Zoll NTP Pacemaker Operation Manual - Clinical Engineering

INTRODUCTION
OPERATION
APPENDIX
TABLE OF CONTENTS
PAGE NO.
TABLE OF CONTENTS. ............................................. 1
PRlNCtPLES OF OPERATION. ....................................... 2
INTENDEDUSE ................................................... 4
COMPLICATIONS .................................................. 6
CAUTIONS ....................................................... 8
OPERATING INSTRUCTIONS ........................................ 9
CONTROLS ....................................................... 14
FRONT PANEL DISPLAYS. .......................................... 17
PATIENT CONNECTIONS ........................................... 19
MAINTENANCE ................................................... 20
SPECIFICATIONS .................................................. 21
OPERATIONAL TEST PROCEDURES. ................................. 23
EXTERNAL INTERFACE CABLE INSTRUCTIONS ....................... 27

variable from 30 to 180 PPM.
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NTPTM allows clear
viewing and interpretation of the electrocardiogram on the
screen, without the offset or distortion produced by the large
electrical stimulus.
NTPTM pacing electrodes placed on the
back and the precordium. The characteristics of the output
pulse, together with the design and placement of the electrodes,
eliminate cutaneous nerve stimulation, lower cardiac stimulation
thresholds, and reduce discomfort due to skeletal muscle
contraction.
The unique
zoll
PACE-VIEWTM feature of the Zoll
mA and the rate is continuously
The pacing output pulse is delivered to the heart by two
specially designed
(NTPTM) is a self
contained noninvasive cardiac pacemaker consisting of a demand
pulse generator, a two trace non fade ECG monitor scope, and a
strip chart recorder. The output current of the pacemaker is
continuously variable up to 140
PRINCIPLES OF OPERATION
Noninvasive electric pacing is an established and proven
technique. This device is safe and is easily and rapidly applied
in both emergency and nonemergency situations when temporary
cardiac stimulation is indicated.
The Zoll Noninvasive Temporary Pacemaker

The entire system is lightweight, compact, and can be transported
with a patient. Built-in batteries are kept at full charge when
the unit is connected to line power. Electrode contact
indicators alert the user to any problems due to poor contact or
faulty connections. The monitor counts the heart rate and is
equipped with adjustable high and low alarm limits.
Proper operation of the instrument, together with correct
electrode placement, is critical to obtaining the best results.
The operator should be thoroughly familiar with the operating
instructions found in the OPERATION
Zoll
instrument.
NTPTM pacing electrodes should
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section of this manual. Only
be connected to this

