Nellcor N-200 User manual

HOME USE GUIDE
for the
NELLCOR® N-200 Pulse Oximeter
Your local NELLCOR • Home Care Provider is:
24-hour hotline:
EDENTEC
A Naieor Company
©1992Nellcor Incorporated
J
Edentec Corporation °
10252 Valley View Road
Eden Prairie, MN 55344
U.S.A.
0
To contact Edentec's representative: in the United States, call 612 941-3006; outside
the United States, call Edentec's local representative.
Caution: Federal law (U.S.) restricts this device to sale by or on the order of a
physician.
023466A-0492
#££•

EMERGENCY PHONE NUMBERS
Post this list near your telephone.
Ambulance
911
Police
911
Fire Department
911
Doctor
Other Telephone Numbers
Caregiver/Home Care Provider
u

Table of Contents
IMPORTANT 1
Intended Use 1
Your Home Care Provider 2
Definitions 2
What You Need to Know About the N-200 4
How the N-200 Works 6
Setting Up 10
Unpacking and Inspection 10
Where Not to Place Your Monitor 10
Pulse Sensors 11
Using a Pulse Sensor 11
Cleaning Your PulseSensor 11
The Parts of the Monitor 12
The Front of the Monitor 13
The Back of the Monitor 15
Using the Monitor 17
Alarms 21
Changing Settings 21
Changingfrom Adult to Neonatal Alarm Limits 21
Changing Alarm Limits 21
Turning the Audio Alarm Off Temporarily 22
Changing the Alarm Volume 23
Changing the Temporary Silence Period 23
Changing the Pulse Tone Volume 24
Changing Operating Mode 24
Using C-LOCK ECG Synchronization 26
If
Using aBedside ECG Monitor 26
If Using aThree-Lead ECG Cable 27
ni

Table of Contents (continued)
Ifthe ECG SignalisLost 28
UsingTrend Memory 29
To Determineif the MemoryisON 29
ToTurn the MemoryON 29
ToPrint Data Usinga
NELLCOR P200 Printer 29
ToSetor Changethe Dateand Time 30
Usingthe Battery 31
To Connect the Interface/Powerbase 31
ToUse the Battery 31
Careand Cleaning of the Monitor 32
Routine Care of the Monitor 32
Cleaning theMonitor 32
Troubleshooting 33
Troubleshooting 33
Status Messages 37
AppendixA: Standard Alarm Settings 38
IV

IMPORTANT
It is essential that you, the Home User of this monitor, read and understand this Home
Use Guide completely before using the monitor. This Home Use Guide provides you
withbasic reference information for proper use of the monitor. This manual is not a
replacement for the N-200 Operator's Manual or for the training your home care
provider or home provider company will provide for you.
Read this manual carefully BEFORE using the monitor. Read all warnings and cautions
(inboldfacetype). If you do not understand any partof the manual or the warnings and
cautions, ask your home care provider or home provider company before using the
monitor.
Intended Use
This monitor can be used for patients of allages. It measures blood oxygen saturation
levels and pulse rate continuously. It sounds an alarm and an alarm light blinks when
detected oxygenlevels or pulse rate areabove or below the alarm settings. The N-200
monitor may be used with or without ECG synchronization.
This monitor does not distinguish between normal hemoglobin and abnormal
hemoglobin. Therefore, this monitor should not be used in cases of carbon monoxide
poisoning or any other situation that may decrease the hemoglobin's capability to carry
oxygen.
The N-200 monitor is not intended for use as an infant apnea (stopped breathing)
monitor. If required, your patient's doctor will prescribe special equipment for detecting
apnea.
Federal law restricts this device to sale by or on the order of aphysician.

