Ramsey Medical petMAP+ II User manual

1
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NowyourpetMAP+II
canmonitorECG

2
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ThismanualappliestotheoperationoftheECGModule(REF#9026),
availableasanoptionwiththepetMAP+II.TheECGModulerequiresa
petMAP+IItobeuseful.ReadthismanualandthepetMAP+IImanual
completelybeforeusingtheequipment.
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petMAP+IIistobeoperatedbyqualifiedpersonnelonly.Beforeuse,
familiarizeyourselfwiththedeviceandreadthemanuals,includingall
warningsandcautions.TheusershouldcheckthatpetMAP+II,alongwith
itsaccessories,isfunctioningbothsafelyandeffectivelypriortouse.
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COPYRIGHT©2012‐2018RamseyMedical,Inc.
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Allrightsreserved.Noportionofthismanualmaybereproducedwithout
thewrittenpermissionofRamseyMedical,Inc.

3
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ECGModuleOPERATOR’SMANUAL
TABLEOFCONTENTS
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Introduction    Page
DeviceDescription  4
IntendedUses4
Configurations&Accessories 6
Symbols,Warnings&Cautions  7
EMCDeclaration10
DeviceOverviewandOperatingInstructions
Controls&Connections  11
PatientPreparation&
Lead/CatheterPlacement 12
UseofEsophagealCatheters
vs.SurfaceLeadWires  12
OperatingInstructions/
UserSelections13
Alarms15
Maintenance17
Troubleshooting18
Warranty/Service20
Specifications22
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4
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INTRODUCTION
DeviceDescription
petMAP+IIisasmall,lightweightandportablebatteryoperated
monitoringdevicedesignedforveterinaryuse.Initsvariousbaseunit
configurations,itiscapableofmeasuringbloodpressure(systolic,diastolic
andmeanarterialpressures),heartrate,temperatureandoxygen
saturation(SpO2).Themeasuredvaluesaredisplayedandtrendedonthe
devicecontinuously.DatatrendedonthepetMAP+II canoptionallybe
savedonaSDmemorycardviathepetMAP+II’sintegratedSDmemory
cardslot.
ModulesforECGandCO2canalsobepurchasedandaddedtothebase
unit.
UseoftheECGModuleallowsthepetMAP+IItodisplayanECGwaveform
andtheHRderivedfromtheECGsignal.TheECGModuleisconnectedtoa
flatfive‐footcablethatplugsintothesideofthepetMAP+II.TheModule
hasconnectionsforthreesurfaceECGleadwiresandanesophagealprobe
thathasECGelectrodesonit(soldseparately).OnlyonesetofECG
electrodescanbeusedatonetime.Theusercanswitchbetweensurface
leadsandtheesophagealprobeusingaslideswitchontheECGModule.
TheusercanalsoadjustthegainontheECGwaveformusingaslideswitch
ontheECGModule.
IntendedUses
petMAP+IIisintendedforuseonveterinarypatientswhenmeasuringor
monitoringofbloodpressure,heartrate,temperatureand/orSpO2is
desired.WhenconfiguredwithanECGModuleandpatientelectrodes
properlyattached,thepetMAP+IIwillalsodisplaytheECGwaveformand
ECGHR.Itcanbeusedonawidevarietyofveterinarypatients,butis
primarilydesignedforcompanionanimals.petMAP+IIcanbeusedon
bothawakeandanesthetizedpatients,butawakepatientsareoften
uncooperative.ECGapplicationsincludeuseforsurgical,ICUandtrauma
monitoringaswellasuseduringprocedures(imaging,dentals,etc.).

