ethernet cable, ensure
the cable is functional and is securely connected to the Ethernet ports of the VitalsBridge and the
manikin. The top of the VitalsBridge indicates when it has established an Ethernet or Wifi connection
with the manikin’s internal router.
(Ethernet Connection)
(Wifi Connection)

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Installation of the VitalsBridge Software
The VitalsBridge software may be installed on a PC that is able to establish a network connection with
the SimMan 3G/Essential manikin or to an instance of the virtual manikin. The instructor application PC
is recommended for installation of the VitalsBridge software. Download the appropriate VitalsBridge
installation software from www.laerdal.com. If necessary, copy the software to the computer on which
it will be installed. Navigate to the installation software file and open in. Follow the on-screen
installation instructions. Upon successful installation, a VitalsBridge icon will be created on the PC's
desktop. Restart the computer if the installation software does not prompt for a reboot.
Note: Choose the appropriate VitalsBridge installation software carefully. There may be specific
installation software that is compatible with the version of software running on the SimMan
3G/Essential (e.g., LLEAP versus legacy versions of SimMan 3G software), or the particular version of
LLEAP.

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Windows Network Settings
Communication between the VitalsBridge instrumentation and the VitalsBridge software occurs over the
UDP network protocol on port 14996. The installation software attempts to allow access of this port
through the Windows Firewall on both the public and private profiles. For older versions of Windows
(e.g., Windows Vista), custom firewall configurations, and custom network settings, consult your IT
support and/or Windows help on how to let communication occur properly on this port.

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Cables, Tubing, and Compressed CO2Setup/Configuration
This section will describe how to connect the cables and tubing between the VitalsBridge, the SimMan
3G/Essential, and the patient monitor. Please note that invasive blood pressure and temperature
patient monitoring cables, specific to the brand and model of patient monitor being used with the
VitalsBridge may be purchased from Laerdal. Note that your monitor will also require a type of non-
invasive blood pressure cuff, either a 1-tube or 2-tube design, depending on the brand and model of
patient monitor being used. In addition, the patient monitor’s SpO2sensor probe and cable is used with
the VitalsBridge. Please consult the patient monitor documentation for more information regarding
temperature cables, invasive/non-invasive blood pressure cables, and SpO2sensor probes and cables.
Pulse Oximetry (SpO2)
Pulse oximetry, or SpO2, is used to determine the oxygen saturation of a patient’s blood. It also will
provide a pulse measurement. SpO2simulation by the VitalsBridge uses special circuitry inside the
manikin’s index finger of the right hand, which provides expected light levels of light to the monitor’s
SpO2probe according to the SpO2value set in the SimMan 3G’s Instructor Application.
Note: The SpO2circuitry in the manikin’s hand must be located at the tip of the index finger. If there is
empty space between the manikin’s fingertip skin and the sensors, the skin will need to be adjusted for
a tight fit. Gently, but firmly, push the manikin skin further down so that it is. Contact Laerdal if
additional assistance is needed.
When placing the patient monitor’s SpO2sensor probe, ensure its orientation is correct. The probe’s
source light should be placed over the manikin’s fingernail. Note: SpO2will not function properly in
other orientations of probe placement. Below is an example depicting proper placement of a Nellcor
non-disposable probe on the manikin’s right index finger.
Top of probe (source light)
Bottom of probe (source
detector)
Manikin’s fingernail

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To use the SpO2function, ensure the SpO2cable is connected to the manikin and the VitalsBridge.
SpO2connector
(to VitalsBridge)
SpO2connector
(to sensor in Manikin's finger)

