OpsManual - (Capnostream20P) - 015458 - RMS1C01

Capnostream®20p
Portable Bedside Monitor

Capnograph/Pulse Oximeter
Operator’s Manual
PN: 015458_RMS1C
0482
Notice: Purchase of this product confers no express or implied license under any Oridion Medical 1987 Ltd.
patent to use the instrument with any accessory that is not manufactured or licensed by Oridion Medical 1987
Ltd.
Possession or purchase of this device does not convey an express or implied license to use the device with
unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of
one or more of the patents relating to this device.
Oridion®, Microstream®, FilterLine, Smart CapnoLine®, CapnoLine®, Smart BiteBloc™, NIV Line™,
CapnoBloc™, Smart CapnoLine Guardian™, SARA™, Integrated Pulmonary Index™, Capnostream®20p,
Microcap®, Microcap® Plus, and VitalCap® are trademarks or registered trademarks of Oridion Medical 1987
Ltd.
Nellcor Puritan Bennett LLC is a Covidien company.
The following are trademarks of Nellcor Puritan Bennett LLC: Oxiband™; Durasensor™; OxiCliq®; Dura-Y™;
Max-Fast™ and OXIMAX™.
The capnography component of this product is covered by: US Patents: www.covidien.com/patents.
The pulse oximetry component of this product is covered by: US Patents: www.covidien.com/patents.
Exemptions
Oridion Medical 1987 Ltd.'s liability under this warranty does not include any transportation damage or other
charges or liability for direct, indirect or consequential damages or delay resulting from improper use or
application of the product or the substitution upon it of parts or accessories not approved by Oridion Medical
1987 Ltd.
All information in this manual is believed to be correct. Oridion Medical 1987 Ltd. shall not be liable for errors
contained herein with the performance or use of this manual.
Copyright © 2014 Oridion Medical 1987 Ltd. All rights reserved.

Table of Contents
Table of Contents 1
List of Figures 8
List of Tables 9
Oridion Medical 1987 Ltd. ("Oridion Medical") - Warranty for
Oridion Monitors 10
11
Safety Information 11
Warnings ....................................................................................................................... 11
General....................................................................................................................................... 11
MRI Scanning............................................................................................................................. 12
Monitor Use with Defibrillators ................................................................................................... 12
Alarms ........................................................................................................................................ 12
Fire Hazard................................................................................................................................. 12
Electrical ..................................................................................................................................... 13
Electro-magnetic Interference .................................................................................................... 13
Definitions ..................................................................................................................... 14
Chapter 1 15
About this Manual 15
Overview ....................................................................................................................... 15
Intended Use ................................................................................................................. 15
Specific Indications for Use ........................................................................................... 16
Who Should Read This Manual ..................................................................................... 16
Contacting Technical Support ....................................................................................... 16
Symbols ........................................................................................................................ 16
Chapter 2 18
Technology Overview 18
Introduction ................................................................................................................... 18
Features ........................................................................................................................ 18
Technology Overview .................................................................................................... 18
What is Capnography? .............................................................................................................. 18
What is Pulse Oximetry? ............................................................................................................ 19
Chapter 3 21
The Capnostream Monitor 21
Unpacking and Inspection ............................................................................................. 21
Installing the Battery Pack ............................................................................................. 22
Portable Bedside Capnograph/Pulse Oximeter 1

Testing the Battery and AC Connections................................................................................... 23
Handling the Battery Pack ......................................................................................................... 23
Storing the Battery ..................................................................................................................... 24
Disposing of the Battery ............................................................................................................. 24
Battery and Power Usage .......................................................................................................... 24
Mounting the Monitor..................................................................................................... 25
Setting up Periodic Maintenance................................................................................... 25
Accessories ................................................................................................................... 25
Available Accessories ................................................................................................................ 25
Monitor Mounting Plate .............................................................................................................. 26
Printer Paper .............................................................................................................................. 26
Buttons, Indicators and Connections ............................................................................. 26
Monitor Front View ..................................................................................................................... 27
Front Panel Control Buttons .......................................................................................... 28
Monitor Rear Panel .................................................................................................................... 29
Monitor Left and Right Views ..................................................................................................... 30
Turning on the Monitor .................................................................................................. 30
Standard Sections of the Display Screen ...................................................................... 31
Home Screen Standard Display................................................................................................. 32
Home Screen Numeric Display .................................................................................................. 36
Terminating Operation of the Monitor ............................................................................ 37
Screen Navigation ......................................................................................................... 37
Configuration Changes .............................................................................................................. 38
Setting Date, Time, Language, and Other Options ....................................................... 38
Screen Timeouts ........................................................................................................... 39
Screen Timeouts ........................................................................................................................ 39
Capnostream®20p: Operational Check Sheet ................................................................ 40
Chapter 4 42
Using the Capnostream Monitor 42
Preparing the Monitor for a Patient ............................................................................... 42
Setting the Patient Type ............................................................................................................. 42
Using Patient Cases and Patient ID Numbers............................................................... 43
Entering Patient Events ................................................................................................. 45
Changing the Alarm and Pulse Volumes ....................................................................... 45
Alarm Volume ............................................................................................................................. 45
Pulse Tone Volume .................................................................................................................... 46
Alarm Volume Default Options................................................................................................... 46
Alarm Delay ................................................................................................................... 47
Use of Scavenging System ........................................................................................... 47
Turning the Pump Off for Suction or Lavage ................................................................. 47
Demo Mode................................................................................................................... 48
Monitor Screen Menu Reference Chart ......................................................................... 48
2 Portable Bedside Capnograph/Pulse Oximeter

Chapter 5 51
Capnography with the Capnostream Monitor 51
Microstream® EtCO2 Consumables ............................................................................... 51
Basic Principles .......................................................................................................................... 51
Microstream® EtCO2 Consumables ........................................................................................... 52
Connecting a FilterLine ................................................................................................. 52
CO2 Data Displayed by the Capnostream Monitor ........................................................ 52
Adjustable CO2 Parameters .......................................................................................... 53
Monitoring CO2 during MRI Scanning ........................................................................... 54
Chapter 6 55
Pulse Oximetry with the Capnostream Monitor 55
Nellcor SpO2 Sensors ................................................................................................... 55
Data Update Period, Data Averaging, and Signal Processing .................................................. 56
Selecting Nellcor SpO2 Sensors ................................................................................................ 56
Performance Considerations ..................................................................................................... 57
Connecting an SpO2 Sensor to the Monitor................................................................... 58
SpO2 Data Displayed by the Capnostream Monitor ...................................................... 58
Adjustable SpO2 Parameters......................................................................................... 60
SPO2 Alarm Limit Message ........................................................................................... 60
Chapter 7 61
Integrated Pulmonary Index™ 61
Introduction ................................................................................................................... 61
Warnings ....................................................................................................................... 62
IPI Display ..................................................................................................................... 62
IPI Options .................................................................................................................... 62
Chapter 8 63
Apneas per Hour and the Oxygen Desaturation Index 63
Introduction ................................................................................................................... 63
Apneas per Hour ........................................................................................................... 63
The Capnostream Apneas per Hour .......................................................................................... 63
A/hr Visual Alert ......................................................................................................................... 64
Oxygen Desaturation Index (ODI) ................................................................................. 64
Apnea and O2 Desaturation Report .............................................................................. 64
Monitoring with A/hr and ODI ........................................................................................ 64
Smart A/hr and ODI Home Screen Display ................................................................... 65
A/hr and ODI Option ...................................................................................................... 65
A/hr and ODI Demo Mode ............................................................................................. 65

Chapter 9 66
Alarms and Messages 66
Introduction ................................................................................................................... 66
Alarm Display ................................................................................................................ 67
Message Priorities ......................................................................................................... 69
Alarm Delay ................................................................................................................... 69
Types of Alarms ............................................................................................................ 69
High Priority Alarms ................................................................................................................... 70
Medium Priority Alarms .............................................................................................................. 71
Advisories ................................................................................................................................... 72
Silent Advisories ......................................................................................................................... 72
Parameter Standby Mode ............................................................................................. 73
Alarm Silence ................................................................................................................ 75
Changing Alarm Limits .................................................................................................. 76
Testing Alarm Settings .................................................................................................. 77
SpO2 Alarms and SatSeconds ...................................................................................... 77
SatSeconds Alarm Display ........................................................................................................ 78
Alarm Limits - Factory Defaults ..................................................................................... 79
Chapter 10 80
Using Trends 80
Introduction ................................................................................................................... 80
The Trend Display Screens ........................................................................................... 81
Graphical Trend Display Screen ................................................................................... 81
Graphical Trend Display............................................................................................................. 81
Using SCROLL and ZOOM ........................................................................................................ 82
Tabular Trend Display Screen....................................................................................... 84
Choosing Trend Parameters ......................................................................................... 86
Important Notes Regarding Trend Reports ................................................................... 86
Specific Events as seen in Trend Data.......................................................................... 86
Using the Graphical Trend Screen for Monitoring Patients ........................................... 86
Printing the Trend Data ................................................................................................. 86
Clearing Trend Memory................................................................................................. 87
Configuring Trends........................................................................................................ 87
Event Marking Mode .................................................................................................................. 88
Trend Graphical Display............................................................................................................. 88
Trend Increment Display ............................................................................................................ 88
Chapter 11 89
Reports 89
Apnea and O2 Desaturation Report ............................................................................... 89
Printed Report Options .................................................................................................. 93
Printed Reports ............................................................................................................. 93
Sample Reports............................................................................................................. 97
Sample Case Reports ................................................................................................................ 97
Sample Trend Reports ............................................................................................................... 98
Chapter 12 99
Downloading Patient Data 99
Introduction ................................................................................................................... 99
Data Transfer via the USB Data Port ............................................................................ 99
USB File Naming Convention .................................................................................................. 102
Examples.................................................................................................................................. 102
USB Error Messages ............................................................................................................... 103
Reading Patient Data from Saved Capnostream Files............................................................ 103
Data Transfer via the RS-232 Port .............................................................................. 103
Analog Data Output with Capnostream ....................................................................... 103
Nurse Call Operation ................................................................................................... 103
Types of Nurse Call Systems ...................................................................................... 104
The Nurse Call Cable ............................................................................................................... 104
Activating Nurse Call ................................................................................................................ 105
Testing Nurse Call.................................................................................................................... 105
Operation with Hospital Patient Data Systems ............................................................ 106
Operation with Nuvon VEGA Systems ........................................................................ 106
Chapter 13 107
Maintenance and Troubleshooting 107
Introduction ................................................................................................................. 107
Determining Monitor Service Hours............................................................................. 107
CO2 Calibration ........................................................................................................... 108
CO2 Calibration Check ................................................................................................ 109
Calibration Check Procedure ................................................................................................... 109
Maintenance ................................................................................................................ 110
Replacing the Fuses.................................................................................................... 110
Replacing the Printer Paper Roll ................................................................................. 111
Cleaning ...................................................................................................................... 111
Troubleshooting........................................................................................................... 112
Electrical ................................................................................................................................... 112
CO2 Problems .......................................................................................................................... 112
SpO2 Sensor ............................................................................................................................ 113
Printer ....................................................................................................................................... 113
Nurse Call................................................................................................................................. 114
CO2 Calibration ........................................................................................................................ 114
Returning the Monitor .................................................................................................. 114
Technical Assistance................................................................................................... 114

Appendix 1 115
Institutional Settings 115
Institutional Defaults .................................................................................................... 115
Changing Institutional Defaults.................................................................................... 115
Resetting to Factory Defaults ...................................................................................... 116
Uploading or Downloading Institutional Defaults ......................................................... 116
Changing Monitor Settings .......................................................................................... 117
Alarm Limits.............................................................................................................................. 117
Alarm Delay .............................................................................................................................. 119
Trend Settings .......................................................................................................................... 119
Changing Parameters Order on the Trend Display ................................................................. 119
Events ...................................................................................................................................... 120
How to Change Event Defaults ................................................................................................ 120
Monitor Settings ....................................................................................................................... 120
CO2 Parameters ....................................................................................................................... 122
SpO2 Parameters ..................................................................................................................... 122
Appendix 2 123
Specifications 123
Power Supply .............................................................................................................. 123
Battery ......................................................................................................................... 123
Controls ....................................................................................................................... 123
Display ........................................................................................................................ 124
Microstream® Capnography ........................................................................................ 124
Nellcor Oximax® Pulse Oximetry ................................................................................. 125
Alarms ......................................................................................................................... 125
Outputs........................................................................................................................ 125
Analog Output .......................................................................................................................... 125
Nurse Call................................................................................................................................. 126
RS-232 ..................................................................................................................................... 127
USB .......................................................................................................................................... 127
Internal Thermal Printer (optional) ............................................................................... 127
General Characteristics ............................................................................................... 128
Equipment Classification ............................................................................................. 128
Compliance ................................................................................................................. 128
Electromagnetic Immunity ........................................................................................................ 128
Appendix 3 132
Microstream EtCO2 Consumables 132
Microstream EtCO2 Consumables............................................................................... 132

Appendix 4 134
Capnostream Service Password 134
Capnostream Service Password ................................................................................. 134

List of Figures
Figure 1 - Installing the Battery Pack ................................................................................................... 22
Figure 2 - Battery Pack Close-up ......................................................................................................... 22
Figure 3 - Menu Bar with Battery Charge Level ................................................................................... 23
Figure 4 - Monitor Bottom View ............................................................................................................ 25
Figure 5 - Capnostream Front View ..................................................................................................... 27
Figure 6 - Front Panel Control Buttons ................................................................................................ 28
Figure 7 - Capnostream Rear View ...................................................................................................... 29
Figure 8 - Capnostream Left View........................................................................................................ 30
Figure 9 - Salutation Screen ................................................................................................................. 31
Figure 10 - Typical Home Screen......................................................................................................... 32
Figure 11 - Typical Home Screen when A/hr and ODI are not Available ............................................ 33
Figure 12 - Standard Home Screen without IPI Option ....................................................................... 34
Figure 13 - Header Area ....................................................................................................................... 34
Figure 14 - Typical Numeric Home Screen .......................................................................................... 36
Figure 15 - System Setup Screen ........................................................................................................ 39
Figure 16 - Menu Bar............................................................................................................................ 46
Figure 17 - Alarm Volume Selection..................................................................................................... 46
Figure 18 - Pulse Tone Volume Selection............................................................................................ 46
Figure 19 - Scavenger System Connection Point ................................................................................ 47
Figure 20 - Screen Menu Reference Chart when A/hr and ODI are available .................................... 49
Figure 21 - Screen Menu Reference Chart when A/hr and ODI are not available .............................. 50
Figure 22 - CO2 Data on the Capnostream Monitor............................................................................. 52
Figure 23 - CO2 Section of Numeric Home Screen ............................................................................. 53
Figure 24 - SpO2 Data on the Capnostream Monitor - Standard Screen ............................................ 59
Figure 25 - SpO2 Data on the Capnostream Monitor – Standard Screen with IPI Disabled ............... 59
Figure 26 - SpO2 Section of Numeric Home Screen ............................................................................ 60
Figure 27 - IPI Trend Graph ................................................................................................................. 61
Figure 28 - Capnostream Alarm Review Screen ................................................................................. 68
Figure 29 - Example Showing Alarms .................................................................................................. 70
Figure 30 - Alarm Limits Screen ........................................................................................................... 76
Figure 31 - Graphical Trend Display .................................................................................................... 81
Figure 32 - Scroll mode in the Graphical Trend ................................................................................... 83
Figure 33 - Tabular Trend Display........................................................................................................ 84
Figure 34 - Trend Memory Message .................................................................................................... 87
Figure 35 - Apnea and Desat Report Screen ....................................................................................... 91
Figure 36 - Apnea and Desat Printed Report ....................................................................................... 92
Figure 37 - Print Screen ....................................................................................................................... 94
Figure 38 - Sample Case Reports Printout .......................................................................................... 97
Figure 39 - Printed Trend Reports........................................................................................................ 98
Figure 40 - Typical Flash Memory Device.......................................................................................... 100
Figure 41 - USB Icon .......................................................................................................................... 101
Figure 42 - Stereo Phono Plug for Nurse Call.................................................................................... 104
Figure 43 - Connection Point for Nurse Call ...................................................................................... 105
Figure 44 - Service Screen ................................................................................................................. 108
Figure 45 - Insert Paper Roll into printer ............................................................................................ 111
Figure 46 - Institutional Defaults Screen ............................................................................................ 116
Figure 47 - Software Support Screen ................................................................................................. 117
Figure 48 - Institutional Defaults Alarm Limits Screen ....................................................................... 118
Figure 49 - Institutional Defaults: Monitor .......................................................................................... 121
List of Tables
Table 1 - Symbols that Appear on the Monitor .................................................................................... 16
Table 2 - Capnostream Accessories .................................................................................................... 25
Table 3 - Printer Paper Specifications.................................................................................................. 26
Table 4 - Capnostream Front View ...................................................................................................... 28
Table 5 - Capnostream Rear View ....................................................................................................... 29
Table 6 - Capnostream Left View......................................................................................................... 30
Table 7 - Header Section ..................................................................................................................... 34
Table 8 - Event Markings ..................................................................................................................... 45
Table 9 - Audio Alarm Volume ............................................................................................................. 46
Table 10 - Adjustable CO2 Parameters ................................................................................................ 54
Table 11 - Nellcor SpO2 Sensors ......................................................................................................... 56
Table 12 - Adjustable SpO2 Parameters .............................................................................................. 60
Table 13 - Adjustable IPI Options ........................................................................................................ 62
Table 14 - Alarm Indications................................................................................................................. 66
Table 15 - High Priority Alarms ............................................................................................................ 70
Table 16 - Medium Priority Alarms ....................................................................................................... 71
Table 17 - Advisories ............................................................................................................................ 72
Table 18 - Silent Advisories.................................................................................................................. 72
Table 19 - Message and Alarm Status during Different Parameter Standby Situations ..................... 75
Table 20 - Tabular Display Example .................................................................................................... 85
Table 21 - Detailed Tabular Display Example...................................................................................... 85
Table 22 - Monitor Parameters............................................................................................................. 87
Table 23 - Printed Reports – Parameters ............................................................................................ 94
Table 24 - Data Transfer Types ........................................................................................................... 99
Table 25 - Select Data Output Type................................................................................................... 101
Table 26 - File Naming Conventions .................................................................................................. 102
Table 27 - Nurse Call Specs .............................................................................................................. 104
Table 28 - Nurse Call Indicators ......................................................................................................... 105
Table 29 - Factory Default Alarm/Indicator Limits .............................................................................. 118
Table 30 - Factory Default and Optional Alarm Delay Settings ......................................................... 119
Table 31 - Factory Default and Optional Trend Settings ................................................................... 119
Table 32 - Guidance and Manufacturer's Declaration - Electromagnetic Emissions ........................ 129
Table 33 - Guidance and Manufacturer’s Declaration – Electromagnetic Immunity ......................... 129
Table 34 - Recommended Separation Distances between Portable and Mobile RF
Communications Equipment and the Monitor .......................................................................... 131