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TheECGModuleisasingleECGlead(uses3electrodes)system,andwhen
usedwithsurfaceleadsattachedasdirected,theECGwaveformisLeadII
andisusedforHRcalculation.Whenusedwiththeesophagealelectrodes
theleadissimilartoaLeadII,butitisbetterreferredtoassimplythe
EsophagealLeadsinceitisnotidenticaltoasurfaceECGleadII.
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6
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Configurations&Accessories
Thefollowingtablesummarizesthestandardaccessoriesandoptional
accessoriesavailableforthepetMAP+IIECGModule:
ProductCodeDescription
Standard
Accessories
(included
withthe
Module)
9026
ECGModule
ECGModule
ConnectorCable(5’)
3LeadWireSet(w/alligatorclips)
Operator’sManual
Optional
Accessories
3205‐0001 CatCatheter (esophageal ECG electrodes
andTemperature)
3207‐0001 DogCatheter (esophageal ECGelectrodes
andTemperature)
Replacement
Items
9030 3ECGLeadWireSet
R316000 ECGModuleConnectorCable(5’)

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EsophagealCatheters
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3205-0001
Cat Catheter 3207-0001
Dog Catheter

7
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SYMBOLS
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CautionSymbol ConsultManualSymbol
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WARNINGS&CAUTIONS
(Pleasereadandunderstand) 
ThepetMAP+IIanditsECGModuleareintendedforVETERINARY
USEONLY.Donotuseonahumanpatient.
 TheusershouldbeawarethatthepresenceofanECGwaveform
doesnotmeanthatthepatienthasausefulheartbeat.Electromechanical
dissociation(EMD)canoccurundervariouscircumstancesandthoughthe
ECGappearstobenormalorabnormal,thereisnoactualcontractionof
theheartandthusthereisnopulseorbloodpressurebeinggeneratedand
theanimaliseffectivelydeadunlesscorrectedquickly.Neverrelyonlyon
theECGtojudgethepatient’scirculatorycondition.AlwaysusetheSpO2,
CO2andBPinadditiontoECGtojudgetheconditionofthepatient's
circulatorystatus.ThepatientcandieandstillhaveanormallookingECG
foraperiodoftime.
 Whenapatient'sheartisbeingpaced,thepacercurrentcan
potentiallyproduceartifactsthatappeartolooklikeanormaloran
abnormalECG.TheECGmoduleattemptstofilteroutthepacemaker
pulses(incertaincircumstancesitisnotpossibletofilterthem),andthe
usermustbeabletodistinguishtrueECGwaveformsfrompaceartifact
inducedwaveformsthatcanlooklikeanECGwaveform.Alwaysjudgethe
adequacyofthepatient’scirculationusingotherparametersinadditionto
theECG,sincetheECGcanappeartobepresenteventhoughthereisno
effectiveheartbeatcontraction.SpO2,CO2,andBPareimportant
parameterstomonitorinordertojudgethepatient’scardio/respiratory
statusandshouldalwaysbeusedinadditiontotheECG.

8
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 UseofanElectrosurgicalUnit(ESU)willoftenresultininterference
ontheECGtraceandpotentiallyerroneousheartrates.NeverusetheECG
fordeterminingheartrateuntiltheECGwaveformhasbeenstablefor10
secondsormoreafterESUuse.TheBPandSpO2aretypicallynot
adverselyaffectedbyESUusage,butundercertaincircumstancestheESU
couldadverselyaffectthem.AlwaysassurethattheESUgroundplateis
wellplacedonthepatientandplaceddistantfromtheECGelectrodes.
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 InaccurateECGheartratereadingsmayresultwhenan
electrosurgicalunit(ESU)isusedwhilemonitoringwiththepetMAP+II.If
thisissuspected,discontinueuseofthepetMAP+IIwhiletheESUisinuse.
WhenESUisused,patientleadsandwiresshouldbeawayfromthe
surgicaloperationsiteandotherdevices.Thisreducestheburningriskdue
toapoorconnectionoftheESUneutralelectrode.
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Thescientificliteraturedescribesinterferencefromanumberof
electricaldevicesthatcanproduceartifactsthatlooklikenormalor
abnormalECGwaveformsbutarenotactualECGwaveforms,andthese
potentialECGartifactgeneratorsincludeIVpumps,lineisolationmonitors,
electrosurgicalunits,pacemakersandotherstimulators,fluidwarmers,
bronchoscopes,etc.Insuchinstances,thesedevicesareusually
malfunctioninginsomewaywhenproducingECGartifacts,butnotalways.
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 Inrarepatientarrhythmiastheremaybe1ormorepeaked
complexeswitheachactualbeatthatresembletheactual,trueQRS
complex.Insuchcircumstancestheunitcanmistaketheadditionalpeaked
complexesforaQRSandhencetheheartratedisplayedwillbehigherthan
thetrueheartrate.OnthedisplaywhereeachQRSisdetectedthereisa
smallindicatormark(yelloworred)belowthedetectedQRSwaveformto
indicateithasbeendetectedasaQRS.IfindoubtabouttheECGheart
rate,confirmthatonlytrueQRScomplexesarebeingidentifiedassuchby
lookingatthesmallmarks.Eveninthepresenceofsuchrarearrhythmias,
theBPandtheSpO2heartratesshouldreadproperly.

