M1722A/B CodeMaster XL+

Defibrillator/Monitor User's Guide

H
HP Part No. M1722-91908
Printed in USA November 1994

Edition 6
E1194
 0 Notice

The information in this document is subject to change without notice.

Hewlett-Packard makes no warranty of any kind on this material, including but not
limited to, the implied warranties of merchantability and fitness for a particular
purpose. Hewlett-Packard shall not be liable for errors contained herein or for
incidental or consequential damages in connection with the furnishing,
performance, or use of this material.

This document contains proprietary information which is protected by copyright.

All rights are reserved. No part of this document may be photocopied, reproduced,
or translated to another language without the prior written consent of Hewlett-
Packard Company.

Before using the instrument, read this guide and become thoroughly familiar with
the contents.

Responsibility of the Manufacturer

Hewlett-Packard only considers itself responsible for any effects on safety,

reliability and performance of the equipment if:

assembly operations, extensions, re-adjustments, modifications or repairs are done

by persons authorized by Hewlett-Packard, and

the electrical installation of the relevant room complies with the IEC or national
requirements, and

the instrument is used according to the instructions for use presented in this man-
ual.

NOTE As with all electronic equipment, radio frequency interference between the
defibrillator and any existing RF transmitting or receiving equipment at the
installation site, including electrosurgical equipment, should be evaluated carefully
and any limitations noted before the equipment is placed in service. Hewlett-

ii
 Packard assumes no liability for failures resulting from RF interference between HP
medical electronics and any radio frequency generating equipment.

THIS PRODUCT IS NOT INTENDED FOR HOME USE.

This is to certify that this equipment is in accordance with the Radio Interference
Requirements of Directive FTZ 1046/84. The German Bundespost was notified that
this equipment was put into circulation, the right to check the device for compliance
with the requirements was granted.

If Test and Measurement Equipment is operated with unscreened cables and/or used
for measurements in open set-ups, the user has to assure that under these operating
conditions the Radio Interference Limits are still met at the border of his premises.

CAUTION Use of accessories other than those recommended by Hewlett-Packard may

compromise product performance.

Printing History
March 1992 Edition 1
June 1992 Edition 2
December 1992 Edition 3
July 1993 Edition 4
October 1994 Edition 5
November 1994 Edition 6

© Copyright 1994, Hewlett-Packard Company

iii
 0 Safety Symbols

Monitor On (Do not confuse with 1 Joule)

Off (Standby)

On/Off

Ground

Shock hazard

Caution - See operating instructions

Meets IEC type BF leakage current requirements and is defibrillator

protected.

Meets IEC type CF leakage current requirements and is defibrillator

protected.

Equipotential (rear of unit, adjacent to a.c. input)

Protective earth (ground)

Conventions Used in This Manual

WARNING Warning statements describe conditions or actions that can result

in personal injury or loss of life.

CAUTION Caution statements describe conditions or actions that can result in damage to the
equipment or loss of data.

iv
NOTE Notes contain additional information on usage.

TEXT represents the labels that appear on the display.

Key represents keys on the key panel.
LIGHT represents lighted indicators on the key panel.

v
vi
1 Contents

Getting acquainted
Operating Controls and Indications 1-1
Safety considerations 1-8
AC and DC (Battery) Operation 1-10
Battery Life 1-11

Defibrillating
Defibrillating a Patient 2-1
1. Select Energy 2-2
2. Charge 2-2
3. Shock 2-3
After Using the Defibrillator 2-4
Defibrillating with Alternate Paddle Sets 2-4

Monitoring
Using Leads to Monitor 3-1
Preparing the Leads for Monitoring 3-2
Preparing the Patient 3-4
Monitoring Electrodes 3-5
Monitoring 3-6
Heart Rate Alarms 3-7
Printing the Event Summary Record 3-8
Recording 3-9
Automatic Recordings 3-9
Post Shock Data 3-10
Recorder Errors 3-10
External Monitoring 3-11

Performing Synchronized Cardioversion

Performing Cardioversion 4-1
Monitoring During Cardioversion 4-1

Contents-1
Performing Synchronized Cardioversion 4-2

Pacing (Optional)
Using the Pacer 5-2
Defibrillation During Pacing 5-4

SpO2 Monitoring (Optional)

SaO2 and SpO2 6-1
Application Notes 6-1
Using SpO2 to Monitor a Patient 6-2
Apply the Sensor to the Patient 6-3
Troubleshooting Sensor Application 6-5
Connect the Sensor to the CodeMaster XL+ 6-6
Start Monitoring 6-7
SpO2 Readings 6-7
SpO2 Alarms 6-8
Activating SpO2 Alarms 6-8
Deactivating SpO2 Alarms 6-8
Recorder Output 6-9

Troubleshooting
Troubleshooting 7-1
Troubleshooting the Defibrillator 7-2
Troubleshooting the Pacer 7-5
Troubleshooting SpO2 7-6
Performing Diagnostics 7-7
Operational Checks 7-8
Every Shift 7-9
Every Day 7-9
Every Week 7-12
Every Three Months 7-12
Every Six Months 7-12

Contents-2
Maintaining the Defibrillator
Changing the Recorder Paper 8-1
Cleaning the Recorder Printhead 8-2
Maintaining the Battery 8-3
Battery Capacity Check 8-4
Replacing the Battery 8-5
Cleaning Exterior Surfaces 8-6
Cleaning and Sterilizing the Internal Paddles 8-7
Steam Sterilizing the Internal Paddles 8-7
Ethylene Oxide Sterilization 8-8
Supplies 8-8

Installation and Setup

Installation A-1
Line Voltage Settings A-1
Installing and Charging the Battery A-1
Loading the Recorder Paper A-3
Connecting Paddles and Patient Cables A-3
Setup A-7
Specifications A-11
Defibrillator A-11
Monitor A-12
Thermal Array Recorder A-12
Size and Weight A-13
Battery A-13
External Pacemaker (Optional) A-14
SpO2 (Optional) A-14
Calling for Service A-15

Contents-3
List of Tables

Defibrillator Operating Controls 1-2

Recorder Operating Controls 1-3
Monitor Operating Controls 1-4
Pacer Operating Controls 1-5
SpO2 Operating Controls 1-6
Indicator Lights 1-7
Audible Indicators 1-8
Switchless Internal Paddles Selection 2-8
Switched Internal Paddles Selection 2-9
Cardiac Monitoring Configurations 3-1
3-Wire Electrode Placement 3-2
Lead Formation 3-3
5-Wire Electrode Placement 3-3
Lead Configurations 3-3
Event Summary Record Information 3-8
Automatic Recordings 3-10
External Monitoring Cables 3-11
Failure Messages 7-1
Defibrillator Messages 7-2
Pacer Messages 7-5
SpO2 Messages 7-6
Setup Menu 1 Settings A-9
Setup Menu 2 Settings A-10

Contents - 5
List of Tables

Contents - 6
List of figures

The CodeMaster XL+ Defibrillator/Monitor 1-1

Defibrillator Operating Controls 1-2
Recorder Operating Controls 1-3
Monitor Operating Controls 1-4
Pacer Operating Controls 1-5
SpO2 Operating Controls 1-6
Indicator Lights 1-7
Defibrillator Control Panel 2-1
The Monitor Control Panel 3-6
The Pacer Control Panel 5-1
Positioning of the Light Emitters and Photodetector 6-2
Application of the HP M1190A Reusable Sensor 6-4
Connecting the SpO 2 Sensor to the CodeMaster XL+ 6-6
CodeMaster XL+ display with SpO2 reading 6-7
Changing the Recorder Paper 8-1
Installing the Battery A-3
Connecting External Paddles, Adhesive Pads, or Internal Paddles A-5
Connecting a Patient Cable A-7

Contents - 4
 1 Getting acquainted

This User’s Guide provides operational and basic maintenance instructions for safe
use and proper care of the Hewlett-Packard M1722A/B CodeMaster XL+
defibrillator/monitor.

Figure 1-1

The CodeMaster XL+ Defibrillator/Monitor

1 Operating Controls and Indications

The following figures and tables detail the controls and indications on the
CodeMaster XL+ defibrillator/monitor.

1-1
 Getting acquainted
Operating Controls and Indications

Figure 1-2

Charge button

Shock buttons

Sync button

Energy Select/power control

Defibrillator Operating Controls

Table 1-1 Defibrillator Operating Controls

Control Description

Energy Select/ Turns the instrument power on and off and selects energy level.
power control

Charg button Charges defibrillator to energy level set on Energy Select control.
Shock but- Administers shock. Labelled .
tons

Sync button Changes operating mode between immediate shock (normal)

mode and synchronized with next R-wave shock (Sync) mode.

1-2
 Getting acquainted
Operating Controls and Indications

Figure 1-3

Record button

Mark button

Recorder Operating Controls

Table 1-2 Recorder Operating Controls

Control Description

Recor Starts and stops the recorder.

Mark • When the recorder is on, pressing Mark will annotate the
ECG at that point.
• If the recorder is not on and the unit is set up to do so, pressing
Mark will print an ECG strip.
See Appendix A for information about setting up the CodeMaster
XL+ for recording when you press Mark (Record on Mark).

1-3
 Getting acquainted
Operating Controls and Indications

Figure 1-4

Lead Select button

ECG Size button
HR Alarm button
Review button

QRS Beeper Volume

ECG Output

Monitor Operating Controls

Table 1-3 Monitor Operating Controls

Control Description

Lead Selects an ECG source to monitor.

ECG Size Changes displayed ECG size.

HR Controls HR Alarms.

Review Prints an Event Summary record. The message "ES" is printed at the
top of the ECG strip when you print the Event Summary record. The
recorder must be off to print an Event Summary with this key.

QRS Beeper Vol- Controls volume of QRS beeper.

ume

ECG Output Provides analog 1V/mV output for external monitoring.

1-4
 Getting acquainted
Operating Controls and Indications

Figure 1-5

Pacer On button

Rate button

Start/Stop button
Output button

Mode button

Pacer Operating Controls

Table 1-4 Pacer Operating Controls

Control Description

Pacer Turns pacer on or off.

Rate Adjusts pacer rate (ppm) up or down.

Start/ Starts and stops pacing.

Output Adjusts pacer output current (mA) up or down.

Mode Changes between fixed and demand pacing modes.

1-5
 Getting acquainted
Operating Controls and Indications

Figure 1-6

SpO2 On/Off button

SpO2 Alarm button

SpO2 Input

SpO2 Operating Controls

Table 1-5 SpO2 Operating Controls

Control Description

SpO2 On/ Turns pulse oximeter on or off.

SpO2 Activates, selects and deactivates SpO2 alarms.

SpO2 input Connector for SpO2 sensor or sensor adaptor cable.

1-6
 Getting acquainted
Operating Controls and Indications

Figure 1-7

Charge Done

Paddle Contact Indicator

Sync Light

AC Power

Battery Charge

Indicator Lights

Table 1-6 Indicator Lights

Indicator Description

Charge Done Indicates that unit is charged and ready to use. Charge lights on
key panel and on Apex paddle.

Paddle Contact IIndicates how well paddles contact patient.

Indicator (PCI)
on Sternum pad-
dle

Sync Light Indicates that unit is in synchronized shock mode as opposed to

defibrillator mode. Flashes off each time an R-wave is detected.

AC Power Indicates that unit is plugged in to AC power.

Battery Charge Indicates that the unit is plugged into AC power and that the battery
is being charged.

1-7
 Getting acquainted
Safety considerations

Table 1-7 Audible Indicators

Indicator Description

Charge Done tone Sounds when instrument is charged and ready to deliver a shock.
Can be disabled in setup.

Auto disarm tone Sounds during the last ten seconds of the Charge Done tone. Beeps
intermittently until disarmed.

QRS beeper Sounds whenever an R-wave is detected. Volume controlled by front

panel adjustment.

CRT alerts Three beeps each time a message appears on the screen. Can be dis-
abled in setup.

HR alarms Sounds if the heart rate is above the higher alarm limit or below the
lower alarm limit.

SpO2 alarm Sounds if the SpO2 level is above the high SpO2 alarm limit or
below the low SpO2 alarm limit.

Shutdown warn- Alternating pitch sounds for 60 seconds when the system is about to
ing turn off. An alert to plug the unit into AC power.

1 Safety considerations

The CodeMaster XL+ stores high voltage energy and is capable of delivering up to
360 joules of DC energy to a 50 ohm impedance.

• To remove power from the instrument, you must turn the Energy Select control to
Off (Standby). Disconnecting the CodeMaster XL+ from an AC outlet will not
remove power because the instrument is battery powered.

• To disarm a charged instrument, use one of three methods:

m Turn the Energy Select control from an energy level setting to the Monitor On or
Off (Standby) position.
or

1-8
 Getting acquainted
Safety considerations

m Place the paddles in their holders and depress both Shock buttons.
or
m Leave the unit charged for 60 seconds and it will automatically disarm.