Your Home Care Provider
A qualified health care professional (called a home care provider) is essential for
providing adequate care for your patient. Your home care provider will:
• Provideyou with amonitor, pulsesensors, and accessories
• Trainyou how to use your monitor, sensors, and accessories
•Teach you how to respond to alarms
If you have any questions,ask your home care provider.
Definitions
Alarm
Battery Charger
ECG Monitor
Hemoglobin
Home Care Provider
Interface/Powerbase
Monitor
Oxygen Saturation
Oxygen Transducers
The tone you hear fromthe monitor and the indicatorthat
flashes when an abnormal condition is detected.
A devicebuilt insideyour monitor that allowsyou to plug
the monitor into astandard wall socket (3 prong) and
recharge the monitor's internal battery.
Amonitor that displays electrical signals from the heart,
through electrocardiogram (ECG), asheart rate (notpulse
rate).
The part of the red blood cellthat carries oxygen.
Health care professional who supplies the monitor, provides
training on its use, and does follow-up and maintenance
checks.
The section of the monitor that allows AC electrical power to
be used to run the monitor.
The partof the pulseoximetry system thatreceivessignals
from the detector on the pulse sensor. The system then
measures, displays,and comparesthe readings to the alarm
settings. The monitor sounds an alarm when the oxygen
saturation level or pulse rateareoutside the alarm settings.
A measure of the amount of oxygen actually carriedin the
blood, compared to the amount it could carry.
See pulse sensor.

jgs\
0\
(^\
<S\
(IPS
(SS
Patient Module
Perfusion
Pulse Oximetry
Pulse Sensor
Synchronization
Standby
The connecting cable between the pulse sensor and the
monitor. If using ECGequipment, the patient module may
also be used to synchronize the saturation measurement
with the ECG signal.
The amount of blood in a particular area, such as the arm or
leg. Poor perfusion indicates that
very little blood flow
occurs in the area.
A method of determining oxygen saturation levels.
The part of the pulseoximetry system that actually sends
and receives the light.
Using signals from more than one source and using them to
synchronize the pulse oximeter's oxygen measurement. This
enhances
oxygen measurement, especially when the patient
has poor perfusion or is
moving around.
Acondition controlled by the ON/STDBY switch that turns
off monitor functions, but allows battery charging and
retains data stored in memory.

What You Need to Know About the N-200
(Safety Information)
Readthis manual carefully BEFORE using the monitor.Readallwarnings and
cautions (in boldface type).
NEVER USE A MONITOR THAT YOU SUSPECT IS NOT WORKING
CORRECTLY. Contactyourhome care providerimmediately to have the monitor
tested or replaced.
The N-200 should be pluggedinto awalloutletatalltimes.The batteryis only for
backup in case of power failure. The batteryprovidesoperationforup to 90
minutes if fully charged. After the batteryhasdischarged, the monitorturns itself
off automatically.
Alwaysuse NELLCOR pulse sensors. Using anyother pulse sensor may cause the
monitor not to work correctly.
Incorrect applicationoruse of the pulse sensors may cause tissue damage or false
readings. DoNOT wrapthe pulse sensors tootightly orapply extra tape. Check
the sensor site every4 hours forredness orswelling. Do not placethe sensor
somewhere it is not intended to be used.
Excessive light (such as fluorescent lamps ordirectsunlight) may causethe
monitornot to work correctly. If this happens, cover the sensor area with a piece
of dark cloth to block the extra light.
DO NOT reuse disposable pulse sensors.Dispose of them asinstructed.
DO NOT get pulse sensors wet or theymay not work correctly.
DO NOT change the alarmsettings that your home care provider has directed you
to use. Check the settings at least once a day orwhenever you turn the monitoron.
When the monitor is turned off and then back on, all alarm settings return to their
standard values (see Appendix A). If necessary, return settings to the values
directed by your home care provider.
Never turn the audio alarm off when you arenot in the room with the patient. If
you do so you maynot know when an alarm condition occurs.If you disable the
alarm, be sure to turn it back on before leaving the room.
Be sure you can hear the alarm from wherever you arein the house.
For continued protection from fire, replace fuses only with those of the same type
and rating.
Shock hazard. DO NOT remove the cover of the monitor.

DO NOT place the monitor in water or any other liquid. Do NOT use abrasive or
caustic cleaners on the monitor or pulse sensors.
Remove the pulse sensor before bathing the patient.