9
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 DonotimmersetheECGModuleinwateroranyliquid.Ifthe
Moduleisaccidentallywetted,itshouldbethoroughlydriedbeforeuse.If
theECGModulehasbeendroppedintowaterorotherfluid,itshouldnot
beusedandshouldbereturnedtothemanufacturerforservice.
 IftheECGModulehasbeendroppedordamagedinanyway,it
shouldbecheckedbyqualifiedservicepersonneltoensureproper
operationpriortouse.
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 UseofaccessoriesotherthanthosespecifiedbyRamseyMedical
mayresultindangertothepatient,malfunctionofthemonitoringunit,
andadditionalincreasedelectro‐magnetic(EM)emissionsordecreasedEM
immunityofthedevice.
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 Followlocalgoverningordinancesandrecyclinginstructions
regardingdisposalandrecyclingofdevicecomponentsandpackaging.


ThepetMAP+IIisnotintendedforuseonpatientsbeingimaged
withanMRIdevicesincethepetMAPdevicecontainsmagneticallyactive
materialsandcouldresultininjuryifusedtooclosetoanMRIdevice,even
iftheMRIisnotoperatingsincetheMRImagnetisstillactiveevenifnotin
use.

Donotgassterilizeorautoclavethedevice.
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10
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EMCDECLARATION
TheECGModule(REF#9026)hasbeentestedtogetherwiththepetMAP+II
asasystem.PleaserefertothepetMAP+IIManual(R400257)fordetailed
EMCcomplianceinformation.

11
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DEVICEOVERVIEW&OPERATINGINSTRUCTIONS
Controls&Connections. Notethebelowdiagramforconnectingthe
ECGModuletothepetMAP+II.
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
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
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Surface ECG
Lead
Connections
Electrode
Selector
Switch
Attach the ECG Cable to
the connector labeled
ECG on the petMAP+II.
NOTE: If a REF# 9028
petMAP cover is in use,
lift the flap to expose the
connector.
Esophageal Catheter
Connection
Attach the cable
to both the
petMAP+II and
the ECG Module.
Green Power “ON”
LED indicator
“GAIN” Switch

12
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PatientPreparation&Lead/CatheterPlacement.