Oridion Medical 1987 Ltd. ("Oridion Medical") -
Warranty for Oridion Monitors
THIS LIMITED WARRANTY applies to any patient monitor manufactured by Oridion Medical 1987 Ltd.
(“Oridion”), (“Products”). Subject to the limitations herein, Oridion warrants that Products, when delivered by
Oridion or its authorized distributor, for two (2) years following the delivery date, but no more than 27 months
following the date of production, will be free from defects in material and workmanship and will substantially
conform to published Oridion specifications for the respective Products and in effect at the time of manufacture.
This limited warranty excludes (i) Products purchased through unauthorized third parties; (ii) Products that have
been subject to misuse, mishandling, accident, alteration, neglect, unauthorized repair or installation; and (iii)
Products that have been used with accessory consumable products other than Oridion’s FilterLine® products.
Furthermore, this limited warranty shall not apply to the use of Products in an application or environment that is not
within Oridion specifications or in the event of any act, error, neglect or default of Customer. Oridion at its sole
discretion will replace or repair the damaged Products. Customer may not return Products without first obtaining a
customer return material authorization (RMA) number from Oridion or one of the Authorized Service centers and a
copy of the Product purchase invoice.
Disclaimer
USER MAY USE THE PARAMETERS (INCLUDING ANY AND ALL REFERENCES TO CO2, SPO2,
CURRENT INTEGRATED PULMONARY INDEX™ AND FUTURE AND RELATED INDICES AND
CONFIGURATIONS AND SIGNAL ALARM NOTIFICATIONS) WHICH APPEAR ON ORIDION'S PATIENT
MONITORING DEVICES AND/OR ORIDION’S COMMUNICATION PROTOCOL AND/OR ANY OUTPUT
IN REPORTS DOWNLOADED FROM ORIDION'S PATIENT MONITORING DEVICES TO PRINTERS OR
USB MEMORY STICKS OR APPROVED SYSTEMS ("DATA") SOLELY AND EXCLUSIVELY FOR THE
PURPOSE OF PATIENT CARE. USER ACKNOWLEDGES THAT DATA TRANSMITTED FROM
ORIDION'S PATIENT MONITORING DEVICES MAY NOT BE TRANSFERRED, INTERFACED,
EXCHANGED OR OTHERWISE TRANSMITTED AND THAT ORIDION ACCEPTS NO RESPONSIBILITY
WHATSOEVER FOR THE ACCURACY OR COMPLETENESS OF DATA THAT HAS BEEN
TRANSFERRED, INTERFACED, EXCHANGED OR OTHERWISE TRANSMITTED. USER FURTHER
ACKNOWLEDGES THAT IT MAY NOT SELL, LICENSE OR OTHERWISE COMMERCIALIZE THE DATA,
IN WHOLE OR IN PART. ANY OTHER USE OF THE DATA OR INTERFACE WITH OTHER SYSTEMS,
WHETHER BY USER OR ANY PARTY ON ITS BEHALF, SHALL BE SUBJECT TO A SEPARATE
LICENSING ARRANGEMENT WITH ORIDION INCORPORATING, BUT NOT LIMITED TO,
COMMERCIAL TERMS TO BE NEGOTIATED IN GOOD FAITH.
USER ACKNOWLEDGES AND UNDERSTANDS THAT THE DATA IS PROVIDED “AS-IS” AND THAT
ORIDION DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WARRANTIES OF
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. ORIDION WILL NOT BE LIABLE
FOR ANY INJURIES OR DAMAGES TO ANY PERSONS OR TANGIBLE OR INTANGIBLE PROPERTY
RESULTING FROM ANY CAUSE WHATSOEVER. ORIDION DISCLAIMS ANY AND ALL LIABILITY
FOR DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR OTHER SIMILAR DAMAGES
REGARDLESS OF THE FORM OF ACTION WHETHER IN CONTRACT, TORT (INCLUDING
NEGLIGENCE), STRICT PRODUCT LIABILITY OR ANY OTHER LEGAL OR EQUITABLE THEORY,
EVEN IF ORIDION HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES OR DAMAGES.

Do not touch this field - it is invisible and does not appear in the
final document
Safety Information
Warnings
Definitions
To use the Capnostream®20P monitor (henceforth referred to as Capnostream) correctly and safely, carefully
read this operator’s manual and the Directions for Use that accompany Microstream® etCO2 consumables
(FilterLines®, henceforth referred to as FilterLines) and the SpO2 sensors. Use of the monitor requires full
understanding and strict observance of these instructions, the precautionary information in boldface type, and
the specifications.
Warnings
General
WARNING: If uncertain about the accuracy of any measurement, first check the patient’s vital signs by
alternate means, and then make sure the monitor is functioning correctly.
WARNING: The device should not be used as an apnea monitor.
WARNING: The device should be considered an early warning device. As a trend towards patient
deoxygenation is indicated, blood samples should be analyzed by a laboratory co-oximeter
to completely understand the patient's condition.
WARNING: To ensure patient safety, do not place the monitor in any position that might cause it to fall
on the patient.
WARNING: Carefully route patient cabling (SpO2 sensor and FilterLine) to reduce the possibility of
patient entanglement or strangulation.
WARNING: Do not lift the monitor by the SpO2 sensor cable or FilterLine, as they could disconnect
from the monitor, causing the monitor to fall on the patient.
WARNING: The monitor should not be used adjacent to or stacked with other equipment; if adjacent or
stacked use is necessary, the monitor shall be observed to verify normal operation in the
configuration in which it will be used.
WARNING: To ensure accurate performance and prevent device failure, do not expose the monitor to
extreme moisture, such as rain.
WARNING: The use of accessories, transducers, sensors and cables other than those specified may result
in increased emission and/or decreased immunity of the equipment and/or system.
WARNING: Re-use of single-use accessories could pose a cross-contamination risk to the patient or
damage the functioning of the monitor.
WARNING: CO2 readings, respiratory rate, pulse oximetry readings, and pulse signals can be affected by
sensor application errors, certain ambient environmental conditions, and certain patient
conditions.
WARNING: The monitor is a prescription device and is to be operated by qualified healthcare personnel
only.
WARNING: No modification of this equipment is allowed.

Warnings
WARNING: If calibration does not take place as instructed in the relevant service manual, the monitor
may be out of calibration. A monitor that is out of calibration may provide inaccurate
results.
Note: Devices connected to the monitor must be medical grade only.
Note: The accurate display of the following parameters is required in order to fill the essential performance of
the device: Carbon dioxide levels in expired breath (CO2) and respiration rate when monitoring with
capnography, and arterial oxygen saturation of blood (SpO2) and Pulse rate when monitoring with pulse
oximetry. If the patient is being monitored with both functions, all of these parameters will be displayed.
MRI Scanning
WARNING: Do not use oximetry sensors during magnetic resonance imaging (MRI) scanning.
Conducted current could cause burns. The sensors may affect the MRI image, and the MRI
unit may affect the accuracy of oximetry measurements.
WARNING: Do not use the FilterLine H Set Infant/Neonatal during magnetic resonance imaging (MRI)
scanning. Using the FilterLine H Set Infant/Neonatal during MRI scanning could harm the
patient.
CAUTION: During MRI scanning, the monitor must be placed outside the MRI suite. When the monitor
is used outside the MRI suite, etCO2 monitoring can be implemented using the FilterLine
XL. (Refer to Monitoring CO2 during MRI Scanning on page 54.
CAUTION: Use of a CO2 sampling line with H in its name (indicating that it is for use in humidified
environments) during MRI scanning may cause interference. The use of non-H sampling
lines is advised. For a list of H sampling lines, see Microstream EtCO2 Consumables on
page 132.
Monitor Use with Defibrillators

WARNING: All cables and tubing, including SpO2 sensors and CO2 sampling lines, should be kept clear
of the defibrillator and its electrodes, and should not run between, adjacent to, or
overlapping the electrodes and the electrode wires, in order to reduce potential interference
between the monitor and defibrillation equipment.
WARNING: All SpO2 sensors must be completely intact and undamaged, in order to enable use of a
defibrillator with the monitor.
Alarms
WARNING: Do not silence the audible alarm if patient safety may be compromised.
WARNING: Always respond immediately to a system alarm since the patient may not be monitored
during certain alarm conditions.
WARNING: Before each use, verify that the alarm limits are appropriate for the patient being monitored.
WARNING: Check the audible alarm silence duration before temporarily silencing the audible alarms.
WARNING: Auditory alarm signal sound pressure levels which are less than ambient sound levels can
impede operator recognition of alarm conditions.
CAUTION: Setting alarm limits to extreme values may impair the alarm system’s effectiveness.
Fire Hazard
WARNING: When using the monitor with anesthetics, nitrous oxide or high concentrations of oxygen,
connect the gas outlets to a scavenger system.
WARNING: The monitor is not suitable for use in the presence of flammable anesthetic mixture with air,
oxygen or nitrous oxide.

Warnings
WARNING: The FilterLine may ignite in the presence of O2 when directly exposed to laser, ESU
devices, or high heat. When performing head and neck procedures involving laser,
electrosurgical devices or high heat, use with caution to prevent flammability of the
FilterLine or surrounding surgical drapes.
Electrical
WARNING: To protect against electric shock hazard, the monitor’s cover is to be removed only by
qualified service personnel. There are no user-serviceable parts inside.
WARNING: To ensure patient electrical isolation, connect only to other equipment with circuits that are
electrically isolated.
WARNING: Connect the device only to a three-wire, grounded, hospital grade receptacle. The three-
conductor plug must be inserted into a properly wired three-wire receptacle; if a three-wire
receptacle is not available, a qualified electrician must install one in accordance with the
governing electrical code. Do not under any circumstances remove the grounding connector
from the power plug. Do not use extension cords or adapters of any type. The power cord
and plug must be intact and undamaged. To avoid the risk of electric shock, this equipment
must only be connected to a supply mains with protective earth.
WARNING: Ensure that the monitor is positioned so that its mains plug is accessible for immediate
disconnection from supply mains, when needed.
WARNING: If there is any doubt about the integrity of the protective earth conductor arrangement,
operate the device on internal battery power until the AC power supply protective
conductor is fully functional.
WARNING: Do not connect to an electrical outlet controlled by a wall switch or a dimmer.
WARNING: Measure the device's leakage current whenever an external device is connected to the serial
port. Leakage current must not exceed 100 microamperes.
WARNING: To avoid risk of electric shock, this equipment must only be connected to a supply mains
with protective grounding.
WARNING: Whenever the equipotential ground at the back of the device (reference Figure 7 -
Capnostream Rear View on page 29) is to be used, the user must connect to the pin in a way
which will ensure that accidental disconnection is avoided.
WARNING: In a facility which provides detachable potential equalization conductors, the Equipotential
ground at the back of the device (reference Figure 7 - Capnostream Rear View on page 29)
may be used for optional connection between the Capnostream and the potential
equalization busbar of the electrical installation. The Equipotential ground at the back of the
device should not be used for a protective earth connection.
WARNING: Always connect power cord to the device first, and then plug the power cord into the wall
outlet.
CAUTION: Electrical installation of the room or the building in which the monitor is to be used must
comply with regulations specified by the country in which the equipment is to be used.
CAUTION: Keep power cord, plug and socket clear in case an urgent power supply disconnection is
required.
Electro-magnetic Interference
This device has been tested and found to comply with the requirements for medical devices according to the
standard EN60601-1-2. This standard is designed to provide reasonable protection against harmful interference
in a typical medical installation.
However, because of the proliferation of radio-frequency transmitting equipment and other sources of electrical
noise in healthcare environments (for example: cellular phones, mobile two–way radios, electrical appliances),

Definitions
it is possible that high levels of such interference due to close proximity or strength of a source may result in
disruption of performance of this device.
WARNING: Operating high frequency electrosurgical equipment in the vicinity of the monitor can
produce interference in the monitor and cause incorrect measurements.
WARNING: Do not use the monitor with nuclear spin tomography (MRT, NMR, NMT) as the function
of the monitor may be disturbed.
Definitions
Note: A Note is inserted to point out procedures or conditions which may otherwise be misinterpreted or
overlooked and to clarify apparently contradictory or confusing situations.
Caution: A Caution is inserted to call attention to a procedure which, if not followed exactly, can lead to
damage or destruction of the equipment.
Warning: A Warning is inserted to call attention to dangerous or hazardous conditions inherent to the
operation, cleaning, and maintenance of the equipment which may result in personal injury or death of the
operator or patient.

final document
Chapter 1
About this Manual

Overview
Intended Use
Specific Indications for Use
Who Should Read This Manual
Contacting Technical Support
Symbols
Overview
This manual provides directions for setting up and operating the Capnostream monitor.
The Capnostream is a portable bedside monitor that continuously monitors a patient’s:
• End tidal carbon dioxide (etCO2) - level of carbon dioxide in exhaled breath.
• Respiratory rate (RR).
• Fractional inspired carbon dioxide (FiCO2) - level of carbon dioxide present during inhalation.
• Oxygen saturation (SpO2).
• Pulse rate (PR).
The device also provides an Integrated Pulmonary Index™ (henceforth referred to as IPI) value, which is a
numerical value that integrates four major parameters measured by Capnostream in order to provide a simple
indication of the patient’s ventilatory status. The integrated parameters are etCO2, RR, SpO2, and PR. Only
these four parameters are used to calculate IPI; other parameters are not taken into account.
In addition, the device provides the Apneas per Hour (A/hr) and an Oxygen Desaturation Index (ODI), used to
help in the identification and quantification of apnea and oxygen desaturation events for patients over age 22, as
follows:
• A/hr: a count of the number of pauses in breathing (of at least 10 seconds) which the patient experienced,
either over the past hour (on the Home screen) or average pauses per hour over a period of time (on the
Apnea and O2 Desaturation screen).
• ODI: the number of times that the SpO2 value dropped 4% or more from baseline and returned to baseline
in 240 seconds or less, either in the last hour (on the Home screen) or average pauses per hour over a
period of time (on the Apnea and O2 Desaturation screen).
The A/hr and ODI indices are not available in all locations. In order to equip your device with the A/hr and ODI
feature, contact [email protected].
Intended Use
The Capnostream®20p combined capnograph/pulse oximeter monitor and its accessories are intended to provide
professionally trained health care providers with continuous, non-invasive measurement and monitoring of
carbon dioxide concentration of the expired and inspired breath and respiration rate, and with continuous non-
invasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate. It is intended
for use with neonatal, pediatric, and adult patients in hospitals, hospital-type facilities, and intra-hospital
transport environments.
Capnostream®20p is to be operated by qualified healthcare personnel only.

The Capnostream®20p monitor provides the clinician with an integrated pulmonary index (IPI). The IPI is based
on four parameters provided by the monitor: end tidal carbon dioxide, respiration rate, oxygen saturation and
pulse rate. The IPI is a single index of an adult or pediatric patient's ventilatory status displayed on a scale of
1 - 10, where 10 indicates optimal pulmonary status. IPI monitoring displays a single value that represents the
patient's pulmonary parameters and alerts clinicians to changes in the patient's pulmonary status.
The IPI is an adjunct to, and is not intended to replace, vital sign monitoring.