How the N-200 Works
Your patient's doctor has decided to place your patient ona device called a pulse
oximeter. Thisdevice usesatechnique called pulse oximetry tomeasure theamountof
oxygenin the blood continuously.
Pulse oximetry requires three parts: an oxygen transducer (called a pulse sensor in this
manual), apatientmodule,andan oximeter (called a monitor in this manual). Refer to
Figure 1.
Pulse Sensor
Patient
Module
I
IH)^
Monitor
aw
SB
US
Figure 1: The pulse sensor, patient module, and monitorare the three parts of
a pulse oximetry system. ECG equipment is optional.
The plastic reusable sensor gentlysandwiches an area of thebody thathasalotof blood
flow near the surface.Reusable plasticsensorsmay be used on a fingeror an adulf s toe.
Disposable adhesive sensors may beusedon the bridge of the nose, a toe, ora bab/s
foot.

<ns
0HS
/S\
(Sy
0\
/PN
/§^i
0b
0\
0!\
0S\
Pulse Sensor
Tissue containing
pulsatile biood
Figure 2: The pulse sensor gently sandwiches an area of the body that has a
lot of blood flow near the surface. A typical application of the
reusable plastic sensor is shown above.
Infrared light (which you cannot see) and red light are sent from one side of the pulse
sensor to the other side through the skin. When this light passes through theblood, some
light is absorbed by the hemoglobin (the part of the blood cell that carriesoxygen). The
light not absorbed is measured by adetector on the other side of the sensor (see Figure 3).
Light source
&
Detector
Pulse Sensor
Tissue containing
pulsatile blood
Figure 3. Some of the light is absorbed when it passes through the blood.
The remaining light reaches the detector on the other side of the
sensor.

Thepulse sensor thensendsinformation ontheamount oflightnot absorbed through
the patient moduleto themonitor
(see Figure 4). Themonitor calculates theoxygen
saturationlevel and the pulse rate, displaysthe readings, and compares them to the
alarm settings.
Pulse Sensor
Monitor
»S
•bnraBt
Figure 4: The sensor sends information to the monitorthrough apatient
module. The monitor then computes the amount of oxygen in the
blood and compares it to the alarm settings.
If eitherthe oxygen saturationor the pulserategoesaboveorbelow the alarmsettings,
an alarm sounds from a loudspeaker in thebottom of the monitor and alight flashes on
the monitor's front panel,(see Figure 5). Your patient'sdoctordetermines these alarm
settings. If you turn the monitoroff andbackon,be surethatyou checkthe alarm
settings and adjust them if necessary.
Alarm tone
sounds
Monitor
G\l
fiS
Figure 5: An alarm occurs when either the oxygen saturation In the blood or
the pulse rate goes above or below the limits.
The monitor may have problems making measurements if your patient has poorblood
flow oris movingaround alot.Your home
care providerwill help to determine this and
obtain the correctpatient module for ECG synchronization (seeFigure 6).
8

(fp^»
ifm
|f!\
(lis
0>i
{S>
wajLEoa
•"
plug ECG cable into
patient module
i
Figure 6: A three-lead ECG cable may be connected to the patient module to
allow ECG and pulse sensor signals to be synchronized.
If you are using an ECG monitor in addition to the N-200, it may be possible to use a
synchronization signal from the ECG monitor to synchronize the N-200's measurements
to the patient's heartbeat. Ask your home care provider to determine if this can be done.
WARNING: This monitor acts as an early warning device. You must
ACT when the alarm sounds. The monitor cannot act for you.
The monitor cannot prevent your patient's oxygen saturation levels from falling below a
safe level or
your patient's heart from stopping. It will, however, warn you of situations
that may be life-threatening. You must respond to alarms immediately.

Setting Up
Unpacking and Inspection
Caution: Notify the carrier if the monitorshippingcarton is damaged.
Do NOT use a damaged monitor.
Carefully unpack the monitor and its accessories. The packages should contain:
one N-200 monitor
one interface/powerbase
one hospital-grade powercord
one patient module (N-200 minipatient module or N-200 patient module with
ECG)
pulse sensors (alsocalled oxygen transducers)
this home use guide
If any of these items is missing,contactyour home careprovider immediately.
Note: Always have an extra pulse sensor available. If you do not havean extra,
contact your home careprovider.
Where Not to Place Your Monitor
Follow these guidelines for placing your monitor:
10
WARNINGS
DO NOT place the monitor in the crib or bed with your patient.
DO NOT place the monitor on a carpeted floor. The alarm may be muffled
by the carpeting.
DO NOT place the monitoron or near electrical equipment such as
television sets, radios, microwave ovens, or electric heaters. These may
affect the monitor and cause it to work improperly.
DO NOT place containersof liquid on or near the monitor. Liquidsspilled
on the monitor may cause it to work improperly.
DO NOT place the monitor on or near avaporizer. Moisture in the air may
condense on the monitor and cause it to work improperly.
Place the monitor where the pulse sensor can reach your patient easily.
Be sure that you can hear the monitor alarm from anywhere in the house.