AccurateECGleadplacementisessentialtoobtainingaclearECGtraceand
accurateHR.Properskinpreparationisnecessarytoachievegoodresults,
likeshavingandusingplentyofelectrodegel.Openthealligatorclipson
thedistalendsoftheleadwirestofirmlybutgentlygrasptheskinforgood
contact.PoorskinelectricalcontactisthemainreasonforpoorECGdisplay
quality.
UseofEsophagealCathetersvsSurfaceLeadWires.
ItisoftendesirabletouseanesophagealcathetertoobtainECG,HRand
Temperature.Cathetersareavailableforcats(orsmalldogs)(REF#3205‐
0001,green)anddogs(REF#3207‐0001,blue).Bothcathetershave4ring
ECGelectrodesandaninternalthermistor,whichgivesthecatheteran
addedadvantageofdetectingtemperature.
Thecatheteriscarefullyandgentlyinsertedintotheesophagusandthe
depthisadjustedtomaximizetheECGsignal.Thebestsignalisgenerally
achievedwhenthelowerelectrodeonthecatheterisbelowtheheartand
theupperelectrodeisabovetheheart.SmalladjustmentsofafewCMcan
greatlyimprovethequalityandamplitudeoftheECGsignal.

II
RA=Rightarm(white)
LA=Leftarm(black)
LL=Leftleg(red)

13

OperatingInstructions/UserSelections.
1) Followtheinstructions(previouspage)forplacingleadwiresor
insertingtheesophagealprobe.

2) TurnECGonbypressingthe
highlightedECGON/OFFbutton
onthepetMAP+II.Verifythe
GreenLEDontheECGmodule
nearthepetMAP+IIconnector
isON,indicatingtheECG
moduleispowered.




3) Thisisanexampleofa
screendisplaywhenthe
ECGwaveformisofadequate
size.Alittlelargerisfine
(better),butitshouldbeno
smaller.Ifsmaller,increasethe
gainusingtheGainslideswitch
ontheECGModule.









14

4) Adjustthegain,ifnecessary.Ifthesignalistoolow,theECGsignal
maynotbedetected,iftoohighthepetMAP+IIwilldisplaya
messagetoreducethegain.


5) Whenmonitoringiscomplete,turnECGOFF.

AnoteaboutHR:TheECGHRisdisplayedifthedetectedECGHRisjudged
bytheunittobeaccurateandwithinexpectedlimits.Otherwise,theSpO2
HRisdisplayedandasmall'o'isdisplayedbelowtheHRlabeliftheECGis
ONtoindicatethattheHRdisplayedisnotfromtheECG,butisfromthe
SpO2.




“GAIN” Switch

15

Alarms
ThefollowingalarmscanbegeneratedbytheECGfeatureanddisplayed
onthepetMAP+II:










No ECG Detected
or
O2 Sensor? ECG?
ECG Lead OFF?
or
ECG: Lead? Switches?
Situation:
The ECG signal or
waveform amplitude is
insufficient to be detected.
Probable causes and/or
suggestions:
The patient has no cardiac
electrical activity or rhythm.
The amplitude or strength is
inadequate. Adjust the
electrodes, and/or increase
the gain.
Situation:
Either a lead is off or the
ECG module has incorrect
switch settings.
Probable causes and/or
suggestions:
Check the ECG leads.
Reposition electrodes and
add gel to surface leads if
necessary.
Check to make sure that
both switches are correct:
oEsophageal or surface
oGain
NOTE: The “No ECG detected”
alarm becomes “O2 Sensor? ECG?”
if at the time the no ECG detected
alarm is triggered, there is already a
SpO2 alarm active.

16

OtherECGAlarms
Fast ECG or Noise Displayed when HR > 260 BPM
Slow ECG Detected Displayed when HR < 40 BPM
ECG or Patient Problem. A non-specific alarm that could be
caused by a potentially lethal arrhythmia or by ECG interference
noise. In any event, it always requires user investigation to
determine a possible cause and correction.
Alarms can be silenced by touching the screen.
The above alarms are self-canceling when the cause of the alarm
is resolved.



17

MAINTENANCE
ECGModuleandConnectionCable:Cleanasneededwithacloth
dampenedwith70%isopropylalcohol.DonotimmersetheModuleor
cablesinanyfluid.
ECGleadwires:Afteruse,cleanthemetalportionoftheclipswithsoap
andwater,butdonotwettheconnectors.
Esophagealcatheters:Afteruse,cleanthecatheterwithsoapandwater.
Donotwettheconnector.