An additional indication of the monitor is to provide information to help in the identification of apnea and
oxygen desaturation events in adult patients (age 22 and up) in hospital ICU and general floor environments,
through the reporting of these events and calculation of the associated apnea per hour (A/hr) and oxygen
desaturation index (ODI).
Who Should Read This Manual

This manual should be read by:
• Health Care Professionals who will be using Capnostream.
• Equipment managers responsible for ensuring that equipment conforms to institutional policies.
• Researchers or laboratory personnel who will be downloading patient data.
• Technical experts who will be connecting Capnostream to a computer via the RS-232 interface.
WARNING: In the United States, federal law restricts this device to sale by or on the order of a
physician.
Contacting Technical Support

For any technical issue involving the Capnostream monitor, please contact Oridion Technical Support, as
follows:
North America: Tel: 1-888-ORIDION (674-3466), Fax: (781) 453-2722; Outside North America:
Tel: + (972) 2-589-9104, Fax: + (972) 2-582-8868; E-mail: [email protected].
Symbols
The following symbols appear on the body of the monitor.
Table 1 - Symbols that Appear on the Monitor

Symbol Description
Monitor ON/OFF button
AC power ON indicator
UNIT ON indicator
Event selection
Patient Admit/Discharge

Symbols
Symbol Description
Pump Off
Temporarily silence
alarms
Type BF Defibrillator
Proof Protection
General warning sign
Gas inlet
Gas outlet
Equipotential ground
USB flash memory

connection port
CE Mark
For prescription use only
Directive on waste
electrical and electronic
equipment
Follow instructions for

use

Introduction
Symbol Description
Chapter
2
Technology Overview
Introduction
Features
Technology Overview
Introduction
The Capnostream bedside monitor provides accurate, continuous capnography and pulse oximetry monitoring
for intubated and non-intubated patients from neonate to adult. Using Microstream® technology, patented
FilterLine® etCO2 consumables, and pulse oximetry technology, Capnostream allows for simultaneous "hassle
free" etCO2 and SpO2 monitoring.
Features
• Dual parameter monitor that supports the current standard of care providing CO2 and SpO2 measurements
• Integrated Pulmonary Index™ (IPI), which provides a simple, clear, and comprehensive indication of a
patient’s ventilatory status and trends
• Apneas per Hour and Oxygen Desaturation Index, indices used to help in the identification and
quantification of apnea and oxygen desaturation events (if available)
• Simple user interface with color screen
• Routine functions are accessed with 2 clicks
• 72 hour trends to review patient history
• One-click alarm review
• SARA™ (Smart Alarm for Respiratory Analysis), an embedded Smart Capnography alarm management
technology, which reduces clinically insignificant alarms
• Event marking to compare events and medication administration to changes in patient status
• Case recording to help organize patient files
• Nurse call
• Optional internal printer
• USB output to transfer patient data to USB flash memory devices
• Analog output for use in sleep labs and other laboratory environments
• RS-232 port for data transfer
Technology Overview
This section provides a basic overview of Capnography and Pulse Oximetry.
What is Capnography?
Capnography is a non-invasive method for monitoring the level of carbon dioxide in exhaled breath (etCO2) to
assess a patient’s ventilatory status.

Technology Overview
Capnostream uses Microstream® non–dispersive infrared (NDIR) spectroscopy to continuously measure the
amount of CO2 during every breath, the amount of CO2 present at the end of exhalation (etCO2), the amount of
CO2 present during inhalation (FiCO2), and the Respiratory Rate.
Infrared spectroscopy is used to measure the concentration of molecules that absorb infrared light. Because the
absorption is proportional to the concentration of the absorbing molecule, the concentration can be determined
by comparing its absorption to that of a known standard.
The Microstream® etCO2 consumables deliver a sample of the inhaled and exhaled gases from the ventilator
consumable or directly from the patient (via an oral/nasal cannula) into the monitor for CO2 measurement.
Moisture and patient secretions are extracted from the sample, while maintaining the shape of the CO2
waveform.
The 50 ml/min. sampling flow rate reduces liquid and secretion accumulation, decreasing the risk of obstruction
in the sample pathway in humid ICU environments.
Once inside the Microstream® CO2 sensor, the gas sample goes through a micro-sample cell (15 microliters).
This extremely small volume is quickly flushed, allowing for fast rise time and accurate CO2 readings, even at
high respiration rates.
The Micro Beam IR source illuminates the micro-sample cell and the reference cell. This proprietary IR light
source generates only the specific wavelengths characteristic of the CO2 absorption spectrum. Therefore, no
compensations are required when different concentrations of N2O, O2, anesthetic agents and water vapor are
present in the inhaled and exhaled breath. The IR that passes through the micro-sample cell and the IR that
passes through the reference cell are measured by the IR detectors.
The microprocessor in the monitor calculates the CO2 concentration by comparing the signals from both
detectors.
What is Pulse Oximetry?

Pulse oximetry is based on the following:
• The difference in the absorption of red and infrared light (spectrophotometry) by oxyhemoglobin and
deoxyhemoglobin
• Changes in the volume of arterial blood in tissue during the pulse cycle (plethysmography), and hence,
light absorption by that blood.
A pulse oximeter determines Spot Oxygen Saturation (SpO2) by passing red and infrared light into an arteriolar
bed and measures changes in light absorption during the pulsatile cycle. Red and infrared low power light
emitting diodes (LEDs) in the oximetry sensor serve as light sources; a photodiode serves as the photo detector.
Because oxyhemoglobin and deoxyhemoglobin differ in light absorption, the amount of red and infrared light
absorbed by blood is related to hemoglobin oxygen saturation. To identify the oxygen saturation of arterial
hemoglobin, the monitor uses the pulsatile nature of arterial flow. During systole, a new pulse of arterial blood
enters the vascular bed and blood volume and light absorption increase. During diastole, blood volume and light
absorption reach their lowest point. The monitor bases its SpO2 measurements on the difference between
maximum and minimum absorption (measurements at systole and diastole). The focus of light absorption by
pulsatile arterial blood eliminates the effects of nonpulsatile absorbers such as tissue, bone, and venous blood.

final document
Chapter 3
The Capnostream Monitor

Unpacking and Inspection
Installing the Battery Pack
Mounting the Monitor
Setting up Periodic Maintenance
Accessories
Buttons, Indicators and Connections
Front Panel Control Buttons
Turning on the Monitor
Standard Sections of the Display Screen
Home Screen Numeric Display
Terminating Operation of the Monitor
Screen Navigation
Setting Date, Time, Language, and Other Options
Screen Timeouts
®
Capnostream 20p: Operational Check Sheet
This chapter describes the physical components of the monitor and how to set up the monitor so it is ready for
use.
The Capnostream®20p Operational Check Sheet is provided at the end of this chapter to simplify the installation,
setup, and getting started processes. Photocopy the Check Sheet from the manual and check off the steps on the
Check Sheet as you set up the monitor.
Unpacking and Inspection

Unpack the monitor and check all the components before performing any further procedures.
 TO UNPACK AND INSPECT THE MONITOR:
1. Carefully remove the Capnostream monitor and the accessories from the box.
2. Check that the items on the enclosed packing list are included:
• Capnostream Monitor
• Operating Manual
• Two 3.15 Amp Type F fuses
• FilterLine Starter Kit
• Mains Electrical Power Cord
• SpO2 Sensor Pack
• SpO2 Extension Cable
• Printer Paper Roll (one installed and one extra roll)
• Battery Pack
• CD with additional documentation (RS-232 Capnostream Data Transfer Protocols, the Patient Data
Transfer Application Note, and this manual in additional languages)
3. Inspect each component.
If any component is damaged or missing, contact your local representative.

Note: When unpacking the monitor, packaging waste shall be disposed of as according to local regulations for
the disposal of packaging waste.

WARNING: The unit should always be operated with the battery installed in order to provide back-up
power in the event of a momentary or temporary power outage.
The monitor operates on AC power or on a battery. It is equipped with a rechargeable Lithium–Ion battery pack.
To install the battery pack, open the battery cover on the side of the monitor as shown below.
Battery
Connection
Socket
Restraining lever
Battery
Compartment
Door
Figure 1 - Installing the Battery Pack

 TO INSTALL THE BATTERY PACK:
1. Slide the two release latches on the battery compartment door inward and open the battery compartment
door.
2. While holding the battery pack with the wires on the right, rotate the restraining lever up to the horizontal
position and place the battery pack in the monitor.
3. Push the battery pack all the way in.
4. Hold the battery pressed in and lock it in position by returning the restraining lever to the vertical position.
5. Attach the battery connector into the battery connection socket, ensuring that the side with the protruding
grooves is on the right, so that the connector fits into the socket. Push the wires back into the monitor.
Restraining lever
Battery
Connection
Socket
Figure 2 - Battery Pack Close-up
6. Align the flaps on the battery compartment door with the slots in the monitor casing, close the door, and
slide the two release latches outward.

Ensure that the battery pack is fully charged before using the monitor without AC power. A fully charged
battery pack provides 2.5 hours of operation (without printer usage). When the monitor is connected to the AC
mains, the battery pack charges automatically. It takes approximately 12 hours to fully charge an empty battery
pack.
When you start using the monitor, verify that the battery icon at the bottom left of the monitor screen indicates
that the battery is full. Refer to Testing the Battery and AC Connections below for details.
If no battery pack is installed during monitor setup, the No Battery icon will appear on the screen and the
advisory message NO BATTERY INSTALLED will appear.
WARNING: It is recommended to always have a battery installed. If the battery is not installed, the unit
will operate properly on AC power, but if AC power is lost for any reason the monitor will
not work.
WARNING: To replace the battery, first turn off the monitor and then unplug the unit from AC power.
Do not attempt to disconnect or connect a battery while the unit is turned on or connected to
AC power.
Note: If the battery is not fully charged, the battery icon will indicate the charge level of the battery.
Testing the Battery and AC Connections

The battery pack charge level and AC power connections should be confirmed before each use.
 TO TEST THE BATTERY:
1. Press the ON/OFF button to turn on the monitor.
2. Observe the battery icon level in the bottom left hand corner of the screen.
Battery Charge
Level Indicator Figure 3 - Menu Bar with Battery Charge Level
3. If you have previously fully charged the battery, the battery icon should indicate that the battery is full.
Note: As part of the monitor power-up, the battery charge level indicator will show full for about 15 seconds
after the monitor is turned on. The monitor will then update the battery charge level indicator to show the
true battery level.
Recharge the battery pack when the advisory message BATTERY LOW appears on the display screen. To
recharge the battery, make sure that the monitor is plugged into the AC mains. The orange AC power indicator
on the front panel of the monitor will light up.
For normal operation, always check that the orange AC power indicator light is on during monitor use. This will
ensure the battery is charged during use and the monitor is prepared in case of a power outage or a patient
transfer. If a patient has to be transferred to another location, the unit can be unplugged and transferred with the
patient. Care should be taken to reconnect the monitor to the AC mains following the transfer.
Handling the Battery Pack

CAUTION: Do not immerse the battery pack in water; it may malfunction.
CAUTION: Recharge the battery pack only in the monitor to avoid possible heating, burning or rupture
of the battery pack.

Storing the Battery

The battery pack must be stored in a cold, dry area, not inside the monitor. Its charge decreases over time. To
restore the battery pack to full power, recharge the battery before use. The battery should be fully recharged
every 3 months at minimum. Store at -20 to 25°C.
CAUTION: Storage or transport of the monitor under environmental conditions beyond those mentioned
in the specification will affect monitor performance and damage the battery and/or the
monitor.
Disposing of the Battery

CAUTION: Do not dispose of the battery pack in fire; it may explode.
Follow local governing ordinances and recycling instructions regarding disposal or recycling of batteries.
Battery and Power Usage

If power is lost when the monitor is operating from AC power, it automatically switches to the internal battery
pack for power. The duration of this backup power usage, based onbattery capacity, is up to 2.5 hours. The
monitor maintains its settings, including alarm settings, while on battery operation. If settings have been set in
Institutional Defaults, these settings will remain in the monitor memory even if the monitor is not receiving
power at all, and will be available once the monitor is turned on again. Likewise, trend data in the device will
remain in the monitor memory even if the monitor is not receiving power at all, and will be available once the
monitor is turned on again.
The orange AC power indicator light is on when the monitor operates from an external power source, with no
relation to the status of the battery pack.
The green power-on indicator is on when the monitor is switched on.
If the orange AC power indicator light is off and the green power-on indicator is on, the monitor is operating
from the battery pack.
The battery icon will show the battery pack’s approximate charge level. An advisory message, BATTERY
LOW, appears when approximately 15 minutes of battery charge (equivalent to 14.0 V) remains.


The bottom of the Capnostream device is designed to fit a 100mm VESA standard mounting plate. (An example
is the GCX model FLP-002-17C mounting plate which fits onto the GCX model RS-0006-64D Roll Stand
Assembly). The VESA mounting plate can be ordered from Oridion; part number is 010713. Please refer to the
appropriate Directions for Use for these products.
Rubber
feet (4)
Mounting
Holes (4)
Figure 4 - Monitor Bottom View

CAUTION: Do not remove the rubber feet from the bottom of the monitor. These rubber feet are
required for operation of the monitor on a table, to prevent unwanted movement of the
monitor while in use. Even if the rubber feet are not currently in use, it is suggested that you
keep them in place for future need.
Setting up Periodic Maintenance

If your institution has a periodic maintenance database, log the monitor in this database for its periodic
calibration procedure. Calibration is required after the first 1,200 hours of use (or 12 months, whichever comes
first) and thereafter every 4,000 hours of use (or 12 months, whichever comes first). The number of operating
hours will appear just after the monitor turns on and on the monitor’s Service Screen. For more details about
calibration and other maintenance procedures, see Maintenance and Troubleshooting on page 107.
Accessories
Available Accessories
See the list of available accessories for Capnostream below.
Table 2 - Capnostream Accessories

Accessory Oridion Part Number Use
Paper (6 rolls) 010516 Paper fits Capnostream's integrated printer.
Monitor is shipped with one paper roll and one
spare paper roll. Refer to Replacing the
Printer Paper Roll on page 111 for paper
installation.
Mounting Adaptor Plate 010713 Used for mounting Capnostream to GCX roll
(Vesa) stands and other mounting assemblies. Refer
to Mounting the Monitor on page 25 for

Accessory Oridion Part Number Use

mounting instructions.
Quick Release Pole Clamp 011782 Clamp fits pole mount (pole diameter 0.75in
[19mm] to 1.5in [38mm]) or rail mount (rail
size 10mm [0.39in] x 25mm [0.98in]).
With quick release mechanism.
Mounting adapter plate is included.
Roll Stand with Basket Not stocked by Oridion GCX model RS-0006-64D
Roll Stand Kit 38" post with 5" Slide-in type
mounting plate – including: 21" base, 4"
casters, 10lb Counterweight, handle, and 6"
basket.
Mounting plate is required to use Roll Stand.
Mounting Adapter for Bernoulli 011892 Used with a Bernoulli/Oxinet hospital system.
Refer to Operation with Hospital Patient Data
Transmitter Systems on page 106.
Battery Pack 016400 Refer to Installing the Battery Pack on page
22 for battery installation.
Nurse Call Cable 011149 Cable length 3.5 meters: Cable is supplied un-
terminated so it can be built to fit system.
Refer to Nurse Call Operation on page 103 for
set up instructions.
US Power Cord 014256
European Power Cord 014255
Monitor Mounting Plate

The mounting kit contains a VESA Mounting Adapter, 100 x 100mm to 75 x 75mm, which can be affixed to the
bottom of the monitor as described above. This allows the monitor to be mounted on a wide range of GCX
stands and mounts including the GCX model RS-0006-64D Roll Stand Assembly. Please contact GCX
(www.gcx.com) for more information on their available solutions for mounting the monitor.
Please note that when mounting the monitor on a roll stand or other pole mount, it is important to use a stand
that has a minimum 21 inch (53.5 cm) wheel base diameter, to ensure stability.
Printer Paper
The monitor uses thermal printer paper with the following specifications:
Table 3 - Printer Paper Specifications

Item Value
Paper Width 58mm (2 ¼ in)
Paper Roll Diameter (maximum) 40mm (1 1/2 in)
Paper Length (maximum) 15.2 meters (50 ft)
Note: Some manufacturers use a different thickness of paper, so that a 15.2 meter roll from a different
manufacturer may exceed the maximum diameter limit and will not fit in the monitor.
Replacement paper rolls that meet the specifications can be obtained from Oridion (part number 010516 for a
package of 6 rolls), or in North America from www.thermalpaperdirect.com (Model number 22550).

Following are the front, rear, and side views of the monitor showing the display, controls, and external
connection points.

Monitor Front View

The front panel of the monitor contains the display screen, action buttons and the control knob.
12
1 11
10
2 3 4 5 6 7 8 9
Figure 5 - Capnostream Front View
Table 4 - Capnostream Front View lists the numbered labels.

Table 4 - Capnostream Front View

Label Name Description Label Name Description
1 Monitor power Button switch 7 Temporary Temporarily disables the
ON/OFF alarm silence Audio Alarm for two
button minutes.
2 AC power Orange light 8 Red alarm Indicator that flashes
indicator indicator during High Priority
alarms (see High Priority
Alarms on page 70).
3 Monitor power Green light 9 Yellow alarm Indicator that lights or
on indicator indicator flashes according to the
alarm status (see Alarm
Display on page 67).
4 Event button Starts the process of 10 Control knob Rotary knob used to
placing either a Quick or navigate the screen and
Detailed Event marker in select a function when
the trend data. pressed.
5 Patient Allows Starting and 11 Display screen Screen displaying the
Admit/Discharge Stopping a case and patient data, menu bar,
button entering patient ID. patient mode, date-time,
and any information or
error messages.
6 Pump Off button Shuts off the 12 Carrying Allows the monitor to be
Capnography pump for handle carried.
a preset time in order to
protect the monitor
during suctioning
procedures.