CAUTION • Do not leave the instrument turned on when it is not in use and it is not plugged
into AC power.

• Do not discharge the defibrillator with the paddles shorted together. To do so can
cause burning and pitting of the metal paddle contacts.

• Disconnect any other medical electronic equipment from the patient during

defibrillation discharge unless labelled as defibrillator protected ( )( ).

WARNING • Avoid open paddle discharges. Dangerous high voltage exists on

the paddles when the defibrillator is discharged. Contact with
this high voltage could cause death or serious injury.

• Avoid touching any metal surfaces on the instrument during

shock.

• Avoid connecting the patient to several devices at once, because

leakage current limits can be exceeded.

• Never touch the bed, the patient, or any equipment connected to

the patient during defibrillation.

• Keep the CodeMaster XL+ and the immediate area clean and
dry at all times to avoid creating potentially dangerous electrical
paths.

• Never open the instrument case. Dangerous high voltages can be

exposed. Only qualified service personnel can service the
instrument.

• Do not use the defibrillator in a flammable or oxygen-rich

atmosphere. This will cause an explosion hazard.

1-9
 Getting acquainted
AC and DC (Battery) Operation

• Do not rely entirely upon heart rate alarms. Rate meters on

patients can continue to count the pacemaker rates during
cardiac arrest or some arrhythmias. Keep pacemaker patients
under close observation.

• Avoid moving a charged defibrillator. If the unit is dropped, it

may discharge.

1 AC and DC (Battery) Operation

The CodeMaster XL+ defibrillator can be operated on AC line or DC battery power.

The following is a list of AC and battery operating instructions.

• The battery will charge when the instrument is connected to AC power even if the
Energy Select switch is in the Off (Standby) position.

• Battery charging is indicated by the BATT light being on.

• A fully depleted battery will recharge to 90% of full capacity in two hours and
100% capacity in 18 hours. To preserve battery integrity, the battery must be fully
recharged each time the battery is depleted.

• A new battery or one that has been stored for an extended period requires 24 hours
of charging before use.

• When the unit is not in use, connect it to AC power with the monitor turned off.
This is to maintain a full battery charge and to prolong battery life.

• To operate on internal battery power only, disconnect the power cord from the AC
outlet.

• A fully charged battery will nominally provide fifty 360 joule charge-shock cycles
or 2.5 hours of continuous monitoring (15C-40C).

1-10
 Getting acquainted
AC and DC (Battery) Operation

NOTE Continuous recording will reduce monitoring time available when you are using the
unit on battery power.

CAUTION When the LOW BATTERY message is displayed on the monitor, plug the unit into
AC power.

From the time the LOW BATTERY message is first displayed to when the battery
capacity is fully depleted (instrument shutdown), there is typically enough reserve
battery capacity to provide either 30 minutes of monitoring, or five 360 joule
charge-shock cycles.

If a battery is defective, there is significantly less monitoring or charge capacity

available after the LOW BATTERY message appears than if the battery is merely
depleted.

A unique audible alarm will sound continuously when there are 60 seconds of
battery capacity remaining. The instrument will automatically shut off after 60
seconds.

If the battery has been fully depleted, plugging the instrument into AC will
immediately restore full operation.

Frequent battery discharges to the low battery level will degrade battery life.

Battery Life
The sealed lead-acid battery used in the CodeMaster XL+ will provide optimum life
when the unit is continually connected to AC power when not in use. The battery
operates best when it is fully charged after each use. To fully charge a depleted
battery requires 18 hours of continuous charge time. Because it is not always
practical to allow a full charge cycle between uses, the CodeMaster XL+ can charge
a depleted battery to 90% of its capacity in approximately two hours. However,
battery capacity and battery life will be reduced if the battery is not allowed to fully
charge after each use. For improved battery life, consider ways to reduce the number
of instrument uses between full charge cycles.

When the instrument is not plugged into AC power, some current is drawn from the
battery to maintain memory and startup logic. Remove the battery if the instrument

1-11
 Getting acquainted
AC and DC (Battery) Operation

is to be stored for extended periods (more than one month) without AC power. Note
on the instrument that the battery has been removed. After an extended storage
period, test the battery according to the battery capacity check as described in
Maintaining the Battery on page 8-3.

This battery was selected because it provides optimum performance and battery life
over a wide range of operating conditions. The life expectancy of this battery is
dependent on many variables, including temperature and usage. Periodically check
the battery capacity to determine whether to replace it. The battery capacity check is
described in Maintaining the Battery on page 8-3.

NOTE When plugged into AC power, the CodeMaster XL+ will function normally with no
battery installed, however the time required to charge the defibrillator will increase.

WARNING If the CodeMaster XL+ is operated without a battery installed,

clearly mark the instrument that it does not have a battery and
requires AC power to operate. When a CodeMaster XL+ has no
battery installed and is plugged into AC power, the front panel
AC light will be on and the BATT light will be off.

WARNING Properly dispose of or recycle depleted batteries according to

local regulations. Do not disassemble, puncture or incinerate the
disposed batteries.

1-12
 2 Defibrillating

This chapter contains information about defibrillating a patient and using different
paddle sets for defibrillating.

Figure 2-1

Charge button

Shock buttons

Sync button

Energy Select/power control

Defibrillator Control Panel

2 Defibrillating a Patient

The following section describes the three steps to defibrillating a patient:

1 Select Energy

2 Charge

3 Shock

2-1
 Defibrillating
Defibrillating a Patient

1. Select Energy
1 Turn the Energy Select control to the desired energy level. The defibrillator is
now on.

2 Prepare the paddles by following these steps.

a. Remove the paddles from their holders by grasping the handles and lifting
them straight up.
b. Apply Redux® electrolyte paste to the electrode surface of each paddle.

WARNING Do not allow paste to accumulate on your hands or on the paddle

handles to avoid risk of electrical shock.

3 Apply the paddles as described below.

a. Place the left (Sternum) paddle near the upper sternum just below the
patient's right clavicle.
b. Place the right (Apex) paddle on the chest just below and to the left of the
patient's left nipple, in the anterior-axillary line.

4 Rub the paddles lightly against the skin to increase contact between the patient
skin and the paddles. Then keep the paddles still to reduce motion artifact on the
monitor.

WARNING Do not spread paste between the paddle electrodes on the chest.
The patient can be burned if the paste forms a path between the
electrodes.

5 Apply 10 to 12 kg of pressure to the paddles.

2. Charge
Press the Charge button on either the right (Apex) paddle or on the instrument front
panel.

2-2
 Defibrillating
Defibrillating a Patient

Wait for the Charge Done indicators. When the unit is armed, the monitor Delivered
Energy display shows the available energy in joules.

If the defibrillator does not charge, refer to Chapter 7, Troubleshooting.

Resetting the Selected Energy Level

To increase or decrease the selected energy level after pressing the Charge button,
perform the following steps.

1 Move the Energy Select control to the new energy level.

2 Wait for the Charge Done indicators.

3. Shock
To shock the patient, perform the following steps.

1 Briefly adjust paddle pressure and placement to optimize patient contact, as reg-
istered on the paddle contact indicator (if supplied).

2 Verify that no one is in contact with the patient, the monitoring cable or leads,
the bed rails, or another potential current pathway.

3 Call out "Clear!" to alert personnel to stand away from the patient.

WARNING Keep hands clear of the paddle electrode edges. Use your thumbs
to depress the Shock buttons on the paddle handles.

4 Press and briefly hold both Shock buttons (one on each paddle) simultaneously,
to deliver energy to the patient.
If the defibrillator does not shock, refer to Chapter 7, Troubleshooting.

NOTE If you must disarm the charged defibrillator (if countershock is not needed), turn the
Energy Select control to Monitor On. Any stored energy will be discharged
internally and the available energy on the display will return to 0.

2-3
Defibrillating
Defibrillating a Patient

After Using the Defibrillator

If you want to print an Event Summary now, press Review . See Printing the
Event Summary Record on page 3-8. After you use the defibrillator, perform the
following steps to prepare the defibrillator for its next use.

1 Turn the Energy Select control to Off (Standby).

2 Return the instrument to its storage location, and plug the power cord into an AC
power outlet. Verify that the BATT and [ AC lights are on.

3 Clean all paddles, controls, and cables. Refer to Chapter 8, Maintaining the
Defibrillator for cleaning instructions.

4 Check that sufficient recorder paper and electrolyte paste or defibrillator pads
are available for the next use of the defibrillator.

Defibrillating with Alternate Paddle Sets

The CodeMaster XL+ will defibrillate with several different pads/paddles sets.

• Adult/Pediatric Anterior/Anterior External Paddles

• External Adhesive Pads

• Internal Paddles

Performing Pediatric Defibrillation

The CodeMaster XL+ paddle set comes with pediatric paddles. To use the pediatric
paddle set, depress the release latch at the front of the standard external paddle set
while pulling forward on the adult paddle surface. This action will remove the adult
paddle contact surface and expose the smaller pediatric contact surface.

Refer to the Defibrillating a Patient section for defibrillation procedures.

2-4
 Defibrillating
Defibrillating a Patient

WARNING The clinician must select an appropriate energy level for the
pediatric patient. There is no energy limit lockout for the
pediatric paddle set.

Defibrillating through External Adhesive Pads

The CodeMaster XL+ has an external pads adaptor that is optional. This adaptor
allows defibrillation through external adhesive pads.

External Pads have the following advantages.

• They allow "hands off" defibrillation.

• They provide good quality monitoring.

• You can perform synchronized cardioversion without using an ECG lead set, while
monitoring through the pads.

• If the optional pacer is installed, you can switch between the pacing and defibrilla-
tion modes of operation quickly.

WARNING The defibrillator will deliver defibrillator energy levels to an open

pads set. The message PADS OFF appears when there is a poor
pads-to-patient contact. Check all patient connections if this
message appears. If possible, dry off the patient's chest prior to
applying the pads. Avoid spreading gel on the patient's body
surface. Excess moisture or pads gel between pads can form a
path between pads. This reduces defibrillation effectiveness and
can possibly burn the patient.

1 Attach the pads adaptor cable (HP M1750A/B) to the paddle connector on the
front of the defibrillator.

2 Slide the paddle connector lock towards the front of the defibrillator to secure
the cable.

2-5
 Defibrillating
Defibrillating a Patient

3 Attach the pads to the patient as instructed on the package.

4 Connect the pads to the pads adaptor cable. The pads are correctly connected
when the locking ring is twisted, locking the ears of the connector to the adaptor
cable.

WARNING Failure to correctly connect the pads to the adaptor cable can
result in a failure to deliver energy to the patient.

If the PADS OFF monitor message is displayed, check all patient connections.

5 Select pads as the ECG source by pressing Lead until PADS appears on
the display under the heart rate.

6 Set Energy Select control to desired energy.

7 Press Charge .

8 Wait for the Charge Done indicators.

9 Press both Shock buttons at once to defibrillate. The Shock buttons for
external pads are on the cable connector housing.

Performing Internal Defibrillation

You can perform internal defibrillation using one of the optional internal
defibrillation paddle sets.

The Switchless paddle sets attach to the internal paddles adaptor cable (M1740A/B).
The Shock buttons are on the connector housing of the internal paddle adaptor
cable.

The Switched paddle set does not require the internal paddles adaptor cable. This
paddle set has a single Shock button on the right-hand paddle handle.

To defibrillate a patient internally, using the switchless paddles, perform the

following steps.

2-6
 Defibrillating
Defibrillating a Patient

1 Attach the internal paddles adaptor cable (HP M1740A/B) to the paddle connec-
tor on the front of the defibrillator.

2 Slide the paddle connector lock towards the front of the defibrillator to secure
the cable.

3 Select correct paddle set size from Table 2-1, “Switchless Internal Paddles
Selection,” on page 2-8.

4 Attach the internal paddles set to the internal paddles adaptor cable. The pads
are correctly connected when the locking ring is twisted, locking the ears of the
connector to the adaptor cable.

WARNING Failure to correctly connect the internal paddles to the adaptor

cable can result in a failure to deliver energy to the patient.

5 Set the Energy Select control to the desired energy.

WARNING If the energy switch is set to a level greater than 50 joules, 50J MAXIMUM will be
displayed. If Charge is pressed, the unit will only charge to 50 joules.

WARNING For safety and sterility when using the paddles, do not touch the
paddle beyond the fingerguard on the handle.

6 Apply the internal paddles.

7 Press Charge .

8 Wait for the Charge Done indicators.

9 Press both Shock buttons at once to defibrillate. The Shock buttons are on
the cable connector housing.

2-7
 Defibrillating
Defibrillating a Patient

Table 2-1 Switchless Internal Paddles Selection

HP Part
Description
Number

M1740A/B Internal paddles adaptor

M1741A Internal paddle set, 7.5 cm diameter

M1742A Internal paddle set, 6.0 cm diameter

M1743A Internal paddle set, 4.5 cm diameter

M1744A Internal paddle set, 2.8 cm diameter

To defibrillate a patient internally, using the switched paddles, perform the following
steps.