INTENDED USE
For cardiac pacing for any purpose in conscious or unconscious
patients for up to a few hours duration as an alternative to
endocardial stimulation. The purposes of pacing include: 1)
resuscitation from standstill or bradycardia of any etiology, 2)
as a standby when standstill or bradycardia might be expected, 3)
suppression of tachycardia.
1. External pacing has been used for resuscitation from
standstill or temporary acceleration of bradycardia in
Stokes-Adams disease, Sick-sinus syndrome, reflex vagal
standstill and drug-induced standstill (due to
procainamide, quinidine, digitalis, B-blockers,
verapamil, etc.) and unexpected circulatory arrest (due
to anesthesia, surgery, angiography, and other
therapeutic or diagnostic procedures). It is safer,
more reliable, and more rapidly applied in an emergency
than endocardial or other temporary electrodes.
2. As a stand-by when arrest or symptomatic bradycardia
might be expected, the external pacer is used especially
in pacemaker procedures, in acute myocardial infarction,
drug toxicity, and in anesthesia or surgery, especially
when disturbances of rhythmicity or conduction are
present. Prophylactic placement of endocardial
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electrodes, which carries risks of displacement,
infection, hemorrhage, embolization, perforation,
phlebitis, and mechanical or electrical stimulation of
ventricular tachycardia and fibrillation can be avoided.
3. An increase in heart rate from external pacing often
suppresses ventricular ectopic activity and prevents
tachycardia.
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COMPLICATIONS
ventricular fibrillation will not respond to pacing and requires
immediate electrical defibrillation (if defibrillation is
successful and standstill ensues, the Noninvasive Temporary
Pacemaker should then be used). Ventricular or atria1
tachycardias may be interrupted with pacing but in the emergency
of circulatory collapse, other treatment (cardioversion) is
faster and more certain, but requires anesthesia. Following
prolonged cardiac arrest or in other disease states with
myocardial depression, electromechanical dissociation may occur
so that pacing may produce ECG responses without effective
mechanical contractions, and other treatment is required.
In the presence of generalized hypoxia, myocardial ischemia,
cardiac drug toxicity, electrolyte imbalance, and other cardiac
diseases, pacing may evoke repetitive responses, tachycardia, or
fibrillation. A cardiac defibrillator should always be readily
available and extra caution is needed to keep the stimulus
amplitude just above threshold.
Pacing by any method tends to inhibit intrinsic rhythmicity.
Abrupt cessation of pacing, particularly at rapid rates, can
cause ventricular standstill and should be avoided.
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The Noninvasive Temporary Pacemaker may cause discomfort of
varying intensity, which may occasionally be severe and preclude
its continued use in conscious patients. Similarly, unavoidable
skeletal muscle contraction may be troublesome in very sick
patients and may limit continuous use to a few hours. Erythema
of the skin under the electrodes often occur but is
inconsequential.
There are reports of transient inhibition of spontaneous
respiration in unconscious patients with previously available
units when the anterior electrode was placed too low on the
abdomen.
This pacemaker is not appropriate for connection to internal
pacemaker electrodes in contact with the myocardium. It should
be used only with ZOLL NTP TM electrodes supplied by ZMI
Corporation.
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1.
2.
3.
4.
5.
6.
7.
8.
apply BACK electrode as shown above.
Apply FRONT electrode as shown above.
Connect pacer output cable to
Set the MODE switch to
1:l or
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mA.
Set POWER switch to MONITOR ON.
Adjust the ECG SIZE for a convenient waveform display
and verify proper QRS detection. Note: Red QRS light
on front panel flashes when proper detection of QRS is
taking place.
OPERATING INSTRUCTIONS
Connect patient to 3 monitoring electrodes and input
cable of ZOLL
NTPTM.
Set the OUTPUT control to 0
NTPTM electrodes.
4:l as desired.

9. Set the ESCAPE RATE to a value somewhat higher
-lO-
(lo-20
PPM) than the patient's intrinsic rate. If no intrinsic
QRS exists, use 60 PPM.
10. Set the POWER switch to PACER ON.
11. Observe the pacing artifact on the ECG trace and verify
that it is well positioned in diastole.
12. Increase the OUTPUT until evidence of capture is visible
(refer to DETERMINING OPTIMUM THRESHOLD).

(0)
(+)
- It is important to recognize when
stimulation has produced a ventricular response.
Ventricular response is normally characterized by
suppression of the intrinsic QRS and production of an
ectopic QRST complex. The following tracings are
typical.
DETERMINING CAPTURE AND OPTIMUM THRESHOLD
1. DETERMINING CAPTURE
- INEFFECTIVE STIMULUS WITH NO - CAPTURE
- EFFECTIVE STIMULUS WITH CAPTURE
Note: Shape and size of the stimulated waveforms can vary
depending on lead chosen. Clinical experience has shown Lead
I produces the least distortion by the pacer stimulus,
however, variation from patient to patient can be expected.
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2.
3.
DETERMINING OPTIMUM THRESHOLD
55
mA. The electrode placement that offers the most
direct current pathway to the heart while avoiding large
chest muscles will usually produce the lowest
threshold. Low stimulation currents produce less
skeletal muscle contraction and are better tolerated.
Placement of the electrodes will affect the current
required to obtain ventricular capture. The front
electrode protective cap is designed in two parts. In
tests of optimum electrode location, the center cap can
be removed to expose only the gelled area of the
electrode. Once the best location has been selected,
the area should be cleansed of salt or other conductive
materials, and the electrode may then be secured with
the adhesive backing.
4:1 TEST MODE
- The
is more comfortable, and it can be easier to interpret
the stimulated response. The
(1:l) when released.
4:l test mode can be used optionally
to test for threshold. In this mode a stimulus is
delivered to the patient approximately every fourth
intrinsic beat. (The stimulus is demand synchronized to
the patient's intrinsic beat). On certain patients
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- The ideal output current
is the lowest value that will maintain capture. This is
usually about 10% above threshold. Typical threshold
currents have usually been between 40
- 60
4:l switch is
mA, averaging
spring-loaded. It will return to normal operating mode
4:l