The figure below is a close-up of the controls shown in Figure 5 - Capnostream Front View on page 27 and
described in Table 4 - Capnostream Front View above.
Figure 6 - Front Panel Control Buttons

Monitor Rear Panel

The rear panel of the monitor contains power and communications connections.
9
6 1
5
10
7
Figure 7 - Capnostream Rear View
Table 5 - Capnostream Rear View describes the functions of the rear-monitor connections.
Table 5 - Capnostream Rear View

Label Function Description Label Function Description
1 Mains fuse holder Two 3.15A fast blow 6 Analog output 15 pin female D type
fuses. connector for 7
channel analog
output.
2 Mains plug Connection for AC 7 Potential For connecting
power. equalization potential
terminal equialization
conductor.
3 USB port For flash memory stick. 8 Manufacturer labels
4 RS-232 9 pin female D type 9 Carrying handle
connector for RS-232
communication.
5 Nurse Call Port used for attaching 10 Power Cord Strain
to Nurse Call system. Relief

Monitor Left and Right Views

The left side of the monitor contains the battery housing and the connection points to the patient interface.
5
3
Figure 8 - Capnostream Left View
Table 6 describes the functions of the features on the left side of the monitor.
Table 6 - Capnostream Left View

Label Function Description
1 FilterLine Input connector To connect the FilterLine to the monitor. Provided
with an automatic door close.
2 Gas outlet To connect to a scavenger system when the
monitor is used in the presence of anesthetic
gases. The gas output is a barbed style connector
intended for 3/32 inch ID tubing.
3 SpO2 To connect SpO2 sensor to the monitor with an
extension cable.
4 Battery housing Where the battery pack is installed.
5 Barcode label Barcode of the Serial Number and Model Number
of monitor.
The right side of the monitor includes only the paper roll used for printing patient reports and buttons used to
control that printer. This printer roll holder is seen in Figure 45 - Insert Paper Roll into printer on page 111, and
instructions for replacing the printer roll appear in Replacing the Printer Paper Roll on page 111.

This section explains how to turn on the monitor.
CAUTION: The monitor is intended only as an adjunct in patient assessment. It must be used in
conjunction with clinical signs and symptoms.
CAUTION: Use only Microstream® etCO2 consumables and Nellcor sensors, to ensure that the monitor
functions properly.

 TO TURN ON THE MONITOR:

1. Plug the electrical cord into the mains plug in the rear of the monitor (see Figure 7 - Capnostream Rear View
on page 29). Clip the power cord strain relief around the cable and tighten to ensure that the power cord does
not accidentally disconnect from the monitor.
2. Plug the electrical cord into the mains AC supply.
3. The orange power indicator on the front panel will light up.
CAUTION: If the orange light is not on, the monitor is running on battery power only and will stop
operating when the battery is discharged.
4. Press the Power ON/OFF button on the front panel to turn on the monitor. The following happens:
• The green power-on indicator lights up, showing that the monitor is turned on.
• An hourglass figure appears on the screen for a few seconds followed by the blue monitor salutation
screen for about 5 seconds as the monitor performs a self-test.
• The red alarm and yellow alarm lights will briefly light up and the speaker will beep.
CAUTION: If the red and yellow alarm lights do not light up or there is no sound from the speaker, the
monitor should not be used and should be sent for servicing.
• You will hear the pump briefly turn on for a few seconds, and then turn itself off. However, if a FilterLine
is connected to the monitor, the pump will remain on.
Figure 9 - Salutation Screen

After the blue Salutation screen, a screen requesting that you clear the trend memory will appear. For an
explanation of that screen, see Using Patient Cases and Patient ID on page 43. Following that screen, the Home
screen will appear.

The Home screen displays the CO2 and SpO2 information along with the IPI value and other information that is
standard on most other screens. This section explains the main parts of the screen.
The Home screen can display in one of two basic formats: graphical and numeric. The default display is the
standard display, described below. The numeric format provides a larger and easier-to-read numeric display
without the distraction of the graphical waveform display. To learn about the numeric display, read Home
Screen Numeric Display on page 36.
Home Screen Standard Display

The typical standard home screen shown in the two figures below shows data and waveforms for a patient being
monitored with a FilterLine and SpO2 sensor.
Header Area
Real Time
CO2 Numeric
Data
CO2
Waveform
Real Time
SpO2
Numeric
Real Time IPI
Data
and A/hr and
ODI Numerics
Menu Bar IPI Trend Data
Figure 10 - Typical Home Screen

Figure 11 - Typical Home Screen when A/hr and ODI are not Available
The Home Screens contains the following sections:

• Header Area described on page 34
• Menu Bar described on page 35
• Real Time IPI Data with Trend Graphical Display described on page 37
• A/hr and ODI Data described on page 35 (if available)
• Real Time CO2 Data and CO2 waveform, described on page 35
• Real Time SpO2 Data described on page 35
Most of the other screens contain the Header Area, the Menu Bar, the Real Time CO2 Data, and the Real Time
SpO2 Data.
In most cases, as you move from screen to screen, the monitor will always display the Header, Menu Bar, real
time CO2 Numeric Data and real time SpO2 Numeric Data sections. The continuous display of the real time CO2
and SpO2 Numeric Data on the right allows continuous patient monitoring even when changing system settings,
or observing patient history on the trend screens.
The IPI option on the screen may be disabled as part of the institutional defaults. (If the Patient Type is
Infant/Neonatal, the IPI is automatically disabled, and the only available option for the standard Home screen
display shows the SpO2 waveform instead of the IPI trend waveform.) See Chapter 7 Integrated Pulmonary
Index™ on page 61 for more information. If the IPI option is disabled, a home screen without the IPI option
will be seen. An example of this Home screen is seen in Figure 12 - Standard Home Screen without IPI Option
on page 34.

Header Area
Real Time
CO2 Numeric
Data
CO2 Waveform
A/hr and ODI Real Time

Data SpO2
Numeric
Data
SpO2 Waveform
Menu Bar
Figure 12 - Standard Home Screen without IPI Option
Header Area
The Header section is always displayed along the top of the screen and contains the information listed in the
table below.
4
1
5
2
6
Figure 13 - Header Area
3
7
Table 7 describes the elements of the header area.
Table 7 - Header Section

Item Function Description
1 Time/Date Displays the Time and Date in selected formats.
2 Patient Type Indicates patient mode. Options are ADULT, PEDIATRIC 1-3 YRS, PEDIATRIC 3-6 YRS,
PEDIATRIC 6-12 YRS, and INFANT/NEONATAL (for infants under 1 year)
3 Screen name Displays the current screen name.
4 Message area Messages explaining alarms and equipment status appear in this area.
5 Patient ID If a patient ID has been entered for the current case, the patient ID will appear.
6 Alarm status Indicates whether the audio alarms are enabled, temporarily disabled or permanently
indicator disabled.
7 USB Indicator Indicates whether a USB Flash Memory device is currently attached to the monitor

Menu Bar
The menu bar of available options and functions is located along the bottom of the monitor display screen. At
the left hand side is the battery charge level indicator. At the right hand side is the speaker volume control.
The menu bar will change depending on which options and functions are available for a specific screen. In some
screens there are additional selectable options in the screen-specific area.
Real Time CO2 Data

This area of the screen displays the real time etCO2 and FiCO2 values along with selected units, and the
respiration rate (RR) in breaths per minute. Numeric display appears at right and a waveform display at left. For
more details regarding the displayed information, see CO2 Data Displayed by the Capnostream Monitor on
page 52.
When the CO2 alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
numeric will appear with a red or yellow background (depending on whether it is a high priority patient [urgent]
alarm or a caution alarm), and a message will appear in the header area of the screen.
This area of the screen can be selected as if it were a menu option. Selecting this area gives access to the setup
screen for changing the CO2 parameter values.
Real Time SpO2 Data

This area of the screen displays real time numeric SpO2 data: SpO2, PR, and the pleth waveform or pulse beat
bar - is always shown. (If IPI is enabled and thus no SpO2 waveform is displayed, the SpO2 pulse beat is
represented by the green bar at the left of this box.)
For more details about the displayed SpO2 data, see Chapter 6 Pulse Oximetry with the Capnostream Monitor
on page 55.
When the SpO2 alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
numeric will appear with a red or yellow background (depending on whether it is a high priority patient [urgent]
alarm or a caution alarm), and a message will appear in the header area of the screen.
screen for changing the SpO2 parameter values, including the option to turn the pulse beat tone on or off.
Real Time IPI Data with Trend Graphical Display

This area of the screen displays the real-time value of the IPI, a numerical value which summarizes four
parameters (etCO2, RR, SpO2, PR) in order to provide a quick indication of the patient’s respiratory status. The
IPI trend graph indicates the trend of this value over the chosen period of time (the default period is one hour).
On the IPI trend graph, the red and yellow horizontal lines indicate the currently set high priority patient
(urgent) alarm and caution alarm limits respectively.
For more information about this parameter, see Chapter 7 Integrated Pulmonary Index™ on page 61.
When the IPI alarm limit is exceeded, the device will alarm: the affected numeric will flash, the numeric will
appear with a red or yellow background (depending on whether it is a high priority patient [urgent] alarm or a
caution alarm), and a message will appear in the header area of the screen.
IPI data is not available for some patients; for more information, see Chapter 7 Integrated Pulmonary Index™
on page 61.
A/hr and ODI Data

This area of the screen displays the A/hr and ODI values (if available).
For more information about A/hr and ODI, see Apneas per Hour and the Oxygen Desaturation Index on
page 63.
When the apnea count in any one hour period during the last 12 hours exceeds a set number, a Visual Alert, in
the form of an asterisk which appears next to the A/hr value, will appear on the screen, indicating to the user

that the A/hr and O2 Desat screen should be viewed. The A/hr and O2 Desat screen is reached with the
REPORTS menu button. For more information about the A/hr Visual Alert, see A/hr Visual Alert on page 64.
Home Screen Numeric Display
Header Area
Real Time
CO2 Numeric
Data
Real Time IPI

Numeric and
IPI Trend Data
and A/hr and
ODI Data
Real Time
SpO2
Numeric
Data
Menu Bar
Figure 14 - Typical Numeric Home Screen
The numeric screen contains the following sections:

• Header Area on page 36
• Menu Bar on page 35
• Real Time IPI Data with Trend Graphical Display on page 37
• Real Time CO2 Data on page 35
• Real Time SpO2 Data on page 35
• A/hr and ODI Data on page 35 (if available)
Header Area
The Header section is identical to the Header area seen with the standard Home screen.
Menu Bar
The menu bar is identical to the menu bar seen with the standard Home screen.
Real Time CO2 Data

This area of the screen displays the real time etCO2 and FiCO2 values along with selected units, and the
respiration rate (RR) in breaths per minute. Numeric display only is provided, sized so that it can easily be read
even at a distance. For more details regarding the displayed information, see CO2 Data Displayed by the
Capnostream Monitor on page 52.

When the etCO2, FiCO2, or RR alarm limit threshold is crossed, the device will alarm: the affected numeric will
flash, the numeric will appear with a red or yellow background (depending on whether it is a high priority
patient urgent alarm or a caution alarm), and a message will appear in the header area of the screen.
screen for changing the CO2 parameter values.
Real Time SpO2 Data

This area of the screen displays real time SpO2 data. Numeric display is provided, sized so that it can easily be
read even at a distance. As in the standard screen, only the parameters which are measured by the probe which
is currently connected to the device will appear on the screen. For more details about the displayed SpO2 data,
see Chapter 6 Pulse Oximetry with the Capnostream Monitor on page 55.
When the SpO2 alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
numeric will appear with a red or yellow background (depending on whether it is an urgent alarm or a caution
alarm), and a message will appear in the header area of the screen.
A/hr and ODI Data

This area of the screen displays the A/hr and ODI values (if available).
For more information about A/hr and ODI, see Apneas per Hour and the Oxygen Desaturation Index on page
63.
When the apnea count in any one hour period during the last 12 hours exceeds a set number, a Visual Alert, in
the form of an asterisk which appears next to the A/hr value, will appear on the screen, indicating to the user
that the A/hr and O2 Desat screen should be viewed. The A/hr and O2 Desat screen is reached with the
REPORTS menu button. For more information about the A/hr Visual Alert, see A/hr Visual Alert on page 64.
Real Time IPI Data with Trend Graphical Display

This area of the screen displays the real-time value of the IPI, a numerical value which summarizes four
parameters (etCO2, RR, SpO2, PR) in order to provide a quick indication of the patient’s respiratory status. The
IPI trend graph below the numeric value indicates the trend of this value over the chosen period of time.
On the IPI trend graph, the red and yellow horizontal lines indicate the currently set urgent alarm and caution
alarm limits respectively.
For more information about this parameter, see Chapter 7 Integrated Pulmonary Index™ on page 61.
When the IPI alarm limit is exceeded, the device will alarm: the affected numeric will flash, the numeric will
appear with a red or yellow background (depending on whether it is a high priority patient [urgent] alarm or a
caution alarm), and a message will appear in the header area of the screen.

Following patient monitoring, operation of the monitor shall be terminated as follows:
1. Remove the FilterLine and SpO2 sensor from the patient.
2. Switch the monitor to OFF by pressing the ON/OFF switch at the front of the monitor.
3. If the monitor is connected to AC power using the AC adapter, it may now be disconnected from AC power.
To continue charging the monitor when not in use for measurement, the monitor shall remain connected to
AC power. The monitor will continue charging its internal battery even when it is switched off.
Screen Navigation
Select options and set values using the control knob. The control knob works in a manner similar to that of a
regular computer mouse. It is also used as a keyboard for entering letters and numbers.

 TO MOVE AROUND THE SCREEN:

1. Turn the control knob to the right or left to move to the next area on the screen, which is highlighted by the
frame changing to blue.
2. To make a selection, push the control knob in until it clicks.
 TO ENTER LETTERS AND NUMBERS:
1. When required to enter alphanumeric data, turn the control knob for navigation and then click on the input
data block on the screen.
The content of the data block is cleared and a small block with a yellow background will appear in place of
the first character. In the block will be a black letter A.
2. As you turn the control knob to the right or left, you will see the complete alphabet and numbers 0-9, the ←
backspace symbol, a blank space and the  Enter symbol.
3. When the desired character is displayed, press on the control knob until it clicks. . The inputted character
will return to its regular color (white) and the yellow block will move to the next character space.
4. Turn the control knob again to begin a new character selection.
5. To end alphanumeric entry, press the control knob twice after entering the final letter or symbol.
 TO CHANGE SETTINGS:
1. When you are on a screen with settings that can be changed, turn the control knob until the desired setting is
highlighted by the frame changing to blue.
2. To select the setting, push the control knob in until it clicks.
3. Turn the control knob until the new setting is reached.
4. To set the setting, push the control knob in until it clicks.
5. Continue to select settings, or turn the control knob to select BACK or HOME.
Configuration Changes
On most selection screens, when you make a change to one or more system parameters the new settings will
only become effective when you exit the screen by selecting HOME or BACK. If the selection screen is exited
by pressing one of the front panel control buttons located below the screen, or if you wait more than one minute
and the screen times out and resets, the changed settings will not be saved.

After you first turn on the monitor, check the top left hand corner of the header to ensure that the date and time
are correct.
 TO CHANGE DATE, TIME, LANGUAGE, OR OTHER OPTIONS:
1. From the Home screen, use the control knob to select SYSTEM in the Menu Bar.
2. To adjust the date and time, use the control knob to select and change each setting. The updated date and
time are saved in the monitor memory when you exit the screen, and will not need to be re-adjusted after the
monitor is turned off.
3. To change the language of the display, use the control knob to change the language.
4. The newly set options (including language) will remain in effect until the monitor is turned off. To
permanently change the display language and other settings, see the information in Changing Institutional
Defaults on page 115.
5. To change any of the other listed parameters, choose the required option, and then select the HOME menu
button to return to the Home screen.
6. If A/hr and ODI are not available, the display option will not appear on this screen.

Screen Timeouts
Figure 15 - System Setup Screen
Screen Timeouts
Screen Timeouts
All setup and system screens will timeout after 60 seconds of no activity with the control knob, and revert back
to the home screen.

Capnostream®20p: Operational Check Sheet

To get the Capnostream monitor up and running quickly and smoothly, follow the list of instructions below:
 1. Unpack the monitor
• Remove the Capnostream monitor and the accessories from the box.
• Check that the items on the enclosed packing list are included.
• Check that paper is in printer.
 2. Install the battery pack
• Refer to Installing the Battery Pack on page 22 for installation instructions.
 3. Turn on the monitor
• Plug the power cord into the mains plug in the rear of the monitor. Clip the power cord strain relief
around the cable and tighten to ensure that the power cord does not accidentally disconnect from the
monitor.
• Plug the power cord into the mains AC supply.
• The power indicator orange light at the front of the monitor will turn on.
• Press the Power ON/OFF button on the front panel to turn on the monitor. The power-on
indicator green light will light up, showing that the monitor is turned on.
• Note that both the power indicator orange light and the power-on indicator green light should both
be on during operation of the monitor.
 4. Change the date, time or language
• Use the control knob to select SYSTEM in the Menu Bar
• Change each setting on that screen, if desired.
 5. Set the Patient Type and Mode
• Use the control knob to select the PATIENT TYPE function on the menu bar of the Home screen
• Select ADULT, PEDIATRIC (by age), or INFANT/NEONATAL as appropriate.
 6. Connect a FilterLine
• Slide open the FilterLine input connector shutter and connect the appropriate FilterLine.
• Connect the FilterLine to the patient as described in the Directions for Use supplied with the
FilterLine. The sampling line connecter should be screwed clockwise into the monitor CO2 port
until it can no longer be turned, to ensure that it is connected securely to the monitor. This will
assure that there is no leak of gases during measurement at the connection point and that
measurement accuracy is not compromised.
 7. Connect a SpO2 Sensor
• Connect the SpO2 extension cord firmly to the monitor SpO2 sensor port, and then connect the
appropriate SpO2 sensor to the extension cord.
• Connect the SpO2 sensor to the patient as described in its Directions for Use.
 8. Once either or both sensors are connected to the monitor, it is ready for operation.
 9. Check Alarm Limits
• Check the alarm limits default and make any permanent changes in the institutional defaults.
• Refer to Alarms and Messages on page 66 for more details about alarms.