Pulse Sensors
WARNINGS
Always use NELLCOR pulse sensors. Using any other pulse sensor may
cause the monitor not to work correctly.
Incorrect application or use of the pulse sensors may cause tissue damage or
false readings. DO NOT wrap the pulse sensors too tightly or apply extra
tape.
Check the sensor site every 4hours for redness or swelling. DO NOT
place the sensor somewhere it is not intended to be used.
Excessive light (such as fluorescent lamps or direct sunlight) may cause the
monitor not to work correctly. If this happens, cover the sensor area with a
piece of dark cloth to block the extra light.
Remove the pulse sensorbefore bathing the patient DO NOT allow the
pulse sensorto get wet. __
Using aPulse Sensor
Nellcorprovides several types of pulse sensors (alsocalled oxygen transducers). Some
pulse sensorsare disposable and others canbe reused. Yourhome careprovider has
determined which is the best type of pulse sensor for your patient.
Followyour home care provider's instructions on how to use the pulsesensor.
Cleaning Your Pulse Sensor
If you are using a reusable pulse sensor:
•Clean the pulsesensor with a disinfectant, such as 70% isopropyl alcohol.
•Gently wipe the sensor with a damp cloth.
If you are using disposable pulse sensors:
•DO NOT clean disposable pulse sensors.
• DO NOT get disposable sensors or the tape wet.
• Dispose of pulse sensors as directed by your home care provider.
11

^9s
The Parts of the Monitor
The N-200 monitor canbe used with any model NELLCOR pulse sensor.The monitor /^
shouldbe run only on AC electrical powerby plugging thehospital-grade powercord
into a standard, grounded wall outlet (3 slots). In caseof power failure, the monitor may
be run on its internal battery for up to 90 minutes. Theinternal batteryis recharged ^
when the monitor is connectedto AC power.It takes 14hours to recharge fully after ^
operatingon battery power. ^
The N-200 monitor must be used with one of the following patient modules: ^
• N-200 patient module with ECG ^
• N-200 mini patient module ^
The momtor will not work with any other kind of patient module or without one. Do ^
notattempt to connect a pulse sensor to any connector onthe monitor's rear panel. The ^
N-200 patientmodule with ECG may be connected to ECG leadsconnectedto the
patient; N-200 mini patient module cannot. (If you wish to use an ECG signal with the ^
N-200 mini patient module, an ECG lead from abedside ECG monitor mustbe ^
connected to the ECG IN/OUT connector on thebackof the N-200 monitor.) ^
Nomatter which patient moduleis used, themonitor willsoundan audible alarm and ^
flashalight when the oxygen levels (detectedby light absorption) fall below orgo ^
above the alarm settings. The monitor will alsoalarm if the pulse rate goes above or ~
falls below the alarm settings.
Besides the alarm functions, the N-200 monitor saves 12 hours of trend information.
This information can be printed on a printer having a serial input.
12 ^

