Non Invasive Blood Pressure - Living on the EDge

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The ABC’s of Spot Vital Signs Device
Age Ranges
Battery Info
Cleaning
Not intended for use on neonates (28 days of age and less OR less
than 44 gestational weeks). No mode changes required for use on
Pediatric or Adult patients. Use appropriate cuff size for NIBP.
Thermometry
Oral (OrL) Mode: all ages; use probe with BLUE ejection button.
Axillary (ALY) Mode: use on patients under the age of 4 years old. If an
axillary temperature is desired on patients older than 4 years, use the
thermometer in OrL mode.
Rectal (REC) Mode: all ages; use thermometer probe with RED ejection
button.
• Uses Welch Allyn 4200-84 lead acid battery.
• Prior to initial use, charge for 16 hours.
• When fully charged, device supports approximately 130 blood
pressure cycles at 7-minute intervals.
• Keep plugged in when not in use.
• Takes approximately 12 hours to full charge battery.
Device
Wipe the device with a cloth slightly dampened with appropriately diluted,
non-staining disinfectant solution. Use either 70% isopropyl alcohol, 10%
chlorine bleach solution, or mild detergent in warm water. Never immerse.
Prevent water or fluids from entering any connectors. Do not sterilize or
autoclave. Do not use ethyl alcohol to clean Spot Vital Signs device.
D
E
Defaults
End Use
Accessories
Do not immerse, soak, or autoclave. Clean removable probe well by
swabbing with a cloth dampened with 70% isopropyl alcohol or 10%
bleach solution. Probe well can be immersed. Ensure that probe well is
dry prior to re-insertion in device.
To change default configurations, follow these steps starting with the
device OFF.
1. Simultaneously press and hold the POWER and BP Start/Stop
buttons. The device will enter the internal configuration mode.
2. Press the MODE button to cycle through the Internal
Configuration menu until you see the menu option displayed on the
screen.
3. Use the Next Patient/Clear/Cancel button or the <strong>Blood</strong>
<strong>Pressure</strong> Start/Stop button to change the default setting.
4. Press the MODE button once to save the change and press the
POWER button to exit the Internal Configuration Mode.
To turn device off, press the POWER button.
After 2 minutes of inactivity, the device goes into Standby mode. “ZZZ”
will appear on the screen. Press the MODE button to activate device.
Spot Vital Signs Device FAQ
MC 7716 08/2010

Spot Vital Signs ® Train the Trainer Outline
A. Light weight and durable
1. Weighs approximately 4 lbs
2. Made of heavy plastic
3. Easy-carry rear handle makes portability simple
B. Sealed Lead Acid Battery
1. Initially upon receiving the device, charge the battery for 16 hrs or until the charging icon no
longer flashes
2. Fully charged battery supports approximately 150 blood pressure cycles
3. The Spot Vital Signs ® device should be charging when it is not in use
4. It takes approximately 12 hours to fully charge the battery
C. Spot Vital Signs Device Intended Use and Configuration Options
The Spot Vital Signs Device is intended to be used on patients 29 days and older, to obtain:
1. NIBP (systolic & diastolic display)
2. Pulse
3. MAP
4. SpO2 (optional)
5. Temperature (optional)
D. Front Panel Buttons and Functions
1. Power: turns monitor On or Off
2. Start/Stop <strong>Blood</strong> <strong>Pressure</strong>: initiates or cancels a blood pressure cycle
3. Next Patient/Clear:
a. While the display is active, clears the screen
b. While device is in Standby Mode, recalls the last patient information
4. mmHg: allows user to change initial NIBP inflation pressure preset
5. Mode:
a. While device is active turns On/Off the backlight
b. While device is in Standby Mode, recalls the last patient information
c. With temperature probe removed from probe holder, pressing Mode switches
temperature from Oral to Axillary
6. Print: (on older versions; no longer available for sale) initiates a printout
E. Initial Startup
1. To turn the device ON , press the power button
2. Standby Mode
a. When the device is powered up but has not been used for 2 minutes, it will go into
Standby Mode. “ZZZ” appears on the display with no backlight, which saves battery power
b. To bring the device out of Standby Mode press Mode
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3. Before taking a NIBP measurement, always perform the following:
a. Select appropriate cuff. The cuff is the appropriate size when the artery index
marker lies between the range markings on the NIBP cuff
b. Position the cuff on a bare arm, midway between the shoulder and the elbow, with the artery
index marker over the brachial artery. It should fit comfortably to allow one to two finger
spaces between the cuff and the arm. The cuffed upper arm should rest at heart level during
the measurement and the patient should remain quiet and have no movement to the arm
NOTE: If the cuff is not level with the heart, subtract 1.8 mmHg to the displayed reading for
each inch of elevation above the heart, or add 1.8 mmHg from the displayed
reading for each inch arm is below the heart.
F. To start a NIBP cycle
1. Press Start/Stop button . The cuff inflates to 160 mmHg as a factory default.
2. The blood pressure reading is displayed for 2 minutes, then disappears. Press Mode to recall
the last reading
3. To change the NIBP pressure preset factory default settings, follow these steps:
a. Press mmHg for half second
b. Keep pressing mmHg to scroll the target NIBP inflation pressure options
(160 mmHg, 140 mmHg, 120 mmHg, 200 mmHg, 180 mmHg)
c. Once target inflation pressure is displayed, press Start/Stop button
d. Target inflation pressure returns to Internal Configuration setting (Factory default is 160
mmHg) after blood pressure reading has been obtained or device is turned off
G. Pulse
1. Pulse rate readings are measured from SpO 2 . If SpO2 is not available pulse rate will be
measured from the NIBP reading
H. MAP
1. MAP can be turned on or off by entering the internal configuration mode
a. Turn the Spot device Off
b. Press both POWER and START/STOP simultaneously. The device will power on
in the internal configuration mode
c. Press Mode button to cycle through the menu to the MAP option screen
d. Press START/ STOP or NEXT PATIENT/ CLEAR button to turn MAP On or Off
e. When the desired functionality is displayed, turn the device off.
I. Sp0 2 ( if applicable)
1. Insert the patient’s index finger completely into the sensor. The thumb is not
recommended for use with the finger clip sensor. NOTE: If blood pressure
measurement is occurring simultaneously, ensure that the finger clip sensor is attached
to the limb opposite the limb with the B/P cuff
2. The pulse signal bar illuminates indicating the relative strength and quality of the patient’s
pulses at the sensor site
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1. The sensor takes approximately 10 seconds to determine initial SpO 2 value and updates the
reading every second. The Spot Vital Signs device will display the SpO 2 continuously for up to
10 minutes. After 10 minutes the device displays an error code.
J. Temperature (if applicable)
1. The Spot Vital Signs device can be used to take oral temperatures in approximately 4 seconds,
axillary temperatures in approximately15 seconds, and rectal temperatures in approximately 10
seconds
2. The Spot Vital Sign device can display temperature in degrees Fahrenheit (°F) or
Celsius (°C). To determine the current temperature scale, remove the temperature probe from
its holder and view °F or °C on the display
3. To change the display from °F to °C you must enter the configuration mode.
a. Turn the Spot Vital Signs device Off
b. Press the POWER and the START/STOP button simultaneously. The device will power on
in the internal configuration mode
c. Press Mode button to cycle through the menu to the Temperature option screen
d. The first option illuminated on the temperature display is °F; press NEXT
PATIENT/CLEAR button to illuminate
e. When the desired temperature scale is selected, turn the device Off
f. When the device is turned on again, the new temperature scale is the default
1. Taking an Oral Temperature
a. Ensure that the probe with the BLUE ejection button is connected to the device
b. Remove the probe from the probe well. A short self test is initiated and the screen
will display “OrL”
c. Once the “OrL” is displayed load a probe cover onto the probe by holding the probe collar
with the thumb and forefinger
d. Place the probe deep into the patient’s sublingual pocket
e. Hold the probe in place maintaining tissue contact until the temperature is complete.
Instruct the patient not to talk or move during the temperature reading process
f. When the final temperature is reached, a beep sounds and the temperature is
displayed. It will remain on the screen for 2 minutes
g. After the temperature measurement is complete, remove the probe from the patient’s
mouth and remove the probe cover by firmly pressing on the ejection button on the
probe. NOTE: Do not re-use probe covers.
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5. Taking an Axillary Temperature
NOTE: Normal mode axillary temperatures are FDA approved for children under the age of 4
years. If an axillary reading is desired for a patient 4 years and older, use the oral probe in
Monitor mode.
a. Ensure that the probe with the BLUE ejection button is connected to the unit.
b. Remove the probe from the probe well. A short self test is initiated and the screen
will display “OrL”
c. Press MODE to change display from “OrL’ to “ALY” for an axillary temperature
d. Load a probe cover onto the probe
e. Avoid folds in the axilla and place probe tip vertically as high as you can as shown. TIP:
Align the probe vertically with the spine
f. Place the arm at the patient’s side. Hold in this position without movement of the arm or
probe during the measurement cycle
g. When the final temperature is reached, a beep sounds and the temperature is displayed. It
will remain on the screen for 2 minutes
h. To take an axillary temperature in monitor mode, follow steps 5a through 5g plus:
i. Leave the probe in place and press the Mode button. An “M” appears on
the temperature display to indicate Monitor mode
ii. Maintain probe tissue contact for at least 5 minutes
iii. Record the monitor mode temperature before placing the probe back in
the probe holder. The Spot Vital Signs device does not save the
Monitor mode temperature
6. Taking a Rectal Temperature
a. Ensure that the rectal probe with the RED ejection button is connected to the Spot Vital
Signs device
b. Remove the probe from the probe well. A short self test is initiated and the screen will
display “Rec” indicating the rectal probe in use
c. Once “Rec” is displayed, load the probe cover onto the probe by holding the probe collar
with the thumb and forefinger. Apply lubricant if desired
d. Separate the buttocks and gently insert the probe into the rectum ONLY 1.5 cm
(5/8 of an inch for adults), and LESS for infants and children
e. Hold the probe in place for the entire temperature. This should take approximately
10 seconds for a reading
f. After the temperature process is finished, eject the probe cover and dispose of properly
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7. Monitor Mode Temperatures
a. May be taken in Oral, Axillary, or Rectal routes by the following the steps discussed in
Section J, 5h
b. To obtain accurate Monitor mode temperatures, you must maintain probe contact with tissue
at the various sites as listed:
i. Oral: 3 minutes
ii. Axillary: 5 minutes
iii. Rectal: 3 minutes
K. Error Codes
1. Refer to the Directions for Use for a list of possible Error Codes which provides a description
and probable cause of each.
L. Cleaning
1. Clean the Spot Vital Signs with a cloth slightly dampened with warm water and a mild detergent
solution. Never immerse the device in any type of fluid. Other solutions that can be used are:
a. a diluted non-staining disinfectant
b. 70% isopropyl alcohol
c. 10% chlorine bleach solution
d. mild detergent in water
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A
The ABC’s of Spot LXi Vital Signs Device
NIBP not for use on neonates (less than 28 days of age or 44 weeks gestational age).
Thermometry
Oral Mode: all ages; use probe with BLUE ejection button and probe well
Age Ranges
Adult Axillary Mode: patients age 18 years and older; use probe with BLUE
ejection button and probe well
Pediatric Axillary Mode: patients age 17 years and younger; use probe with
BLUE ejection button and probe well
Rectal Mode: all ages; use probe with RED ejection button and probe well
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D
Battery Info
Cleaning
Defaults
Tympanic thermometer (if applicable): appropriate for use on all ages
Uses a sealed lead-acid battery.
Battery must be connected upon initial receipt per instructions on battery door.
Charge for 6 hours (+1 hour with Braun 4000 device) prior to initial use OR charging icon on screen ceases to flash.
Charge for 4 additional hours if device has a printer.
Charge when not in use.
Duration of battery is model specific:
• 45MTO = 14.5 hours
• 45NTO = 13 hours
• 45MEO = 13.5 hours
• 45NEO = 12.5 hours
Device
Wipe the device with a cloth slightly dampened with appropriately diluted, non-staining disinfectant solution. Use either
70% isopropyl alcohol, 10% chlorine bleach solution, mild detergent in warm water, or PDI Sani-System cloths. Never
immerse. Prevent water or fluids from entering any connectors. Do not sterilize or autoclave the Spot LXi device.
Accessories
Do not immerse, soak or autoclave. Clean removable probe well by swabbing with a cloth dampened with 70%
isopropyl alcohol or 10% bleach solution. Probe well can be immersed. Ensure probe well is dry before re-inserting into
device.
To enter the Internal Configuration menu, follow these steps starting with the device powered OFF:
1. Press and hold the POWER and SELECT buttons simultaneously. The Internal Configuration
menu will display on the screen.