18

TROUBLESHOOTING
FailuretodisplayausableECGcanbecausedbyanumberofproblemsand
canusuallybefixedbycorrectingoneormoreofthefollowing:
1)IstheECGModuleconnectedtotheproperconnectoronthe
petMAP+IIandisthegreenLEDontheModulelitwhentheECGis
selectedON?
IfnogreenLEDisvisibleontheECGmodule,thereisaproblemwiththe
unit,thecable,and/ortheECGModuleitself.WithoutthegreenLEDon,
theECGwillnotfunction.

2)Electrodesarenotproperlyplaced,arenotmakinggoodelectrical
contactand/orarenotproperlypluggedintotheECGModule.
MakesuretheleadwiresareproperlypluggedintotheECGModuleand
thatsufficientelectrodegelisusedonsurfaceelectrodestoassuregood
contactoftheclipswiththeskinifsurfaceleadsareinuse.
Ifanesophagealcatheterisbeingused,itshouldbeinsertedsufficientlyso
thatthemostdistalelectrodeisbelowtheheartandthemostproximal
electrodeisabovetheheart.NotethatafewCMofinsertiondepth
changecanmakeabigdifferenceinthequalityoftheECGtracefromthe
esophagealelectrodes.PositionitsothattheQRScomplexisatmaximum.

3)TheECGModule'selectrodeselectorswitchmustbeintheproper
positionforeitheresophagealorsurfaceelectrodes.

4)SetthegainswitchontheECGmodulesothattheQRSpeakisat
orslightlyabovethelevelofthetopofthenumericHRdisplay.
ReducethegainiftheQRSwaveformpeaksaremorethanslightly
enteringintotheSpO2tracespace,oriftheunitdisplaysthe
suggestion.


19

5)Ifthereismainspowernoise(50or60Hznoise)ontheECGsignal
waveform,checkthesurfaceelectrodesandaddelectrodegelif
necessaryorrepositiontheesophagealelectrode,beingcarefulto
notinsertittoodeeplyasitcouldenterandinjurethestomach.
Checkallconnectionsforsecurity.


20

WARRANTY/SERVICE
Warranty
RamseyMedical,Inc.warrantsthattheECGModule,whennew,iscovered
byaone‐yearwarrantyagainstdefectsinmaterialsandworkmanship.All
warrantiesbeginatthedateoforiginalpurchasefromCardioCommand,
Inc.oritsauthorizeddistributors.
ECGModuleaccessories,includingleadwires,connectorcableand
esophagealcatheters,arewarrantedtobefreefromdefectsinmaterials
andworkmanshipfor90days.Theseitemswillrequireperiodic
replacementduetonormalwear.
RamseyMedical’sobligationunderthiswarrantyislimitedtorepairingor,
atitsoption,replacingdefectivepartsorentireunitswithoutcharge,if
suchdefectsoccurasaresultofnormalusewithpromptnotification
withinthewarrantyperiod.
Damageresultingfrominappropriateuseorphysicalabuseisnotcovered
bythewarranty.
THEREARENOWARRANTIESWHICHEXTENDBEYONDTHOSEEXPRESSLY
LISTEDABOVE.INADDITION,THEREARENOWARRANTIESOF
MERCHANTABILITYORFITNESSFORAPARTICULARPURPOSE.
CustomerService&Repairs
Allunitsreturnedforserviceand/orrepairs(warrantyandnon‐warranty)
musthaveaRMAobtainedbycallingCustomerServiceat
CardioCommand,Inc.TheRMAnumberobtainedshouldbewrittenonthe
outsideoftheshippingcontainerandthedeviceshouldbesentto:
CardioCommand,Inc.
4920W.CypressSt.,Ste.110
Tampa,FL33607
Phone: 800‐231‐6370
813‐289‐5555
Fax:  813‐289‐5454