TO LOAD THE CHART PAPER:
RECORDER
1. Turn the POWER switch to MONITOR ON. Open paper carrier
by pulling down the black handle at the top of the
recorder. Take care not to touch the stylus at the top
of the recorder assembly.
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It is FRAGILE and HOT.
2. Remove the empty paper core of the previous roll by
pulling the clear plastic tab.
3. Unroll about 5-6 inches of paper with the printed side
up and insert the roll, making sure that the roll
holders snap into the open ends of the paper core.
Close the recorder door.
4. Feed the edge of the paper between the drive rollers and
push either of the RECORD buttons to advance the paper
until the slack is taken up and the paper is aligned
properly.

0 POWER
0 RATE
instrument.
0 OUTPUT
(mA).
- The 3 position POWER switch activates the
OFF
operate.
PACER ON
the ECG trace.
- All power in the unit is off. (Batteries
will charge as long as unit is plugged in).
MONITOR ON
- Adjusts the pacer output from O-140 milliamps
Output current is displayed in red digits below
- The RATE control sets the rate at which the pacer
will run unless suppressed by intrinsic QRS activity.
RATE in pulses per minute (PPM) is displayed in red
digits below the ECG trace. To adjust, push in and
rotate the rate control knob. Due to the nature of the
demand circuitry, there will be a difference between the
rate selected for pacing and the actual pacing rate once
capture is obtained.
CONTROLS
- Switch is down. Monitor and recorder
- Switch is up. Activates pacer. The
OUTPUT and RATE digital displays are illuminated on
the front panel when pacer is on.
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0 MODE
0 ECG SIZE
cm/mV ) adjust the size of the display on the screen and
the recorder.
0 LEAD SELECTOR
0 QRS BEEPER VOLUME
beeper.
- Rotate to select Lead I, Lead II, or
Lead III. Note: Clinical experience has shown Lead I
produces the least distortion by the pacer stimulus,
however, variation from patient to patient can be
expected.
- The MODE switch controls the timing of the pacing
pulse. The switch is spring-loaded and must be held in
the
4:l (test) mode.
1:l (NORMAL)
4:l (TEST)
- The pacing stimuli are delivered to
the patient at an interval equal to approximately
every fourth beat synchronized with intrinsic
activity.
- The pacing stimuli are delivered to
the patient at the rate selected by the RATE
control.
- Three calibrated positions
- Adjusts the audio level of the QRS
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(
.5, 1, and 2

ALARM
and
0 FREEZE
0 RECORD
TEST
,& symbols on the display screen are lit. The
operator should maintain visual contact with the patient
whenever the alarms are disabled.
LOW ALARM LIMIT
0 HIGH ALARM LIMIT
- The ALARM pushbutton disables the heart rate
alarms. When the alarms are disabled, the
rate alarm limit.
rate alarm limit.
RECORD 2
1mV
- Push to freeze the lower ECG trace. Push a
second time to release the trace.
- The delayed ECG from either the upper or lower
trace can be recorded. Push and hold in to operate.
RECORD 1
per minute (PPM).
- records upper trace.
- records lower trace.
- Generates a rectangular test waveform
internally for testing the display and rate counting
circuitry. Test signal is
- The slide control sets the low heart
- The slide control sets the high heart
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ALARM
1mV amplitude and 120 pulses

