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4-6 Rad-57 Signal Extraction CO-Pulse Oximeter Operator’s Manual

Rad-57 Signal Extraction CO-Pulse Oximeter Operator’s Manual 4-7

operation

NUMERIC DISPLAY - SpCO

A stable SpCO reading is associated with correct sensor placement, small physiological

changes during the measurement and acceptable levels of arterial perfusion in the patient's

fingertip (measurement site). Physiological changes at the measurement site are mainly

caused by fluctuations in the oxygen saturation, blood concentration and perfusion.

Inaccurate measurements may be caused by:

■ Significant levels of methemoglobin.

■ Intravascular dyes such as indocyanine green or methylene blue.

■ Abnormal hemoglobin levels.

■ Abnormally low arterial perfusion.

NUMERIC DISPLAY - PULSE RATE

The Pulse Rate displayed on the Rad-57 may differ slightly from the heart rate displayed

on ECG monitors due to differences in averaging times. There may also be a discrepancy

between cardiac electrical activity and peripheral arterial pulsation. Significant differences

may indicate a problem with the Signal IQ due to physiological changes in the patient or

one of the instruments or application of the sensor or patient cable. The pulsations from

intra-aortic balloon support can be additive to the pulse rate displayed on the Pulse CO-

Oximeter .

LOW SIGNAL IQ (LOW SIQ)

The Rad-57 display provides a visual indicator Signal IQ and an alert when the displayed

SpO

values are not based on adequate Signal IQ. The Signal IQ indicator displayed on

the Rad-57 as “Low SIQ”.

The Low SIQ indicator flashes when the SpO

measurement may be compromised. When

the Low SIQ indicator is flashing, proceed with caution and do the following:

■ Assess the patient.

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

well secured to the site for the Rad-57 to maintain accurate readings. Also,

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

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

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

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

sensor, severe hypotension, peripheral vasoconstriction in response to hypothermia,

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

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

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

during a diaper change.

operation

After performing the above, if the “Low SIQ” indication occurs frequently or continuously,

obtaining an arterial blood specimen for CO-Oximetry analysis may be considered to verify

the oxygen saturation value.

LOW PERFUSION / PERFUSION INDEX (PI)

Perfusion Index, or PI, is a relative assessment of the perfusion at the monitoring site. PI

is displayed on a 10 segment LED bar, ranging from <1% (very weak perfusion) to >5%

(strong perfusion). The lower two segments of the bar will turn red when the amplitude

of the arterial pulsations are very low (weak perfusion). The highest LED will remain lit

continuously to allow a PI level to be viewed.

The PI is shown as a "bouncing bar" indicator, where the peak of the bar coincides with the

peak of an arterial pulsation. Even with a plethysmographic waveform obscured by artifact,

the Rad-57 locates the arterial pulsation. The pulse tone (when enabled) coincides with

the peak of the PI bar.

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

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

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

ACTIONS TO BE TAKEN

If the SpO

readings show significant differences, do the following:

■ Make sure the emitter and photodetector are aligned directly opposite each other.

■ Select a site where the distance between the emitter and photodetector is minimized.

■ Wipe the sensor site with a 70% isopropyl alcohol pad or rubefacient cream (10-

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

creams, such as nitroglycerin paste, are not recommended.

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

electrical/electronic equipment.

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

remove the polish/artificial nails.

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

CAUTION: IF ANY MEASUREMENT SEEMS QUESTIONABLE, FIRST CHECK THE

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

OXIMETER FOR PROPER FUNCTIONING

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Masimo Radical Signal Extraction Manuel de l'opérateur Page 15

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