Masimo Rad-5 Návod k obsluze stáhnout pdf (Strana 15)

Rad-5/5v Signal Extraction Pulse Oximeter Operator’s Manual 4-7

operation

LOW PERFUSION

The Rad-5/5v indicates perfusion on a 10-bar LED indicator. The lower two segments of

the bar will turn red when the amplitude of the arterial pulsations is very low (low perfu-

sion).

It has been suggested that at extremely low perfusion levels, pulse oximeters can meas-

ure peripheral saturation, which may differ from central arterial saturation

. This “localized

hypoxemia” may result from the metabolic demands of other tissues extracting oxygen

proximal to the monitoring site under conditions of sustained peripheral hypoperfusion.

(This may occur even with a pulse rate that correlates with the ECG heart rate.)

CAUTION: IF THE LOW PERFUSION INDICATION IS FREQUENTLY DISPLAYED, FIND

A BETTER-PERFUSED MONITORING SITE. IN THE INTERIM, ASSESS THE PATIENT

AND, IF INDICATED, VERIFY OXYGENATION STATUS THROUGH OTHER MEANS.

Severinghaus JW, Spellman MJ. Pulse Oximeter Failure Thresholds in Hypotension and

Vasoconstriction. Anesthesiology 1990; 73:532-537

ACTIONS TO BE TAKEN

If the SpO

readings show significant differences, do the following:

■

Make sure the emitter and photodetector are aligned directly opposite each

other.

■

Select a site where the distance between the emitter and photodetector is

minimized.

■

Wipe the sensor site with a 70% isopropyl alcohol pad or rubefacient cream

(10-30% methyl salicylate and 2-10% menthol) for 20-30 seconds. Strong

vasodilator creams, such as nitroglycerin paste, are not recommended.

■

If possible, remove electrical noise sources such as electrosurgical units or

other electrical/electronic equipment.

■

If artificial nails or excessive fingernail polish are present, select another site

or remove the polish/artificial nails.

■

If possible, ensure that the sensor is placed in a location with low ambient

light. Although the Rad-5/5v Handheld Pulse Oximeters with integrated

Masimo SET technology have significant immunity to ambient light, excessive

ambient light may cause readings to be incorrect.

CAUTION: IF ANY MEASUREMENT SEEMS QUESTIONABLE, FIRST CHECK THE

PATIENT’S VITAL SIGNS BY ALTERNATE MEANS AND THEN CHECK THE PULSE

OXIMETER FOR PROPER FUNCTIONING.

SIGNAL IQ AND PULSEBAR

The Rad-5/5v display provides a visual indicator of the plethysmogram signal quality and

an alert when the displayed SpO

values are not based on adequate signal quality. The

signal quality indicator displayed on the Rad-5/5v is called the Signal IQ. The Signal IQ

can be used to identify the occurrence of a patient’s pulse and the associated signal qual-

ity of the measurement.

The Signal IQ is shown as a “bouncing bar” indicator, where the peak of the bar coincides

with the peak of an arterial pulsation. Even with a plethysmographic waveform obscured

by artifact, the Rad-5/5v locates the arterial pulsation. The pulse tone (when enabled) coin-

cides with the peak of the Signal IQ bar. As saturation increases or decreases, the pulse

tone will ascend or descend accordingly, for each 1%.

The height of the Signal IQ bar indicates the quality of the measured signal. A high verti-

cal bar indicates that the SpO

measurement is based on a good quality signal. A small

vertical bar indicates that the SpO

measurement is based on data with low signal quality.

When the signal quality is very low the accuracy of the SpO

measurement may be com-

promised. A “Low Signal IQ” is indicated by a bar height of two bars or less and the bars

turn red. When this occurs, proceed with caution and do the following:

■

Assess the patient.

■

Check the sensor and ensure proper sensor application. The sensor must be well

secured to the site for the Rad-5/5v to maintain accurate readings. Also, misalign-

ment of the sensor’s emitter and detector can result in smaller signals.

■

Determine if an extreme change in the patient’s physiology and blood flow at the

monitoring site occurred, (e.g. an inflated blood pressure cuff, a squeezing motion,

sampling of an arterial blood specimen from the hand containing the pulse oximetry

sensor, severe hypotension, peripheral vasoconstriction in response to hypother-

mia, medications, or a spell of Raynaud’s syndrome.)

■

With neonates or infants, check that the peripheral blood flow to the sensor site is

not interrupted. For example, as may occur while lifting or crossing their legs, dur-

ing a diaper change.

After performing the above, if the “Low Signal IQ” indication occurs frequently or continu-

ously, obtaining an arterial blood specimen for CO-oximetry analysis may be considered to

verify the oxygen saturation value.

operation

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