1 Select correct paddle set size from Table 2-2, “Switched Internal Paddles Selec-
tion,” on page 2-9.

2 Attach the switched internal paddles cable to the paddle connector on the front
of the defibrillator.

3 Slide the paddle connector lock towards the front of the defibrillator to secure
the cable.

4 Set the Energy Select control to the desired energy.

NOTE If the energy switch is set to a level greater than 50 joules, 50J MAXIMUM will be
displayed. If Charge is pressed, the unit will only charge to 50 joules.

WARNING For safety and sterility when using the paddles, do not touch the
paddle beyond the fingerguard on the handle.

5 Apply the internal paddles.

2-8
 Defibrillating
Defibrillating a Patient

6 Press Charge .

7 Wait for the Charge Done indicators.

8 Press the Shock button on the right-hand internal paddle handle.

Table 2-2 Switched Internal Paddles Selection

HP Part
Description
Number

M1784A Internal paddle set, 7.5 cm diameter

M1785A Internal paddle set, 6.0 cm diameter

M1786A Internal paddle set, 4.5 cm diameter

M1787A Internal paddle set, 2.8 cm diameter

2-9
Defibrillating
Defibrillating a Patient

2-10
 3 Monitoring

This chapter contains information about monitoring a patient with the CodeMaster
XL+ defibrillator/monitor. This chapter also contains details of patient preparation
that apply to the synchronized cardioversion and pacing procedures described later
in this manual.

The CodeMaster XL+ can be used for either short term or long-term cardiac
monitoring. A fully charged battery pack provides a minimum of two and a half
hours of continuous monitoring. The power cord can be connected to AC power for
unlimited monitoring periods.

3 Using Leads to Monitor

The CodeMaster XL+'s monitoring functions can be used for cardiac monitoring,
elective cardioversion, and pacing (optional). Table 3-1, “Cardiac Monitoring
Configurations,” on page 3-1 details the different ECG sources that can be used for
cardiac monitoring and monitoring applications for which each is suited.

Table 3-1 Cardiac Monitoring Configurations

For this ECG In this monitoring

Use this cable type... Electrode P/N
source... application...

LEADS, 3-Wire: • ECG Normal. 14445C

LEAD I,II,III • 6 Pin - M1731A • Synchronized
• 8 Pin - M1733A Cardioversion.
• 12 Pin - M1605A/ • Pacing.
M1500A

LEADS, 5-Wire: • ECG Normal. 40493D

LEAD • 6 Pin - M1732A • Synchronized
I,II,III,aVR,aVL • 8 Pin - M1734A Cardioversion.
, aVF, and V • 12 Pin - M1625A/ • Pacing.
M1520A

3-1
 Monitoring
Using Leads to Monitor

Table 3-1 Cardiac Monitoring Configurations

For this ECG In this monitoring

Use this cable type... Electrode P/N
source... application...

PADS Pads adaptor cable: • ECG Normal M1749A

M1750A/B • Synchronized
Cardioversion
You can use these
pads for pacing, how-
ever you must select
LEADS as the moni-
tor source during pac-
ing.

PADDLES Standard with instrument Emergency ECG N/A

M1746A Monitoring

Preparing the Leads for Monitoring

The CodeMaster XL+ can be configured to use either a 3-wire or a 5-wire patient
cable. Use setup menu 2 as described in Appendix A to select the patient cable type
(3-wire, 5-wire).

3-Wire Patient Cable

Table 3-2, “3-Wire Electrode Placement,” on page 3-2 describes typical lead-wire
placement using the 3-wire patient cable. Table 3-3, “Lead Formation,” on page 3-3
shows how the individual leads are formed using the individual leadwires.

Table 3-2 3-Wire Electrode Placement

Electrode Placement

RA/White Near right midclavicular line, directly below the clavicle.

LA/Black Near the left midclavicular line, directly below the clavicle.

LL/Red Below the left pectoral muscle on the left midclavicular line.

3-2
 Monitoring
Using Leads to Monitor

Table 3-3 Lead Formation

Lead + — ref

I LA RA LL

II LL RA LA

III LL LA RA

5-Wire Patient Cable

Table 3-4, “5-Wire Electrode Placement,” on page 3-3 describes a typical lead-wire
placement using the 5-wire patient cable. Table 3-5, “Lead Configurations,” on page
3-3 shows how the individual leads are formed using the individual leadwires.

Table 3-4 5-Wire Electrode Placement

Electrode Placement

RA/White Near right midclavicular line, directly below clavicle.

LA/Black Near left midclavicular line, directly below clavicle.

LL/Red Below the left pectoral muscle on the left midclavicular line.

RL/Green Below the right pectoral muscle on the right midclavicular line.

V/Brown As appropriate for the V lead to be monitored (V1 - V6).

Table 3-5 Lead Configurations

Lead Leadwire Combinations

I LA - RA

II LL - RA

III LL - LA

aVR RA - .5 (LA + LL)

aVF LL - .5 (RA + LA)

3-3
 Monitoring
Preparing the Patient

Table 3-5 Lead Configurations

Lead Leadwire Combinations

aVL LA - .5 (RA + LL)

V V - 1/3 (RA + LA + LL)

3 Preparing the Patient

Proper application and placement of electrodes is essential for quality ECG

monitoring. Good contact between the electrode and the skin reduces the effects of
motion artifact and signal interference.

1 If necessary, shave hair from the site to ensure good electrode to skin contact.

2 Clean the skin with soap and water or with alcohol, then wipe it dry.

NOTE You can safely monitor a patient during defibrillation. However, monitoring
electrodes can become polarized during defibrillation shock, causing the ECG
waveform to briefly disappear from the display. You can reduce this effect by using
silver- silver chloride electrodes.

3 Attach disposable electrodes, perform the following steps.

a. Peel the protective backing from the electrode. Be careful to keep adhesive
surface free from electrolyte paste.
b. Apply the electrodes firmly to the patient's skin, pressing around the entire
edge of the electrode.
c. Attach snap-on or clip-on leads, assuring good contact between the elec-
trode and the lead end. Tape the lead wire to the skin to prevent the elec-
trode or lead from loosening.
d. Plug the patient cable connector into the ECG input connector that is in the
lower front of the defibrillator, behind the carrying handle.

NOTE Be careful to correctly align the cable plug when connecting the patient ECG leads
cable to the defibrillator/monitor. Correctly orient the cable plug key with the

3-4
 Monitoring
Preparing the Patient

defibrillator connector slot. If the ECG leads cable falls off or is incorrectly
connected, the message LEADS OFF appears on the display.

Monitoring Electrodes

Using Pads

Standard pads (HP1749A) allow you to monitor through the pads for defibrillation
and synchronized cardioversion. If you wish to use the pads for pacing however, you
must attach separate electrodes for monitoring. To use standard pads, perform the
following steps.

1 Attach pads as instructed on the pads package.

2 Attach the pads adaptor cable to the defibrillator.

3 Connect the pads to the pads adaptor cable.

4 PADS is the only selectable ECG source.

Using Paddles

For an emergency evaluation you can monitor a patient's ECG through the paddles
electrodes when leads are not attached to the patient.

WARNING Do NOT use paddles to monitor the ECG during elective

cardioversion procedures when the instrument is in synchronous
(SYNC) mode. Refer to Chapter 4, Performing Synchronized
Cardioversion, for detailed information on performing elective
cardioversion.

3-5
 Monitoring
Monitoring

3 Monitoring

Figure 3-1

Lead Select button

ECG Size button
HR Alarm button
Review button

QRS Beeper Volume

ECG Output

The Monitor Control Panel

To monitor a patient's ECG with the CodeMaster XL+, perform the following steps.

1 Prepare the patient for ECG monitoring.

2 Turn the Energy Select control to the Monitor On position.

3 Press Lead to select the ECG source. The selected source appears in the
upper right corner of the display. For example, PADS appears on the display
when it has been selected.
m If the message LEADS OFF or PADS OFF appears on the display, inspect the
electrodes, patient cable, leadwires, and associated connections. If the selected
ECG source is not connected, a dashed line will replace the normal ECG trace.

3-6
 Monitoring
Heart Rate Alarms

4 Ensure that the ECG size has been automatically adjusted for optimal size. If
you wish to reduce the ECG size, press ECG Size . The "gain bar" along the
left side of the display represents 1 mV of signal amplitude.

NOTE Autogain allows an initial quick setup when the instrument is turned on. To remove
the instrument from Autogain, press ECG Size . You then must adjust the ECG
size manually.

Adjust the QRS beeper volume to the desired volume.

3 Heart Rate Alarms

The CodeMaster XL+ provides three configurable pairs of upper and lower heart
rate alarm limits. Each pair of heart rate alarm limits can be defined in setup menu 1
as described in Appendix A. While monitoring, you can select and enable any pair
of pre- defined limits using HR .

When HR alarms are inactive, the monitor will display a bell symbol with a "\"
through it.

To select a pair of HR alarm limits, press HR until the pair of limits you
wish to use are displayed. If you do not press the key again, the displayed HR alarm
limits become active and the limits are replaced by the bell symbol.

If the HR alarm limits are violated, the HR alarm limits replace the bell symbol, and
the violated limit is highlighted. Pressing HR at this point will turn off the
HR alarms.

If the HR Alarms are active and you wish to review the limits, press HR .
The currently active pair of HR alarm limits are displayed momentarily.

If the HR alarms are active and you wish to select another pair of limits, press
HR until the pair of limits you wish to use are displayed. Pressing
HR repeatedly cycles through the three pairs of HR alarm limits and the HR
alarms inactive choice.

3-7
 Monitoring
Printing the Event Summary Record

NOTE HR alarms are automatically turned off when you press Charge .

3 Printing the Event Summary Record

During defibrillator usage, the monitor stores up to 28 ECG strips of critical

information called events. Events include all shocks, heart rate alarms, SpO2 alarms
and mark events. Each event record includes date of event, heart rate, ECG source,
and size setting as shown in Table 3-6, “Event Summary Record Information,” on
page 3-8. The time annotated on the ECG strip is within 8 seconds of the recorded
event. The message "ES" is printed at the top of the ECG strip when you print the
Event Summary record.

Table 3-6 Event Summary Record Information

Event Event Summary Description

Shock Shock#, Delivered energy, peak current, and patient impedance.

Heart Rate Heart Rate alarm limits.

Alarms viola-
tion

SpO2 Alarms SpO2 alarm limits.

violation

Mark Mark Marker symbol ( ) annotates strip at point Mark was pressed.

• To print the Event Summary on the recorder, press Review . The recorder must
not be printing to print an Event Summary with this key. After printing an event,
you must wait 10 seconds before printing another event.

• To stop printing the Event Summary, press Review or Record .

• To review the Event Summary later, turn the unit on and press Review .

3-8
 Monitoring
Recording

NOTE The Event Summary record is cleared each time the defibrillator is turned on and a
new event occurs. This allows you to turn off the defibrillator and return later to
review event information such as code statistics.

Turn the defibrillator off between uses to ensure that Event Summary records are
patient specific.

3 Recording

To print a record of the current ECG and of the monitor status, press Record .

• The upper line of the ECG strip contains a periodic report of monitor parameters
(Date, Time, Heart Rate, ECG Source, ECG Size, and Recorder mode).

• The lower line of the ECG strip records asynchronous events such as Shock deliv-
ery or Heart Rate Alarm violations.

• Several graphic symbols are used to annotate events such as Shock, HR Alarms,
Mark, or Sync.
A 1 mV, 200 ms calibration pulse can be printed on the ECG strip by pressing both
arrows on the ECG Size key simultaneously.

Appendix A contains a list of configuration settings in setup menu 2 which affect

recorder operation. The recorder can be configured for either monitor or diagnostic
ECG bandwidth data. Delayed (6 seconds) or non-delayed operation is also
configurable.

Automatic Recordings
In setup menu 2, you can enable or disable any of the following automatic
recordings:

• Record on Mark

• Record on Charge

3-9
 Monitoring
Recording

• Record on Shock

• Record on Alarms

The automatic recordings for both delayed and non-delayed recorder modes of
operation are defined in Table 3-7, “Automatic Recordings,” on page 3-10.

Table 3-7 Automatic Recordings

Delayed mode
Delayed mode Non- Delayed mode
Event Post-event
Pre-event time Post-event time
time

Mark pressed 6 seconds 3 seconds 3 seconds

Charge 6 seconds Until Shock or Until Shock or Disarm

Disarm event event.