 10. Open a Patient Case

• To record patient data so that it is easy to track and retrieve, opening a patient case is recommended.
Opening a patient case is required when recording a Tabular Case Report.
• Refer to Using Patient Cases and Patient ID Numbers on page 43 for instructions.
 11. Print Patient Data
• Choose the desired type of patient report and press the PRINT button on the screen.
• Refer to Chapter 11 Reports on page 89 for detailed information.
 12. Set Up Nurse Call Operation (if applicable; Nurse Call connectivity accessories must be
purchased separately)
• Plug the Nurse Call cable into the Nurse Call socket on the back of the monitor and connect the
other end of the cable to the institution's system as determined by the institution's requirements.
Check that all cables are connected and tightened.
• Enable Nurse Call on the monitor as described in Nurse Call Operation on page 103.
• Verify communication between the monitor and the Nurse Call system.
 13. Set Up Bernoulli System Interface (if applicable; central monitoring system and accessories must
be purchased separately)
• Connect the Client Bridge to the RS-232 port at the back of the monitor. Make sure that all
connections are in place and sufficiently tightened.
• Verify that the Client Bridge is mounted safely.
• Verify communication between the Capnostream monitor, the client bridge and the Bernoulli central
station.
• See Operation with Hospital Patient Data Systems on page 106 for more details.
 14. Set Up Data Transfer via USB (USB flash drive must be purchased separately)
• Connect the USB Flash drive to the back of the monitor.
• Choose the desired type of patient report and press the Start USB button on the screen.
• Refer to Data Transfer via the USB Data Port on page 99 for detailed information.

Preparing the Monitor for a Patient
final document
Chapter 4
Using the Capnostream Monitor

Using Patient Cases and Patient ID Numbers
Entering Patient Events
Changing the Alarm and Pulse Volumes
Alarm Delay
Use of Scavenging System
Turning the Pump Off for Suction or Lavage
Demo Mode
Monitor Screen Menu Reference Chart

CAUTION: If any monitor response does not seem appropriate, do not use the monitor. Instead, contact
your local representative.
The following steps describe the procedure for preparing the monitor for a patient.
 TO PREPARE THE MONITOR FOR A PATIENT:
1. Turn on the monitor by pushing the on/off switch on the front panel.
2. The complete power on sequence is described in Turning on the Monitor on page 30.
3. Confirm that the green power-on indicator and the orange AC power indicator light are both on.
CAUTION: If the orange light is not on, the monitor is running on battery power only and will stop
operating when the battery is discharged. See Turning on the Monitor on page 30.
4. The red alarm and yellow alarm lights will briefly light up and the speaker will beep.
CAUTION: If the red and yellow alarm lights do not light up or there is no sound from the speaker, the
monitor should not be used and should be sent for servicing.
5. Connect one or both sensors to the monitor, following the instructions in this manual. To connect the
sensors, please see Connecting a FilterLine on page 52 and Connecting an SpO2 Sensor to the Monitor on
page 58.
Once either or both sensors are connected to the monitor, it is ready for operation.
If a FilterLine is not connected, there is no CO2 waveform and the message FILTERLINE DISCONNECTED
will appear.
If an SpO2 sensor is not connected, there is no SpO2 waveform and the message SpO2 SENSOR
DISCONNECTED will appear.
It is possible to use either the Capnography function (etCO2) or the Pulse Oximetry function (SpO2) without
using the other function. If you only want to operate one function, connect ONLY the sensor for that function,
and the monitor will operate normally.
Note: The Capnostream monitor is for use with one patient at a time only.
Setting the Patient Type

There are five different patient types recognized by the monitor, listed below.
 Infant/Neonatal: for patients from birth to the age of one year
 Pediatric 1-3 yrs: for patients aged one to three years

 Pediatric 3-6 yrs: for patients aged three to six years

 Pediatric 6-12 yrs: for patients aged six to twelve years.
 Adult: for patients aged 12 years and up
The patient type is displayed at the top left hand corner of the screen. Setting the patient type is compulsory.
The original default patient type on the monitor is ADULT; once the patient type has been changed, the default
will be the current patient type.
CAUTION: The characteristics of a breath are calculated differently for the different patient types.
Setting the correct patient type is therefore very important. Incorrect setting will result in
inaccurate monitoring of the patient's respiration and affect the patient’s IPI value.
 TO CHANGE THE PATIENT TYPE:
1. If the patient type that appears on the screen is correct for the current patient, there is no need to make any
change to the patient type. If you want to make a change, use the control knob to select the PATIENT TYPE
function on the menu bar of the Home screen.
2. Rotate the control knob to change the patient type, and press the control knob to register the change. This
change will remain in effect until the patient type is changed.
The monitor has independent alarm limit settings for Adult/Pediatric and Infant/Neonatal Patients which can be
configured according to the physiology observed in the particular age groups. See the relevant information in
Changing Alarm Limits on page 67.

It is strongly recommended that you associate all data stored in the monitor with a patient ID that will identify
its origin with a particular patient. This allows stored trend data to be associated with a patient ID, and avoids
the possibility of confusing data from several patients in one trend printout or download.
 TO BEGIN A NEW CASE:
1. Once the patient is already connected to the monitor, press the Patient Admit/Discharge button on the
front panel of the monitor. The PATIENT ID field appears on the screen, and an automatically generated
14-digit ID number will appear in the ID field:
PATIENT ID 20101209072645
2. This automatically generated ID indicates the start date and time of the case session (format
YYYYMMDDhhmmss, indicating year, month, day, hour, minute and second of the session start). To use
the automatically generated ID number, use the control knob to select START CASE and click the START
CASE button to begin the case.
3. To change the ID number, if desired, turn the control knob to highlight PATIENT ID in blue on the screen
and click the control knob. Use the control knob to enter a new alphanumeric Patient ID by rotating and
pressing the control knob to select letters and numbers. If you wish to enter a space, turn the knob until you
see an empty square instead of a letter or numeral, and click to enter a space. You will note that the space
you are currently filling is highlighted in yellow. The maximum permitted length for the Patient ID is
20 characters. Select the  Enter symbol to finish. See the section Screen Navigation on page 37 for
instructions on how to enter letters and numbers.
4. If you want to change the patient type for this patient, you may do so from this screen, using the control knob
to select and change the patient type.
5. Use the control knob to select START CASE.
Note: Once the START CASE button is pressed, the case has begun, and that button now becomes STOP
CASE.
Note: A new case cannot begin until the previous case has been stopped with the STOP CASE button.

Note: If you are not sure whether the monitor is currently monitoring a case, click the Patient Admit/Discharge
key to display the screen in which the START CASE button appears. The status of the START
CASE button can provide an indication of current status: when there is no case started, it will show
START CASE, and, in the middle of a case, it will show STOP CASE.
6. To end a case when monitoring the patient is finished, press the Patient Admit/Discharge key, and then
select STOP CASE. This marks the end of the data for that patient. Stopping a case will erase the Trend
Memory, and a warning that indicates STOPPING THE CASE WILL ERASE TREND MEMORY;
PRESS "STOP CASE" AGAIN TO CONFIRM will appear on the screen when STOP CASE is pressed.
If you want to transfer or print case or trend data, this must be done before the case is stopped. If you do not
want to stop the case, simply turn the knob to remove the question from the screen and continue the case. If
you do want to stop the case, click the control knob again.
7. If STOP CASE is not pressed when the user finishes monitoring and powers off the monitor, the case will
continue when the monitor is turned off and then on again. However, when the monitor is powered up again
in such a case, a warning will suggest that the user clear trend data and close the case (to clear patient ID)
before beginning a new monitoring session. This screen is seen in Figure 34 - Trend Memory Message on
page 87. Oridion strongly suggests that you do so in order to avoid mis-identification of patient data.
However, if you intend to continue monitoring the same patient as previously, you may want to retain the
trend and case data.
Clicking YES and CONFIRM? in the screen seen in Figure 34 - Trend Memory Message on page 87, will clear
the trend memory and close the current case, thus erasing all data in the monitor regarding that case.
WARNING: The monitor can store only one case at a time. The trend memory includes only data for the
current case, and, when the case is stopped, the trend memory is erased.
The monitor automatically stores patient data and records the date and time for all events, whether or not the
patient case option is used. As long as the trend memory is not erased, this data remains stored in the monitor,
until the trend memory is full and the beginning of the trend data is overwritten by new data. (See Chapter 10
Using Trends on page 80 for more information on trend capacity.) However, case printouts will only include
data recorded after the current case was started (even if the trend memory also includes data previous to the
current case). On the other hand, displayed trend data and trend printouts will include all data stored in the trend
memory.


When scanning patient history in the monitor, it is often useful to have a record of patient events that could have
influenced the recorded readings. The monitor has the ability to record a wide variety of patient events. There
are two options: Quick Events and Detailed Events.
If the monitor is set to record Quick events, pressing the event button ( ) places a mark in the trend memory
showing that an event took place at the date and time the button was pushed. See Table 20 - Tabular Display
Example for an example of a quick event mark.
Detailed events allow the clinician to record more detail. There are three categories of events: administering
medication, physical activity by the patient, and interventions. These events can be marked in the monitor's
memory to assist in tracking patient care and appear in the trend displays and data output.
 TO USE DETAILED EVENTS:
1. Press the event button on the front display panel of the monitor.
2. The table below will appear on the display. Use the control knob to click on an event.
3. Click the control knob again to store the event and return to the HOME screen.
The table below shows the factory default settings. The event names can be changed using the institutional
defaults as described in Changing Institutional Defaults on page 115.
Table 8 - Event Markings

MEDICATION PATIENT INTERVENED
Fentanyl EATING OXYGEN
Versed DRINKING SUCTION
MIDAZOLAM COUGHING ADJ AIRWAY
Morphine AMBULATING NARCAN
Demerol CHEST PT ROMAZICON
Propofol TURNED NEB TX
SURFACTANT SNORING STIMULATED
Other OTHER CO2 insuffl*
ABG
OTHER
* CO2 Insufflation
If the monitor is set to record detailed events, but you do not wish to designate a specific event name, pressing
the event button twice will record an unlabeled event similar to a quick event mark. This is useful when
there is no time to designate details.

The alarm volume can be made louder or softer for patient alarms and pulse tone. The pulse tone can also be
turned off using the SpO2 menu. By default, the pulse tone is turned off.
Alarm Volume
 TO MAKE THE ALARM VOLUME LOUDER OR SOFTER:
1. Use the control knob to select the speaker icon at the right hand side of the menu.

Speaker
Volume
icon
Figure 16 - Menu Bar
2. Click the control knob once to select the alarm volume control.
3. Turn the control knob to raise or lower the volume. The selected alarm volume level will be audible as you
turn the knob. Click the knob twice to set the new volume level.
Figure 17 - Alarm Volume Selection
Note: The alarm volume cannot be set to zero using the alarm volume control. The audible alarm can only be
disabled in the Institutional Default settings.
Pulse Tone Volume

The monitor can be set to sound an audible beep for each pulse beat. The monitor is shipped from the factory
with the pulse tone turned off.
The pulse tone can also be turned off using the SpO2 menu. By default, the pulse tone is turned off.
Setting the Pulse Tone Volume
To make the pulse tone louder or softer, use the control knob to select the speaker icon and click twice to select
the Pulse Tone volume setting.
Figure 18 - Pulse Tone Volume Selection
The pulse tone volume can be set to zero.

Turning the Pulse Tone On/Off
 TO TURN THE PULSE TONE VOLUME ON:
1. Use the control knob to select the SpO2 display area. Click the control knob to go to the SpO2 Setup screen.
2. Turn the control knob to highlight the PULSE TONE setting, click the knob to select the option, turn the
knob once to change the setting to ON, and push the knob again to set the option.
3. A beep now sounds once for each pulse beat. To turn the pulse tone off, repeat the procedure and select
PULSE TONE off.
Alarm Volume Default Options

The institutional default alarm volume can be set to one of the three choices described below, in the
Institutional Defaults>Monitor screen. These choices determine the audio alarm volume when the device is
turned on. See Institutional Defaults on page 115 to learn more about Institutional Defaults.
Table 9 - Audio Alarm Volume

Audio Alarm Volume Option Description
Maximum The audio alarm volume will revert to the maximum volume when
the device is turned on, regardless of previous settings.
Last Setting The audio alarm volume will remain at the level last set on the
device, even after it is turned off and then turned on again.
Audio Off The audio alarm volume is off.

Alarm Delay
CAUTION: The Audio off option (which will create permanent alarm silence) should be set in the
Institutional Defaults only in a situation in which the caregiver is also monitoring the
patient by other means, to avoid the chance of missed alarms.
Alarm Delay
An option for Alarm Delay (for a number of alarms) is available. For more information, see Alarm Delay on
page 69.
Use of Scavenging System

When the patient is being sedated with a gaseous anesthetic, a scavenging system can be attached to the
monitor. The gas output connection is a barbed style connector intended for 3/32 inch ID tubing. Using any
appropriate tubing, connect the scavenging system to the gas outlet, located between the FilterLine and SpO2
connections, as shown below in Figure 19, below.
Disposal of sampled gases should be carried out according to according to standard operating procedures or
local regulations for the disposal of gases.
Scavenger system Connection Point
Figure 19 - Scavenger System Connection Point
Turning the Pump Off for Suction or Lavage

Use the Pump Off mode whenever performing suction or lavage. During Pump Off mode, pump activity is
suspended to protect the monitor from drawing in liquids which could cause a malfunction.
In the Pump Off mode, the CO2 module pump is switched OFF for a preset time to prevent liquids from
entering the monitor.
WARNING: If at any time the device displays the FILTERLINE BLOCKAGE message, replace the
FilterLine.
 TO CHANGE THE PUMP MODE:
1. Before performing lavage or suction, press the Pump Off button located on the front of the monitor.
The CO2 module pump turns off, the countdown timer begins and the Pump Off screen is displayed. The
countdown timer is shown in the CO2 waveform area.

Demo Mode
Note: While the pump is off, CO2 is not monitored and no breath waveform, etCO2, FiCO2, or respiration rate
number values are displayed. SpO2 and pulse rate monitoring continues.
2. Pump Off mode can be ended by pressing the Pump Off button again.
3. Pump Off mode can be extended by using the control knob to select the EXTEND TIMER menu option.
When the monitor is in Pump Off mode, a timer appears in the message area at the top of the screen and shows
the total hours and minutes that the CO2 monitoring has been turned off.
When the timer finishes or you manually exit Pump Off by pressing the Pump Off button again, the pump will
turn on and CO2 monitoring will resume. The monitor automatically returns to the Home screen.
Note: The Pump Off button does not function while scrolling in Graphical and Tabular Trend screens.
Demo Mode
The Capnostream monitor provides the possibility of viewing pre-recorded standard data to display an example
of the monitor's appearance under standard measurement conditions. The Demo Mode permits clinicians and
technicians to understand what the screen will show when monitoring patients, and is useful to them as a guide
before attaching the monitor to real patients.
 TO USE THE DEMO MODE:
1. To enter the Demo Mode, click SYSTEM and then SERVICE on the menu bar at the bottom of the screen.
Enter the Service password (see Changing Institutional Defaults on page 115) to enter the Service screen.
2. On the Service screen, click the DEMO MODE button on the menu bar. The monitor will now enter Demo
Mode and will display pre-recorded CO2 and SpO2 data. As an indicator of operation under Demo mode, the
header will indicate DEMO MODE on a flashing orange background. An advisory message DEMO MODE
- PRERECORDED DATA will also appear. Service options and the Calibration Check feature are not
available to the user while the device is in Demo mode.
3. To exit the Demo Mode, you must turn off the monitor using the ON/OFF button at the front of the monitor.
When the monitor is turned on again, it will have returned to its standard operating status.

The chart below shows the menu flow paths for navigating through the different screens of the Capnostream.

Figure 20 - Screen Menu Reference Chart when A/hr and ODI are available

Figure 21 - Screen Menu Reference Chart when A/hr and ODI are not available

final document
Chapter 5
Capnography with the Capnostream Monitor

®
Microstream EtCO2 Consumables
Connecting a FilterLine
CO2 Data Displayed by the Capnostream Monitor
Adjustable CO2 Parameters
Monitoring CO2 during MRI Scanning
Microstream® EtCO2 Consumables

CAUTION: Before use, carefully read the Microstream® etCO2 consumables Directions for Use.
CAUTION: Only use Microstream® etCO2 consumables to ensure the monitor functions properly.
CAUTION: Microstream® etCO2 consumables are designed for single patient use, and are not to be
reprocessed. Do not attempt to clean, disinfect or blow out the FilterLine as the monitor can
be damaged.
CAUTION: Dispose of Microstream® etCO2 consumables according to standard operating procedures or
local regulations for the disposal of contaminated medical waste.
WARNING: Loose or damaged connections may compromise ventilation or cause an inaccurate
measurement of respiratory gases. Securely connect all components and check connections
for leaks according to standard clinical procedures.
WARNING: If too much moisture enters the FilterLine (i.e., from ambient humidity or breathing of
unusually humid air), the message Clearing FilterLine will appear in the Capnostream
message area. If the FilterLine cannot be cleared, the message FilterLine Blockage will
appear in the CO2 waveform display section on the Home screen and in the Capnostream
message area. (If there is no waveform display, the message will appear only in the message
area.) Replace the FilterLine once the FilterLine Blockage message appears.
WARNING: The FilterLine may ignite in the presence of O2 when directly exposed to laser, ESU
devices, or high heat. When performing head and neck procedures involving laser,
electrosurgical devices or high heat, use with caution to prevent combustion of the
FilterLine or surrounding surgical drapes.
Note: When connecting a sampling line to the monitor, screw the sampling line connecter clockwise into the
monitor CO2 port until it can no longer be turned, to ensure that it is connected securely to the monitor.
This will assure that there is no leak of gases during measurement at the connection point and that
measurement accuracy is not compromised.
Note: Following connection of the CO2 sampling line, check that CO2 values appear on the monitor display.
Basic Principles
When choosing Microstream® etCO2 consumables, the following should be considered:
• Whether the patient is intubated or non-intubated
• Whether the patient is on mechanical ventilation
• Duration of use
• Patient’s size and weight
• Whether the patient is breathing through his nose, his mouth, or alternating between oral and nasal
breathing

For further information, please contact your local representative.