2. Use the NAVIGATION buttons to move through the menu options.
3. Use the SELECT button to access options or accept a change.
E
End Use
4. Press the POWER button to exit the Internal Configuration menu.
Press the POWER button to turn device off. After 2 minutes of inactivity, the device goes into STANDBY
mode. The screen will go blank; press any key to activate device. After 30 minutes of inactivity, the device powers itself
off.
Spot LXi FAQ
MC 7715 08/2010

Spot Vital Signs® LXi Outline Train the Trainer
A. Intended Use
1. Depending upon the configuration of your particular device, the Spot Vital Signs® LXi can measure:
a. Systolic and diastolic blood pressure (on patients greater than 29 days ONLY)
b. Pulse rate
c. Temperature (oral, adult axillary, pediatric axillary, rectal, or ear)
d. SpO2
e. MAP
f. The Spot LXi also allows the user to manually enter height, weight, respiration rate, and pain level.
The device will calculate the Body Mass Index (BMI) following height and weight entries.
B. Battery
1. The device contains a sealed Lead Acid battery.
2. Initially upon receiving the Spot LXi device, connect the battery inside the device per the label on the
battery door.
3. Prior to initial use, charge the battery for 6 hours or until the charging icon on the front panel of the
device no longer flashes. If your device includes a Braun Thermoscan PRO 4000 ear thermometer,
charge an additional hour. If there is an external printer attached, you must charge the Spot LXi an
additional 4 hours.
4. The Spot LXi should be charging when not in use.
C. Front Panel Buttons/Controls
Button Function Description
Power
Turns device On or Off
<strong>Blood</strong> <strong>Pressure</strong> Start/Stop
Initiates or cancels a blood pressure cycle
Memory Button
Recalls up to 50 most recent readings
Select Button
Navigation Buttons
Accepts the current option
Move throughout the options in the Navigation
Window or to increase/ decrease parameter
units
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D. Spot LXi Side and Rear Panels Related to Connections
1. Connect the blood pressure hose, thermometer probe and optional attachments of the appropriate
ports depending upon configuration of the device.
E. Turn Spot LXi device ON
1. Press the Power button .
2. The display lights up, a beep sounds, and the device performs an internal self-check.
3. Standby Mode:
a. When the device is powered on and left unused for 2 minutes it will go into Standby Mode. This
saves battery power and the display will turn blank.
b. Press any button to bring the device out of Standby Mode.
4. The device automatically powers off when not used for 30 minutes.
F. Display Window
1. Before using the Spot LXi the first time, you must program an initial configuration screen.
Once this is done, you will not see this screen again.
2. Press the Power button .
3. Press the Select button to access options and accept entries. Use the Navigation buttons to
move through the menu.
4. The word “Exit” appears at the bottom of the list when you have programmed all items. You must
program the settings before you can start to use the device.
5. Scroll to Exit and press the Select button to save the entries.
G. <strong>Blood</strong> <strong>Pressure</strong> (to be used on patients greater than 29 days of age ONLY)
1. Before taking a BP measurement, always perform the steps described below:
a. Select appropriate cuff. The cuff is the appropriate size when the artery index marker lies
somewhere between the range markings on the BP cuff.
b. Position the cuff. The cuff should always be positioned on a bare arm (or alternate site as
necessary), preferably 1-2 cm above the elbow, with the artery index marker over the brachial
artery. It should fit comfortably to allow no more than 1-2 fingers space between the cuff and the
arm. During the BP measurement cycle, the patient should have no movement to the extremity
and should remain quiet.
2. To initiate blood pressure measurements:
a. Press the <strong>Blood</strong> <strong>Pressure</strong> Start/Stop button . Spot LXi inflates the cuff to the appropriate
level, measuring the BP as the cuff is inflating. The display shows the inflation pressure as the BP
determination is in process. A reading will be obtained in about 15 seconds.
b. If a reading cannot be obtained during inflation, i.e., due to severe arrhythmias or patient movement,
the device will attempt to obtain a reading during deflation. A message will be displayed in the
Navigation Window if this occurs.
3. To cancel a reading while in progress, press the <strong>Blood</strong> <strong>Pressure</strong> Start/Stop button .
H. Pulse Rate
1. Pulse rate readings are measured from SpO 2 . If SpO 2 is not available, pulse rate will be measured from
the blood pressure. NOTE: If there is a HR displayed that was derived from SpO2, it will not be over-ridden by a HR
from a blood pressure reading. The device defaults to the SPO2 HR since it senses for a reading over a longer period of
time (approx. 8-10 seconds), versus a HR that is obtained in one moment during a blood pressure reading.
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2. To remove last HR readings and clear the display screen: press Save after each reading, turn Off the
device or, after 30 minutes of not touching any buttons the device will automatically shut down and
clear the display screen.
I. MAP
1. MAP display can be turned on or off by entering the Internal Configuration Mode (refer to Section Q).
Factory default will be set to off.
2. If MAP is turned on, after a blood pressure measurement, the word “MAP” will appear in the Systolic
window and the value will appear in the Diastolic window.
J. Temperature Measurements
SureTemp® Plus Thermometry (if applicable)
1. Can be used to take an oral temperature in approximately 4-6 seconds, an adult axillary temperature
(ages 18 years and older) in approximately 12-15 seconds, a pediatric axillary temperature (ages 17
years and younger) in approximately 10-13 seconds, or a rectal temperature in 10-13 seconds.
2. The temperature can be displayed in degrees Fahrenheit (°F) or Celsius (°C). To determine the
current temperature scale, remove the temperature probe from its holder and view °F or °C on the
device display. To change scales, refer to the Internal Configuration Mode section.
3. Taking an Oral Temperature:
a. Ensure that the probe with the BLUE ejection button and the BLUE probe well are connected to the
Spot LXi.
b. Hold the probe handle with your thumb and two fingers on the indentations of the probe handle,
then withdraw the probe from the probe well.
c. Verify the appropriate mode, Oral, is in the display window and the head icon is flashing. To
change modes, press the Navigation buttons until desired setting is displayed; then press the
Select button .
d. Insert the probe into a new probe cover and press down firmly until a new probe cover engages
onto the probe.
e. Instruct the patient not to talk or move during the temperature reading process.
f. Place the probe into the patient’s posterior sublingual pocket.
g. Have the nurse hold the probe in place maintaining tissue contact until the temperature is
complete.
h. When the final temperature is reached, three beeps sound and the reading is displayed in the
Temperature window in the pre-selected scale. Temporarily the reading will appear in both °F and
°C in the Navigation Window.
i. The following may interfere with accurate readings for up to 20 minutes:
• Ingesting hot or cold liquids
• Brushing teeth
• Eating
• Chewing gum or mints
• Smoking
• Performing strenuous activity
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4. Taking an Axillary Temperature:
a. Ensure that the probe with the BLUE ejection button and the BLUE probe well are connected to the
Spot LXi.
b. Hold the probe handle with your thumb and two fingers on the indentations of the probe handle,
then withdraw the probe from the probe well.
c. Ensure the appropriate mode, Adult Axillary (A.AXI) or Pediatric Axillary (P.AXI), appears in the
display window and the associated icon is flashing. Adult Axillary will display a flashing shirt;
Pediatric Axillary will display a small child crawling. To change the mode, press the Navigation
buttons until desired setting is displayed; then press the Select button .
d. Insert the probe into a new probe cover and press down firmly until a new probe cover engages
onto the probe.
e. Lift the patient’s arm to fully expose the axilla. Place the probe tip as high as possible in the axilla,
against bare skin, aligning the probe vertically with the spine. Lower the patient’s arm, ensuring
axillary tissue completely surrounds the probe tip. The patient should remain still, maintaining
good tissue contact throughout the process.
f. When the final temperature is reached, three beeps sound and the temperature is displayed in the
Temperature window in the pre-selected scale. Temporarily the reading will appear in both °F and
°C in the Navigation Window.
5. Taking a Rectal Temperature:
a. Ensure that the RECTAL PROBE with the RED ejection button and the RED probe well are
connected to the Spot LXi device.
b. Hold the probe handle with your thumb and two fingers on the indentations of the probe handle,
then withdraw the probe from the probe well.
c. Ensure the appropriate mode, REC, appears in the display window and the lower body icon is
flashing.
d. Insert the probe into a new probe cover and press down firmly until a new probe cover engages
onto the probe. The use of lubricant is optional.
e. Separate the buttocks with one hand. Using the other hand, gently insert the probe inside the
rectum ONLY 1.5 cm (5/8 of an inch for adults) and LESS for infants and children.
f. Tilt the probe so that the tip of the probe is in contact with tissue. Hold the probe in place
throughout the measurement process. When the final temperature is reached, three beeps sound
and the temperature is displayed in the Temperature window in the pre-selected scale. Temporarily
the reading will appear in both °F and °C in the Navigation Window.
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6. Taking a Monitor Mode Temperature:
a. Take the patient’s temperature in the appropriate site, Oral, Axillary, or Rectal as outlined above.
Leave the probe in place after the device beeps and the temperature is displayed. In
approximately 30 seconds, a snail icon will appear on the display, indicating the device is now in
Monitor Mode.
b. Continue to hold the probe in place for 3 minutes for oral or rectal temperatures, 5 minutes for
axillary temperatures. The thermometer will not beep to indicate a final temperature.
c. Once the time limit is achieved, record the temperature before removing the probe from the site.
Monitor Mode temperatures are not stored in memory.
d. Return the probe to the probe well to reset the thermometer to Normal Mode.
NOTE: The thermometer enters Monitor Mode automatically if the probe is removed from the well
and not used for 60 seconds or if the patient’s temperature is too low to allow the device to predict
a reading.
K. Braun ThermoScan ® PRO 4000 Ear Thermometry (if applicable)
1. Pull the thermometer gently toward you and remove it from the housing.
2. Locate the probe cover box inside the thermometer housing. Firmly push the probe tip into the probe
cover box. When the probe cover is in place, the thermometer turns on automatically.
3. Listen for the ready signal beep and three dashes to appear on the thermometer.
4. Fit the probe snugly into the ear canal. Correct probe placement is essential for accurate readings.
Aim the probe tip in the direction of the tympanic membrane.
5. Press the Start button. If the probe is positioned correctly in the ear canal the “Exac Temp” light
flashes. When the thermometer detects an accurate measurement, the “Exac Temp” light is
continuously on, a long beep signals the end of the measurement, and the display shows the result.
6. When finished, press the ejector button to eject the used probe cover.
7. Return the thermometer to its holder. Spot LXi displays the patient’s temperature and temperature
scale in the Temperature window on the device.
L. SpO 2 (if applicable)
1. Insert the patient’s finger completely into the sensor. The thumb is not recommended for use with the
finger clip sensor. Do not attach the SpO2 sensor to the same limb as the blood pressure cuff.
2. The pulse signal bar illuminates, indicating the relative strength and quality of the patient’s pulses at the
sensor site.
3. Within approximately 10 seconds an initial SpO 2 value will be displayed and is updated every second.
The Spot LXi displays the SpO 2 for up to 10 minutes. You must remove the sensor to save the
reading in Memory.
4. The following may interfere with accurate readings (for a comprehensive list, see the Spot LXi
Directions for Use manual):
• Bright light
• Fingernail polish
• Excessive patient movement
• Poor perfusion
• Sensor placement on extremities with blood pressure cuff, arterial catheter, or intravascular line
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M. Manual Entries
1. Weight, Height, Respiration Rate, and Pain Level can be manually entered in the Spot LXi.
a. Press the Navigation buttons until the arrow is pointing to the chosen parameter in the
Navigation Window.
b. Press the Select button . The default parameter value appears and flashes above the
Navigation buttons.
c. Press the Navigation buttons to increase or decrease the value.
d. Press the Select button to accept the value.
2. Body Mass Index (BMI) is calculated with weight and height entry.
a. Once weight and height are entered, use the Navigation buttons to scroll to Save/Next
Reading. Press the Select button to save the reading.
b. Press the Memory button to view the BMI calculation.
N. Memory Recall
1. Spot LXi retains up to 50 readings in memory. Press the Memory button to display the previous
reading.
2. Press the Navigation buttons to Scroll, Print, Erase, or Erase All readings.
3. Press the Select button to choose the desired option. Follow instructions on the display.
O. Error Codes
1. If the Spot LXi detects an error, an error code will display in the parameter that has the error and a
message will display in the Navigation Window.
P. Cleaning
1. Never immerse the Spot LXi in any type of fluid. Clean the device with a cloth slightly dampened with
one of the following:
a. 70% isopropyl alcohol
b. 10% chlorine bleach solution
c. Mild detergent in water
d. PDI Sani-System cloths
Q. Internal Configuration Mode
1. The Internal Configuration Mode allows the user to change operating parameters and adjust power-up
default settings. This mode also allows you to see non-changeable device configurations for technical
service purposes. To enter the Internal Configuration Mode:
a. Turn the Spot LXi off by pressing the Power button .
b. Press and hold the Power and the Select buttons for 5 seconds. The Internal
Configuration Menu appears on the display. The Configuration Menu options are: Version
Numbers, Battery, Location Identifier, Date/Time, <strong>Blood</strong> <strong>Pressure</strong>, Temperature, Manual
Parameters, External Devices, Save Readings, Buttons Lockout, Defaults, and Event Log.
c. Use the Navigation buttons to move through the menu options.
d. Press the Select button to access options or to accept a change.
e. Press Power button to exit the Internal Configuration Mode.