Shocking the 6 seconds 12 seconds 12 seconds

patient

Alarms violation 6 seconds 3 seconds 6 seconds

Disarm 6 seconds 3 seconds 3 seconds

Test discharge N/A 3 seconds 3 seconds

Post Shock Data

As described in Appendix A, you can enable or disable the recording of post shock
statistics in setup menu 2.

• If Post Shock Data is enabled, the defibrillator will record the shock delivery sta-
tistics (Actual Delivered Energy, Patient Impedance, Peak Current).

• If Post Shock Data is disabled, the defibrillator will record the energy to which it
was charged as the delivered energy. For example, if the unit was charged to 200J,
the delivered energy annotation on the ECG strip would be DEL 200J.

3-10
 Monitoring
External Monitoring

Recorder Errors
The message CHECK RECORDER appears if an error occurs while recording. If this
message appears, check the recorder paper supply. This message may also appear if
the recorder door is open.

3 External Monitoring

The ECG output provides an analog 1V/mV ECG signal for connection to an
external monitor. Compatible external monitoring divider cables are listed in Table
3-8, “External Monitoring Cables,” on page 3-11.

Table 3-8 External Monitoring Cables

1000:1 voltage
Divider Cable
HP Part No.
Connector
Type

Six Pin M1782A

Eight Pin M14482A

Twelve Pin M1783A

The ECG output is also compatible with the interface to the HP central station ECG
input.

NOTE Do not use the ECG output to synchronize another defibrillator. (The ECG-In to
ECG-Out delay is 35 milliseconds.)

CAUTION The connection of external equipment may increase leakage currents. Always
request that local safety personnel verify that multiple connected equipment comply
with local regulatory standards before putting such equipment into service.

3-11
Monitoring
External Monitoring

3-12
 4 Performing Synchronized Cardioversion

This chapter contains information about performing synchronized cardioversion on

a patient with the CodeMaster XL+ defibrillator/monitor.

Refer to Chapter 3, Monitoring for information on patient preparation.

4 Performing Cardioversion

Treatment for certain arrhythmias require synchronizing a defibrillator shock with

the ECG's R-wave. It is essential that this R-wave is detected to avoid inducing
ventricular fibrillation.

Monitoring During Cardioversion

Using an External Monitor

WARNING Whenever possible, we recommend that you perform

synchronized cardioversion procedures while directly monitoring
the patient through the defibrillator's pads or leads inputs. If you
use an external monitor as the ECG source, ask your biomedical
technician to verify that the monitor/CodeMaster XL+
combination will deliver a synchronized shock within 60 ms of the
peak of the R-wave. (See the service manual for test procedure.)
Use a 1 mV QRS complex with a QRS width of 40 ms. This
performance cannot be guaranteed with all commercially
available monitors.

When the patient is already connected to bedside monitoring equipment, there is a

cable which plugs into the ECG output jack of the bedside monitor and connects to
the CodeMaster XL+ for monitoring. To use an external monitor with the
CodeMaster XL+, perform the following steps.

4-1
 Performing Synchronized Cardioversion
Performing Cardioversion

1 Select Lead I or Lead II on the CodeMaster XL+.

2 Plug the input end of the cable from the monitoring equipment into the ECG
input plug on the CodeMaster XL+.

Using Pads for Cardioversion

Synchronized cardioversion can be performed with external pads. PADS can be

selected as the ECG source for cardioversion because they are a reliable contact for
monitoring. To perform synchronized cardioversion with pads, perform the
following steps.

1 Attach the pads adaptor cable (M1750A/B) to the defibrillator.

2 Attach pads to patient as instructed on the package.

3 Connect pads to the pads adaptor cable.

If the PADS OFF monitor message is displayed, check all patient connections.

4 Select pads as the ECG source by pressing Lead .

5 Set Energy Select control to desired energy.

6 Perform the procedure described inPerforming Cardioversion on page 4-1.

Performing Synchronized Cardioversion

To start cardioversion, perform the following steps.

1 Turn the Energy Select control to Monitor On.

2 Select the desired ECG lead by pressing Lead .

3 Press Sync once to place the instrument in Sync mode. The message SYNC
will appear on the display.

NOTE If the paddles are selected as the ECG source, the message USE LEADS will appear
on the display. Although the instrument will allow synchronized shock in paddles

4-2
 Performing Synchronized Cardioversion
Performing Cardioversion

ECG mode, leads mode is recommended. Artifact induced by moving the paddles
may resemble an R-wave and trigger defibrillator shock.

Cardioversion can be performed with the instrument in Autogain mode. Always

inspect the displayed ECG before delivering the countershock, and verify that an
R-wave marker (indicating shock point) appears only with each R-wave. If a
marker dot does not appear, or if a marker dot is viewed on the T-wave segment
of the ECG, follow these instructions.
m Adjust the ECG size by pressing ECG Size until the marker dot appears
only with each R-wave.
m Select a different lead or adjust the electrode placement, if necessary, to improve
ECG R-wave quality.

4 Select the desired energy level with the Energy Select control.

Verifying Defibrillator Operation

Before the cardioversion procedure is started, verify defibrillator operation by

performing the following brief test.

1 Ensure that the paddles connector is attached and the paddles are in their hold-
ers.

2 Ensure that the patient cable is connected to the ECG Input jack in the front of
the defibrillator and the leads are attached to the patient.

3 Turn the Energy Select control to 100 joules.

WARNING Keep hands clear of the paddle electrode edges. Use your thumbs
to depress the Shock buttons on the paddle handles.

4 Press Charge . Wait for the Charge Done indicators, and for the Delivered
Energy display to read 100 joules.

5 With the paddles pressed firmly into their holders, press and hold both Shock
buttons at once. The defibrillator will shock with the next detected R-wave.

4-3
 Performing Synchronized Cardioversion
Performing Cardioversion

After the shock, the ECG strip will indicate whether the 100 joule test shock
passed or failed.
If the defibrillator does not charge, refer to Chapter 7, Troubleshooting.

Applying the Paddles

1 Prepare the paddles by performing the following steps.

a. Remove paddles from their holders by grasping the handles and lifting
straight up.
b. Apply a liberal amount of Redux® paste to the electrode surface on each
paddle or use defibrillator pads.

WARNING Do not allow paste to accumulate on the hands, the paddle

handles, or the paddle electrodes on the chest to avoid the risk of
electrical shock or burns.

c. Gently rub the electrode surfaces together to evenly distribute the applied
paste.

2 Apply the paddles to the chest as follows.

a. Place the left (Sternum) paddle to the right of the sternum just below the
clavicle.
b. Place the right (Apex) paddle on the chest just below and to the left of the
left nipple, in the anterior-axillary line.

3 Rub the paddles slightly against the skin to increase the paddle-to-patient con-
tact.

4 Apply 10 to 12 kg (22 - 25 lb) of pressure per paddle.

5 Press the Charge button on either the right (Apex) paddle or on the instrument
front panel.

6 Wait for the Charge Done indicators.

4-4
 Performing Synchronized Cardioversion
Performing Cardioversion

NOTE If you must disarm the charged defibrillator (if countershock is not needed), turn the
Energy Select control to Monitor On. Any stored energy will be discharged
internally and the available energy on the display will return to 0.

Resetting the Selected Energy Level

To increase or decrease the selected energy level after the Charge button has been
pressed, move the Energy Select control to the new energy level, and wait for the
Charge Done indicators.

Delivering the Synchronized Shock

To perform synchronized cardioversion, perform the following steps.

1 Verify again that the ECG waveform is stable, and that a marker dot appears
only with each R-wave of the cardiac cycle.

2 Briefly adjust paddle pressure and placement to optimize contact, as registered

on the paddle contact indicator.

3 Depress both Shock buttons (one on each paddle) until shock occurs. The
defibrillator will shock with the next detected R-wave.

4 If additional countershocks are required, readjust the Energy Select control as

necessary, and repeat the synchronized cardioversion procedure.

NOTE Depending on how the unit has been configured, it will either remain in the
synchronized shock mode or it will return to defibrillator mode following a
synchronized shock. Refer to Appendix A for instructions on configuring the
defibrillator for operation after synchronized cardioversion.

If the defibrillator does not shock, refer to Chapter 7, Troubleshooting.

After Using the Defibrillator

After using the defibrillator, perform the following steps to ensure that the
defibrillator is ready for use.

4-5
Performing Synchronized Cardioversion
Performing Cardioversion

1 Turn the Energy Select control to Off (Standby).

2 Return the instrument to storage.

3 Plug the power cord into an AC power outlet. Verify that the BATT and
AC lights are on.

4 Clean all paddles, controls, and cables as necessary. Refer to Chapter 8, Main-
taining the Defibrillator for information on cleaning the defibrillator.

5 Check that there are adequate recorder paper, electrolyte paste, and defibrillator
pads for the next use.

4-6
 5 Pacing (Optional)

This chapter contains information about pacing with the CodeMaster XL+
defibrillator/monitor.

Figure 5-1

Pacer On button

Rate button

Start/Stop button

Output button

Mode button

The Pacer Control Panel

The CodeMaster XL+ with the optional pacer can perform external transcutaneous
pacing. The pacing option provides demand (synchronous) and fixed
(asynchronous) pacing modes. The patient is connected to the pacer by external
adhesive pads. The patient can be paced and defibrillated through the same set of
pads.

WARNING While pacing, avoid touching the gelled area of the pacing pads or
the patient to prevent electrical shock.

Use only HP recommended pads (M1749A) with the external

pacer option. The CodeMaster XL+ delivers pacer pulses through
a low-impedance multifunction pad. The CodeMaster XL+ does
not pace effectively with high-impedance, pace-only electrodes.

Do not use pads for more than eight hours of continuous pacing.

5-1
 Pacing (Optional)
Using the Pacer

The CodeMaster XL+ will pace on battery power alone. However, whenever
possible, plug the CodeMaster XL+ into AC power while pacing.

5 Using the Pacer

To use the pacer, perform the following steps.

1 Apply the pads (M1749A) as instructed on the package.

2 Attach monitoring electrodes as instructed in Using Leads to Monitor on page

3-1.

3 Attach the patient cable to the CodeMaster XL+'s ECG Input connector.

4 Attach the patient cable leads to the monitoring electrodes.

5 Attach the pads adaptor cable (M1750A/B) to the defibrillator output connector.
Pull the latch connector toward the front of the defibrillator to lock the connec-
tor in place.

6 Attach the pads to the pads adaptor cable and turn the twist lock.

7 Turn the Energy Select control to the Monitor On position.

m If the message NO PADDLES is displayed, check that the pads adaptor cable
connector is properly seated and latched.
m If the message PADS OFF is displayed, check the pads connection to the patient
and to the pads adaptor cable.

8 Press Pacer to turn the pacer on. Pacer parameters will now be displayed at
the bottom of the display (PACER STOP, DEMAND MODE, 70 PPM 30
MA). The rate (ppm) and output (mA) settings for when the pacer is turned on
can be selected in setup menu 1. The original rate and output settings from the
factory are 70 ppm and 30 mA. The pacer is always in Demand mode when it is
turned on.

5-2
 Pacing (Optional)
Using the Pacer

NOTE At this point, no pacer pulses are being delivered to the patient. The pacer must be
started before the pacer pulses are delivered at the selected rate (ppm) and output
(mA).

9 Press Lead to select the best Lead for monitoring while pacing. You can
only select Leads as the ECG source when the pacer is on.
m If the message LEADS OFF is displayed, check all patient cable connections.

10 Press Rate to adjust the rate. The selected rate (PPM) is displayed on the
monitor.

11 Press Mode to select the pacing mode (Demand Mode/Fixed Mode). The
selected mode is displayed on the monitor.
m When in Demand mode, the pacer will only deliver pacer pulses when the
patients heart rate is lower than the selected pacer rate.
m When in Fixed mode, the pacer will deliver pacer pulses at the selected pacer
rate.

WARNING Use Demand pacing mode whenever possible. Use Fixed pacing
mode (Asynchronous) for cases when reliably monitoring the
patient is impractical. For example, use Fixed mode when there is
motion artifact or other ECG noise that makes R-wave detection
unreliable.

12 Press Start/ to start pacing. The monitor will now display the message
PACING as well as the selected mode, rate and output.

The pacer will not start pacing if there is a problem with either the pacing pad
connections or the monitoring electrode connections.

If there is a problem with the pacing pad connection, the message ATTACH
PADS will be displayed briefly when you press Start/ .

13 Verify that the pacer pulses are well positioned in the diastole.

5-3
 Pacing (Optional)
Using the Pacer

14 Increase output (mA) by pressing Output until the beat is captured. Selecting
an alternate lead can help you to determine capture.