Select the appropriate FilterLine and connect it to the monitor before attaching it to the patient’s airway. Be sure
to follow Microstream® etCO2 Consumables’ Directions for Use for proper connection.
Microstream® EtCO2 Consumables

A list of Microstream® etCO2 consumables appear in Microstream EtCO2 Consumables on page 132.
Note: Smart products provide oral and nasal sampling.
H products are for long term use.
®
Note: The generic term FilterLine, used in this manual, is interchangeable with any of the Microstream etCO2
consumables.
Note: The listed products are also available in versions designed for other patient sizes.
This listing describes the main products available. For more information about Oridion FilterLines or additional
sizing and packaging options for these products, see http://www.covidien.com/rms/brands/microstream.
Before monitoring a patient with capnography, the appropriate FilterLine must be connected to the monitor and
to the patient.
 TO MAKE THE CONNECTIONS:
1. Slide open the FilterLine input connector shutter and connect the appropriate FilterLine. Screw the
FilterLine connector into the monitor clockwise until it can no longer be turned.
2. Connect the FilterLine to the patient as described in the Directions for Use supplied with the
FilterLine.
When the FilterLine is connected, the monitor will immediately begin to search for breaths, but it will not
indicate a No Breath condition before any valid breaths have occurred.
Note: The Capnostream monitor’s CO2 function will enter standby mode automatically in cases when the
Capnostream monitor is left on for 30 minutes or longer without a FilterLine attached. In this case, CO2
monitoring on the monitor will go into automatic standby mode and then will re-initialize once a FilterLine
is attached. This initialization process takes typically 30 seconds; it may take up to 180 seconds.
CO2 Data Displayed by the Capnostream Monitor

The Capnostream monitor Home screen displays real time CO2 data. The displayed data includes:
• Real time etCO2 and FiCO2 values along with selected unit (see CO2 Data Displayed by the
Capnostream Monitor on page 52 for details regarding the available units)
• Real-time FiCO2 values along with selected unit (see Adjustable CO2 Parameters on page 53 for
details regarding the available units)
• Respiration rate (RR) in breaths per minute
• CO2 Waveform
CO2 Waveform EtCO2, FiCO2

and Respiration
Rate values
Figure 22 - CO2 Data on the Capnostream Monitor

Additionally, the monitor can display CO2 data in trend form, showing time, date, etCO2, RR, alarms, events,
and a CASE START marker. For more information about trend display, see Chapter 11 Using Trends on
page 80.
When the EtCO2 High or Low alarm limits are exceeded, the affected numeric will flash to alert the attending
health care professional to the specific parameter that is affected.
A delay may be set on a number of alarms, if desired, so that these alarms will sound only if the parameter
exceeded alarm limits for the set number of seconds. This option can be set using Institutional Defaults. See
Institutional Defaults on page 115 for more information on how to set Institutional Defaults.
If the numeric home screen is chosen, the CO2 waveform will not appear. Instead, CO2 data will appear in a
large font, to enable easy viewing, even at a distance. The CO2 section of the numeric home screen is seen in
Figure 23 - CO2 Section of Numeric Home Screen, below.
Note: For both neonatal and adult patients, the EtCO2 numeric displayed on the screen is the maximum value
of CO2 over the last 20 seconds, updated once a second. An etCO2 alarm will occur based on the EtCO2
value displayed on the screen.
Note: In high-altitude environments, EtCO2 values may be lower than values observed at sea level, as
described by Dalton's law of partial pressures. When using the monitor in high-altitude environments, it
is advisable to consider adjusting EtCO2 alarm settings accordingly.
Note: Measuring mode corrects the CO2 value for BTPS setting (Body Temperature, Pressure, Saturation)
which assumes that alveolar gases are saturated with water vapor. BTPS should remain on for patient
measurement. For other purposes, it may be turned off in the CO2 Setup screen.
Figure 23 - CO2 Section of Numeric Home Screen

The Capnostream monitor provides the option of adjusting some parameter settings used for CO2 measurement
to suit your patients, your institution's requirements, or other needs. To change these settings on a temporary
basis, until the device is turned off, follow the procedure below. To set changes as institutional defaults so that
the settings will remain in effect even after the monitor is turned off, see CO2 Parameters on page 121.
 TO CHANGE CO2 PARAMETER SETTINGS:
1. On the Home screen, move the control knob to the CO2 section of the screen, so that it is outlined in blue.
Click the control knob.
2. The CO2 Setup screen will appear. Move the control knob to the parameter that you wish to change and click
to select that parameter. Move the control knob to select the desired setting and click to select the setting. A
list of the settings that can be changed appears in Table 10 - Adjustable CO2 Parameters, below.
3. Move the control knob to the HOME button and click to select. The screen will also revert to the Home
screen after a few seconds if no additional actions are taken on that screen, but if the screen timed out and
reverted back to the HOME screen in this manner, changes will not be saved.

4. The changes in the parameters will remain in effect until the device is turned off.
Table 10 - Adjustable CO2 Parameters

Parameter Choices Factory Default
BTPS* On/Off On
FiCO2 Display On/Off On
Pump-Off Timeout (minutes) 5, 10, 15 or 30 15
CO2 Waveform Scale (mmHg) 50, 100, 150, Auto Auto
EtCO2 Scale for Trend Display 50, 100, 150 50
RR Scale for Trend Display 50, 100, 150 50
Sweep Speed (mm/sec) [for current patient type] 1, 2, 3, 6.3, 12.5, 25 6.3
A/hr Visual Alert Level (Apnea/Hr) (if available) 1-99 10
* BTPS denotes the standard correction used during measurement for body temperature, pressure, and saturation.
BTPS should be set to ON during all measurement procedures. The device automatically turns off the BTPS
correction during calibration procedures and turns it on again following these procedures. There is no need for the
user to make any changes to the BTPS setting.

WARNING: Do not use the FilterLine H Set Infant/Neonatal during magnetic resonance imaging (MRI)
scanning. Using the FilterLine H Set Infant/Neonatal during MRI scanning could harm the
patient.
CAUTION: During MRI scanning, the monitor must be placed outside the MRI suite. When the monitor
is used outside the MRI suite, EtCO2 monitoring can be implemented by attaching the
FilterLine XL, to provide extended length.
CAUTION: Use of a CO2 sampling line with H in its name (indicating that it is for use in humidified
environments) during MRI scanning may cause interference. The use of non-H sampling
lines is advised. For a list of H sampling lines, see Microstream EtCO2 Consumables on
page 132.
Non-invasive etCO2 monitoring during magnetic resonance imaging (MRI) can be accomplished with the
monitor, a FilterLine XL, and an appropriate CO2 sampling line.
 TO USE THE MONITOR DURING MRI SCANNING:
1. Place the monitor outside the MRI suite. There must be a hole in the wall of the suite (approximately 10 cm.
diameter).
2. Connect the FilterLine XL to the monitor and guide the FilterLine XL through the hole in the wall of the
MRI suite.
3. Attach the FilterLine XL to the patient.
Note: Due to the extended length of the FilterLine XL, there may be an increased delay time and thus a slower
response time.
To purchase the FilterLine XL, contact your local representative.

final document
Chapter 6
Pulse Oximetry with the Capnostream Monitor

Nellcor SpO2 Sensors
Connecting an SpO2 Sensor to the Monitor
SpO2 Data Displayed by the Capnostream Monitor
Adjustable SpO2 Parameters
SPO2 Alarm Limit Message

WARNING: Before use, carefully read the sensor Directions for Use, including all warnings, cautions,
and instructions.
WARNING: Do not immerse the sensor in water, solvents, or cleaning solutions (the sensor and
connectors are not waterproof). Do not sterilize by irradiation, steam, or ethylene oxide. See
the cleaning instructions in the directions for use for reusable pulse oximetry sensors.
WARNING: Before each use of SpO2 sensors, assure that the sensor is intact. Damaged sensors (torn,
worn out [abraded], or exposed optical components, wires or metal) are prohibited for use.
Use of damaged sensors may compromise patient safety and may result in patient injury.
Protection of the monitor against the effects of the discharge of a cardiac defibrillator is
dependent upon the use of appropriate SpO2 cables and sensors listed in Table 11 on
page 56.
WARNING: Use only Nellcor sensors for SpO2 measurements. Other sensors may cause improper
monitor performance.
WARNING: Do not use oximetry sensors during magnetic resonance imaging (MRI) scanning.
Conducted current could cause burns. The sensors may affect the MRI image and the MRI
unit may affect the accuracy of oximetry measurements.
WARNING: Tissue damage can be caused by incorrect application or use of a pulse oximetry sensor.
Inspect the sensor site as directed in the Instructions for Use. Do not apply the sensor too
tightly or by using excessive pressure. Do not wrap the sensor, apply supplemental tape, or
leave the sensor too long in one place. If the skin under the sensor becomes irritated, change
the location of the sensor.
CAUTION: Single-patient use sensors and adhesive sensors are intended for single-patient use only. Do
not transfer a single-use sensor or an adhesive sensor from one patient to a second patient.
Note: The oxygen transducers (sensors) used in this device can be categorized as surface devices contacting
skin for a limited duration of time. The sensors have passed the recommended biocompatibility testing
and are therefore in compliance with ISO 10993–1.
Note: Because light absorption by hemoglobin is wavelength dependent and because the mean wavelength of
LEDs varies, a monitoring system must know the mean wavelength of the sensor's red LED to
accurately measure SpO2. During monitoring, the monitoring system’s software selects coefficients that
are appropriate for the wavelength of that individual sensor's red LED; these coefficients are then used
to determine SpO2. Additionally, to compensate for differences in tissue thickness, the light intensity of
the sensor's LEDs is adjusted automatically. Together these features provide automatic calibration of the
SpO2 feature.

Data Update Period, Data Averaging, and Signal Processing

The advanced signal processing of the OxiMax™ algorithm automatically extends the amount of data required
for measuring SpO2 and pulse rate depending on the measurement conditions. The OxiMax™ algorithm
automatically extends the dynamic averaging time required beyond seven (7) seconds during degraded or
difficult measurement conditions caused by low perfusion, signal artifact, ambient light, electrocautery, other
interference, or a combination of these factors, which results in an increase in the dynamic averaging. If the
resulting dynamic averaging time exceeds 20 seconds for SpO2, the algorithm sets the pulse search bit while
continuing to update SpO2 and pulse rate values every second.
As such measurement conditions extend, the amount of data required may continue to increase. If the dynamic
averaging time reaches 40 seconds, and/or 50 seconds for pulse rate, a technical alarm state results: the
algorithm sets the Pulse Timeout bit and the monitoring system reports a zero saturation indicating a loss-of-
pulse condition, which should result in an audible alarm.
Functional Testers and Patient Simulators
Some models of commercially available bench top functional testers and patient simulators can be used to verify
the proper functionality of Covidien Nellcor™ monitoring systems, sensors, and cables. Reference the
individual testing device's operator's manual for the procedures specific to the model of tester used. While such
devices may be useful for verifying that the sensor, cabling, and monitoring system are functional, they are
incapable of providing the data required to properly evaluate the accuracy of a system's SpO2 measurements.
Fully evaluating the accuracy of the SpO2 measurements requires, at a minimum, accommodating the
wavelength characteristics of the sensor and reproducing the complex optical interaction of the sensor and the
patient’s tissue. These capabilities are beyond the scope of known bench top testers. SpO2 measurement
accuracy can only be evaluated in vivo by comparing monitoring system readings with values traceable to SaO2
measurements obtained from simultaneously sampled arterial blood using a laboratory CO-oximeter.
Many functional testers and patient simulators have been designed to inter-face with the monitoring system's
expected calibration curves and may be suitable for use with monitoring systems and/or sensors. Not all such
devices, however, are adapted for use with the OxiMax™ digital calibration system. While this will not affect
use of the simulator for verifying system functionality, displayed SpO2 measurement values may differ from the
setting of the test device. For a properly functioning monitoring system, this difference will be reproducible
over time and from monitoring system to monitoring system within the performance specifications of the test
device.
Selecting Nellcor SpO2 Sensors

When selecting a sensor, consider the patient's weight and activity, the adequacy of perfusion, the available
sensor sites, and the anticipated duration of monitoring. The sensor models are summarized in Table 11 -
Nellcor SpO2 Sensors, below. For further information, please contact your local representative.
Nellcor pulse oximetry sensors contain light emitting diodes (LEDs) that emit red light at a wavelength of
approximately 660 nm, and infrared light at a wavelength of approximately 900 nm. The total optical output
power of the sensor LEDs is less than 15 mW. This information may be useful to clinicians, such as those
performing photodynamic therapy.
Table 11 - Nellcor SpO2 Sensors

Oxygen Sensor Model Patient Weight
®
OXIMAX oxygen transducer MAX-N <3 kg or >40 kg
(single patient use)
MAX-I 3 to 20 kg
MAX-P 10 to 50 kg
MAX-A >30 kg
MAX-AL >30 kg
MAX-R >50 kg

MAX-FAST >40 kg
® ®
OXIMAX OxiCliq oxygen transducer P 10 to 50 kg
(single-use only)
A >30 kg
® ®
OXIMAX Dura-Y multisite oxygen transducer D-YS >1 kg
(Nonsterile, reusable)
For use with Dura-Y sensor: D-YSE 30 kg
Ear clip (Reusable, nonsterile)
Pedi-Check™ pediatric spot-check clip D-YSPD 3 to 4 kg
(Reusable, nonsterile)
® ®
OXIMAX Oxiband oxygen transducer OXI-A/N <3 kg or>40 kg
(Reusable with disposable nonsterile
adhesive) OXI-P/I 3 to 40 kg
® ®
OXIMAX Durasensor oxygen transducer DS-100A >40 kg
(Nonsterile, reusable)
Nellcor™ Preemie SpO2 Sensor, non- SC-PR <1.5 kg
adhesive (Single-patient use)
Nellcor™ Neonatal SpO2 Sensor, non- SC-NEO 1.5 to 5 kg
adhesive (Single-patient use)
Nellcor™ Adult SpO2 Sensor, non-adhesive SC-A >40 kg
(Single-patient use)
Nellcor™ Adult Respiratory Sensor, SpO2, RR 10068119 >30 kg
Sensor cable DOC-10 DOC-10 NA
Sensor cable OC-3 OC-3 NA
Performance Considerations
WARNING: Pulse oximetry readings and pulse signal can be affected by certain ambient environmental
conditions, sensor application errors, and patient conditions.
WARNING: Tissue damage can be caused by incorrect application or inappropriate duration of use of an
SpO2 sensor. Inspect the sensor site as directed in the sensor Directions for Use.
WARNING: Use only Nellcor-approved sensors and pulse oximetry cables. Other sensors or oximetry
cables may cause improper monitor performance and may also result in increased
electromagnetic emission or decreased immunity to electromagnetic interference.
Inaccurate measurements can be caused by:
• incorrect application of the sensor
• placement of the sensor on an extremity with a blood pressure cuff, arterial catheter, or intravascular line
• ambient light
• prolonged and/or excessive patient movement
• intravascular dyes or externally applied coloring, such as nail polish or pigmented cream
• failure to cover the sensor site with opaque material in high ambient light conditions
Loss-of-pulse signal can occur for the following reasons:
• the sensor is applied too tightly
• a blood pressure cuff is inflated on the same extremity as the one with the sensor attached
• there is arterial occlusion proximal to the sensor

• poor peripheral perfusion

Clean and remove any substances such as nail polish from the application site. Periodically check to ensure that
the sensor remains properly positioned on the patient.
Select an appropriate sensor, apply it as directed, and observe all warnings and cautions presented in the
directions for use accompanying the sensor.
High ambient light sources such as surgical lights (especially those with a xenon light source), bilirubin lamps,
fluorescent lights, infrared heating lamps, and direct sunlight can interfere with the performance of an SpO2
sensor. To prevent interference from ambient light, ensure that the sensor is properly applied, and cover the
sensor site with opaque material.
CAUTION: Failure to cover the sensor site with opaque material in high ambient light conditions may
result in inaccurate measurements.
If patient movement presents a problem, try one or more of the following remedies:
• Verify that the sensor is properly and securely applied.
• Move the sensor to a less active site.
• Use an adhesive sensor that tolerates some patient motion.
• Use a new sensor with fresh adhesive backing.
If poor perfusion affects performance, consider using the MAX-R sensor; it obtains measurements from the
nasal septal anterior ethmoid artery, an artery supplied by the internal carotid. This sensor may obtain
measurements when peripheral perfusion is relatively poor.
Reading accuracy in the presence of low perfusion (detected IR pulse modulation amplitude between 0.03% and
1.5%) was validated using signals supplied by a patient simulator. SpO2 and pulse rate values were varied
across the monitoring range over a range of weak signal conditions and compared to the known true saturation
and pulse rate of the input signals.