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R. External Devices (Optional)
The following external devices – Printer, Weight Scale, Barcode Scanner, and Wireless Radio – must be
enabled in the Internal Configuration Mode before using and then attached to the back of Spot LXi.
1. Printer
a. To print the most recent reading:
• Press the Memory button to recall the last reading.
• Use the Navigation buttons to scroll to “Print” and then press the Select button .
b. To print a previous reading:
• Press the Memory button and the most recent reading is displayed.
• Use the Navigation buttons to move to “Scroll.” Press the Select button .
• Use the Navigation buttons to scroll to the appropriate reading; then press the Select
button .
• Use the Navigation buttons to scroll to “Print.” Press the Select button .
2. Weight Scale
a. When the weight scale is enabled in the Internal Configuration Mode, you cannot manually enter a
patient’s weight.
b. Follow the weight scale’s instructions to zero out the weight scale.
c. Instruct the patient to step on the scale and remain still until the weight levels off. The weight will
be displayed on the Spot LXi.
3. Barcode Scanner
a. Supports linear or 2 D barcodes.
b. When enabled in the Internal Configuration Mode, allows the scanning of patients’ and/or clinicians’
barcodes for identification purposes.
4. Wireless Radio
a. Verify the Information System is enabled in the Internal Configuration Mode.
b. Obtain patient vital signs. “Send/Next Reading” appears in the Navigation Window. Verify patient’s
barcode appears on the display.
c. Use the Navigation buttons to go to “Send/Next Reading.” Press the Select .
d. Spot LXi displays “Sending reading to information system” and successful icon upon completion.
e. If reading was not sent, it is retained in memory and a failed send operation icon is displayed. Spot
LXi will attempt to re-send with the next reading.
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The ABC’s of Vital Signs Monitor 300 Series
A Age Ranges
Neonatal Pediatric Adult
Neonate: Term birth (37 weeks) through 28 days, or up to 44 weeks gestational age.
Pediatric: 29 days through 12 years of age.
B
C
D
Battery Info
Cleaning
Defaults
Adult: 13 years and older.
Uses a sealed lead-acid battery.
Provides 8 hours of continuous monitoring of Adult NIBP (3 minute intervals/165 readings)
with simultaneous temperature and continuous SpO2.
Charges to 90% of capacity in 12 hours.
Should be charging when not in use.
Patient data is erased if battery goes dead.
If not plugged in, monitor turns off 15 minutes after the battery discharge reaches “failure
level.”
Battery indicator is located on front panel when the unit is turned on. When battery is LOW,
a warning tone sounds and the low battery indicator flashes. (To avoid shutdown, plug in and
connect the AC power). When the low battery indicator appears, there is enough charge
remaining to perform at least ONE of the following functions over the next hour:
• 20 NIPB cycles
• 30 minutes of SpO2
• 20 temperatures
• a single printing of 99 stored data sets
Device
Wipe the monitor with a cloth slightly dampened with warm water, a mild detergent or
appropriately diluted, non-staining disinfectant. Never wet or immerse the device.
Accessories
Do not immerse, soak, or autoclave. Wipe the NIBP hose and reusable cuffs with a damp
cloth moistened in a mild detergent. Clean the SpO2 sensor with a cloth dampened with
70% alcohol or 10% bleach solution. Wipe the temperature probe with a cloth dampened
with alcohol, warm water, or an appropriately diluted, non-staining disinfectant solution.
Clean removable probe well by swabbing with a cloth dampened with 70% isopropyl alcohol
or 10% bleach solution. Probe well can be immersed.
To access the Internal Configuration menu, press and hold the MENU button for 3
seconds. Continue to press the MENU button until you reach the setting of interest. Use the
UP and DOWN buttons to change the values. Set the new value either by doing
nothing for 10 seconds or by pressing any button other than the UP and DOWN buttons.
If you press a function button such as the NIBP
button, the monitor returns to
E
End Monitoring
normal operation with that function activated. Powering OFF
the values.
Note: When Time/Date are changed, patient data is erased.
To shut off the device, press
or configurations.
the device will save all
. This will erase all stored patient data but not settings
VSM 300 FAQ
MC 7722 08/2010

Vital Signs Monitor 300 Series (VSM) Train the
Trainer Outline
A. Light Weight and Durable
1. Weighs approx 5 lbs
2. Made of heavy plastic
B. Battery
1. Sealed lead acid battery 6 V
2. Battery life provides approx 8 hours of continuous monitoring of B/P, Temperature and Sp02.
3. The battery charges to 90% of capacity in 12 hours.
4. The VSM should be charging, unless it is being used.
C. Low Battery Warning
1. Battery indicator is located on front panel when the unit is turned on.
2. When battery is LOW, a warning tone sounds and the low battery indicator flashes. (To avoid
shutdown, plug in and connect the AC power)
3. When the low battery indicator appears, there is enough charge remaining to perform at least
ONE of the following functions over the next hour:
a. 20 NIPB cycles
b. 30 minutes of SpO2
c. 20 temperatures
d. a single printing of 99 stored data sets
D. Transport Handle
E. Start Up
The VSM runs a self check upon power up (will see 888 in various parameter windows) and a short
tone sounds twice.
Buttons on the front of the VSM 300 face plate:
1. Turn the VSM on by pressing On/ Off
2. Review
3. Set NIBP interval
4. Auto
5. B/P start/ stop
6. Limits
7. Suspend
8. Up/ Down arrows
9. Menu
10. Printer
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F. Menu
1. Each time you press the Menu button, it will scroll through a series of menus
that you can select to change. These include:
a. Patient Type
b. Target Cuff Inflation <strong>Pressure</strong>
c. Temperature Mode
d. SpO2 / Pulse Tone Volume
2. Patient Type
ADULT (ages over 12 yrs)
PEDIATRIC (ages 1 month - 12 yrs)
NEONATE (ages < 29 days, 0-44 weeks gestational)
a. Press the Up/ Down ARROWS until you reach the selected mode.
NOTE: Patient Type icon is on Left above ON/ OFF button
Neonatal Pediatric Adult
b. To set the displayed new values, do nothing for 10 seconds.
3. Target Cuff Inflation <strong>Pressure</strong>
Allows you to change the initial cuff inflation pressure for each patient type. (This is
the nominal starting point - if it is too low to take a measurement, the monitor takes
another measurement using a higher initial pressure.)
a. Press UP/DOWN arrow to make changes to the target pressure.
b. To set the displayed new values, do nothing for 10 seconds.
4. Temperature Mode (if applicable)
If configured with the temperature option, the monitor can obtain predictive or monitored
temperature measurements.
Predictive measurement: a one-time temperature reading which takes only a few
seconds.
Monitored measurement: continuous temperature monitoring used when the situation
prevents an accurate predictive measurement.
a. F Fahrenheit Predictive temperatures: approximately 4-6 second Oral,
approximately 10-13 second pediatric Axillary, approximately 12-15 second adult
Axillary, and approximately 10-13 second Rectal
b. F M Fahrenheit Monitored temperatures: 3 minutes Oral, 5 minutes
Axillary, and 3 minute Rectal
c. C Celsius Predictive temperatures: approximately 4-6 second Oral, approximately
10-13 second pediatric Axillary, approximately 12-15 second adult Axillary, and
approximately 10-13 second Rectal
d. C M Celsius Monitored temperatures: 3 minutes Oral, 5 minutes Axillary,
and 3 minute Rectal
e. Press the UP/DOWN arrow to choose the temperature mode you want.
f. To set the displayed new values, do nothing for 10 seconds
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5. SpO2/Pulse Tone Volume
a. Press MENU repeatedly until VOLUME appears on the screen
b. Press UP/ DOWN KEYS to raise or lower the volume
c. The pulse tone can be set from level 00 (volume Off) to 05 (volume On full)
d. To set the displayed new values, do nothing for 10 seconds
NOTE: Changing the volume of the pulse tone has no effect on the volume of
alarm tones.
G. Configuration Menu
1. This menu allows you to make configuration changes for:
a. Time and Date:
Hour (0-23 or 1-12)
Minute
Year
Month
Day
b. MAP Measurement (the value will be displayed in the message window):
Enabled
Disabled
c. <strong>Blood</strong> <strong>Pressure</strong> Measurement units:
mmHg
kPa
d. Print Mode(if applicable):
Batch will print all data in memory up to 99 cycles
Stream prints results as soon as each cycle is finished.
2. To Change a Configuration Parameter:
a. PRESS and HOLD the MENU button for 3 or more seconds.
b. Then press MENU repeatedly until you reach the parameter you wish to change.
c. Now press the UP/ DOWN until you reach the value you wish to change the parameter to.
d. To set the displayed new values, do nothing for 10 seconds.
H. Limits
1. This feature allows you to make changes to the high and low alarm limits for the
following vital signs:
a. Systolic HIGH and Systolic LOW
b. Diastolic HIGH and Diastolic LOW
c. Pulse Rate HIGH and Pulse Rate LOW
d. SpO2 HIGH and SpO2 LOW
e. (if applicable) MAP HIGH and MAP LOW
2. To make changes to the limits:
a. Press Limits button
b. For the selected vital sign, do one of the following:
1. Leave the limit unchanged or
2. Press UP/ DOWN as needed to change the limit OR (--) to disable the alarm
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c. The alarm parameter you are changing, such as HR HIGH, will be displayed in the message
window.
d. Press LIMITS button to accept alarm limit and advance to next vital sign.
e. To return to normal operation, do nothing for 10 seconds.
3. Suspend Button
When an alarm sounds, pressing the suspend button will silence it for 90 seconds. NOTE:
you will see a flashing display of the alarming parameter.
I. NIBP
1. Before starting the NIBP measurement, always perform the steps described below:
a. Select appropriate cuff. The cuff is the appropriate size when the artery index
marker lies somewhere between the range markings on the NIBP cuff.
b. Position the cuff. The cuff should always be positioned on a bare arm, midway
between the shoulder and the elbow, with the artery index marker over the
brachial artery. It should fit comfortably to allow no more than 1-2 fingers space
between the cuff and the arm. During the NIBP measurement cycle, the patient should
have no movement to the extremity and should remain quiet.
NOTE: If the cuff is not level with the heart, subtract 1.8 mmHg to the displayed reading
for each inch of elevation above the heart, or add 1.8 mmHg from the displayed reading for
each inch below the heart.
2. Manual NIBP measurements
a. Attach the appropriate cuff to the patients arm
b. Press B/P
c. When the B/P cycle is completed, a tone sounds and the NIBP results are
displayed in the SYS, DIA, and Pulse rate windows
d. If MAP is enabled, the results are displayed in the message window
e. The results are displayed for 2 minutes or until another NIBP cycle is initiated.
NOTE: If the SpO2 sensor is attached and generating valid pulse data, then the
displayed Pulse Rate is derived from the SpO2 sensor reading.
3. Automatic NIBP—Interval measurements
a. Attach the appropriate cuff to the patients arm
b. Press to set the measurement interval which includes: ST (Stat),1,3,4,5, 10,15, 30,
45, 60, 90, 120, and 240 minutes. The two dashes ( -- ) in the message window
indicate that the automatic mode for NIBP is turned OFF.
c. Ten seconds after you select an interval, and assuming that safe venous return
pressure has been maintained for at least 30 seconds, the monitor starts the first
automatic NIBP cycle.
d. When the cycle ends, a tone sounds and the monitor displays the reading. The
measurement will remain on the screen until the next measurement cycle begins, 2
minutes pass, or the NIBP is pressed again.
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4. ST/ STAT Measurement
If the selected interval is STAT, the monitor takes repeated NIBP measurements for 5
minutes, starting a new cycle each time the cuff deflates below a safe venous return
pressure (SVRP) for 2 seconds.
5. MAP Measurement
Is a calculated figure, available for adults, pediatric, and neonatal patients. Factory
default setting is enabled MAP display for neonates, and disabled for adult and pediatric
patients. If MAP is enabled, the monitor displays MAP readings in the message window at the
end of a NIBP reading.
J. SpO2 Monitoring
1. Verify that the SpO2 sensor is connected to the monitor.
2. Attach the SpO2 sensor to the patient’s index finger. Do not attach the SpO2 sensor to the same
limb as B/P cuff.
3. Within a few seconds, the pulse amplitude indicator reflects the rate and strength of the pulse.
4. Within less than 20 seconds, the SpO2 window displays the SpO2 measurement and a numeric
pulse rate value appears in the window.