15 To set the lowest possible output level to capture, decrease the current by decre-
ments of 5 mA by pressing Output .

NOTE If the monitoring ECG lead falls off while pacing in Demand mode, the pacer will
stop delivering pulses and the messages PACER STOP and LEADS OFF will
appear. To resume pacing, reattach the lead and press Start/ . Pacing in Fixed
mode does not require leads to be attached for the pacer to deliver pulses.

If a pacing pad comes off during pacing, the pacer will stop delivering pulses and the
messages PACER STOP and PADS OFF will appear. To resume pacing, reattach
the pad and press Start/ .

WARNING HR meters and HR alarms function during pacing, but they can
be unreliable. The HR meter attempts to count QRS activity in
both Demand and Fixed pacing modes. Observe the patient
closely while pacing. Do not rely on HR alarms or the indicated
Heart Rate as a measure of the patient's health.

Defibrillation During Pacing

If the patient must be defibrillated during pacing, perform the following steps.

1 Set the desired energy level with Energy Select control.

2 Press Charge . The defibrillator will automatically turn off the pacer and start
charging. The pacer status messages will be cleared and replaced with the
defibrillator Delivered Energy Display.

3 Wait for the Charge Done Indicators.

4 Call out "Clear!" to alert personnel to stand away from the patient.

5 Press and briefly hold both Shock buttons. The shock will be delivered through
the multifunction pads.

5-4
Pacing (Optional)
Using the Pacer

After the shock, the pacer remains off. Resume pacing if it is required.

5-5
Pacing (Optional)
Using the Pacer

5-6
 7 Troubleshooting

This chapter contains information about troubleshooting and performing diagnostics

on the CodeMaster XL+defibrillator/monitor.

7 Troubleshooting

This section provides information about messages that appear on the display.

Table 7-1 Failure Messages

Message Possible Solutions

DEFIB Use a back-up defibrillator and call service.

FAILURE

MONITOR Use a back-up defibrillator and call service. If there is no alternative,

FAILURE try to use the defibrillator without the monitor. Use Charge Done indi-
cators to verify defibrillator functionality.

SYSTEM Use a back-up defibrillator and call service. If there is no alternative,

FAILURE try to use the defibrillator. Use Charge Done indicators to verify
defibrillator functionality.

7-1
 Troubleshooting
Troubleshooting

Troubleshooting the Defibrillator

Table 7-2 Defibrillator Messages

Message Cause Possible Solutions

NO PADDLES Paddle set is not connected to the Attach external paddles,

defibrillator. internal paddles, or pads
adaptor as required.

LEADS OFF Leads are not securely attached to Attach lead.

the patient or the cable is not con-
nected to the defibrillator.

USE LEADS Paddles are connected to the •

defibrillator and:

• Sync was pressed when • Press Sync to remove

PADDLES is selected. the defibrillator from sync
mode.

• Defibrillator is in sync mode • Select PADS or LEAD

and PADDLES is selected. I, II, or III
instead of PADDLES.

• Defibrillator is in defib mode • Select PADS or LEAD

and PADDLES is selected I, II, or III instead
when leads are attached to the of PADDLES.
patient.

• Defibrillator is in defib mode, • Select PADS or LEAD

PADDLES is the ECG source I, II, or III instead
when attaching leads to the of PADDLES.
patient.

50J MAXI- Internal paddles are attached and CodeMaster XL+ will charge
MUM the Energy Select control has been to 50 joules.
turned past 50 joules.

LOW BAT- CodeMaster XL+ is not connected Connect the unit to AC

TERY to AC power and the battery voltage power.
is below the low battery threshold.

SETUP LOST Call for service.

7-2
 Troubleshooting
Troubleshooting

Table 7-2 Defibrillator Messages

Message Cause Possible Solutions

DEFIB DIS- CodeMaster XL+ has internally dis-

ARMED charged energy and is now dis-
armed.

CHECK The recorder door is open. Close the recorder door or

RECORDER or replace the paper roll as
The recorder is out of paper. described in “Changing the
Recorder Paper” (page 7-1).

If the Defibrillator does not Charge

If the defibrillator does not charge, perform the following steps.

1 Verify the proper setting of the Energy Select control.

2 If it is correct, follow these steps.

a. Turn the Energy Select control to Off (Standby), and then back to the
desired energy setting.
b. Press Charg again.

3 If the instrument remains unable to charge, turn the Energy Select control to Off
(Standby) and use a backup defibrillator.

4 Press Revie to print an event summary and keep any ECG strips from the
defibrillator for later evaluation.

5 Alert appropriate service personnel.

If the Defibrillator does not Deliver a Shock

If the defibrillator does not deliver a shock, perform the following steps.

7-3
Troubleshooting
Troubleshooting

1 Make sure the unit is not in synchronized shock mode. The SYN light is on
when the unit is in synchronized shock mode.

2 If the unit discharges internally (that is, the energy display decrements slowly
then beeps three times and displays the screen message DEFIB DISARMED)
verify proper connections from the patient to the defibrillator. This includes con-
nections to the pads/paddles adaptor cable if one is being used. Also check for
worn or broken areas along the cables.

3 Press Charg again, wait for the Charge Done indicators.

4 Press the Shock buttons again.

5 If the unit remains unable to shock, turn the Energy Select control to the Moni-
tor On or Off (Standby) position and use a back-up defibrillator.

6 Press Revie to print an event summary and keep any ECG strips from the
defibrillator for later evaluation.

7 Alert appropriate service personnel as soon as possible.

7-4
 Troubleshooting
Troubleshooting

Troubleshooting the Pacer

Table 7-3 Pacer Messages

Message Cause Possible Solutions

PACER The unit detected a delivered current 1 Change pads and make
FAILURE error. sure pads adaptor cable is
properly connected.
2 Turn the Energy Select
switch to Off (Standby),
then turn back to Monitor
On.
3 Restart the pacer.
If PACER FAILURE hap-
pens again, use a back-up
pacer and call for service.

PACER OUT- The pacer cannot deliver the 1 Stop the pacer.
PUT LOW required current. 2 Change the pads and
Pacer current check the pads adaptor
highlighted on cable for proper connec-
the display. tion.
3 Restart the pacer.

STOP PACER An attempt was made to change pac- Stop the pacer before you
ing mode while pacing. change the pacing mode.

NO PADS Pacer is on and one of the following Attach pads for pacing.
occurs:
• No pads adaptor attached.
• Paddles attached.
• Internal paddles attached.

PADS OFF Pads adaptor cable is attached and a Attach pad for pacing. If pads
pad is off. are already applied to patient,
change to a new set of pads.

ATTACH Pads adaptor cable is attached. Attach the pacer pads.

PADS Charg is pressed and pads are
not attached. Pacer is pressed
and pads are not attached.

7-5
 Troubleshooting
Troubleshooting

Troubleshooting SpO2
Table 7-4 SpO2 Messages

Message Cause Possible Solutions

SPO2 FAILURE The unit detected a failure in

SpO2 subsystem hardware. Press SpO2 twice to
This failure does not affect On/Off
other parts of the instrument.
power cycle the SpO2 option.
If the error happens again,
call for service.

SPO2 SENSOR The sensor or adaptor cable is Replace the sensor or adaptor
FAIL broken. cable.

SPO2 CABLE OFF Sensor or cable is discon- Check SpO2 connections

nected. between CodeMaster XL+
and the sensor cable or adap-
tor cable.

Dashes appear on dis- Can’t derive measurement Check the patient for a pulse.
play instead of SpO2 because: Reapply the sensor, and make
reading. • The sensor is not on the sure it is correctly positioned.
patient. If it doesn’t work, replace the
• No pulse is detected. sensor.
• The sensor is incorrectly
positioned.
• The sensor is defective.

SPO2 NOISY Irregular pulse patterns. Reapply sensor.

SIGNAL Patient motion. Consider using a different
sensor site.

SPO2 LIGHT Too much interference from Reapply sensor.

INTERF external light. Turn off lights in the room.
Damage to sensor or adaptor If other options do not work,
cable. replace the sensor.

SPO2 LOW SIG- Bad connection to patient, or Check the patient for poor
NAL patient has poor perfusion. perfusion. Reapply disposable
and semi-disposable sensors.
Readjust reusable sensors.
Consider using a different
sensor site.

7-6
 Troubleshooting
Performing Diagnostics

7 Performing Diagnostics

The following procedure allows complete functional inspection of the CodeMaster

XL+ defibrillator/monitor.

1 Plug the power cord into an AC outlet. Verify that the BATT and
AC lights are on.

2 Turn the Energy Select control to the Monitor On position. The monitor trace
will appear within ten seconds.

3 Press Lead until Lead I is displayed and verify that the message LEADS
OFF appears, indicating that one or more leadwires are not connected.

4 Press Lead to return to the paddles ECG selection.

5 With the paper installed, press Recor once to turn on the recorder.
a. Allow the recorder to run for approximately 20 seconds and check that
Date, Time, HR (heart rate), PADDLES (ECG source), and AUTOGAIN
(ECG gain mode) are noted on the ECG strip.
b. Press Mark and verify that the mark (t) symbol is printed. It will be
delayed 6 seconds if the recorder is in the delayed mode.
c. Press Recor to stop the recorder.

6 Press HR . Verify that the configured alarm limits appear briefly, then
are replaced by the bell symbol bell in the upper right of the display. With no
ECG signal, an audible alarm tone should sound within four seconds.

7 Press HR to turn off the alarms.

8 Verify that the adult paddle electrodes are installed.

9 Turn the Energy Select control to 100 joules.

10 Leaving the paddles in their holders, press either Charge button.

m The Charge Done indicators should occur within two seconds when operated
with a fully charged battery.
m The Delivered Energy display should indicate 100 joules.

7-7
 Troubleshooting
Operational Checks

WARNING Keep hands clear of the paddle electrode edges. Use your thumbs
to depress the Shock buttons on the paddle handles.

11 Grasp the paddle handles, and without removing the paddles from their holders,
press both Shock buttons simultaneously. A brief automatic recorder run prints
the delivered energy test report.

12 Press Sync to place the instrument in Sync mode.

13 Verify that the messages SYNC and USE LEADS appear on the display.

14 Press Lead once to select Lead I, and verify that the message USE
LEADS no longer appears. The message LEADS OFF should now appear, indi-
cating that one or more leads are not connected.

15 Turn the Energy Select control to Off (Standby).

The defibrillator is ready for use if it passes the above checklist.

A more extensive test of defibrillator/monitor functionality can be performed using

the diagnostic service mode described in the M1722/M1723 CodeMaster XL Series
Defibrillator/Monitor Service Manual.

7 Operational Checks

These checks are intended to briefly verify the proper operation of the CodeMaster
XL+ defibrillator/monitor. Regularly perform a test routine incorporating the
following checks along with visual inspection of all cables, paddles, and controls.

Every Shift
Perform the following checks every shift.

7-8
Troubleshooting
Operational Checks

o Verify that the instrument is connected to AC power, and that the

BATT and AC lights are on.

o Check for adequate thermal paper in the recorder.

o Check for ECG leads, electrodes, and adequate REDUX® electrolyte paste or
defibrillator pads.

Every Day
o Visually check AC power cord for wear.

o Visually check the patient cables, paddles, cables, and pads adaptor cables for
wear, insulation nicks, and other damage.

o Ensure that the BATT and AC lights are on. If the unit is
plugged in and the AC light is not on, the power cord may have a
broken wire.

o Check that the BATT and AC lights go off when the unit is
unplugged.
o Perform the Delivered Energy and Shock Button Functional Test, which
follows.
o If your instrument has the external pacing option, perform the Quick Pacer
Functionality Test as described in Quick Pacer Functionality Test on page 7-
11.

Delivered Energy and Shock Button Functional Test

To check the instrument with the paddles, perform the following steps.

1 Turn the Energy Select control to the 100 joules position.

1 Verify that the adult paddle electrodes are installed.

2 Push the paddles completely into their holders (Apex paddle in right pocket,
Sternum in left) and press either Charge button. Wait for the Charge Done indi-
cators.

7-9
 Troubleshooting
Operational Checks

WARNING Keep hands clear of the paddle electrode edges. Use your thumbs
to depress the Shock buttons on the paddle handles.

3 With the paddles in their holders, grasp the paddle handles and press the Apex
paddle Shock button. Verify that the defibrillator does not discharge.

4 Release the Apex paddle Shock button, then press the Sternum paddle Shock
button. Verify that the defibrillator does not discharge.

5 Press Sync to place the defibrillator in sync mode.

6 Press and hold both Shock buttons. Verify that the defibrillator does not dis-
charge.

7 Press Sync again to remove the defibrillator from sync mode.

8 With the paddles in their holders, press and briefly hold both Shock buttons at
once.

9 The recorder will print a test report.

To check the instrument with the pads adaptor cable, perform the following steps.