Instruments:
Description:
Battery Capacity
Test, N-200:
Technical Update
Number 2
Battery Capacity Testing for
NELLCOR® Pulse Oximetry Products
Nellcor Technical Updates are intended to inform Biomedi
cal andClinical Engineers of timely serviceand maintenance
issuesregarding Nellcor products.Theseupdatesaredistrib
uted to customers who own the identified products. Addi
tionalcopies maybe requested by contactingNellcor Techni
cal Services at 1-800-NELLCOR (inside the U.S. A.), or Nellcor
corporate offices at 510 887-5858.
NELLCOR N-100, N-200, and N-250 pulse oximeters and N-1000 multi
function monitor.
NELLCOR monitors are equipped with sealed lead-acid batteries. Electrical
specifications for each monitor can be found in the operator's manuals.
Battery capacity decreases over time due to several factors such as tempera
ture, depth of discharge and number of charge/discharge cycles. Replacing
the battery periodically ensures battery operation when needed. Aperiodic
battery capacity check is also recommended. The time interval for this check
is left to the discretion of the customer. Depending on
how the unit is used,
the customer may wish to perform abatterycheck as often as every 6months.
This check should also include inspection of the batteries' physical condi
tion. Anybatteries with signs of leakage or corrosion should be replaced.
Refer to the applicable "Battery Capacity Test" below for instructions on
testing battery capacity. Regardless of periodic test results, Nellcor recom
mends replacement of lead-acid batteries every 2 years. Replacement
batteries can be purchased through Nellcor Technical Services.
This test requires that the unitbe fully charged for 14hours. Use the
following procedure:
1. Place the N-200 in either ON or STDBY mode, ensuring that the instrument
is plugged into an operational, properly grounded AC outlet. (Ifan N-200
220-240V monitor is being tested, the MAINS switch on the powerbase
rear panel
must be on.)
2. Charge the battery for a minimum of 14hours.
3. Test the N-200for operation in the battery mode (unplugged from AC
power). The operating time in battery mode must be a minimum of 45
minutes.

Battery Capacity This test requires that the unit be fullycharged for 14hours. Use the
Test, N-250: following procedure:
1. Place the N-250in either ON or
STDBY mode, ensuringthatthe N-50inter-
face/ECG momtor isplugged into an operational, properlygrounded AC
outlet and the mains switch on the N-50rear panelis in the ON position.
2. Chargethe batteryfor a minimum of 14hours.
3. Testthe N-250 foroperationin the battery mode (unplugged from AC
power). The operatingtime in battery mode must be a minimumof 45
minutes.
Battery Capacity This test requires that the unitbe fully charged for 8 hours. Use the
Test, N-100: following procedure:
1. Placethe N-100 in either the ON or STDBY mode, ensuring that the
instrument is plugged into an operational, properly grounded AC outlet.
(Ifan N-100 220-240 Vunit is being tested, the MAINS switch on the rear
panel must be on.)
2. Charge the battery for a rninimum of 8 hours.
3. Test the N-100 for operation in battery mode (unplugged from AC
power). The operating time in battery mode mustbe a minimum of 60
minutes.
Battery Capacity This test requires that the unit be fully charged for 14hours. Use the
Test, N-1000: following procedure:
1. Placethe N-1000 in either ON or STDBY mode, ensuring that the instru
ment is plugged into an operational,properly grounded AC outlet.
2. Turn on the
N-1000 MAINS switchand verify that the rear-panel AC
power indicator illuminates.
3. Charge the battery for a minimum of 14hours.
4. Testthe N-1000 for operation in battery mode (unplugged from AC
power). The operating time in battery mode mustbe a minimum of 15
minutes before the monitor powers down.
Note: The message "WARNING: POWER DOWN ISIMMINENT DUE TO LOW BATTERY
VOLTAGE" appears before actual power-down; the 10-minutebattery test period
applies to monitor power-down, not appearance of message.
Ifany unit doesnot meet the specified batteryoperatingtime,further testingor repairmaybe
necessary. Only qualified servicepersonnel or Nellcorrepair facilities are recommended for
testing orrepair. If you encounter problems or have questions regarding this update, contact
Nellcor Technical Services at 1-800-NELLCOR.
NELLCOR isa trademark of Nellcor Incorporated. © 1992 Nellcor Incorporated. All rights reserved.
027016B-0194
Nellcor Incorporated Pleasanton, CA 94588 U.S.A. Toll free 1 -800-NELLCOR Fax [phone]
TECH 2/pg2