K. Temperature Monitoring
1. Prep Thermometer Probe
a. Hold the probe handle with your thumb and two fingers on the indentations of the probe
handle, then withdraw the probe from the probe well.
b. Wait for the 188.8 and the ORL to appear in the temperature screen.
c. Insert the probe into a new probe cover and press down firmly until a new probe cover
engages onto the probe.
2. Taking Oral Temperatures
It is IMPORTANT while taking an Oral predictive temperature to:
a. Instruct the patient not to talk or move during the temperature reading process.
b. Place the probe deep into the patient’s posterior sublingual pocket.
c. Have the nurse hold the probe in place maintaining tissue contact until the temperature is
complete.
d. The predictive temperature reading will be displayed for 1 minute in window.
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e. Interferences with oral measurements for up to 20 minutes include:
1. Ingesting hot or cold liquids
2. Talking
3. Eating food
4. Chewing gum or mints
5. Brushing teeth
6. Mouth care
7. Smoking
8. Performing strenuous exercises
3. Taking Axillary Temperatures
a. Hold the probe handle with your thumb and two fingers on the indentations of the
probe handle, then withdraw the probe from the probe well.
b. Wait for the 188.8 and the ORL to appear in the temperature screen.
c. Press the UP/ DOWN arrows to change the display to:
AP( axillary pediatric 17 years and younger) or
AA ( axillary adult 18 years and older)
d. Insert the probe into a new probe cover, and press down firmly until a new probe cover
engages onto the probe.
e. Lift the patients arm to fully expose the axilla. Place the probe tip as high as possible in the
axilla, aligning the probe vertically with the spine. Next, lower the patients arm down to make
maximum contact with the probe tip. The patient should always remain still, maintaining good
tissue contact throughout the process.
f. The predictive temperature reading will be displayed for 1 minute in message window.
4. Taking Rectal Temperatures
For rectal temperatures, use only the RECTAL PROBE with the RED ejection button and the RED
probe well.
a. Hold the probe handle with your thumb and two fingers on the indentations of the probe handle,
then withdraw the probe from the probe well.
b. Wait for the 188.8 and the rEC to appear in the temperature window.
c. Load the probe cover onto the probe.
d. Apply a thin coat of water-based lubricant to the tip of the probe cover (optional).
e. Insert the probe tip 5/8 of an inch for adults and approximately ½ inch for children, inside the
rectal sphincter
f. Tilt the probe slightly to ensure good tissue contact.
g. The predictive temperature reading will be displayed for 1 minute in message window.
** WARNING**: Use extreme care to avoid risk of bowel perforation.
**NEVER reuse probe covers; reusing covers will give inaccurate temperature readings.
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L. Monitored Mode Temperatures
*Remember: Press MENU to select the correct Temperature Mode, F M (Fahrenheit
Monitored), or C M (Celsius Monitored)
1. Continuous monitoring mode is not recommended for use over 5 minutes.
2. Measurements are not stored in memory.
3. 3-5 minute thermometer reading is equivalent to using a glass thermometer.
4. Useful for double-checking fast predictive readings; i.e. an infant exposed to cool ambient
temperatures, or hypothermic patient.
5. To use monitor mode:
a. Select the correct probe/probe well.
b. Load probe cover.
c. Determine the site for the Temperature reading: Oral, Axillary, or Rectal.
d. Take the patient’s reading in the appropriate site. Continue to hold the probe in position for
the required duration:
Oral 3 minutes
Axillary 5 minutes
Rectal 3 minutes
e. Record the temperature before removing the probe from the site. Monitor Mode temperatures
are not stored in memory.
f. Discard the probe cover. Upon returning the probe to the well, the thermometer will stay in the
present mode used. Change as needed.
NOTE: The thermometer enters Monitor Mode automatically, if the probe is removed from the well and
not used for 60 seconds, or if the patient’s temperature is too low to allow the device to predict a
reading.
M. Review Button
1. Press Review to display most recent set of vital signs.
2. Press UP/ DOWN or to cycle through stored data. The monitor stores 99 sets.
3. The message window displays READING with data-set sequence number and time of displayed
reading; the most recent is displayed first.
N. Nurse Call (if applicable)
When the cable is connected and operational, the monitor immediately notifies the Nurse Call system
when a patient alarm occurs.
O. Error Codes
1. The VSM 300 is equipped with the technology to detect an error when calculating a patient’s vital
sign. The codes will display on the parameter that has the error.
2. The error code references are located on the right side of the VSM 300 and also in the VSM 300
Directions for Use.
P. Erasing Data
1. All patient vital sign data is erased when the monitor is powered Off, or when you change the date
and time settings.
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a. To erase patient data during normal operation, press and hold Review for 3 seconds.
b. When the monitor prompts for confirmation, press the Up to confirm or the Down to
cancel.
2. You cannot change the date and time setting without also erasing all stored patient data.
a. When asked to erase patient data, press Up for yes; the monitor erases the data and
enables the date and time adjusted.
Q. Cleaning
1. Wipe the Monitor with a damp cloth with one of the following:
a. Mild detergent and water
b. Hospital disinfectant that is non-staining
2. Wipe the Temperature Probe with a damp cloth with one of the following:
a. Alcohol
b. Warm water
c. Hospital disinfectant that is non-staining
3. Wipe the SpO2 Sensor with a damp cloth with one of the following
a. 70% isopropyl Alcohol
b. 10% or less Bleach Solution
R. Replacing Printer Paper (if applicable)
1. Press Printer button to open the printer door.
2. Insert new roll of paper; use only WA thermal paper.
3. Thread end of roll over the roller and through slot in printer door.
4. Pull slightly on paper to take up any slack, then close printer door.
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A
B
C
The ABC’s of CVSM 6000
Age Ranges
Battery Info
Cleaning
To change patient modes, from the screen, touch in bottom left hand
corner. Touch Type on right side of screen. Choose between Adult, Pediatric, or Neonate. Touch
to save and go back to Home screen. Age ranges are as follows:
• Neonate: 28 days or less of age if born at term (37 weeks), otherwise, up to 44 weeks
gestational age
• Pediatric: 29 days of age through 12 years of age
• Adult: >13 years of age
Approximate hours of use: 7 – 8 hours
6 Cell 9 Cell
Composition Lithium ion Lithium ion
Charge time to 80% 2 hr 7 min 2 hr 25 min
Charge time to 100% 3 hr 4 hr
Patient exams per charge 1 26 47
Age to 70% capacity 2 300 300
Device/Stand
• Disconnect from AC power before cleaning
• Do not submerge or autoclave monitor or accessories
The following agents are compatible with the monitor:
• CaviWipes
• Sani-Cloth® Plus
• 70% isopropyl alcohol
• 10% chlorine bleach
Apply solution to cloth and wipe down monitor; never spray solution directly on monitor.
Allow monitor to dry 10 minutes before use.
Rinse off bleach with a cloth dampened with water.
Note: Disinfect according to your facility’s protocols and standards or local regulations.
D
E
Defaults
End Monitoring
Accessories
NIBP hose/reusable cuffs: wipe down with mild detergent solution.
SpO2 Sensor:: wipe with cloth dampened with 70% isopropyl alcohol or 10% chlorine bleach solution.
Temperature probe: wipe with cloth dampened with alcohol, warm water, or an appropriately diluted,
non-staining disinfectant solution.
To change the default power on settings:
1. Enter or adjust desired settings. (Note: The new settings appear as they are completed but are
temporary until they are saved).
2. Touch the Settings tab.
3. Touch the Device tab.
4. Enter or adjust desired settings you want to add or change. Touch SAVE AS DEFAULT.
5. Touch OK to confirm you want to overwrite your previous settings and replace them with your
current settings, or touch Cancel to retain the previous settings.
Power Down: From the Home screen, touch the battery icon.
Touch Power Down.
Power Save (Standby):
Press the Power button once briefly and choose Power Save OR leave monitor inactive.*
*The time limit can be set by users by touching Settings, Advanced, Display, and then Power
Saver. Choose the time limit that the monitor will wait before going into Standby mode.
Reset: Press and hold the power button
for 6 seconds. NOTE: you will lose all
patient data and configuration settings that are not saved as defaults.
1 A patient exam includes NIBP, Temperature, and SpO2 measurements at the rate of one patient every 10 minutes with a 2 minute display time out setting and a new battery.
2 After this many full charge and discharge cycles, the battery has aged to where its total capacity has been reduced to 70% of its rating.
CVSM 6000 FAQ
MC 7719 08/2010

Connex Vital Signs Monitor 6000 Series (CVSM) Outline
Train the Trainer
A. Intended Use
1. Depending upon the configuration of your particular device, the VSM 6000 Series can
measure:
a. Systolic and diastolic blood pressure on Adult, Pediatric, and Neonate
patients.
b. Pulse rate
c. Temperature (oral, adult axillary, pediatric axillary, or rectal)
d. SpO 2
e. Mean Arterial <strong>Pressure</strong>
f. The monitor allows you to enter patient data manually, scan in a patient's
name with a barcode scanner, or download a patient's name from an ADT.
You can enter specific patient information such as patient demographics,
modifiers, and manual parameters.
B. Power
1. The power button is located on the right side of the monitor, and it turns the monitor
on, sets the monitor to standby, and also indicates the charging status.
Power icon:
a. Press the power button to turn the device on.
b. If the device is on, pressing the power button again puts the device in Standby
mode.
c. Green LED in center of power plug symbol indicates AC power is present and
that the battery is fully charged or has been removed.
d. Amber LED indicates AC power is present and that the battery is charging.
2. Display power saving mode conserves battery power by turning off the backlight of the
monitor display after two minutes of inactivity. (Touch anywhere in the Home tab to
bring the monitor out of this mode.)
3. The Standby mode conserves battery power by shutting down the monitor if you do
not touch any button for ten minutes.
4. To properly power off the monitor, touch the Battery icon located on the upper right
hand section of the touch screen and then select/touch “Power Down”.
Note: The settings for Display power-saving mode and Standby mode can be configured.
C. Battery
1. The battery status is represented by three icons in the Device status area (at the top of
the screen).
a. The monitor is connected to an electrical receptacle and the battery is
charging or is fully charged.
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. The monitor is not connected to an electrical receptacle and is running on
battery power. The estimated battery capacity is displayed in the hour(s):
minute(s) format.
c. The monitor is connected to an electrical receptacle but the battery is not able
to maintain a charge.
d. If the battery is not being recharged and becomes low, an information
message displays in the Device status area. If this is dismissed, a low-battery
alarm condition will result, with an error message as power diminishes.
D. Home Screen/Profiles
1. The device utilizes touchscreen technology and all navigation can take place from the
home screen with the touch of a finger.
2. The home screen is divided into three sections:
a. Device Status Area (the top section of the screen) provides information
such as Clinician identification, Device location, Time and Date, Connection
status (Ethernet, USB, Wireless), Alarms and Messages, etc.
b. Content Area (the large middle section of the screen) displays vital-sign
measurements frames, patient information frame, manual parameters frame,
and shortcuts to several controls.
c. Navigation Area (the bottom section of the screen) provides tabs for other
settings. Touching these tabs opens another screen and provides setting
options.
3. Profiles: Profiles are variations of the Home tab. Each profile gives you access to a
different set of features. Depending on the model number purchased, the monitor may
offer multiple profiles, including Monitor, Spot Check, and Triage.
a. Monitor: Enables you to use alarms and timed intervals. It is designed for
continuous patient monitoring.
b. Spot Check: Profile is optimized for clinicians who take spot-check vital
readings and do not need continuous monitoring or alarm features. Therefore,
the Alarms tab and all features related to alarms and timed intervals are
unavailable.
c. Triage: Allows for vital-signs capture without alarms or access to the Patients
tab.
4. Selecting a Profile:
a. Touch Settings.
b. Touch Profiles.
c. Touch the desired profile.
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d. Touch Home (Profiles can’t be changed while acquiring data.)
E. Keypad
1. When navigating, some screens have an option to enter numeric information using the
Keypad, indicated by this symbol: To open the keypad, touch any field that
includes this icon.
2. To use the keypad:
a. With the keypad open, enter the new value by touching the number buttons.
The value must be within the range that displays below the data field.
b. Touch OK.
c. To close the keypad, touch OK to exit the keypad and insert the value, or
Cancel to exit the keypad without saving data.
F. Keyboard
1. When navigating, some screens have an option to enter numeric information using the
Keyboard, indicated by this symbol. To open the keyboard, touch any field that
includes this icon.
2. To use the keyboard:
a. With the keyboard open, touch letters or numbers.
b. Do one of the following:
i. Touch Next. This accepts the entry for the current field, then clears
the data field to allow data entry in the next field.
ii. Touch OK. The keyboard disappears and the entered characters
appear in the data field.
iii. Touch Cancel. This exits the keyboard without saving the entered
data.
G. NIBP
The monitor enables you to take manual and interval NIBP measurements.