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Configuration of a Compressed CO2Source
For capnography and non-invasive blood pressure (NIBP) simulation, a source of compressed CO2
regulated to 20-30 PSI is required. A portable CO2regulator that uses cartridges of compressed CO2is
provided with the VitalsBridge. Alternatively, compressed CO2from another external source may be
available at your facility (wall source, a tank, etc). Consult your facility's engineering regarding external
CO2sources and the appropriate regulators and adapters for correct and safe connection.
Using the Portable CO2 Regulator: The portable CO2regulator is mounted to the side opposite the
switch and uses a 16g threaded disposable cartridge of compressed CO2. The regulator may be
detached by lifting the regulator up out of the slot that is on the side of the VitalsBridge. The regulator
has a luer lock fitting that will connect into the VitalsBridge, and regulator knob to control the flow of
gas. The regulator should be turned to the off position when it is not connected to the VitalsBridge via
the luer connection. Only turn the regulator on when a tight secure connection to the VitalsBridge has
been verified.
Note: Carefully verify the regulator that you are using. Some regulators supplied with the VitalsBridge
have a maximum pressure of 30 PSI on the gauge, while other regulators have a higher maximum
pressure reading on the gauge (e.g., 140 PSI). Either are acceptable, where the regulated pressure will
be set to 20-30 PSI as per the instructions below.
Caution: The regulator must be kept upright when the CO2cylinder is attached. Do no tilt the
regulator more than 30 degrees from vertical when in use. The CO2cylinder is pressurized. Sudden
release of pressure may cause injury. Turn regulator to OFF when not in use.

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Installing a CO2Cartridge (see images labeled (2) –(7) that correspond with the steps below):
1. Temporarily remove the regulator from its bracket on the VitalsBridge instrumentation.
2. Adjust the regulator knob to the “OFF”position by rotating it counterclockwise.
3. Orient the VitalsBridge so the threaded connection on the regulator can be seen. Hold the
regulator in one hand, align the cartridge under the housing, and quickly turn it clockwise into
the regulator. Do not stop until tight. Do not over tighten; the cartridge only needs to be hand-
tight. It is normal for a small amount of CO2 to leak out during cartridge installation.
4. Attach the blue tubing to the blue luer lock (CO2 in) on the front of the VitalsBridge and verify a
secure connection.
5. Replace the regulator back on the bracket that is attached to the VitalsBridge instrumentation.
6. If the regulator supplied with the VitalsBridge has a maximum pressure of 30 PSI on the gauge,
then SLOWLY turn regulator knob clockwise to the “HI” position, usually set at or just above 20
PSI. Note: it is acceptable if the gauge reading is in the red area.
For regulators that have a maximum pressure on the gauge that is greater 30 PSI (e.g., 140 PSI),
then SLOWLY turn the regulator knob clockwise until the pressure on the gauge reads 30 PSI. Do
not set the regulator to a reading higher than 30 PSI.
7. The regulator is now set at the maximum regulated pressure.
(2)
(3)
(4)
(4)

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Caution: Ensure CO2 has been fully released prior to disposing of the cartridge. This may be
accomplished by: (i) turning the regulator to “OFF”, (ii) detaching the female luer fitting from
the blue luer lock ring on the VitalsBridge, (iii) slowly turning the regulator knob clockwise
(towards “HI”), and (iv) allowing the remaining compressed CO2 gas to expel in a controlled
manner. The CO2cartridge may be very cold. Point the outlet of the cartridge away from
yourself and others. Wear eye protection. Ensure that the knob is turned to the off position
before a new cartridge is installed.
Caution: When not in use turn the CO2to the off position and disconnect the CO2line from the
VitalsBridge.
Warning: CO2cartridges may become extremely cold when discharging. Protect eyes and hands
when installing and handling CO2 handling CO2cartridges.
Warning: Mishandled CO2cartridges may become a projectile.
Caution: CO2 cartridges may not be transported by air.
(5)
(6)
(7)

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Capnography (Side-stream End Tidal CO2)
The VitalsBridge is configured for simulating side-stream capnography. Capnography is the
measurement of patients’ exhalation of CO2. The VitalsBridge utilizes an air pump and the compressed
CO2source to provide a mixture composed of the correct amount of air and CO2to simulate the fraction
of CO2exhaled over each breath by a patient. To use the capnography function, first ensure that your
patient monitor supports capnography measurement. If it does, connect its capnography line to the
white fitting on the VitalsBridge.
Non-invasive Blood Pressure (NIBP)
The VitalsBridge is capable of simulating non-invasive blood pressure by simulating the pulsing of the
artery. It uses two tubing connections; the red connection provides the pulse, and the green connection
measures the pressure in the cuff. The
VitalsBridge automatically detects and
controls pulsing during a non-invasive blood
pressure reading by the patient monitor. A
specially configured blood pressure cuff is
used with the VitalsBridge. Some patient
monitors require a 1-tube cuff, others a 2-
tube. Please consult the patient monitor’s
configuration and associated
documentation to determine which cuff is
required.
To side-stream CO2
connection on vital signs
monitor.