1 Connect the Test Load (M1781A) to the Pads Adaptor Cable (M1750A/B).

2 Turn Energy Select to 100 joules.

3 Press Charge. Wait for the Charge Done indicators.

4 Press each Shock button independently. Verify that the defibrillator does not dis-
charge.

5 While depressing Charge, press and briefly hold both Shock buttons.

6 The recorder will print a test report.

7-10
 Troubleshooting
Operational Checks

NOTE Notify Service Personnel if the ECG strip prints TEST 100J FAILED or if any of
the Shock button tests fail.

7 Disconnect the Test Load (M1781A) from the Pads Adaptor Cable
(M1750A/B).

Quick Pacer Functionality Test

1 Connect the pads adaptor cable (M1750A/B) to the defibrillator and the test load
(M1781A) to the adaptor cable. Turn the unit on by turning the Energy Select
switch to Monitor On.

2 Press Pacer On (ignore the LEADS OFF message if it occurs).

3 Put the pacer into fixed mode by pressing Mode .

4 Adjust the pacer current to 30mA by pressing Output . Adjust the pacer rate
to 60ppm by pressing Rate .

5 Start the pacer by pressing Start/Sto , and start the recorder by pressing
Recor .

6 Verify that the pacer pulses are shown on the recorder strip approximately every
five large boxes (if the recorder is in delay mode it will take several seconds
before the pacer pulses appear). Allow the pacer to run for 10-12 seconds.

7 Turn the pacer off by pressing Pacer On and stop the recorder by pressing
Recor . Disconnect the test load (M1781A) from the adaptor cable.

Notify service personnel if:

• PACER FAILURE is displayed on the monitor.

• The unit beeps three times and displays PACER OUTPUT LOW.

• The pacer pulses are not shown on the recorder strip as described in the test.

7-11
Troubleshooting
Operational Checks

Every Week
Perform the following checks on the internal paddle set every week.

o Check for excessive residue from sterilization on the paddle set and clean as
needed. Oxidation can be an indication the paddle set is old and must be
replaced.

o Check for pitting or discoloration on the electrode surfaces. Polish or replace as

required.

o Ensure that the cable, connector, and electrodes have no cracks in the
insulation.

Every Three Months

Have the cable set tested for electrical continuity every three months.

Every Six Months

See the M1722/M1723 CodeMaster XL Series Service Manual for extensive
electrical, operational and safety tests to be performed by a qualified Biomedical
Equipment Technician (BMET) or equivalent service technician every three to six
months.

7-12
 8 Maintaining the Defibrillator

This chapter contains information about maintaining and cleaning the CodeMaster
XL+ defibrillator/monitor.

8 Changing the Recorder Paper

Figure 8-1

Changing the Recorder Paper

To change the recorder paper, perform the following steps.

1 Slide the recorder door to the right of the defibrillator as shown in Figure 8-1, on
page 8-1. The paper platen will tilt up.

2 Pull up on the plastic removal tag to remove the empty or low paper roll.

8-1
 Maintaining the Defibrillator
Cleaning the Recorder Printhead

3 Place a new roll of thermal paper (HP 40457C/D) in the recorder so that the
paper unrolls from the top of the roll and the grid faces down as it comes out of
the recorder.

4 Pull the end of the paper past the recorder platen.

5 While holding the recorder door open, (to the right) press the platen down over
the paper.

6 Allow the door to close over the platen roller.

8 Cleaning the Recorder Printhead

If the ECG strip has light or varying density printing, clean the printhead to remove
any possible buildup of paper residue.

To clean the printhead, perform the following steps.

1 Slide the recorder door to the right of the defibrillator. The paper platen will tilt
up.

2 Remove the paper roll.

3 Clean the printhead surface (above the brush) with rubbing alcohol and a cotton
swab.

4 Re-install the paper roll.

5 While holding the recorder door open, (to the right) press the platen down over
the paper.

6 Allow the door to close over the platen roller.

8-2
 Maintaining the Defibrillator
Maintaining the Battery

8 Maintaining the Battery

The sealed lead-acid battery used in the CodeMaster XL+ will provide optimum life
when the unit is continuously connected to AC power and fully charged after each
use. To fully charge a depleted battery requires 18 hours of continuous charge time.
Because it is not always possible to allow a full charge cycle between uses, the
CodeMaster XL+ was designed to charge a depleted battery to 90% of its capacity in
approximately two hours. However, battery capacity and battery life will be reduced
if the battery is not allowed to fully charge after each use. For improved battery life,
applications where the CodeMaster XL+ is used frequently between full charge
cycles, consider ways to decrease the number of instrument uses between full charge
cycles.

When the instrument is not plugged into AC power, some current is drawn from the
battery to maintain memory and startup logic. If the battery is to be stored for
extended periods (more than one month) without AC power, observe the caution in
Appendix A, Installing and Charging the Battery.

This battery was selected because it provides optimum performance and battery life
over a wide range of operating conditions. The life expectancy of this battery is
dependent on many variables, including temperature and usage. Periodically check
the battery capacity to determine whether to replace it. The battery capacity check is
described in the next section.

NOTE When plugged into AC power the CodeMaster XL+ will function normally with no
battery installed, however the time required to charge the defibrillator will increase.

WARNING If the CodeMaster XL+ is operated without a battery installed,

clearly mark that the instrument does not have a battery and
requires AC power to operate. When a CodeMaster XL+ has no
battery installed and is plugged into AC power, the front panel
AC light will be on, and the BATT light will be off.

8-3
Maintaining the Defibrillator
Maintaining the Battery

Battery Capacity Check

Perform the battery capacity check at least once every six months. If the battery is
frequently depleted without adequate time for full charge cycles, perform the check
more often.

A new battery will provide a minimum of 2.5 hours of monitoring time. Hewlett-
Packard recommends that you replace the battery when it fails to provide a
minimum of 2.5 hours of monitoring time or 10 minutes of Low Battery warning
time when starting from a fully charged battery.

To test the battery capacity, perform the following steps. This test will require up to
3.5 hours to perform (not including battery charge times). Allow 30 hours to test the
battery and have it ready for use again.

1 Charge the battery by plugging the instrument into AC power for eight hours.
Verify that the AC and BATT lights are on.

2 Verify that there is recorder paper in the recorder.

3 Depress Sync HR while turning the Energy Select control from Off
(Standby) to Monitor On. While pressing Sync , turn the Energy Select con-
trol from the Off position to the Monitor On position. The Setup/Diagnostic Ser-
vice menu will appear in a moment.

4 Press ECG Size to highlight the Test Battery diagnostic test.

5 Unplug the instrument from AC power (the AC and BATT

lights are off).

6 Press Lead to start the Battery Capacity Test.

m The starting battery voltage, the current battery voltage, the Monitor elapsed
time, and the Low Battery warning elapsed time will be displayed.
m When the test is finished, the recorder will print the final values of the displayed
results just prior to turning off the instrument.
m Replace the battery if the recorded value for elapsed monitor time is less than 2.5
hours or the value for elapsed Low Battery warning time is less than 10 minutes.

7 Turn the Energy Select control to the Off (Standby) position.

8-4
 Maintaining the Defibrillator
Cleaning Exterior Surfaces

8 Fully recharge the battery by plugging the instrument into AC power for 18
hours. Verify that the AC and BATT lights are on.

9 The instrument is now ready to be returned to service.

CAUTION The battery can be permanently damaged if left uncharged for a prolonged period.

Replacing the Battery

To install a new battery, perform the following steps:

1 Remove AC power from the instrument.

2 Place the instrument upside down on a workbench.

3 Turn the two battery compartment quarter-turn screws counter-clockwise.

4 Lift out the battery door.

5 Disconnect the battery connector and remove the battery.

6 Connect the new battery and slide it into the compartment.

7 Replace the battery door and secure it by turning the two retaining screws a
quarter-turn clockwise.

8 Perform the Battery Capacity Check above before placing instrument in service.

8 Cleaning Exterior Surfaces

The CodeMaster XL+ and its accessories are chemically resistant to common
hospital cleaning solutions and non-caustic detergents. The following list includes
some approved cleaning solutions.

o 90% Isopropyl alcohol (except adaptors and patient cable)

8-5
 Maintaining the Defibrillator
Cleaning and Sterilizing the Internal Paddles

o Soap and water

o Chlorine bleach (30 ml/l water)

o Ammonia-based cleaners

o Keep the outside of the instrument clean and free of dust and dirt. Clean the
paddles thoroughly to prevent build-up of dried electrolyte paste.

o Do Not allow any fluids to penetrate the instrument case. Avoid pouring fluid
on the unit while cleaning.

o Do Not use abrasive cleaners, or strong solvents such as acetone, or acetone-

based compounds.

o Clean the display screen carefully. It is especially sensitive to rough handling

and subject to scratching.

o Do not steam sterilize the monitoring leads, submerge them for prolonged
periods, or heat them above 50ºC. If metallic surfaces become oxidized, clean
them with a very light abrasive (toothpaste). Do not use highly abrasive
cleaners such as steel wool or silver polish.

o Do not steam or gas sterilize the external paddle set.

8 Cleaning and Sterilizing the Internal Paddles

o Clean the electrode surface and handle with standard hospital solution.

o Do not use acetone and ammonia-based cleaners.

o Use a small, soft brush with cleaning solution to clean any contamination from
the electrode surface and edges.

o Before sterilizing, clean any excessive residue which accumulates on the

handles or electrode surfaces.

8-6
Maintaining the Defibrillator
Cleaning and Sterilizing the Internal Paddles

Internal paddle sets can be sterilized using any of four different methods. Three of
these methods use steam sterilization, the fourth method uses Ethylene Oxide (EtO).
Although the internal paddle sets are constructed using the highest quality materials,
the severe conditions of steam sterilization will limit their useful life.

Hewlett-Packard Company provides the standard, 90 day consumables warranty on

the paddles. Since the useful life of these paddles is limited, replace them when
functionality or appearance is questionable. When using the sterilization procedures
described in this guide, the paddles will withstand approximately 200 sterilization
cycles. This will vary depending on the equipment and the process used.

Steam Sterilizing the Internal Paddles

Prevacuum Sterilization

Preparation Double wrapped in sterilization grade wrap

Exposure Temperature 132–135ºC (270–275ºF)
Exposure Time 3 minutes

Flash Sterilization

Preparation Unwrapped
Exposure Temperature 132–135ºC (270–275ºF)
Exposure Time 3 minutes

Gravity Sterilization

Preparation Double wrapped in sterilization grade wrap

Exposure Temperature 121–123ºC (250–254ºF)
Exposure Time 30 minutes

8-7
 Maintaining the Defibrillator
Supplies

Ethylene Oxide Sterilization

Temperature 54ºC ± 1ºC (130ºF ± 2ºF)

Relative Humidity 60% ± 20%
EtO Concentration 600 mg/L ± 30 mg/L 12/88 EtO
Exposure Time 1 hour 45 minutes
Aeration Time 18 hours

8 Supplies

The Hewlett-Packard warranty is only assured if you use Hewlett-Packard approved

accessories and replacement parts.

Battery

M1758A Battery assembly

Patient Cables

M1731A Patient cable 6-pin/3-wire AHA

M1732A Patient cable 5-wire/6-pin AHA
M1733A Patient cable 8-pin/3-wire AHA
M1734A Patient cable 5-wire/8-pin AHA
M1735A Patient cable 8-pin/3-wire IEC
M1736A Patient cable 5-wire/8-pin IEC
M1500A Trunk cable 3-wire/12-pin - AHA
M1605A Lead set 3-wire - AHA
M1510A Trunk cable 3-wire/12-pin - IEC
M1615A Lead set 3-wire - IEC
M1520A Trunk cable 5-wire/12-pin - AHA
M1625A Lead set 5-wire - AHA

8-8
Maintaining the Defibrillator
Supplies

M1530A Trunk cable 5-wire/12-pin - IEC

M1635A Lead set 5-wire - IEC

Power Cords

8120-1692 Continental Europe

8120-4464 Australia, New Zealand
8120-1703 United Kingdom, Ireland
8120-2957 Denmark
8120-1692 Italy
8120-5213 North America
8120-2296 Switzerland
8120-4600 South Africa

Paddles

M1740A Internal paddle adaptor

M1740B Internal paddle adaptor (yellow)
M1741A Switchless Internal paddle set 7.5cm diameter
M1742A Switchless Internal paddle set 6.0cm diameter
M1743A Switchless Internal paddle set 4.5cm diameter
M1744A Switchless Internal paddle set 2.8cm diameter *
M1784A Switched Internal paddle set, 7.5 cm diameter
M1785A Switched Internal paddle set, 6.0 cm diameter
M1786A Switched Internal paddle set, 4.5 cm diameter
M1787A Switched Internal paddle set, 2.8 cm diameter *
M1746A Anterior/anterior paddle set - PCI
M1746B Anterior/anterior paddle set (yellow) - PCI
M1747A Anterior/anterior paddle set - no PCI
M1747B Anterior/anterior paddle set (yellow) - no PCI
M1748A Anterior/anterior paddle set, EtO sterilizable - no PCI

*
Does not comply with IEC 601-2-4 standard for contact area.