1. Measurements can be taken from the NIBP frame.
a. Systolic, Diastolic, and MAP can be seen. (Touching the frame toggles the
primary and secondary view between SYS/DIA and MAP.)
b. The monitor supports single- and dual-lumen hoses.
2. Taking the NIBP measurement should include these steps:
a. Select the appropriate size cuff.
i. Measure the circumference of the patient's bare upper arm, midway
between the elbow and shoulder.
ii. Wrap the cuff around the patient's limb and verify that the artery index
marker lies somewhere between the two range markings on the cuff
iii. Choose the appropriate cuff size based on the circumference
measurement of the patient’s arm. Ensure that Artery Index Marker arrow
falls in between the cuff range markers that are depicted in “cm”. If the
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circumference of the patient's limb falls between two cuff sizes, use the
larger cuff size.
b. Attach the cuff.
i. Position the cuff on the patient's bare upper arm midway between the
shoulder and the elbow.
ii. Wrap the cuff snugly so that there is room for no more than two
fingers between the cuff and the patient's bare upper arm.
iii. Position the Artery Index Marker on the cuff directly over the brachial
artery.
iv. Ensure that the blood pressure tubing has no kinks or twists.
3. Manual BP
a. For manual BP, press the BP start button. When a measurement is
started, the monitor inflates the cuff to the appropriate level. In the NIBP
frame, the systolic display shows the cuff pressure while the blood pressure
measurement is in progress.
b. The monitor measures blood pressure as the cuff is inflating. If patient
movement, excessive noise, or an arrhythmia prevents the monitor from
determining the blood pressure while the cuff is inflating, the monitor attempts
to measure the blood pressure while the cuff is deflating.
c. When the measurement is complete, the monitor displays the final reading.
The monitor displays the measurement until you save it to the patient's record
or you take another blood pressure measurement.
4. Interval BP
a. The monitor can take NIBP measurements automatically based on intervals
you choose.
b. The Intervals tab provides all interval features. From this tab, you can do the
following: Configure intervals, Turn off intervals, or Configure the monitor to
print automatic measurements as they are completed.
c. The button changes to a timer , which counts down to the next
automatic measurement. Automatic measurements continue until you turn
off intervals.
d. Types of intervals:
i. Automatic Intervals: You can configure the monitor to take
automatic NIBP measurements at consistent intervals (e.g., every 60
min.).
ii. On the Home tab touch , select automatic, use the numeric
keypad to enter the length of time between NIBP measurements, and
touch start intervals.
iii. Program Intervals: You can configure the monitor to take automatic
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NIBP measurements at variable intervals.
(a) Customized programs can exist but they are programmed by
the end users’ discretion.The numbers below the program
name indicate the length of time between each interval in the
cycle.
(b) When you start a program, the following occurs:
(i.) The monitor starts the first measurement
(ii.)
immediately.
After the first measurement, the interval cycle begins.
The second measurement starts at the programselected
time (e.g., 15 minutes) after the first
measurement is complete. The third measurement
starts (e.g., 30 minutes) after the second
measurement is complete, and so on.
Note: You can use the programs as is, or you can edit them.
5. Stat Intervals: If you select the Stat option in the Intervals tab, the monitor takes
repeated NIBP measurements for five minutes, starting a new cycle each time the cuff
deflates below safe venous return pressure (SVRP) for two seconds.
6. Stop automatic measurements:
a. On the Home tab, touch the interval timer button. The Intervals tab displays.
b. Touch to select Stop Intervals.
7. Cancel a measurement that is in progress:
a. On the Home tab, touch .
b. The monitor rapidly deflates the cuff. The screen displays NIBP cancellation
message and if intervals are turned on, the
button changes to a timer
(for example, ), which counts down to the next automatic
measurement.
8. Configure NIBP alarms steps:
a. Verify that you are using the Monitor profile, which contains the Alarms tab.
b. Touch Alarms. The Alarms tab displays.
c. Touch the NIBP tab.
d. Enter the desired upper and lower alarm limits for Systolic, Diastolic, and MAP
readings using the up/down arrows or the keypad.
e. Touch Home. The new alarm settings display in the alarm control button.
H. Temperature
The device utilizes SureTemp ® Plus thermometry (range 80°-110° Fahrenheit or 26.6°- 43.4°
Celsius).
1. Device is configurable to Celsius and Fahrenheit in all profiles.
2. Remove your temperature probe from the probe well and then within the thermometry
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frame touch Temperature site control to toggle between modes. (Rectal will only be
an option when red top probe is utilized)
Rectal Oral Pediatric Axillary Adult Axillary
3. Predictive Mode
a. One-time measurement that takes only a few seconds.
i. Oral—approx. 4 to 6 seconds.
ii. Adult axillary (age 18 years and older)—approx. 12 to 15 seconds.
iii. Pediatric axillary (age 17 years and younger)—approx. 10 to 13
seconds.
iv. Rectal—approx. 10 to 13 seconds.
b. It results in a single temperature reading which is displayed at the end of the
brief measurement.
c. The monitor sounds a tone to indicate the end of a predictive measurement.
d. Steps to use Predictive Mode:
i. Remove the temperature probe from the probe well.
ii. Insert the probe into a new probe cover and press the probe handle
down firmly.
iii. Touch Temperature Site Control to choose from these readings:
oral, pediatric axillary, or adult axillary temperature.
iv. Hold the thermometer probe tip in place at the measurement site.
(a) For oral temperatures, place the thermometer probe tip under
the patient’s tongue on either side of the mouth to reach the
sublingual pocket and ask the patient to close his/her lips.
(b) For axillary temperatures, lift the patient’s arm so that the
entire axilla is easily seen and place the temperature probe
tip as high as possible in the mid-axilla. Align the probe
vertically with the spine. Next, lower the patient’s arm down to
make maximum contact with the probe tip
e. The monitor beeps when the final temperature is reached. The Home tab
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displays the patient temperature. The temperature continues to display in
degrees Fahrenheit and degrees Celsius even after the probe is returned to
the probe well.
f. Remove the probe after the temperature measurement is complete and firmly
press the ejection button on the top of the probe to release the probe cover.
g. Return the probe to the probe well.
4. Direct Mode
a. The monitor changes to Direct mode:
i. 60 seconds after the thermometer probe is removed from the probe
well and exposed to air.
ii. After you complete a Predictive mode measurement, then touch
to switch from Predictive to Direct mode. The temperature
frame (in the lower-left corner) changes to ”MODE: Direct..." as it
switches to the Direct mode.
iii. If you have a patient whose body temperature is below the normal
temperature range and you follow predictive mode steps, the probe
sensor identifies this condition and turns off the probe preheater in
order to accommodate the lower body temperature measurement.
b. The monitor does not retain Direct mode temperatures in memory for recall. A
manual recording of the reading is required.
c. The patient’s temperature will reach final equilibrium in approximately three
minutes in the oral and rectal sites and five minutes in the axillary site.
d. After 10 minutes of Direct mode use, a technical alarm condition is generated
and the reading is cleared.
e. Steps to use Direct mode:
i. Remove the temperature probe from the probe well.
ii. Insert the probe into a new probe cover and press the probe handle
down firmly.
iii. Touch Temperature Site Control to choose from these options: oral,
pediatric axillary, or adult axillary temperature.
iv. Hold the thermometer probe tip in place at the measurement site for a
total of three minutes for oral and rectal mode or five minutes for
axillary mode.
v. While the measurement is taking place, the Home tab displays the
patient's continuous temperature readings in degrees Fahrenheit and
degrees Celsius.
vi. Document the temperature on the patient record before removing the
probe tip from the measurement site.
vii. Remove the probe after the temperature measurement is complete
and firmly press the ejection button on the top of the probe to release
the probe cover.
viii. Return the probe to the probe well to reset the SureTemp Plus
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module to predictive mode.
5. Taking the temperature in Rectal mode: You must use the temperature probe with
the red ejection button and red probe well. The SureTemp Plus module only operates
in rectal mode if the red rectal probe is installed.
a. Remove the rectal probe from the rectal probe well.
b. Insert the rectal probe into a new probe cover and press the probe handle
down firmly.
c. The Temperature Site Control defaults to rectal mode.
d. Separate the patient’s buttocks with one hand. Use the other hand to gently
insert the probe tip only 5/8 in. (1.5 cm) inside the rectum. The use of a
lubricant is optional.
e. Tilt the probe so that the tip is in contact with tissue. Continue to separate the
buttocks and hold the probe in place throughout the measurement process.
f. The monitor beeps when the final temperature is reached. The Home tab
displays the patient temperature. The temperature continues to display in
degrees Fahrenheit and degrees Celsius even after the probe is returned to
the probe well.
g. Remove the probe after the temperature measurement is complete and firmly
press the ejection button on the top of the probe to release the probe cover.
h. Return the probe to the probe well.
WARNING: Use extreme caution when taking rectal temperatures on children.
Insert the probe tip only 3/8 in. (~1 cm) to avoid risk of bowel perforation.
NOTE: Do not reuse probe covers. Discard after each use.
6. Configure temperature alarms manually:
a. Touch the Settings tab.
b. Touch to select Monitor.
c. Touch the Alarms tab.
d. Touch Temp.
e. To turn alarm on or off, use the up and down arrow keys or the numeric
keypad to adjust upper and lower temperature alarm limits.
f. Touch Home to save your settings, return to the Home tab, and take a
temperature measurement.
I. SpO 2 and Pulse Rate (if applicable)
SpO 2 (Nellcor or Masimo) and pulse rate monitoring continuously measure saturation level of
oxygen in hemoglobin as well as the pulse in a patient through a pulse oximeter.
1. Steps to Measuring SPO 2 /Pulse Rate:
a. Verify the SpO 2 sensor cable is connected to the monitor.
b. Clean the application site. Remove anything, such as nail polish, that could
interfere with sensor operation.
c. Attach the SpO 2 sensor to the patient. Place the SpO 2 sensor and the NIBP
cuff on different limbs.
d. Confirm the monitor displays SpO 2 and pulse rate data within 15 seconds of
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eing connected to a patient.
2. Configure SpO 2 alarms: Pulse oximetry alarms can be manually set.
a. Touch the Settings tab.
b. Touch to select Monitor.
c. Touch the Alarms tab.
d. Touch SpO 2 .
e. To turn alarm on or off, use the up and down arrow keys or the numeric
keypad to adjust upper and lower SpO 2 alarm limits.
f. Touch Home to save your settings, return to the Home tab, and take an SpO 2
measurement.
WARNING: Inspect the SpO 2 cable. Replace it if it shows any signs of wear,
breakage or fraying. Failure to do so could harm the patient, harm the monitor, or
produce inaccurate readings.
NOTE:
• During an SpO 2 measurement, the displayed pulse rate is derived from the
SpO 2 sensor. If SpO 2 is not available, the pulse rate is derived from NIBP.
• If SpO 2 is being measured continuously on a patient for an extended period,
change the sensor location at least every three hours or as indicated by the
sensor manufacturer's directions for use.
3. SatSeconds alarm management: The SatSeconds feature is an SpO 2 alarm
management system available only with Nellcor-equipped monitors.
a. The SatSeconds feature has a built-in safety protocol that sounds an alarm
whenever three SpO 2 violations of any amount or duration occur within a oneminute
period.
b. The SatSeconds feature delays alarms for a set amount of time when it is
enabled. If a condition or alarm resolves on its own within the preset time, the
alarm will automatically reset.
c. The feature can be set to 0, 10, 25, 50, or 100 SatSeconds. The SatSeconds
feature is the product of the time and magnitude that a patient exceeds SpO 2
alarm limits. For example, three points below the alarm limit for 10 seconds
equals 30 SatSeconds. An alarm is triggered only when a desaturation event
reaches the SatSeconds limit.
d. When the feature is not enabled, the SatSeconds graphic will not appear and
SpO 2 alarm conditions will not be delayed.
e. To set SatSeconds limits:
i. Touch the Alarms limit control of the SpO 2 frame.
ii. Touch the Alarms tab.
iii. Touch to select a SatSeconds setting. Values are 10, 25, 50, or 100.
iv. Touch Home to save your settings and return to the Home tab.
4. Perfusion index: Perfusion index is an SpO 2 feature available only with Masimoequipped
monitors.
a. Perfusion Index (PI) is a relative reading of pulse strength at the monitoring
site and is a numerical value that indicates the strength of the IR (infrared)
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signal returning from the monitoring site.
b. PI display ranges from .02% (very weak pulse strength) to 20% (very strong
pulse strength).
c. During sensor placement, the PI can be used to evaluate the appropriateness
of an application site by looking for the site with the highest PI number.
J. Manual Parameters
You can manually enter parameters including height, weight, pain level, temperature, or
respiration rate.
1. From the Home tab, ensure that the current patient information is correct.
2. Touch anywhere within the manual parameters frame. The manual parameters of the
Patients tab displays.
3. Use the up and down arrow keys or the numeric keypad to manually adjust height,
weight, pain level, temperature, or respiration levels.