Before monitoring a patient with pulse oximetry, the appropriate SpO2 sensor must be connected to the monitor
and to the patient.
 TO CONNECT THE SPO2 SENSOR:
1. Connect the SpO2 extension cord firmly to the monitor SpO2 sensor port, and then connect the appropriate
Nellcor SpO2 sensor to the extension cord.
2. Connect the Nellcor SpO2 sensor to the patient as described in its Directions for Use, using a Nellcor SpO2
sensor extension cable.
3. When the SpO2 sensor is plugged into the extension cable and connected to the monitor, the monitor will
immediately begin to search for a pulse. It will indicate NO PULSE FOUND and SpO2 SENSOR NOT
ON PATIENT until the time that the sensor is placed on the patient. This is classified as a Medium Priority
Alarm, and will generate a triple beep every thirty seconds. To avoid the alarm message and beeping, you
can connect the extension cable to the monitor, but wait to connect the SpO2 sensor to the extension cable
until it is time to connect the patient to the monitor.

The Capnostream monitor Home screen displays real time SpO2 data. The displayed data includes:
• SpO2 Numeric
• Pulse Rate
• Sat Seconds figure (see SpO2 Alarms and SatSeconds on page 77 for an explanation of this issue)
• Plethysmograph (SpO2 waveform)
• Interference Indicator SpO2

SpO2 Waveform Bar

(plethysmograph)
Interference
Indicator Pulse Rate
Sat Seconds
Figure 24 - SpO2 Data on the Capnostream Monitor - Standard Screen
On the standard home screen with IPI enabled (default standard home screen), the plethysmograph (the SpO2
waveform) is seen as a green vertical bar on the SpO2 section of the screen (just to the left of the Sat Seconds
value). The bar indicates pulse beat by rising and falling with the patient's pulse beat. An interference indicator
(the yellow jagged line seen in the figure above) is shown when the incoming signal is inadequate or degraded.
If the signal is adequate, the indicator will not appear.
When the IPI display on the home screen is disabled (see IPI Options on page 62 and Institutional Defaults on
page 115), the SpO2 section of the home screen will appear as seen in Figure 25 - SpO2 Data on the
Capnostream Monitor – Standard Screen with IPI Disabled, below. The plethsysmographic waveform is non-
normalized, using real-time sensor signal to reflect relative pulsatile strength.
SpO2, Sat
SpO2 Seconds and
Waveform Pulse Rate
(plethysmo- values
graph)
Figure 25 - SpO2 Data on the Capnostream Monitor – Standard Screen with IPI Disabled
Additionally, the monitor can display SpO2 data in trend form, showing time, date, SpO2, pulse rate (PR),
alarms, events and case markers to differentiate between patients. For more information about trend display, see
Chapter 11 Using Trends on page 80.
When the SpO2 high or low alarm limits are exceeded, the affected reading will flash to alert the attending
health care professional to the specific reading that is affected.
If the numeric home screen is chosen, the SpO2 waveform will not appear. Instead, SpO2 data will appear in a
large font, to enable easy viewing, even at a distance. The SpO2 section of the numeric home screen is seen in
Home Screen Numeric Display on page 36.

SpO2, Sat
Seconds and
Pulse Rate
values
Figure 26 - SpO2 Section of Numeric Home Screen

The Capnostream monitor provides the option of adjusting some parameter settings used for SpO2 measurement
to suit your patients, your institution's requirements, or other needs. To change these settings on a temporary
basis, until the device is turned off, follow the procedure below. To set changes as institutional defaults so that
the settings will remain in effect even after the monitor is turned off, see Institutional Defaults on page 115.
 TO CHANGE SPO2 PARAMETER SETTINGS:
1. On the Home screen, move the control knob to the SpO2 section of the screen, so that it is outlined in blue.
Click the control knob.
2. The SpO2 Setup screen will appear. Move the control knob to the parameter that you wish to change and
click to select that parameter. Move the control knob to select the desired setting and click to select the
setting. A list of the settings that can be changed appears in Table 12 - Adjustable SpO2 Parameters, below.
screen after a few seconds if no additional actions are taken on that screen.
Table 12 - Adjustable SpO2 Parameters

Pulse Tone On/Off On
Sat Sec (Sat Seconds) On/Off On
SpO2 Scale for Trend Display 0-100, 50-100 50-100
PR Scale for Trend Display 150, 300 150
Sweep Speed (mm/sec) 3, 6.3, 12.5, 25 25
[for current patient type]
SPO2 Alarm Limit Message

When the SpO2 alarm limit is set below 85%, a message reading SpO2 LOW ALARM LIMIT: xx will appear in
the header area, indicating the level of the SPO2 LOW alarm limit.

final document
Chapter 7
Integrated Pulmonary Index™

Introduction
Warnings
IPI Display
IPI Options
Introduction
The Integrated Pulmonary Index™ (henceforth referred to as IPI) is a numerical value which integrates four
major parameters measured by Capnostream in order to provide a simple indication of the patient’s overall
ventilatory status. The integrated parameters are EtCO2, RR, SpO2, and PR. Only these four parameters are used
to calculate IPI; other parameters are not taken into account.
IPI is calculated using the current values of these four parameters and their interactions, based on known clinical
data. IPI can thus provide an early indication of a change in ventilatory status which may not be shown by the
current value of any of these four parameters individually. The IPI is designed to provide additional information
regarding patient status, possibly before EtCO2, RR, SpO2, or PR values reach levels of clinical concern.
The IPI trend graph (seen on the Capnostream home screen) is particularly valuable, as it displays the patient
ventilatory status trend in one easy-to-use graph, and thus can alert caregivers to changes in patient status. The
importance of the IPI, thus, lies not only in its absolute numeric number, but also in its relationship to previous
values, so that a graph can display an upward or downward trend in patient status and indicate to the caregiver
that attention or intervention may be required.
Figure 27 - IPI Trend Graph
A technical note containing details regarding the IPI algorithm is available from Oridion.
Since the index uses data from the monitoring of both CO2 and SpO2, it will only be available when both
parameters are available.
The range of the index is 1-10; index values should be understood as seen in the table below.
Index Range Patient Status
10 Normal
8-9 Within normal range
7 Close to normal range; requires attention
5-6 Requires attention and may require intervention
3-4 Requires intervention
1-2 Requires immediate intervention
Note: The interpretation of the patient's IPI score may change in different clinical environments. For example,
patients with specific respiratory difficulties (in contrast to normally healthy patients who are being

Warnings
monitored during sedation or pain management) may require a lower IPI Low Alert threshold to reflect
their impaired respiratory capacity.
The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult
patients. It is not available for Neonatal/Infant patients (patients up to the age of one year), and thus will not
appear on screens for Neonatal/Infant patients.
Warnings
WARNING: Ensure that the patient type is correctly selected before beginning monitoring of a patient.
Choosing an incorrect patient type could produce incorrect patient IPI data.
WARNING: When an IPI Low Alert is triggered for a patient, medical staff should review the patient's
status to determine if a change in medical care is required.
IPI Display
IPI appears on the Home screen and is available in all Capnostream functions as a default option, along with
other patient parameters such as etCO2 or SpO2. On the Home screen, both numerics and a trend graph are
provided for IPI.
The IPI option may be disabled from the Institutional Defaults screen; see below for more information. In the
Neonatal measurement mode, the IPI option is automatically disabled.
IPI Options
 TO CHANGE IPI OPTION SETTINGS:
1. On the Home screen, click the SYSTEM button in the menu bar at the bottom of the screen.
2. The System Setup screen will appear. Move the control knob to the parameter that you wish to change and
click to select that parameter. Move the control knob to select the desired setting and click to select the
setting. A list of the IPI settings that can be changed appears in Table 13 - Adjustable IPI Options, below.
4. If the IPI Alert is disabled, it will not appear in the Home screen or in any other screen. It will be listed but
grayed out in the Alarm Limits screen.
Table 13 - Adjustable IPI Options

Home IPI Display 1 hour, 2 hour, 4 hour 1 hour
IPI Alert Enabled/Disabled Disabled
To change IPI Display and Alert options on a more permanent basis, use the Institutional Defaults option,
described in Institutional Defaults on page 115. The Home IPI Display settings can be changed in the
Institutional Defaults: Trend screen and the IPI Low Alert (enabled or disabled) can be changed in the
Institutional Defaults: Monitor screen. IPI Low Alert Alarm Limits can be changed in the Institutional
Defaults:Alarm Limits:Set Adult/Pediatric screen.

final document
Chapter 8
Apneas per Hour and the Oxygen Desaturation

Index
Introduction
Apneas per Hour
Oxygen Desaturation Index (ODI)
Apnea and O2 Desaturation Report
Monitoring with A/hr and ODI
Smart A/hr and ODI Home Screen Display
A/hr and ODI Option
A/hr and ODI Demo Mode
Introduction
The Apneas per Hour (A/hr) and Oxygen Desaturation Index (ODI) algorithm is part of the Smart Capnography
family of innovative algorithms developed by Oridion. Smart Capnography simplifies the use of CO2
monitoring on Microstream® enabled products, to improve patient safety and clinical workflow.
A/hr and ODI are not available in all locations. In order to equip your device with these algorithms, contact
[email protected].
A/hr and ODI provide an easy way to help with the identification and quantification of apnea and oxygen
desaturation events during a patient’s hospital stay.
A/hr and ODI report apnea and oxygen desaturation events and calculates the associated Apnea per Hour (A/hr)
and Oxygen Desaturation Index (ODI). By using A/hr and ODI, clinicians are able to recognize ventilation and
oxygenation abnormalities while patients are being monitored during their hospital stay with Capnostream. A/hr
and ODI are for adult patients only (age 22 and older).
A/hr and ODI are displayed in real time on the home screen and on an easy-to-read Apnea and O2 Desat Report
screen, which is available for printed reports and in file format exported to a USB flash drive.
Apneas per Hour

An apnea is a period of time during which breathing stops or is greatly reduced. The Apnea per Hour (A/hr)
calculated by the Capnostream monitor as seen on the Home screen provides a count of the number of pauses of
at least 10 seconds in breathing the patient experienced over the past hour.
On the Apnea and O2 Desat Report screen, A/hr is the average Apneas per Hour over the selected time period
of 2, 4, 8 and 12 hours. On that screen, the number of apnea events of ≥10 seconds; 10-19 seconds;
20-30 seconds; and >30 seconds over the selected time period are also shown.
This A/hr value is used to help indicate to the caregiver the regularity of the patient’s breathing.
The Capnostream Apneas per Hour

In the Capnostream device, apnea per hour is a count of the number of times in an hour that breathing ceased for
ten seconds or more. Since this is a per-hour count, dashed lines will appear on the screen until one hour has
commenced since the beginning of monitoring.
A/hr is currently available for adult patients only and is intended for patients age 22 and older. It is not available
for infants (age 0-1) or for patients under age 22.

A/hr Visual Alert

The A/hr Visual Alert, which appears as an asterisk next to the A/hr value, is used to indicate to the caregiver
that the apnea count in any one hour period during the last 12 hours exceeded a set number. (The default value
which will trigger an A/hr Visual Alert is 10.) The asterisk will appear only when an A/hr Visual Alert is
triggered, and it is updated once every 10 minutes. The Visual Alert on the screen indicates to the caregiver that
the Apnea and O2 Desat screen should be viewed to learn more about the patient’s breathing patterns. To change
the value which will trigger an A/hr Visual Alert, see Adjustable CO2 Parameters on page 53.

The Oxygen Desaturation Index (ODI) indicates the “dips” in SpO2 – that is, the number of times that the SpO2
value dropped 4% or more from baseline and returned to baseline in 240 seconds or less. (This refers to percent
of oxygen saturation, not percent of the patient’s current SpO2 rate). The baseline is created when a consistent
and stable (in the range of ± 1 SpO2 point (%)) SpO2 value is detected over a 20-second period. This baseline,
updated once a second, will be the rounded maximum SpO2 over these 20 seconds. If a valid baseline cannot be
established based upon the definition above, then the previous baseline is kept.
On the Home screen, the ODI for the previous hour is shown. A lower ODI (that is, fewer such instances)
indicates more stability of the patient’s oxygen saturation. Since this index is a per-hour count, dashed lines will
appear on the screen until one hour has commenced since the beginning of monitoring.
On the Apnea and O2 Desat Report screen, ODI is average per hour “dips” in SpO2 over the selected time period
of 2, 4, 8 and 12 hours.
ODI is currently available for adult patients only and is intended for patients age 22 and older. It is not available
for infants (age 0-1) or for patients under age 22.

The on-screen and printed Apnea and Desat reports show a comprehensive picture of the number of A/hr and
ODI events over a set time period of 2, 4, 8, or 12 hours. These reports provide both details regarding the A/hr
and ODI status of the patient and a general picture which can help the caregiver spot patient trends in these
areas. For more information on this report, see Apnea and O2 Desaturation Report on page 89.
Monitoring with A/hr and ODI

When monitoring patients with A/hr and ODI, please take the following issues into consideration:
CAUTION: Please note that A/hr and ODI do not report hypopnea events.
CAUTION: Apnea per Hour (A/hr) and Oxygen Desaturation Index (ODI) do not represent and should
not be interpreted as an apnea hypopnea index (AHI) as reported by formal
polysomnography studies.
CAUTION: Apnea per Hour (A/hr) and Oxygen Desaturation Index (ODI) do not represent and should
not be used to diagnose sleep disordered breathing.
CAUTION: Alarms and a noisy environment may affect A/hr and ODI values. See the Note regarding
recommendations on changing device settings for a sleeping patient below.
CAUTION: A/hr and ODI are reported by the monitor throughout the monitoring period; however, the
monitor cannot discern if the patient is actually sleeping. Also, if a patient removes a
sensor, the monitor may indicate apneas when no such apneas took place.
CAUTION: The administration of opioid analgesia and sedatives may cause respiratory depression,
which will result in transient apnea and O2 desaturation events that will be reflected in A/hr
and ODI values.
CAUTION: Please read all user information to ensure complete understanding of A/hr.
CAUTION: ODI values may be affected by the algorithms employed by the pulse oximetry module.

Note: Please note that the patient type is used to calculate the A/hr and ODI. For this reason, it is important to
choose the patient type correctly. For the same reason, changing the patient type (from adult to
pediatric, for example) will clear the A/hr and ODI data stored for the current patient. A/hr and ODI
headings will not appear for infant/neonatal or pediatric patients.
Note: No A/hr or ODI data will appear on the Home screen for the first hour of monitoring, since A/hr and ODI
indicate the number of events over the last hour. Once one hour of monitoring has passed, they will
appear on the Home screen.
Note: When using the Capnostream A/hr and ODI with a sleeping patient, it is recommended that the
Capnostream device be attached to a central monitoring station where alarms will be heard. Once this is
done, the alarm sound on the Capnostream at the patient’s bedside can be disabled, so as not to disturb
the patient’s sleep. The audible alarms are silenced through SYSTEM>SERVICE>Service password
(see Capnostream Service Password on page 134>INST DEFAULTS>MONITOR. In the list of options
on this screen, change the AUDIO ALARM VOLUME to AUDIO OFF. This should only be done if the
Capnostream is under constant surveillance via connection to a central station (or another means of
surveillance), so that patient alarms are noted by caregivers while the alarm sound is turned off on the
bedside Capnostream device.

A/hr and ODI appear on the Home screen and are available in all Capnostream functions as a default option,
along with other patient parameters such as EtCO2 or SpO2.
The A/hr and ODI option may be disabled from the SYSTEM screen or from the Institutional Defaults screen;
see below for more information. For Infant/Neonatal and Pediatric patients, the Smart A/hr and ODI option is
automatically disabled.
A/hr and ODI Option

 TO CHANGE A/HR AND ODI OPTION SETTINGS:
1. On the Home screen, click the SYSTEM button in the menu bar at the bottom of the screen.
2. The System Setup screen will appear. Change A/hr, ODI DISPLAY to ENABLED or DISABLED as
desired.
4. The changes in the A/hr and ODI display will remain in effect until the device is turned off.
To change the A/hr and ODI option on a more permanent basis, use the Institutional Defaults option, described
in Institutional Defaults on page 115.
A/hr and ODI Demo Mode

To view the A/hr and ODI display without connecting a patient, you may set the monitor to Demo Mode by
clicking System>Service>Enter Service Password>Demo Mode. (For the Service Password, see
Capnostream Service Password on page 134.)