Technical Update
Number 2
Battery Capacity Testing for
NELLCOR9 Pulse Oximetry Products
Nellcor Technical Updates are intended to inform Biomedi
cal and Clinical Engineers of timely service and maintenance
issues regarding Nellcor products. These updates are distrib
uted to customers who own the identified products. Addi
tionalcopies may be requested by contactingNellcor Techni
cal Services at 1-800-NELLCOR (inside the U.S. A.), or Nellcor
corporate offices at 510 887-5858.
Instruments: NELLCOR N-100, N-200, and N-250 pulse oximeters and N-1000 multi
function monitor.
Description:
Battery Capacity
Test, N-200:
NELLCOR monitors are equipped with sealed lead-acid batteries. Electrical
specifications for each monitor can be found in the operator's manuals.
Battery capacity decreases over time due to several factors such as tempera
ture, depth of discharge and number of charge/discharge cycles. Replacing
the battery periodically ensures battery operation when needed. Aperiodic
battery capacity check is also recommended. The time interval for this check
is left to the discretion of the customer. Depending on how the unit is used,
the customer may wish to perform a battery check as often as every 6 months.
This check should also include inspection of the batteries' physical condi
tion. Any batteries with signs of leakage or corrosion should be replaced.
Refer to the applicable "Battery Capacity Test" below for instructions on
testing batterycapacity. Regardless of periodic test results, Nellcor recom
mends replacement of lead-acid batteries every 2 years. Replacement
batteries can be purchased through Nellcor Technical Services.
This test requires that the unit be fully charged for 14hours. Use the
following procedure:
1. Place the N-200in either ON or STDBY mode, ensuring thatthe instrument
is plugged into an operational, properly grounded AC outlet. (Ifan N-200
220-240V monitor is being tested, the MAINS switch on the powerbase
rear panel must be on.)
2.
Charge the battery for a minimum of 14 hours.
3. Test the N-200 for operation in the battery mode (unplugged from AC
power). The operating time in battery mode must be a minimum of 45
minutes.

Battery Capacity This test requires that the unit be fully charged for 14hours. Use the
Test, N-250: following procedure:
1. Placethe N-250 in eitherON or STDBY mode, ensuring that the N-50inter-
face/ECG monitor is plugged into an operational, properlygrounded AC
outlet and the mains switchon the N-50rear panel isin the ON position.
2. Chargethe batteryfor a minirnum of 14hours.
3. Testthe N-250foroperation in the battery mode (unplugged from AC
power). The operatingtime in batterymodemustbe a minimumof45
minutes.
BatteryCapacity This test requires that the unit be fully charged for 8 hours. Use the
Test, N-100: following procedure:
1. Place the N-100in either the ON or STDBY mode, ensuring thatthe
instrumentis plugged into an operational, properly grounded AC outlet.
(Ifan N-100 220-240 Vunit isbeing tested, the MAINSswitchon the rear
panel mustbe on.)
2. Charge thebattery for a minimum of 8 hours.
3. Test the N-100 for operation in battery mode (unplugged from AC
power). The operating time in battery
mode must be a minimum of 60
minutes.
Battery Capacity This test requires that the unit be fully charged for 14hours. Use the
Test, N-1000: following procedure:
1. Place the N-1000in either ON or
STDBY mode, ensuring that the instru
ment is plugged into an operational, properly grounded AC outlet.
2.
Turn on the N-1000MAINS switch and verify that the rear-panel AC
power indicator illuminates.
3. Charge the batteryfor a minimum of 14 hours.
4. Test the N-1000for operationin battery mode (unplugged from AC
power). The operating time in battery
mode must be a minirnum of 15
minutes before the monitor powers down.
Note: The message "WARNING: POWER DOWN ISIMMINENT DUE TO LOW BATTERY
VOLTAGE" appears before actual power-down; the 10-minutebattery test period
applies to monitor power-down,not appearance of message.
If
any unit does not meet the specified battery operating time, further testing or repair may be
necessary. Onlyqualified service personnel or Nellcor repair facilities are recommended for
testing or repair. If
you encounter problems or have questions regarding this update, contact
Nellcor Technical Services at 1-800-NELLCOR.
NELLCOR is atrademark of Nellcor Incorporated.© 1992Nellcor Incorporated. All rights reserved.
027016B-0194
Nellcor Incorporated Pleasanton, CA 94588 U.S.A. Toll free 1-800-NELLCOR Fax [phone]
TECH 2/pg2