4. Touch OK.
K. Alarms
The monitor presents physiological alarms and technical alarms. Physiological alarms occur
when vital sign measurements fall outside of set alarm limits, but they occur only in the Monitor
profile. Technical alarms occur in all profiles
1. The following occurs on the LED light bar on the device handle with alarms.
a. Flashing red for high-priority alarms
b. Flashing amber for medium-priority alarms
c. Constant amber for low-priority alarms
2. Alarm Types
3. Home Tab Notifications:
a. Device Status area: The area changes color and displays a message with an
accompanying status icon or button. If the alarm tone is in a pause interval, a
timer countdown appears. If multiple alarms and information messages are
active, the Device Status area shows the highest-priority alarm. If the alarms
are equal in priority, the most recent alarm message appears. You can cycle
through the messages for each active alarm.
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. Parameter frame: The background color changes. Touch this area to pause or
turn off an alarm audio tone and nurse call notification.
c. Alarm Limit control: The icon in this control indicates the status of the alarms
limit settings. Red and amber icons indicate measurements that have
exceeded alarm limits. Touch this control to navigate to a parameter-specific
tab where you can modify the alarm limit setting
4. Icons in parameter frames:
a. The icons in the parameter frames indicate alarm notification settings. When
alarm limits are on, the icons will be black and white until an alarm occurs.
Then, the icons will change color to indicate the priority of the alarm.
b. Icons that can be seen in parameter frames and their meanings:
Alarm off and no visual or audio alarms or nurse call notification will
occur for this parameter.
Alarm and audio and visual notifications are enabled.
Alarm audio off and only visual notifications will occur.
Alarm audio paused and the audio tone is paused for 60 seconds or
longer. The icon remains until the paused time counts down to 0.
c. Icons in the device status area and their meanings:
Alarm active. One or more alarms are active. Touch this icon to
pause or turn off the audio tone.
Alarm audio off and the audio signals are disabled, but alarm limits
and visual alarm signals remain active.
Multiple alarms. Touch this icon to cycle through the messages for
each active alarm.
Alarm audio paused. The audio tone is paused for 60 seconds or
longer. The icon remains until the paused time counts down to 0.
Touch this icon to reset the pause interval, which is determined by
settings in the Advanced tab.
5. Reset (pause or turn off) audio alarms:
a. After you reset an audio alarm, some tones do not return, but others return
after the pause interval if the condition that caused the alarm persists. Settings
in the Advanced tab determine the length of the pause interval.
b. If a new alarm condition occurs during a pause interval, a new audio tone
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occurs.
c. If an audio alarm is not paused or turned off after a period of time, a buzzer
accompanies the tone.
6. Pause or turn off an audio alarm:
a. In the Device Status area, touch .
b. Visual indications remain in the parameter frame until the condition is
corrected or until the next measurement is taken.
c. In the Device Status area, if the icon changes to and the message
remains, the timer counts down and the audio tone returns after a pause
interval. You can touch again to restart the timer.
d. If you responded to an NIBP alarm and multiple NIBP limits have been
exceeded, the first audio tone and message go away, but another NIBP limit
message shows with a countdown timer. A new NIBP audio tone sounds after
the countdown unless you touch to dismiss each remaining NIBP limit
message.
e. If audio tones continue, multiple alarms are active. A multiple alarm toggle will
appear in the Device Status area. Respond to multiple alarms as follows:
i. Touch in the Device Status area.
ii. Read the alarm message for the second alarm.
iii. Touch .
iv. Continue to touch multiple alarm toggle buttons and to reset tones
until you have read all of the messages.
7. Adjust vital sign alarm limits: You can adjust vital sign alarm limits or turn off alarm
limit checking for individual parameters.
a. On the Home tab, touch the alarm limits control in the selected parameter
frame. For example, to adjust the NIBP alarm limits, touch
.
b. Adjust vital sign alarm limits: Enter the desired upper and lower alarm limits
using the up/down arrow keys or the keypad.
c. To turn alarm limits off or on for the vital sign: Touch or . This
button toggles to display the current alarm state.
d. If you turn off alarm limit checking for a vital sign, no visual or audio alarm
signals will occur for those limits. If alarm limit checking is off, the icon
changes to on the
on the Home tab in the parameter frame.
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Nurse call: If nurse call is operational, nurse call notification occurs for certain
alarms, depending on the alarm priority. Nurse call notification settings are
specified in the Advanced settings. Nurse call notification is paused when alarm
tones are paused, and it is turned off when alarm tones are turned off.
L. Patient Data Management
1. Managed through the Home tab
a. Can enter patient data manually.
b. Scan in a patient's name with the barcode scanner.
c. Can enter specific patient information such as patient demographics,
modifiers, and manual parameters.
d. Patient can be selected from a list
2. Creating a patient:
a. Touch the Patients tab.
b. Touch Add.
c. Enter the patient data using the keyboard controls.
d. Touch OK to return to the Home tab. Any information entered is automatically
saved.
3. Load patient data with the barcode scanner:
a. You can use a barcode scanner to query existing patient records and perform
an ADT patient name match.
i. Ensure that you are on the Home tab.
ii. Scan the patient's barcode with the barcode scanner.
iii. The Patient ID appears in the Patient frame.
Note: If Welch Allyn Connex ® VM software is installed on your network,
the monitor can automatically return a patient name associated with a
scanned ID number.
4. Save patient data: Patient data can be saved to the monitor.
a. After taking a patient reading, touch Save.
b. A message will indicate that a save is in progress.
Note: Depending on the profile and settings, readings may be saved
automatically.
5. Select a patient:
a. Touch the Patients tab.
b. From the patient list, touch the patient's identifier.
c. Touch Select.
Note: In the Spot Check and Triage profiles, previous patient data and readings
will be overwritten by a new save. In the Monitor profile, selecting a new patient
will clear the current patient data.
6. Manage patient records: Patient records can be sent to the network, printed, or
deleted.
a. Touch the Review tab.
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. Select patients by touching the check box next to their name.
c. Touch Send to transmit the records to the network.
d. Print to print the records.
e. Delete to permanently remove the records as desired.
Note: The icon indicates the records have been sent to the network.
Note: Depending on the profile and settings, readings may be automatically sent
to the network.
7. Delete a patient from the list:
a. From the patient list, touch the patient's name you wish to delete.
b. Touch Delete. (At the Delete Confirmation window, touch Yes to permanently
delete the name. Touch No to cancel the deletion.)
Note: Deleting a name from the patient list does not delete saved records. Touch
Review to see or delete records.
M. Accessories
1. Barcode Scanner: The monitor enables the scanning of patients’ and/or clinicians’
barcodes to enter identification information. The barcode scanner supports linear and
two-dimensional barcodes.
a. Ensure that the barcode scanner is connected and properly configured.
b. Remove the barcode scanner from its holder.
c. Hold the scanner approximately 6 inches (15.4 cm) from the barcode and
squeeze the trigger so that the light from the scanner appears on the barcode.
d. The patient or clinician identification displays in the targeted area (Patient
frame, data field, Device Status area).
i. Scanning a patient's barcode while on the Home tab will place the
scanned ID into the Patient frame.
ii. Scanning a patient's barcode while the Patients List tab is open
requires the following additional steps:
(a) Touch Add to add a new patient.
(b) Touch the keyboard in the Patient ID field.
(c) Scan the patient's barcode.
(d) Confirm the patient information by touching OK.
iii. Scanning a clinician ID while the Clinician ID pane is open will place
the scanned ID into the Clinician ID section of the Device Status area.
Touch Select to return to the Home tab and to begin taking patient
measurements.
iv. Use the Advanced settings Data Management tab to change the
appearance of the Clinician ID if you do not want your ID to appear in
the Device Status area. (This requires the Advanced settings access
code.) However, this information is still retained in the monitor
memory for recall, printing, or to send measurements electronically to
the network.
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N. Printer Options
1. Print options include manual and automatic print commands.
a. Manual option
i. Touch Review from the Home tab.
ii. Touch next to the names of the patients whose data you want to
print. Once selected, a check mark - will be added to the box.
iii. Touch Print.
iv. Confirm the number of records you wish to print and touch Yes.
v. The data is sent to the printer.
b. Automatic option (for interval printing)
i. Touch the Settings tab.
ii. Touch the Intervals tab.
iii. Touch the box next to Automatic print on interval.
O. Cleaning
1. Clean on a routine basis according to your facility's protocols and standards.
2. The following agents are compatible with the monitor:
a. Cavi-Wipes
b. Sani-Cloth ® Plus
i. Using Cavi-Wipes or Sani-Cloth Plus, wipe the surface of the monitor
to remove all gross debris.
ii. Allow the monitor surface to dry for a minimum of 10 minutes before
using the monitor.
c. 70% isopropyl alcohol
i. Wipe the monitor with a clean cloth slightly dampened with 70%
isopropyl alcohol.
d. 10% chlorine bleach solution
i. Wipe the monitor with a clean cloth slightly dampened with a 10%
bleach and water solution. Follow the cleaning agent manufacturer's
guidelines.
ii. Rinse with a clean cloth slightly dampened with water that meets EP
and USP quality standards.
iii. Allow the monitor surface to dry for a minimum of 10 minutes before
using the monitor.
P. General Settings/Parameters
1. General settings such as Language, Date/Time, General Alarms, Screen Display,
Device Location, and Demo mode can be changed by selecting General tab and then
choosing the appropriate tab option for each.
2. Parameter settings allows for specific changes in the parameters for each vital sign
being monitored. To change these, select the Parameters tab and then select the
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specific vital sign tab which is to be changed.
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TIPS FOR TAKING AN
ACCURATE BLOOD PRESSURE
F R O M W E L C H A L L Y N
(Use Range Indicator) (Roll Sleeve) (Align with Brachial Artery) (Just Two Fingers) (Do Not Move) (Shhhh) (Support Back—Legs Crossed) (Arm at Heart Level)
Use the proper
size cuff
Place the cuff on
a bare arm
Place the artery
marker over the
brachial artery
Apply the cuff
snugly, allowing
room for no more
than two fingers
Once the cuff is
placed, allow the
patient to sit
quietly for a
few minutes
Do not talk to the
patient while
taking the BP
Support the
patient’s back
and feet during
measurement;
keep legs
uncrossed
Keep the upper
arm at heart level
and passively
support the lower
arm when
measuring the
blood pressure
Keep the arm
still during the
measurement
cycle
(i.e., hand resting on lap)
IF THE ACCURACY OF A BP MEASUREMENT IS IN QUESTION, VERIFY THE ACCURACY OF A DEVICE READING USING THE AUSCULTATORY METHOD
© 2005 Welch Allyn MC 3021

<strong>Blood</strong> <strong>Pressure</strong> Accuracy &
Variability Quick Reference
Accurate <strong>Blood</strong> <strong>Pressure</strong> Tips
• Use the proper size cuff; if two cuff sizes fit, use the
larger one.
• Place the cuff on a bare arm.
• Place the artery marker over the brachial artery.
• Apply the cuff snugly, allowing room for no more than
two fingers underneath.
• Have the patient sit quietly for a few minutes.
• Do not talk to the patient while taking a blood
pressure.
• Support the patient’s back and feet; keep legs
uncrossed.
• Keep the upper arm at heart level with the lower arm
passively supported, i.e. resting on lap.
• Keep the arm still during the measurement cycle.
<strong>Blood</strong> <strong>Pressure</strong> Variability
The following activities affect a blood pressure reading.
Activity
Cuff too small 2,4,6,7,8,10,12,14,16,18,19
Cuff over clothing 10,16,18
Back/feet unsupported 3,18
Legs crossed 1,5,9,16,17,18
Not resting 3 to 5 minutes 2,10,16,18,19,20
Patient talking 2,10,11,16,17,18
Labored breathing 16,18
Full bladder 13,16,18
Pain 16
Arm below heart level 2,10,13,16,17,18
Arm above heart level 10,13,16,17,18
Systolic (mmHg)
10 to 40 ⇑
10 to 40 ⇑ or ⇓
5 to 15 ⇑
5 to 8 ⇑
10 to 20 ⇑
10 to 15 ⇑
5 to 8 ⇑
10 to 15 ⇑
10 to 30 ⇑
1.8 /inch ⇑
4.6 /cm ⇑
1.8 /inch ⇓
4.6 /cm ⇓
For references, refer to the footnotes listed on this card.

References
1. Adiyaman Ahmet, Tosun Nevin, Elving LammyD, Deinum Jaap, Lenders JacquesWM,
Thien Theo. The effect of crossing legs on blood pressure. <strong>Blood</strong> Press Monit June
2007; 12:3: 189-193.
2. Campbell NormanRC, McKay DonaldW. Accurate blood pressure measurement: Why
does it matter? CMAJ 1999; 161(3): 277-278.