8-9
Maintaining the Defibrillator
Supplies

Pads

M1749A Defibrillation/pacing pads

M1750A Pads adaptor
M1750B Pads adaptor (yellow)
M1781A Pads adaptor test load

Electrolyte (Redux®)

651-1008-050 Redux®

Paper

40457C/D Recorder paper

Cases

M1778A Carry case

M1779A Accessory pouch

Wall Mount Kit

M1722-80001 Wall mount hardware

8-10
 A Installation and Setup

1 Installation

The CodeMaster XL+ is ready for operation when the following tasks have been
properly performed:

o Install battery.

o Charge battery (for 24 hours).

o Install paper.

o Make sure that the paddle set connector is seated and locked.

o Select configuration settings; set date and time.

Line Voltage Settings

The defibrillator automatically adjusts to the line voltage that is supplied (from 100–
230 VAC ± 15% at 50/60 Hz). No manual setting or adjustment is required.

WARNING Use only three wire power cords with three-pronged grounded
plugs. Make sure that the outlet accepts the three-pronged plugs
and is grounded. Never adapt a three- pronged plug to fit a two-
pronged outlet.

Installing and Charging the Battery

To install the battery, refer to the battery replacement procedure in “Replacing the
Battery” (page 8-5). After installing the battery, connect the power cord to the back
of the defibrillator, then plug the cord into an AC outlet. The green AC
and BATT indicators on the front panel should light up. (The AC
indicator lights when the instrument is plugged into AC power; the BATT
indicator is on when the battery is installed and the instrument is plugged into AC
power.)

A-1
 Installation and Setup
Installation

NOTE To ensure full battery capacity, charge the battery for 24 hours following its
installation in the defibrillator.

The defibrillator operates from either battery or AC power.

Use only HP battery assembly M1758A.

WARNING To avoid the possibility of hazardous electrical shock, unplug the

instrument from the AC power source before installing or
replacing the battery.

CAUTION If the defibrillator will be stored for longer than one month without AC power, first
charge the battery for 48 hours, then remove the battery from the unit. Note on the
instrument that the battery has been removed. Store the battery in a cool, dry
location. Recharge a stored battery for at least 24 hours every six months. This will
ensure that the battery does not completely discharge while in storage. The battery's
shelf life is longer with cooler temperatures, but the battery must not be stored
below freezing. After an extended storage period, the battery should be tested using
the “Battery Capacity Check” (page 8-4).

A-2
 Installation and Setup
Installation

Figure 1-1

Battery

Battery compartment

Battery plug

Battery

Installing the Battery

Loading the Recorder Paper

The defibrillator recorder uses two-inch wide, thermal paper (HP 40457C/D). To
load the paper, refer to the procedure in “Changing the Recorder Paper” (page 7-1).

Connecting Paddles and Patient Cables

The defibrillator has a paddles connector for attaching pads/paddles sets and an
ECG Input connector for attaching leads.

Paddles Connector

A-3
Installation and Setup
Installation

The defibrillator connector accepts external paddles, external adhesive pads, or

internal paddles.

Connecting Paddles or Pads To connect external paddles, internal paddles, or

adhesive pads to the defibrillator, perform the following steps:

1 Slide the paddle connector lock on the paddles plug to the unlock position. To
do this, push the lock towards the top of the connector.

2 Insert the paddles/pads adaptor cable plug into the paddles connector on the
defibrillator, as shown in Figure 7-1 on page 7-1.

3 Slide the paddle connector lock to the lock position, to latch the plug in place.

A-4
 Installation and Setup
Installation

Figure 1-2

Paddles plug in paddles connector

Connector lock
Push the lock in the direction
indicated by the arrow to move the
lock to the lock position (shown).

Connecting External Paddles, Adhesive Pads, or Internal Paddles

ECG Input Connector

The ECG Input connector on the defibrillator is a 6-, 8-, or 12-pin connector,
depending on the option purchased with the instrument. For each connector option,
several different patient cables can be used for various ECG sources and
applications.

Refer to Table 3-1, “Cardiac Monitoring Configurations,” on page 3-1 for a list of
available patient cables and lead sets, and their part numbers.

A-5
 Installation and Setup
Installation

NOTE 3 wire = RA, LA, LL

5 wire = RA, RL, LA, LL + V (C)

Connecting a Patient Cable The 3-wire or 5-wire patient cable connects to the ECG
Input connector located on the front of the defibrillator, behind the carrying handle.
The patient cable plug has 6- , 8-, or 12-pins. Before installing the patient cable,
make sure that the pin count of the patient cable plug matches the pin count of the
ECG Input connector. To install the patient cable:

1 Align the keyed cable plug with the slot in the ECG Input connector. See Figure
1-3 on page A-7.

2 Push the cable plug firmly into the ECG Input connector.

NOTE When a lead is selected for monitoring, the message LEADS OFF appears on the
display if the patient cable falls off or is incorrectly connected. Also, a dashed line
appears on the display in place of an ECG trace.

A-6
 Installation and Setup
Setup

Figure 1-3

ECG Input connector with key slot

Keyed plug of patient cable

Connecting a Patient Cable

1 Setup

To configure the CodeMaster XL+ you must use the setup menus. Table 1-1, “Setup
Menu 1 Settings,” on page A-9 and Table 1-2, “Setup Menu 2 Settings,” on page A-
10 list the choices you can make on the setup menus. Perform the following steps to
configure the CodeMaster XL+.

A-7
Installation and Setup
Setup

1 Depress Sync HR while turning the Energy Select control from Off
(Standby) to Monitor On. A menu will appear with the following choices.
CALIBRATE DEFIB
SETUP MENU 1
SETUP MENU 2
RESTORE FACTORY SETTINGS
PRINT LOG
TEST DEFIB
TEST ECG
TEST CRT
TEST RECORDER
TEST CONTROLS
TEST INDICATORS
TEST BATTERY
TEST PACER

2 Select SETUP MENU 1 by pressing ECG Size until the highlight appears
on SETUP MENU 1 .

3 Press Lead . SETUP MENU 1 will appear with the current setup values
displayed.

4 Press ECG Size or ECG Size until the highlight appears on the value
you wish to change.

5 Press Lead .

6 Press ECG Size or ECG Size to scroll through the available choices for
this parameter.

7 When the choice you want is displayed, press Lead to set your choice.

8 Press ECG Size or ECG Size until the highlight appears on the next
value you wish to change.

9 Repeat steps 5 through 8 until you are finished configuring the settings in setup
menu 1.

10 Depress both sides of the ECG Size key at once to return to the setup/diag-
nostic menu.

A-8
 Installation and Setup
Setup

NOTE You must depress both sides of the ECG Size key at the same time to return to the
setup/diagnostic menu.

11 To change settings in setup menu 2, select SETUP MENU 2 from the setup/
diagnostic menu and repeat the above steps.

12 Turn the Energy Select control to Off (Standby) to leave setup/diagnostic mode.
You can use the factory setting for most values by selecting
RESTORE FACTORY SETTINGS from the setup/diagnostic menu.

WARNING The setting values can have critical impact on how your
defibrillator operates.

If the CodeMaster XL+ loses your configuration settings, it will

display the message SETUP LOST on the screen and use the factory
settings for all setup values. To clear the SETUP LOST message, go
to setup menu 1 or setup menu 2. The "Setup Lost" condition will
be cleared when you view the setup menus. You do not have to
change the values if you want to keep the factory settings.

Table 1-1, “Setup Menu 1 Settings,” on page A-9 and Table 1-2, “Setup Menu 2
Settings,” on page A-10 show configurable parameters on the instrument.

Table 1-1 Setup Menu 1 Settings

Setting Choices Description

Language English, Dutch, Swedish, French, German, Printed and displayed text language
Italian, Spanish, Finnish, Danish, Norwegian

Upper Alarm 120, 140, 160, 20 to 280 in increments of 5 Upper heart rate limits LAL to 280
Limits (UAL)

Lower Alarm 40, 60, 90, 20 to 280 in increments of 5 Lower heart rate limits 20 to UAL
Limits (LAL)

A-9
 Installation and Setup
Setup

Table 1-1 Setup Menu 1 Settings

Setting Choices Description

Time HH:MM Current time

Date DD MMM YY Current date

Armed Tone ON, OFF Beep on Charge done

CRT Alerts ON, OFF Beep on alert message

Alert Volume 3 to 15 Alerts volume

Mode after CV SYNC, DEFIB Specifies mode after cardioversion

Pacer Rate (pacer 70 (ppm), 40 to 180 in increments of 10 Sets the pacer rate and the initial power-on
option only) default rate.

Pacer Output 30 (mA), 30 to 200 in increments of 10 Sets the pacer current and the initial power-on
(pacer option default pacer current.
only)

Table 1-2 Setup Menu 2 Settings

Setting Choices Description

Recorder Delay Delay 6s, No Delay Printout is delayed 6 seconds or immediate

Recorder BW Monitor, Diagnostic Bandwidth (recorder only)

Record on Mark ON, OFF Records during mark

Record on Charge ON, OFF Records during charge

Record on Shock ON, OFF Records during discharge

Record on Alarms ON, OFF Records during alarms.

Post Shock Data ON, OFF ON prints the delivered energy statistics.
OFF prints Energy Select control setting.

Power On Lead PADDLES, LEAD I, LEAD II, LEAD III Sets the ECG monitoring source that
appears when you turn on the instrument.

Patient Cable 3 WIRE, 5 WIRE

Notch Filter 60 HZ, 50 HZ, ON, OFF

A-10
 Installation and Setup
Specifications

Table 1-2 Setup Menu 2 Settings

Setting Choices Description

ECG Trace SWEEP, SCROLL ECG trace style.

1 Specifications

Defibrillator
Waveform: Damped sinusoidal (Lown).

Output Energy (Delivered): 2, 3, 5, 7, 10, 20, 30, 50, 70, 100, 150, 200, 300, and
360 joules.

Charge Control: Push-button on apex paddle and on front panel.

Charge Time: Less than 5 seconds to 360 joules with battery present. Less than 15
seconds to 360 joules on AC only.

Armed Indicators: Charge done tone, charge done lamp on apex paddle, and
available energy indicated on display.

Paddle Contact Indicator: 3-color LED bar graph array on STERNUM paddle
indicates quality of defibrillator paddle contact before discharge.

Paddles: Standard paddles are anterior/anterior, adult and pediatric. Adult

electrodes (83 cm sq) slide off to expose pediatric electrodes (21 cm sq). Paddle cord
is 10 ft (3 m). Full range of internal paddles available.

Synchronizer: SYNC message appears on monitor and is annotated periodically on

recorder while in synchronous mode. An audible beep sounds with each detected R-
wave, while a marker on the monitor and sync designator on the recorder strip
indicate the discharge point.

Environmental Operating Conditions: 0 to 55 deg C, 15 to 95% relative humidity,

15,000 ft altitude.

A-11
Installation and Setup
Specifications

Environmental Storage Conditions: -20 to 70 deg C, 90% relative humidity for 24

hours at 65 deg C, 15,000 ft altitude.

Monitor
Inputs: ECG may be viewed through paddles or patient cable. Lead I, II, III, or
PADDLES selectable. Additional leads (avR, avF, AvL, V Leads) and PADS are
available. Monitor and recorder indicate selected ECG source.

Lead Fault: LEADS OFF message and dashed baseline appear on monitor if a lead
becomes disconnected.

Common Mode Rejection: Greater than 100 dB measured as per AAMI standards
for cardiac monitors (EC13).

Display Size and Type: 5 inch (12.7 cm) diagonal CRT for 4 seconds of ECG data
on screen; non-fade, fixed trace. Scrolling trace is selectable.

Sweep Speed: 25 mm/sec nominal.

Frequency Response: 0.5 to 40 Hz.

Heart Rate Display: Digital readout on monitor from 15 to 300 BPM.

Heart Rate Alarms: Three configurable pairs of high and low heart rate alarm limits
from 20 to 280 BPM.

ECG Output: 1V/mV.

Patient Cable Length: 10 ft (3 m).

Thermal Array Recorder

Event Summary: Stores and prints 3 seconds pre- and 8 seconds post-critical event
data for up to 28 events. Data retained after unit is turned off.

Annotates: Time, date, HR, event marker, ECG mode, defibrillator mode, selected
energy, actual delivered energy, peak current, and patient impedance.

Speed: 25 mm/sec.

A-12
Installation and Setup
Specifications

Paper Size: 50 mm by 30 m (100 ft).

Recorder Mode: Automatically documents events and ECG during defibrillation

episodes. The recorder can be configured to run in either real time or with a six-
second delay.