0 POWER
0 CHG
w
wand
0 BATT
0 HEART RATE
0 OUTPUT
- Illuminated when the instrument is plugged into
1lOV power and batteries are being charged.
- The low battery indicator will light up when
batteries are near exhaustion. Battery operating time
will depend on parameters of stimulation such as rate
and output, as well as the amount of recorder operation.
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mA) is displayed in
red beneath the lower trace when the POWER switch is set
to PACER ON.
- The HEART RATE is digitally displayed
beneath the ECG trace. The display range is 20-300
beats per minute.
J& symbols will be illuminated. THE OPERATOR
SHOULD MAINTAIN VISUAL CONTACT WTIH THE PATIENT WHEN THE
ALARMS ARE DISABLED.
FRONT PANEL DISPLAYS
- (GREEN LED) indicates power on.
- When the heart rate alarms are disabled, the
- The pacer's output (O-140

0 RATE
0 QRS
0
- The QRS trigger indicator will flash when
triggered by either an intrinsic beat or a stimulated
QRS.
- The pacing rate (30-180PPM) is displayed in red
beneath the lower trace when the POWER switch is set to
PACER ON.
w- The ECG lead fault detector indicates a high
impedance or open circuit condition in any of the 3 ECG
electrodes or lead wires.
Pyf- Flashes during pacing if a poor contact or open
circuit exists between the
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NTPTM pacing electrodes.

0 ECG INPUT
0 PACER OUTPUT
- Accepts model NTP-3002 output cable. The
output stimulus of this device is intended for use with
Zoll
- Accepts model NTP-3001 three lead patient
cable. Connects to patient with standard disposable ECG
monitoring electrodes.
PATIENT CONNECTIONS
NTPTM external pacing electrodes only.
DO NOT CONNECT ANY OTHER DEVICE TO THE PACER OUTPUT.
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PACER OUTPUT
Pulse Type:
Synchronization:
Pulse Duration:
Pulse Amplitude:
Pacing Rate:
Output Protection:
Isolation:
ECG INPUT
Patient Connection:
Isolation:
Input Protection:
Overload Protection:
CONTROLS
Frequency Response:
Rate:
output:
ECG Size:
Calibration:
Test Mode:
QRS Beeper Volume:
Alarm Limits:
Power:
Recorder Activation:
Freeze Control:
SPECIFICATIONS
MODEL NTP-1000
Rectilinear, constant current
Full demand pacing
40 milliseconds
Variable O-140
mA
Variable, 30-180 PPM
Fully defibrillator protected
Meets AAMI, VA, CSA specifications
Via 3 lead ECG Cable (supplied with
instrument)
Meets AAMI, VA, CSA specifications
Fully defibrillator protected
Patented PACE-VIEWTM feature prevents
distortion of ECG by pacer stimulus
DC-40hz (-3db)
Variable, 30-180 PPM
variable, O-140 mA
3 Position, .5, 1, 2 cm/mV
Push button 1 mv signal checks display
circuits and rate meter
1:l (normal) and 4:l (test) modes
Adjustable
High and Low alarm slide controls, alarm
range O-240 BPM
3 position toggle switch, power off,
monitor only, monitor and pacer on
Push button, upper or lower trace can be
recorded
Push button, freezes lower trace
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GENERAL
Type: Specially designed anterior/posterior
pregelled, zoll NTPTM disposable
electrodes. Packaged in pairs.
RECORDER
ECG Waveform:
Display Screen:
Viewing Time:
Heart Rate:
Output Current:
Pacer Rate:
ECG Lead Fault:
Pacer Electrode
ELECTRODES
Type: Single channel hot stylus
Paper: 40 mm thermal
Speed: 25 mm/second
Delay: 4 or 8 seconds
Type:
Running Time:
Battery Status:
Recharge Time:
Size:
Weight:
Power Requirements:
Power Consumption:
Two trace cascade format, lower trace
can be frozen
5.5" non-fade, two color
4 seconds per trace
Digital display O-240 BPM
Digital display O-140
mA
Digital display 30-180 PPM
LED indicator, front panel
Fault: LED indicator, front panel
Nickel cadmium, rechargeable,
self-contained
Approximately 1 l/2 hours
LED indicator front panel
16 hours for fully discharged pack
6"H x 12"W x 15"D
18 lbs. fully equipped
loo-117 volts 60 HZ
45 watts
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