3. Cushman WilliamC, Cooper KarenM, Horne RichardA, Meydrech EdwardF. Effect of
back support and stethoscope head on seated blood pressure determinations. Am J
Hypertens 1990; 3: 240-241.
4. Fonseca-Reyes Salvador, Garcia de Alba-Garcia Javier, Parra-Carrillo JoseZ, Paczka-
Zapata Jose Antonio. Effect of standard cuff on blood pressure readings in patients
with obese arms. How frequent are arms of a ‘large circumference’? <strong>Blood</strong> Press
Monit 2003 8:3: 101-106.
5. Foster-Fitzpatrick Lucille, Ortiz Anna, Sibilano Helena, Marcantonio Richard,
Braun LynneT. The effects of crossed leg on blood pressure measurement. Nursing
Research Mar/Apr 1999; 48:2: 105-108.
6. Geddes LA, Whistler SJ. The error in indirect blood pressure measurement with the
incorrect size cuff. Amer Heart J July 1978; 96:1: 4-8.
7. Gomez-Marin O, Prineas RJ, Rastam L. Cuff bladder width and blood pressure
measurement in children adolescents. J of Hypertens Oct 1992; 10:10: 1235-1241.
8. Iyriboz Y, Hearon CM, Edwards K. Agreement between large and small cuffs in
sphygmomanometry: A quantitative assessment. J of Clin Monitoring Mar 1994; 10:2:
127-133.
9. Keele-Smith Rebecca, Price-Daniel CeCilia. Effects of crossing legs on blood pressure
measurement (Research Data). Virginia Henderson Internat Nurs Lib Aug 2007.
10. Lockwood Craig, Conroy-Hiller Tiffany, Page Tamara. Vital signs. JBI Reports 2004;
2: 207-230.
11. Lynch JamesJ, Long JackM, Thomas SueAnn, Malinow KennethL, Katcher
AaronHonori. The effects of talking on the blood pressure of hypertensive and
normotensive individuals. Psychosomatic Medicine Feb 1981; 43:1: 25-33.
12. Manning DennisM, Kuchirka Carolee, Kaminski Jill. Miscuffing: inappropriate blood
pressure cuff application. Diag Methods Hypertens 1983; 68:4: 763-766.
13. Marx GertieF, Orkin LouisR. Overdistention of the urinary bladder during and after
anaesthesia. Can Anaes Soc J Sep 1966; 13:5: 500-504.
14. Netea RT, Lenders JWM, Smits P, Thien T. Arm position is important for blood
pressure measurement. J Hum Hypertens Feb 1999; 13:2: 105-109.
15. Nicholas WC, Watson RL, Barnes TY, Goodinow C, Russel E. Does blood pressure
cuff size make a difference in blood pressure readings? J Mississippi Med Assoc Feb
1985; 26:2.
16. O’Brien Eoin, Asmar Roland, Beilin Lawrie, Imai Yutaka, Mallion Jean-Michel,
Mancia Giuseppe, Mengden Thomas, Myers Martin, Padfield Paul, Palatini Paolo,
Parati Gianfranco, Pickering Thomas, Redon Josep, Staessen Jan, Stergiou George,
Verdecchia Paolo. European Society of Hypertension recommendations for
conventional, ambulatory and home blood pressure measurement. J Hypertens 2003;
21: 821-848.
17. Peters GrantL, Binder SaraK, Campbell NormRC. The effect of crossing legs on blood
pressure: a randomized single-blind cross-over study. <strong>Blood</strong> <strong>Pressure</strong> Monitoring
1999; 4:2: 97-101.
18. Pickering ThomasG, Hall JohnE, Appel LawrenceJ, Falkner BonitaE, Graves John,
Hill MarthaN, Jones DanielW, Kurtz Theodore, Sheps SheldonG, Roccella EdwardJ.
Recommendations for blood pressure measurement in humans and experimental
animals: Part 1:<strong>Blood</strong> pressure measurement in humans: A statement for professionals
from the Subcommittee of Professional and Public Education of the American Heart
Association Council on High <strong>Blood</strong> <strong>Pressure</strong> Research . Hypertens 2005; 45: 142-161.
19. Rastam I, Prineas RJ, Gomez-Marin O. Ration of cuff width/arm circumference as a
determinant of arterial blood pressure measurements in adults.
20. Roubsanthisuk Weranuj, Wongsurin Unticha, Saravich Surachai, Buranakitjaroen
Peera. <strong>Blood</strong> pressure determination by traditionally trained personnel is less
reliable and tends to underestimate the severity of moderate to severe hypertension.
<strong>Blood</strong> Press Monit 2007; 12: 61-68.
1-800-289-2501 ©2010, Welch Allyn, Inc. All rights reserved. 08/2010 MC4978

HOW TO USE
Welch Allyn Flexiport <strong>Blood</strong> <strong>Pressure</strong> Cuffs
1 Position 2 Check 3 Attach 4 Rotate 5 Detach
Position the Artery Index Marker
over the Patient’s Brachial Artery
and wrap the cuff around the
patient's arm.
Ensure the Artery Index Marker
falls within the range markings
on the cuff.
Snap the FlexiPort fitting, from
the device directly into the cuff.
Rotate the device tubing to a
comfortable position for both
patient and practitioner.
Squeeze the FlexiPort fitting and
pull away to detach from the cuff.
© 2008 Welch Allyn MC5102

(Irish Journal of Medical Sciences 1994; 4:112-3)
The Microbial Flora of In-Use <strong>Blood</strong> <strong>Pressure</strong> Cuffs
Authors: M.G.M. Cormican, D.L. Lowe, P. Flynn, D. O’Toole
Objective
This study was conducted to determine the extent of microbial
contamination on blood pressure cuffs used in the operating and
recovery rooms of a teaching hospital. The authors suggest that the
blood pressure cuff is as yet an unrecognized source of bacterial
contamination, which may play a part in the hospital’s nosocomial
infection rate.
Settings & Patients
As part of this study, new blood pressure cuffs were placed in six
operating rooms, and one recovery room. A defined area of the cuff in
contact with the patient was sampled before issue and at the end of the
operating day for a period of five days. Swabs were plated, incubated
and evaluated after 48 hours.
Results
Results indicated that 68 different microorganisms were isolated from
the forty-two samples. Seventy-one percent (n=61) were Staphylococci.
One of the Staphylococcus aureus was found to be resistant to
methicillin, gentamycin and erythromycin. The remaining 25 organisms
were thought to be skin and environmental representatives, although
they may pose a risk to certain groups of patients.
Summary
It was concluded that the majority of microorganism isolates in this
study posed little risk to healthy patients undergoing surgery. The
one case where the gentamycin-methicillin resistant pathogen was
identified caused concern, since no patient known to have that pathogen
had been in the operating room during the corresponding day of data
collection. Therefore, the bacteria would have had to survive for some
time on the cuff, implying that the cuff acts as a vehicle of infection. The
authors noted that enforcing policies that prohibit the transfer of cuffs
outside a room where isolation precautions are in effect is very difficult.
In addition, general-use blood pressure cuffs are handled by many
health care workers and patients. Because there are often no visible
signs of contamination, no disinfecting procedures are employed on the
cuff. The potential for cross contamination magnifies, as often patients,
who are sources of antibiotic-resistant pathogens, are unknown to the
hospital staff. <strong>Blood</strong> pressure cuffs attached to resuscitation equipment
were identified as another source of contamination.
Conclusions
This study emphasizes the need for increased awareness of the
potential for cross contamination of patients and health care workers
from seemingly innocuous items of general-use hospital equipment,
specifically blood pressure cuffs.
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(Infection Control Today 5/2006)
The Case of the <strong>Blood</strong>y Cuff
By: Kelly M. Pyrek Editor in Chief kpyrek@vpico.com
While last month’s cover story focused on keeping patients safe,
we can’t ignore the everyday risks to healthcare workers (HCWs).
You’ll find recounts of a number of hair-raising medical errors and
near-misses reported to the Agency for Healthcare Research and
Quality (AHRQ) on its Morbidity & Mortality Rounds on the Web
(www.webmm.ahrq.gov). In what seems to be a page taken from
a bad medical thriller, one case study illustrates the ghastly things
that can happen when complacency creeps in. A patient who had
been in a car crash presented to an ER with massive injuries and
profuse bleeding. A fabric-and-nylon blood pressure (BP) cuff used
on this patient was saturated with so much blood, it could be wrung
out. The patient later died from his injuries. A second patient, also
in a collision and who had cuts all over her body, was placed in the
same trauma bay vacated by the first patient. The same bloody cuff
was used on her, with no regard for standard precautions. A nurse
noted that the cuff was used from patient to patient, an observation
that was received by other staff members with a shoulder shrug.
Several weeks later, the medical examiner revealed that the first
patient was HIV and hepatitis B virus positive and that the collision
was a suicide.
In an analysis of this case, Atul K. Madan, MD, of the department
of surgery at the University of Tennessee, says, “The early days of
the AIDS epidemic saw first responders trying to literally guess
which patients might be harboring a potentially lethal blood borne
agent. In addition to the obvious problems of profiling and stigma,
these ‘eyeball tests’ proved highly inaccurate, sometimes with
serious consequences. Ultimately, the healthcare system embraced
a strategy of universal precautions—in essence, assuming that
any patient might be harboring a blood-borne infectious agent and
acting accordingly. Unfortunately, as with many sensible infection
control practices, universal precautions are sometimes neglected.”
Madan says the prevalence of HIV infection in ER patient populations
ranges from 0.15 percent to 7.8 percent. He adds that the presence
of HIV is smaller than that of most other blood-borne pathogens,
with the risk of hepatitis and other bacteria much greater. He
points to several studies of ER and trauma patients that found
almost 25 percent of patients exhibited seropositivity for at least one
transmissible, infectious agent.
Madan says that while rates of nosocomial transmission from
equipment to patients remain unknown, cases of such transmission
have been documented. He says hospitals should establish—and
enforce—policies and processes for the proper cleaning or disposal
of contaminated equipment in the ER, and adds that at least one
study has shown implementation of policies like these can improve
compliance with universal precautions.
“This case raises the specific issue of whether disposable BP cuffs
(or disposable covers) should be added to universal precautions, at
least in settings such as trauma care. One study from the OR revealed
blood contamination of approximately 30 percent of surfaces tested.
Cuffs are already known to be reservoirs of bacterial pathogens
such as Clostridium difficile.
“Contamination with blood and bloodborne viruses is likely a
significant—albeit under-recognized-patient-safety problem. Until
the cost-effectiveness of disposable BP cuffs has been established,
we can at least recommend explicit attention to the cleaning and
disinfection of cuffs between patients, even in hectic settings such
as trauma resuscitations.”
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Significant Bacterial Colonization on the Surface of <strong>Non</strong>-Disposable
Sphygmomanometer Cuffs and Re-Used Disposable Cuffs
Authors: Andrew L. Stemicht, M.D. and Alan Van Poznek, M.D.
Affiliation: Department of Anesthesiology, New York Hospital —Comet Medical Center, New York, NY 10021
Introduction
This study investigated the possibility that significant bacterial
contamination of re-usable, non-disposable blood pressure cuffs
might occur in the operating room, P.A.C.U., and I.C.U. settings.
Such contamination might be of clinical significance were the
BP cuff to be located in the region of the operative site during
a surgical procedure, or near a wound in the post-operative
period. Colonization might be of greater significance in the
case of immunosuppressed, obstetric and orthopedic patients
undergoing total joint replacement because of the increased
need for sterility. Previous studies had pointed out that blood
pressure cuffs could indeed be a vector for the transmission of
bacterial infections in ward and I.C.U. settings 1,3 . A comparison
of the relative colonization of re-used cuffs of both permanent
and disposable types used with manometers and non-invasive
automatic blood pressure monitors was made with clean,
disposable cuffs.
Methods
<strong>Blood</strong> pressure cuffs for study were obtained from the operating
rooms and I.C.U. settings at three institutions: a university
hospital, an orthopedic hospital and a cancer-center hospital.
Cuffs were cultured within their utilization site and were all
‘clean’ and ready for patient use. Cultures were taken at different
times of the day, so as to avoid a possible bias of cuffs being
cleaned at the end of the day. Cuff cultures were coded so those
microbiologic technicians were unaware of their source. Actual
cultures were obtained using Rodak trypticase soy agar plates,
which were directly applied to the surface of the cuffs on inner
and outer surfaces, since both are potentially contaminable and
thereby potentially communicable.
Results
In a data collection group of 80 separate patient-related cultures,
the colonization rate was 98.7% (p

Discussions
The study showed that “significant” bacterial colonization
of blood pressure cuffs utilized in the O.R., I.C.U. and P.A.C.U.
settings does occur. Cuff types surveyed included automatic and
manometric types of the permanent and disposable types. Cuff
materials were either nylon or plastic. Previous studies have
shown that blood pressure cuffs can actually be a clinically
important vector in the transmission of infection on an in-patient
floor 1 , and in a neonatal I.C.U. 3
Attitudes of staff employing the cuffs, including anesthesiologists
and nursing professionals were also informally surveyed and
revealed that almost none routinely cleaned cuffs between
patients and few regarded the cuff as a possible source for
infection.