Frequency Response: 0.5 to 40 Hz or 0.05 to 150 Hz selectable.

Size and Weight

Dimensions: 7.9 in H by 11.8 in W by 15.6 in L (20 cm H by 30 cm W by 39.7 cm
L).

Weight: 24 lbs (10.9 kg). Includes external paddles, battery, and recorder paper.

Battery
Type: Rechargeable sealed lead-acid battery. 4 Ah, 12 V nominal.

Charge Time: 2 hours to 90% of full capacity. 18 hours to 100% capacity.

Repeated charging to less than 100% will reduce useful life of battery.

Capacity: 2 1/2 hours monitoring or fifty (50) full-energy discharges or 1 hour

monitoring and recording.

Battery Indicators: Illuminated LED indicates battery is charging. LOW BATTERY

message appears on monitor when limited battery capacity remains.

AC Input: 100 to 230 VAC +/-15%, 50 to 60 Hz.

External Pacemaker (Optional)

Current Pulse Amplitude: 30 mA to 200 mA.

Pulse Width: 20 msec.

Rate: 40 ppm to 180 ppm.

Modes: Demand or fixed rate.

A-13
Installation and Setup
Specifications

Refractory Period: 40 to 80 ppm 340 msec; 90 to 180 ppm 240 msec.

SpO2 (Optional)
Measurement Range: 0 to 100%.

Accuracy with HP M1190A sensor: 1 standard deviation, 65-80%: ±2.5%, 80-

100%: ±1.5%, resolution: 1%.

Averaging: 8 beats.

SpO2 alarm limits — range: 100/90, 100/85, 100/80.

SpO2 alarm delay: ten seconds after value drops below the low alarm setting.

INOP alerts: Triggered by disconnected sensor, noisy signal, light interference or

low signal.

Pulse rate measurement range: 30 to 300 bpm ± 1%; resolution 1 bpm.

Pulse amplitude indicator: Indicates pulsatile activity.

A-14
 Installation and Setup
Calling for Service

1 Calling for Service

United States

Eastern Region Western Region

Tel: 1-800-245-4406 Tel: 1-800-428-0949

Southern Region Midwestern Region

Tel: 1-800-845-8374 Tel: 1-800-323-2280

Canada

Eastern Region Central Region

Tel: 1-800-361-9790 Tel: 1-800-387-3900

Western Region
Tel: 1-800-661-5626

Other International Areas

European Headquarters France

Hewlett-Packard S.A. Hewlett-Packard France S.A.
150 Route du Nante d'Avril Parc d'activite du Bois Briard
P.O. Box CH-1217, Meyrin 2 2, avenue du Lac
Geneva, Switzerland F-91040 Evry Cedex
Tel: 22 838-111 Tel: (1)60 77 83 83

Austria, Eastern Europe, Germany

Yugoslavia Hewlett-Packard GmbH
Hewlett-Packard Ges.m.b.H Hewlett-Packard-Strasse
Lieblgasse 1 D-6380 Bad Homburg
P.O. Box 72 Tel: 0 61 72/400-0
A-1222 Vienna
Tel: 222/25 00-0

Belgium Mediterranean and Middle

Hewlett-Packard Belgium SA/ East
NV Hewlett-Packard S.A.
Boulevard de la Woluwe, 100 Atrina Center
Woluwedal 32, Kifissias Ave.
B-1200 Brussels Paradissos-Amaroussion GR-
Tel: 2/761 31 11 Athens 15125
Tel: 1/682 88 11

A-15
 Installation and Setup
Calling for Service

Other International Areas

Netherlands Spain
Hewlett-Packard Nederland Hewlett-Packard Espanolas
B.V. S.A.
Startbaan 16 Crta. de la Coruna
1187 XR Amstelveen km 16, 400
P.O. Box 667 Las Rozas
NL-11 8O AR Amstelveen E-Madrid
Tel: 20/547 69 11 Tel: 1/637 00 11

Norway Sweden
Hewlett-Packard Norge A/S Hewlett-Packard Sverige AB
P.O. Box 34 Skalholtsgatan 9, Kista
Osterndalen 16-18 Box 19
N-1345 Osteras S-163 93 Spanga
Tel: 2/24 60 90 Tel: 8/750 20 00

Denmark United Kingdom

Hewlett-Packard A/S Hewlett-Packard Limited
Kongevejen 25 Harman House
DK-3460 Birkerod No. 1 George Street
Tel: 2/81 66 40 Uxbridge Middlesex UB8
1YH
Tel: 895/720 20

Finland Italy
Hewlett-Packard OY Hewlett-Packard Italiana
Piispankalliontie 17 S.p.A.
02200 Espoo Via G. di Vittorio, 9
Tel: 0/887 21 20063 Cernusco S/N (MI)
Tel: 2/92 36 91

A-16
 6 SpO2 Monitoring (Optional)

SpO2 monitoring gives information on both cardiac and respiratory systems, and
details of oxygen transportation in the body. It is widely used because it is non-
invasive, continuous, easily applied and painless.

The quality of SpO2 measurements depends on careful application of the sensor.

Read the following section, “Application Notes” (page 6-1), to understand the
importance of sensor application. For more detailed information, refer to SpO2
Concepts (HP part number M1722-93950).

You can use the SpO2 monitor with sensors made by other manufacturers as well as
with HP sensors. For a list of approved sensors, see the Sensor Guide (HP part
number M1722-93970).

SaO2 and SpO2

Hewlett-Packard is adopting the convention of referring to the SpO2 parameter.
Previously it was referred to as SaO2.

SaO2 is the term used to indicate the oxygen saturation of arterial blood.

SpO2 is the term used to indicate the oxygen saturation of arterial blood as
measured by pulse oximetry.

6 Application Notes

The pulse oximetry method used for measuring SpO2 uses LEDs (light emitting
diodes) to transmit red and infrared light through suitable peripheral areas of the
body, typically the foot in neonates or the finger in adults. The oxygen saturation is
gauged by measuring the "redness" of the blood in the arterial pulse.

A photodetector positioned opposite the light emitter compares light absorption

before and after pulsation to provide measurements that are displayed on the
monitor. If there is no pulse, measurements cannot be made. See the following
figure.

6-1
 SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

Figure 6-1

Positioning of the Light Emitters and Photodetector

For accurate measurements, the following conditions must apply:

o All transmitted light must pass through the extremity to the detector.

o The patient must have at least a minimum pulse.

o The light emitter and the photodetector must be opposite each other.

6 Using SpO2 to Monitor a Patient

There are three types of sensors:

Disposable Disposable sensors should be used once only and

then discarded. However, they can be relocated to
a different application site on the patient if the
first location does not give the desired results.
Disposable sensors must not be reused on differ-
ent patients.

6-2
SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

Semi-Disposable Semi-disposable sensors can be reused, but the

adhesive wrap must be discarded after each use.
Semi-disposable sensors are recommended for
single-patient use only.

Reusable Reusable sensors can be reused on different

patients.

Before you start SpO 2 monitoring:

1 Estimate the patient’s weight, and determine the best site for the sensor.

2 Use the Sensor Guide to select the correct type and size of sensor for the identi-
fied location.

3 Prepare the sensor:

m Disposable: Remove protective backing.
m Semi-Disposable: Apply a new adhesive wrap to the sensor.

4 Apply the sensor to the identified location.

5 Connect the sensor to the monitor. To connect sensors from other manufacturers
you need the HP M1900B Connector Cable.

Apply the Sensor to the Patient

HP supports the use of many sensors. Use the Sensor Guide to find the sensor which
is best for your case. Follow the manufacturer’s guidelines for applying and using
the sensor.

6-3
 SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

Application of the Reusable Sensor

Figure 6-2

Application of the HP M1190A Reusable Sensor

Push the sensor over the fingertip so the cable lies on the back of the hand, and
secure the cable to the wrist with the wrist-strap supplied. Make sure the finger is
not pinched in the end of the sensor. This ensures that the light sources in the sensor
lie over the base of the fingernail, giving the best measurement results. If the sensor
is not in the correct position, inaccurate readings result. In extreme cases, the
instrument displays dashes instead of an SpO2 reading. When correctly positioned,
the end of the finger just touches the end of the sensor.

CAUTION When non-HP SpO2 sensors are used, application must be consistent with the
manufacturer's own guidelines.

WARNING Prolonged, continuous monitoring may increase the risk of

undesirable changes in skin characteristics, such as irritation,
reddening, blistering or pressure necrosis, particularly on
neonates and on patients with impaired perfusion and varying or
immature skin morphology. Specific attention must be given to
sensor site inspection for changes in skin quality, proper optical

6-4
SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

path alignment and attachment. Check the application site at

regular intervals — at least every two hours — and change the site
if any compromise in skin quality should occur. More frequent
checking may be required due to an individual patient's condition.

Troubleshooting Sensor Application

Failure to apply the sensor properly may cause incorrect measurement of arterial
oxygen saturation.

Do not use a damaged sensor or one with exposed electrical circuits.

Patient Movement

Make sure that the application site chosen does not move excessively, which may
adversely affect the performance of the sensor. You may have to replace the sensor
to ensure good adhesion, or you may have to choose another application site.

Inspecting the Application Site

Inspect the SpO2 sensor site at least once every 2 hours to ensure adhesion, skin
integrity, and correct alignment of the light emitter and photodetector. Should
alterations of skin integrity occur, remove the sensor and reapply at another
recommended site. Avoid application of the sensor to edematous or fragile tissue.
Check circulation distal to the sensor site routinely.

Circulation at Application Site

Wrapping the tape too tightly, or using supplemental tape, can cause venous
pulsations that could potentially lead to inaccurate saturation measurements.
Therefore, do not wrap the adhesive too tightly and do not use additional tape to
secure the sensor. High positive intrathoracic airway pressures, valsalva maneuvers,
or other consequences of impaired venous return may also cause venous pulsations.

Only use adhesive wraps recommended by Hewlett-Packard.

6-5
 SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

Avoid placing the SpO2 sensor on any extremity with an arterial catheter, blood
pressure cuff, or intravascular venous infusion line.

Connect the Sensor to the CodeMaster XL+

When you have applied the sensor to the patient, plug the disposable and semi-
disposable sensors into the connector cable and plug this cable into the SpO2 socket
on the lower right of the CodeMaster XL+. Plug the HP M1190A sensor directly
into the SpO2 socket of the CodeMaster XL+. The plug is keyed and is color-coded
blue to distinguish it from the white ECG socket.

Figure 6-3

SpO2 input

Connecting the SpO2 Sensor to the CodeMaster XL+

CAUTION Do not force the SpO2 connector into the ECG input socket. Doing so may damage
the pins on the cable connector.

6-6
 SpO2 Monitoring (Optional)
Using SpO2 to Monitor a Patient

Start Monitoring
Turn the defibrillator on, if necessary, by turning the Energy Select control to

Monitor On. Press the SpO2 button to display the SpO2 reading in the upper
On/Off
right corner of the display.

SpO2 Readings

Figure 6-4

HR
LEAD I I
SpO2 reading SPO2
PR 72
Pulse rate

Pulse amplitude indicator

CodeMaster XL+ display with SpO2 reading

The pulse amplitude indicator shows the quality of the SpO 2 signal. Since it is
derived from the patient’s plethysmograph signal, it varies with the pulse of the
patient. If the patient has a very low signal the pulse amplitude indicator does not
vary through its full range. If the signal is noisy, the pulse amplitude indicator does
not vary rhythmically with the pulse.

6-7
 SpO2 Monitoring (Optional)
SpO2 Alarms

The pulse rate is derived from the pulse oximeter. It should correlate closely with
the patient’s heart rate.

6 SpO2 Alarms

Activating SpO2 Alarms

There are three preset high/low SpO2 alarm limits: 100/90, 100/85 and 100/80. Press

the SpO2 button repeatedly to cycle through the alarm options and the no-
Alarm

alarm option. Stop when you see the alarm you would like to choose and after three

seconds that alarm will take effect. A symbol replaces the limits to show that

the alarm is active. To review the limit set, press the SpO2 button.
Alarm

If the SpO2 level falls below the low alarm limit, an alarm sounds and the violated
limit is highlighted.

NOTE SpO2 alarms are automatically turned off when you press Charge .

Deactivating SpO2 Alarms

Press the SpO2 button. The symbol to the right of the SpO 2 display
Alarm

indicates that the alarms are off.

6-8
SpO2 Monitoring (Optional)
SpO2 Alarms

Recorder Output
After an alarm event, the recorder prints a strip. The bottom of the strip shows the
alarm violation, and the top of the strip shows the SpO2 reading.

You may print an event summary record, which contains SpO2 information, as
described in “Printing the Event Summary Record” (page 3-8).

6-9
SpO2 Monitoring (Optional)
SpO2 Alarms

6-10