It is thus recommended that efforts be made to reduce bacterial
contamination of blood pressure cuffs. Cuffs should be located on
the contralateral limb to the operative site when at all possible.
Spraying cuffs with a topical disinfectant such as entornexidine
can reduce their bacterial load by 75% 2,4 . Repeated use of
a disposable cuff on different patients produces significant
colonization on the cuffs and defeats their major advantage. Only
clean, non-used disposable cuffs had insignificant colonization
rates in this study. Ideally, it is recommended that where
applicable, a cleansed cuff or an unused disposable cuff be
dedicated to a patient upon arrival at the hospital, and that it
follow the patient to the O.R., to the P.A.C.U. and to the floor. This
can also be adopted in I.C.U. settings. Such a procedure has been
associated with a threshold reduction in nosocomial infection
rate in I.C.U. setting 3 . Further studies are underway to quantify
colonization rates on patient's skin directly, pre- and postoperatively
following application of a re-usable blood pressure
cuff in the O.R. It is hoped that these results and safeguards
might further reduce the risks and improve the care of patients in
the operating room, P.A.C.U. and I.C.U. settings.
References
1. Med. Journ. Australia 56:758-763, 1969.
2. Dorson and Dorsch: Understanding Anesthesia Equipment:
438: Williams & Wilkin, 1984.
3. Pediatrics 61 (1):42-45, 19783.
4. Brit. Journ. Anesth., 36:471-473, 1964.
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Prevention of Cross Transmission of Microorganisms Is Essential to
Preventing Outbreaks of Hospital-Acquired Infections
David Schwegman, MD., Assistant Professor of Medicine, Emory University
Introduction
Hospital-acquired infection outbreaks may be prevented by providing
single-patient-use disposable blood pressure cuffs that
will remain with that patient from admission until discharge from
the hospital before being discarded. Single-patient-use disposables
may prevent hospital-acquired infections that result from
use of devices by multiple patients.
Background
Hospital-acquired infections (HAIs) are becoming increasingly
common worldwide and occur during more than two
million hospitalizations in the United States each year 1 . Due
to an increase in invasive procedures and a growing resistance
to antibiotics, HAIs have increased by 36% in the last
20 years and are consuming more health care dollars each year.
The burdens these infections place on our health care system
can be divided into three categories: the cost of quality, the cost
of human lives and the financial impact. The human cost is over
99,000 deaths per year in the United States, which represents
a 5% death rate for HAIs. 2 Quality costs include increased ICU
stays by 8 days, and increased average hospital stay between 7.4
and 9.4 days. 3,4,5 Total dollar costs added to the health care system
are between $4.5 and $5.7 billion annually, with the average
cost per infection of $13,973 and an increased cost to patients
(who survived) of approximately $40,000. 6 Specifically, methicillin-resistant
Staphylococcus aureus (MRSA) has become endemic,
even epidemic in many U.S. hospitals and added 2.7 million
extra days in the hospital with an average cost of $35,367. 6
Where do the funds come from to pay for HAIs? Do they come
from third-party payers, Medicare/Medicaid, hospitals, or patients?
Haley et al analyzed 9423 nosocomial infections and
found that only 5-18% of nosocomial infections would have
caused the admission to be reclassified to a higher diagnosis
related group (DRG). 7 Of those hospitalizations able to be reclassified
to a higher DRG, the extra payment only funded 5% of the
total cost to treat the infection. 7 That leaves 95% of the financial
burden of HAIs to hospitals and patients.
Problem
Common HAIs include pneumonia, catheter-associated urinary
tract infections, intravascular device-related infections, and
surgical site infections from various bacteria, viruses and fungi.
The sources of infection, modes of transmission, and rates of
transmission vary based on setting, immune status of patients,
and adherence of staff to infection control procedures. Because
of the multifactorial nature of HAIs, tendency to affect immunosuppressed
patients, and often multi-drug resistant organisms,
the primary method to avoid morbidity/mortality and costs associated
with these infections is through prevention. Harbath
et al found that at least 20% and as much as 70% of HAIs are
preventable, depending on the setting and type of infection. 8 To
prevent HAIs it is necessary to identify sources and modes of
transmission of the infection and to implement prevention guidelines
and practices. The modes of transmission of HAIs include
direct-contact transmission (direct contact between two people)
and indirect-contact transmission (transfer of an infectious agent
through a contaminated intermediate object).
HAIs are the result of a high prevalence of pathogens with susceptible
hosts and efficient transmission mechanisms from patient
to patient. Unfortunately, these pathogens tend to become
incorporated into the normal flora of hospital workers and are
Total Health Care Cost
from Hospital-Acquired Infections
• Over 99,000 deaths per year in the United States
• Increased ICU stay 8 days
• Increased average hospital stay between
7.4 and 9.4 days
• Total dollar cost between $4.5 and $5.7 billion
• Average cost per infection of $13,973
• Increased total cost per patient who survived
approximately $40,000
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eadily transmitted through direct-contact transmission. Although
less common, medical devices such as sphygmomanometers,
thermometers, and stethoscopes have been implicated in the
spread of HAIs through indirect-contact transmission. In a study
by Base-Smith, sphygmomanometer cuffs from various inpatient
settings were found to have bacterial colonization rates of 81-
100%. 9 Also, 45.7% of the “clean” cuffs were contaminated with
organic and/or inorganic substances. The patient contact sides of
cuffs were contaminated twice as often as the nonpatient sides.
Stemicht et al found similar colonization rates of re-used disposable
blood pressure cuffs. 10 Myers et al identified a single blood
pressure cuff as the common source of a nosocomial infection
outbreak in a neonatal intensive care unit. 11
Similarly, Livornese et al found an electronic thermometer as the
vehicle which caused an outbreak of vancomycin-resistant Enterococcus
faecium in a med-surg intensive care unit and ward of
a university hospital. 12 Marinella et al found that 100% of stethoscopes
were contaminated with coagulase negative staphylococcus
and 38% were contaminated with Staphylococcus aureus. 13
In general, physicians tended to have a higher bacterial load on
their stethoscopes than nurses.
Solution
Numerous organizations worldwide including the World Health
Organization (WHO) and the Infection Control Practices Advisory
Committee at the Centers for Disease Control and Prevention
(CDC) have developed recommendations on protecting patients
and health care workers from HAIs. The foundation of HAI prevention
is proper hand-hygiene technique, and the CDC 2002
guidelines explicitly cover indications for handwashing and
hand antisepsis, hand-hygiene technique, surgical hand antisepsis,
and selection of hand-hygiene agents. 14 If health care
workers achieved 100% compliance with proper hand-hygiene
techniques it would significantly reduce the spread of HAIs. Unfortunately,
studies have found hand-hygiene compliance rates
to be consistently less than 50%. 15,16 Perceived barriers to hand
hygiene include skin irritation, inaccessible supplies, interference
with worker-patient relation, patient needs perceived as
priority, wearing gloves, forgetfulness, ignorance of guidelines,
insufficient time, high workload and understaffing, and lack of
scientific information demonstrating impact of improved hand
hygiene on hospital infection rates. Eliminating perceived barriers
to hand hygiene is an important first step in improving handhygiene
compliance rates and reducing HAIs. The CDC has also
published clear guidelines for isolation precautions, prevention
of hospital-acquired pneumonias, intravascular device-related
infections, surgical site infections, and catheter-related urinary
tract infections, and these guidelines must also be closely followed
to achieve maximum patient safety.
CDC recommendations regarding indirect transmission through
patient care devices and environmental reservoirs are less specific
than the recommendations listed and require some interpretation.
The recommendations include: 17
1. Establish policies and procedures for containing, transporting,
and handling patient-care equipment and instruments/devices
that may be contaminated with blood or body fluids.
2. Remove organic material from critical and semi-critical instruments/devices,
using recommended cleaning agents before
high-level disinfection and sterilization to enable effective
disinfection and sterilization processes.
3. Wear personal protective equipment (PPE), such as, gloves
and gowns, according to the level of anticipated contamination
when handling patient-care equipment and instruments/
devices that are visibly soiled or may have been in contact
with blood or body fluids.
Because it has been shown that patient care devices such as
blood pressure cuffs and thermometers are frequently colonized
with bacteria and have been implicated in various outbreaks
of HAIs, it is necessary to reduce the possibility of cross contamination
with these devices. A simple solution would be to
provide each patient with a new disposable blood pressure cuff
that remains with the patient during his/her hospital stay and is
disposed of when the patient is discharged from the hospital.
By providing a single-patient-use disposable blood pressure cuff,
the possibility of an outbreak from cross contamination would be
greatly reduced. This solution does not eliminate the possibility
of a HAI from the cuff, because the cuff will become colonized
with the patient’s flora and be a potential source of a future HAI.
It is necessary to maintain hospital recommendations for disinfection
and sterilization procedures for these devices. However,
this solution does eliminate the possibility of cross contamination
from a blood pressure cuff from multiple patient contact and
will possibly prevent HAI outbreaks from a colonized blood pressure
cuff.
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Conclusion
Hospital-acquired infections represent an increasing financial
burden and declining quality of health care in the United States.
Approximately 95% of the estimated $5 billion total health care
cost from hospital-acquired infections falls on the shoulders of
the hospitals and patients. The need for strict prevention guidelines
is essential. One possible strategy for the prevention of
hospital-acquired infection outbreaks can be achieved by providing
each patient with a disposable blood pressure cuff that will
remain with them during their hospital stay and be disposed of
when the patient is discharged. Likewise, providing medical devices
(thermometers) in each patient room that are appropriately
sanitized between patients can prevent outbreaks of HAIs. Strict
adherence to CDC guidelines regarding handwashing, handhygiene,
and use of standard precautions also remains critical to
preventing future HAIs.
References
1. Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The
nationwide nosocomial infection rate: a new need for vital
statistics. Am J Epidemiol 1985; 121:159-67.
2. Klevens RM, Edwards JR, Richards CL, Horan TC. Estimating
Health Care-Associated Infections and Deaths in U.S.
Hospitals, 2002. Public Health Reports 2007; 122:160-166.
3. Brachman PS, Dan BB, Haley RW, Hooten TM, Garner JS,
Allen JR. Nosocomial surgical infections: incidence and cost.
Surg Clin North Am 1980; 60:15-25.
4. Zhan C, Miller MR. Excess length of stay, charges,
and mortality attributable to medical injuries during
hospitalization. JAMA 2003 Oct; 290(14):1868-1874.
5. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream
infection in critically ill patients. Excess length of stay,
extra costs, and attributable mortality. JAMA 1994 May 25;
271(20):1598-601.
6. Stone PW, Larson E, Kawar LN. A systematic audit of
economic evidence linking nosocomial infections and
infection control interventions: 1990-2000. Am J Infect
Control 2002; 30:145-52.
7. Haley RW, White JW, Culver DH, Hughes JM. The financial
incentive for hospitals to prevent nosocomial infections under
the prospective payment system. An empirical determination
from a nationally representative sample.
8. Harbath S, Sax H, Gastmeier P. The preventable proportion
of nosocomial infections: an overview of published reports. J
Hosp Infect 2003; 54:258-266.
9. Base-Smith V. <strong>Non</strong>disposable sphygmomanometer cuffs
harbor frequent bacterial colonization and significant
contamination by organic and inorganic matter. AANA J. 1997
Feb; 65(1):28.
10. Stemicht AL. Significant bacterial colonization of the surface
of non-disposable sphygmomanometer cuffs and reused
disposable cuffs. Comet Med. Ctr., New York, NY 10021.
11. Myers MG. Longitudinal evaluation of neonatal nosocomial
infections: association of infection with a blood pressure
cuff. Pediatrics 1978; 61:42-45.
12. Livornese LL, Levison ME, Johnson CL. Electronic
thermometers and nosocomial infections. An of Intern Med
1993; 118(2):156-157.
13. Marinella MA, Pierson C, Chenoweth C. The stethoscope. A
potential source of nosocomial infection? Arch Intern Med
1997; 157:786-790.
14. Boyce JM, Pittet D. Guideline for Hand Hygiene in Healthcare
Settings. Recommendations of the Healthcare Infection
Control Practices Advisory Committee and the HICPAC/
SHEA/APIC/IDSA Hand Hygiene Task Force. October 25th,
2002 www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.
htm.
15. Albert RK, Condie F. Hand-washing patterns in medical
intensive-care units. N Engl J Med 1981; 304:1465.
16. Graham M. Frequency and duration of handwashing in an
intensive care unit. Am J Infect Control 1990; 18:77-81.
17. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for
isolation precautions: preventing transmission of infectious
agents in healthcare settings 2007. June 2007 www.cdc.
gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf.
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