Introduction
final document
Chapter 9
Alarms and Messages

Introduction
Alarm Display
Message Priorities
Alarm Delay
Types of Alarms
Parameter Standby Mode
Alarm Silence
Changing Alarm Limits
Testing Alarm Settings
SpO2 Alarms and SatSeconds
Alarm Limits - Factory Defaults
Introduction
Capnostream triggers alarms related to patient condition as well as equipment errors. Alarms alert the health
care provider that the patient’s condition is beyond predefined limits, or indicate a malfunction or operating
condition of the monitor hardware.
The monitor contains four levels of alarms and advisories, each defined by a set of audible and/or visual
indications:
• High Priority Alarms
• Medium Priority Alarms
• Advisories
• Silent Advisories
High Priority Alarms are provided with the option of setting red urgent alarms for each alarm issue, as well as
the possibility of setting yellow caution alarms for each alarm issue, if desired, in order to permit the clinician to
follow developing alarm situations.
The following table describes how the alarms are indicated.
Table 14 - Alarm Indications

Alarm Type Indicators
Audible Numerics Messages Indicator Light
High Priority Repeated Beep Flashing Red Message area Flashing Red
(Patient) Alarms Pattern (except NO
(red high priority BREATH)
patient urgent
alarms
High Priority Repeated Beep Numeric reverts to Message area (with Flashing Red
(Patient) NO Pattern zero (0) indication of time
BREATH Alarm elapsed since NO
BREATH) and in
waveform area
Yellow caution Repeated Beep Flashing Yellow Message area Flashing Yellow
alarms Pattern

Alarm Display
Alarm Type Indicators

Audible Numerics Messages Indicator Light
Medium Priority Repeated triple N/A Message area Flashing Yellow
beep (some messages
also in waveform
area – see below)
Advisories Single Beep N/A Message area N/A
Silent Advisories None N/A Message area N/A
Some messages are displayed in the waveform area as well as in the message area; these messages are:
CO2 Waveform Area Messages:
• FILTERLINE BLOCKAGE
• PERFORMING AUTO ZERO
• CLEARING FILTER LINE
• CO2 ERROR
• CO2 STANDBY
• FILTERLINE DISCONNECTED
SpO2 Waveform Area Messages:
• SpO2 SENSOR NOT ON PATIENT
• SpO2 STANDBY
• SpO2 SENSOR DISCONNECTED
• SPO2 ERROR
• PULSE NOT FOUND
Alarm Display
In order to view the visual alarm indicators, the intended position of the operator is in front of the monitor
display screen. The intended position of the operator in order to hear audible signals is any position near the
monitor (in a 360° range).
Alarm occurrences are prominently displayed in the real-time numeric section of all screens by the flashing of
the numeric and a change of color of the numeric background: the background of the numeric will flash red if
the value crosses the high priority patient (urgent) alarm limit threshold and flash yellow if the value crosses the
caution alarm limit threshold. (The latter is relevant only if caution alarm limits, which are optional, have been
enabled.)
Alarm occurrences are also displayed on all screens in the header area, in order to provide immediate input on
alarms to the health care provider. The preference of alarm display in the header area is described in Message
Priorities on page 69.
In addition, the message "NO BREATH" and "FILTERLINE BLOCKED" appear in the CO2 waveform area as
well as in the header if this alarm condition exists. If the numeric home screen option is displayed (so that there
is no waveform area), this message will appear only in the header area.
Likewise, the message "SpO2 SENSOR NOT ON PATIENT" appears in the SpO2 waveform area as well as in
the header if this alarm condition exists. If the IPI option is enabled or the numeric home screen is displayed, (so
that there is no waveform area), this message will appear only in the header area.
The alarm occurrences for a specific patient over a specific period of time can be reviewed in the trend screen
(see Chapter 10 Using Trends on page 80 for more details). Capnostream also provides an Alarm Review screen
which displays the absolute number of each type of alarm generated over the last hour for the patient currently
being monitored. The Alarm Review screen is seen in Figure 28 - Capnostream Alarm Review Screen, below.

Alarm Display
This screen enables the health care provider to see at a glance how many alarms have been generated over the
last hour by the patient, in order to assess patient status. It is reached by clicking the ALARMS soft button on
the menu bar, from the Home screen or the Trend screens.
Figure 28 - Capnostream Alarm Review Screen
The Alarm Review screen covers the following alarms:

• No Breath Alarm
• EtCO2 High and Low Alarms
• Respiration Rate High and Low Alarms
• SpO2 High and Low Alarms
• Pulse Rate High and Low Alarms
• IPI Low Alert
The order in which the parameters appear in this screen can be changed from the Institutional Defaults screen
(once a change is made, it will affect both this screen and the trend screens). See Changing Parameters Order on
the Trend Display on page 119 for more information.
The Alarm Review screen displays the absolute number of alarms that occurred in the last hour. Each type of
alarm is indicated by a horizontal bar of a different color, sized to represent the quantity of alarms. The number
of alarms appears to the right of the bar. The thin red vertical lines seen on the bar indicates the point at which a
change in alarm limits occurred.
All alarms displayed are based on the high priority patient (urgent) alarm limit set on the device. For example, if
the etCO2 High alarm limit is set at 60, a level of 60 will be shown on the Alarm Review screen for etCO2 High,
to the left of the upper white bar. If the alarm limit has been changed, the current limit will appear, but the
number of alarms will reflect the limit in place when that alarm occurred, thereby accurately representing the
number of alarms that occurred under each different alarm limit.
The Alarm Review screen will be cleared if the monitor is turned off or if the trend memory is cleared.

Message Priorities
The Alarm Review screen will display alarms for the past hour, if the monitor has been running for an hour or
more. If the monitor has been running for less than an hour, the screen will display data from the time the
monitor was turned on. If the trend memory was cleared, data from the time the trend memory was cleared will
be shown.
Message Priorities
Alarms and advisory messages are displayed in the header area of the monitor in order of priority. When there is
an alarm, only the alarm messages will appear in the message area, and advisory messages will not appear until
the alarm condition is cleared. For example, if there is a RR HIGH ALARM, this alarm message will appear in
the message area, and the advisory message SPO2 WEAK. REPOSITION SENSOR. will not appear even
though the condition exists to generate this message.
If more than one alarm condition exists, the monitor will display each alarm message for about 4 seconds and
continue to repeat the messages in turn until the alarm conditions are cleared. For example, the RR HIGH
ALARM and SpO2 LOW ALARM messages will alternate in the message area.
If no alarm condition exists but more than one advisory message condition exists, the advisory messages will
each appear for four seconds as described above. The advisory messages will continue to appear until the
condition clears or an alarm condition occurs and the alarm message is displayed instead of the advisory
message.
Alarm Delay
Capnostream provides the option to delay alarms (both the audible alarm and the alarm indicator on the screen)
by a number of seconds. If this option is used, the alarm signal (audio or visual) will only appear if the alarm
condition continues to be present past the delay time which has been set.
EtCO2, RR and PR High Alarms and SpO2 and PR Low Alarms can be delayed by 10, 15, 20, or 30 seconds, or
not at all (Alarm Delay disabled). The default option is Alarm Delay disabled. This option is available for all
patient types.
The Alarm Delay can be set from the Institutional Defaults screen, which can be reached by
SYSTEM>SERVICE>Input Service Password>INST DEFAULTS>ALARM LIMITS>SET ALARM
DELAY.
Types of Alarms
High priority patient alarms (urgent) indicate that the particular parameter has exceeded the set limit. A default
alarm limit is provided for each alarm situation. Alarm limits can be changed to fit the particular institution, if
desired.
In addition, Capnostream provides the possibility to set a caution alarm for patient alarms at a lower value level
than that set for the standard high priority patient (urgent) alarm, to provide information for caregivers and
allow the caregiver to address a developing situation before it is critical. By default these caution alarms are
disabled. If they are enabled, a limit which is between the high priority alarm limit and the normal (healthy)
level is provided for each alarm situation and may be set to provide a caution alarm. To enable these caution
alarms, see Changing Alarm Limits on page 76.
The associated numeric on the display will blink yellow if the numeric has reached the caution alarm limit or
red if it has reached the high priority patient (urgent) alarm limit. Also, the red alarm LED and yellow caution
alarm LED will light appropriately. If a user does not wish to use this caution alarm on any particular alarm, he
can set both the high priority patient (urgent) alarm and caution alarm for that alarm to the same limits (see
Changing Alarm Limits on page 76). Then only the high priority patient (urgent) alarm will occur. You can also
revert to a single level system for all alarms by pressing the button for Caution Disable.
All recording and digital reporting of patient alarms involves both the high priority patient (urgent) alarms and
the caution alarms.

Types of Alarms
In addition, medium priority alarms, which alert the clinician to device issues (as opposed to patient issues,
which are covered by high priority alarms and caution alarms), are also provided.
The following is an example for illustration purposes only, showing how the red high priority patient (urgent)
alarm and the yellow caution alarm appear on the monitor.
Figure 29 - Example Showing Alarms
In the above example, RR has exceeded the RR HIGH alarm limit. The RR reading will flash red, the red arrow
pointing up indicates that the upper limit has been exceeded, and the message RR HIGH ALARM appears in the
message area at the top of the screen. In addition, the IPI value is below the IPI Low Alert alarm limit, indicated
by the IPI value flashing red, and the red arrow pointing down. The message IPI LOW ALARM will also appear
on the screen header (alternately with RR HIGH ALARM).
The yellow background on the SpO2 value together with the yellow arrow pointing down indicates that the SpO2
LOW caution alarm level has been exceeded.
High Priority Alarms
Table 15 - High Priority Alarms

Message Description Corrective Action
NO BREATH XXX SECONDS No valid breath has been Patient requires immediate
detected for xxx seconds medical attention.
ETCO2 HIGH ALARM The etCO2 is above the upper Patient requires immediate
alarm limit medical attention.
ETCO2 LOW ALARM The etCO2 is below the lower Patient requires immediate
RR HIGH ALARM The RR is above the upper Patient requires immediate
RR LOW ALARM The RR is below the lower alarm Patient requires immediate
limit medical attention.
SPO2 HIGH ALARM The SpO2 is above the upper Patient requires immediate

Types of Alarms

SPO2 LOW ALARM The SpO2 is below the lower Patient requires immediate
PULSE RATE HIGH ALARM The pulse rate is above the Patient requires immediate
upper alarm limit medical attention.
PULSE RATE LOW ALARM The pulse rate is below the Patient requires immediate
lower alarm limit medical attention.
FiCO2 HIGH ALARM The FiCO2 is above the upper Patient requires immediate
IPI LOW ALARM* The IPI is below the lower alarm Patient requires immediate
limit. medical attention.
SYSTEM RESET, CHECK The system has reset and will Reset your alarm limits and
SETTINGS revert to institutional default other settings to match the
settings. requirements of the patient
being monitored.
* The IPI LOW ALARM is an alert which is intended to indicate a change in patient status to the physician.
When this alert appears, levels of other patient parameters should be evaluated.
Medium Priority Alarms
Table 16 - Medium Priority Alarms

CO2 ERROR Failure has occurred which Contact Oridion authorized
prohibits the operation of the CO2 personnel.
function.
SPO2 ERROR Failure has occurred which Contact Oridion authorized
prohibits the operation of the personnel.
SpO2 function.
PULSE NOT FOUND No detectable pulse. Patient requires immediate medical
attention. Reposition sensor on
patient.
FILTERLINE No FilterLine is connected to the Will occur only when Parameter
DISCONNECTED device. Standby is enabled.
Insert FilterLine into CO2 port on
device.
SPO2 SENSOR No SpO2 sensor is connected to Will occur only when Parameter
DISCONNECTED the device. Standby is enabled.
Insert SpO2 sensor into SpO2 port on
device.
SPO2 SENSOR NOT ON Sensor is off patient. Place sensor properly on patient.
PATIENT
REPLACE SpO2 CABLE The SpO2 cable is defective. Replace the SpO2 cable.
FILTERLINE BLOCKAGE FilterLine is kinked or clogged. Disconnect and reconnect the
FilterLine. Check the airway adapter
and if necessary, replace the
FilterLine.
BATTERY LOW Battery charge level is low and Connect monitor to AC power.
monitor will shut down soon.

Types of Alarms

REMOTE SYSTEM Capnostream is no longer Check connection with remote
DISCONNECTED connected to a remote system. system
This message will only be present
if enabled by the host computer,
and may have different wording if
so programmed by the host
computer.
Advisories
Table 17 - Advisories
Message Description
CLEARING FILTERLINE FilterLine kinked or clogged with water. Appears
during clearing time until FilterLine is unclogged, or
a blockage state is determined.
NO USB DEVICE FOUND A valid flash memory device is not connected to
the USB port.
USB FLASH FULL No room on the USB flash memory device.
USB TIME OUT USB communication stopped due to lack of
response from the USB device.
SPO2 WEAK. REPOSITION SENSOR. SpO2 module detects a weak pulse and suggests
SPO2 WEAK. TOO MUCH LIGHT. possible causes.
SPO2 WEAK. TRY EAR SENSOR.
SPO2 WEAK. TRY NASAL SENSOR.
SPO2 WEAK. TRY ADHESIVE SENSOR
SPO2 WEAK. TRY USING HEADBAND
SPO2 WEAK. SENSOR TOO COLD.
SPO2 WEAK. CHECK BANDAGE.
SPO2 WEAK. NAIL POLISH?
SPO2 WEAK. SENSOR TOO TIGHT?
SPO2 WEAK DUE TO INTERFERENCE.
SPO2 WEAK. CLEAN SENSOR SITE.
Silent Advisories
Table 18 - Silent Advisories

Message Description
CO2 WARM UP CO2 module is preparing for operation.
CO2 READY Before the first measurement of CO2, after the FilterLine is
connected and before patient breath is detected, CO2 READY
replaces the CO2 WARM-UP message.
CALIBRATION REQUIRED CO2 calibration is overdue.
MAINTENANCE REQUIRED CO2 maintenance is overdue.
PERFORMING AUTOZERO The monitor automatically performs a zeropoint calibration.
USB DATA TRANSFER IN USB data communication in progress.
PROGRESS
RS-232 DATA TRANSFER IN RS-232 data communication in progress.
PROGRESS*
USB DATA TRANSFER ABORTED USB data communication has been stopped.
RS-232 DATA TRANSFER RS-232 data communication has been stopped.
ABORTED

Message Description
USB DEVICE FAILED A USB device connected to the monitor has failed.
REPORT TRANSFER COMPLETE Data communication is complete.
CO2 MONITORING HAS BEEN Displays the hours and minutes the pump has been turned off
OFF FOR HH:MM during PUMP OFF mode.
DEMO MODE - PRERECORDED Displayed during demo mode when no other message is
DATA displayed.
SPO2 LOW ALARM LIMIT: XX Displayed if the SpO2 Low alarm limit is set below 85%.
REMOTE SYSTEM CONNECTED* Capnostream is connected to a remote system. This message
will only be present if enabled by the host computer, and may
have different wording if so programmed by the host computer.
REMOTE SYSTEM Capnostream is no longer connected to a remote system. This
DISCONNECTED* message will only be present if enabled by the host computer,
and may have different wording if so programmed by the host
computer.
INCOMPATIBLE SOFTWARE Displayed during transfer of institutional defaults
VERSION
NO FILE FOUND Displayed during transfer of institutional defaults
A/hr REQUIRES 1 HOUR OF A/hr does not appear, since one hour of data is required to
DATA (if available) compute this value, and one full hour of data is not yet available
ODI REQUIRES 1 HOUR OF DATA ODI does not appear, since one hour of data is required to
(if available) compute this value, and one full hour of data is not yet available
CO2 STANDBY CO2 standby has been activated.
SPO2 STANDBY SpO2 standby has been activated.
NO BATTERY INSTALLED No battery is installed in the device
* When used with a remote system, this message may be displayed with a different wording if so programmed by
the host computer. The host computer may also initiate a message which would appear upon the stopping of
communications.

There is an option of placing the monitor in a separate parameter standby mode for capnography and for pulse
oximetry. Once in this mode, the user can activate Parameter Standby as required. The purpose of this option is
to enable a situation in which the device will alarm when a sampling line/sensor is disconnected from the
device, but permit the user to turn off this option at will.
The options are as follows:

In Standard Mode (when Parameter Standby Mode is not enabled), removing a FilterLine or SpO2
sensor/extension cable from the device will cause a message to appear on the screen (FILTERLINE
DISCONNECTED or SpO2 SENSOR DISCONNECTED, as relevant) but no alarms will sound. Removing
the SpO2 sensor from patient will set off an audible alarm and an on-screen message. By default, Parameter
Standby mode is disabled.
When Parameter Standby Mode is enabled, after a FilterLine has been connected and then removed from the
device, a medium priority alarm FILTERLINE DISCONNECTED will sound. Likewise, after a pulse oximetry
sensor/extension cable has been connected and then disconnected from the device, a medium priority alarm
SPO2 SENSOR DISCONNECTED will sound. The purpose of this alarm is to prevent unauthorized
disconnection of a FilterLine/SpO2 sensor from the device, perhaps by patients or patients’ visitors.
When Parameter Standby Mode is enabled, removing the SpO2 sensor from patient will set off an audible alarm
and an on-screen message, as it does in Standard Mode.
Parameter Standby mode can be enabled by entering SYSTEM>SERVICE>Enter Service password>INST
DEFAULTS>MONITOR>Turn PARAMETER STANDBY MODE to ENABLED. Return to the Home screen
by clicking BACK>BACK>HOME.
However, there may be situations in which the clinician wants to use the Parameter Standby Mode but does not
want these alarms to sound, for either a disconnected FilterLine or an SpO2 sensor, because they have
authorized the disconnection. For these situations, the monitor provides an option to put one or both parameters
on standby while these activities take place.
Once Parameter Standby mode is enabled under institutional defaults, it can be made active as follows:
1. Remove the FilterLine and/or SpO2 sensor from the device or remove the SpO2 sensor from the patient.
Note: The capnography parameter standby mode can be made active only if the FilterLine Disconnected alarm
is currently alarming, or if a FilterLine has not yet been connected to the device, since the time that it
was turned on. Likewise, the pulse oximeter parameter standby mode can be accessed only if the SpO2
Sensor Disconnected alarm or the SpO2 Sensor Not on Patient alarm is currently alarming, or if an SpO2
sensor has not yet been connected to the device or sensed a pulse, since the time it was turned on.
Note: The capnography parameter standby mode cannot be activated if the monitor is currently monitoring a
patient with capnography. Likewise, the pulse oximeter parameter standby mode cannot be activated if
the monitor is currently monitoring a patient with pulse oximetry.
2. To activate Parameter Standby Mode, press the alarm silence button at the bottom of the front panel ( )
for 2 seconds or longer. A new message CO2 STANDBY and/or SPO2 STANDBY (as required) will now
appear in the waveform area (if the waveform area is available) and in the message area. (This is in addition

Alarm Silence
to the FILTERLINE DISCONNECTED or SPO2 SENSOR DISCONNECTED or SpO2 SENSOR NOT

ON PATIENT alarms, as relevant, which will continue to appear in the waveform and message areas.)
Note: A short press on the Alarm Silence button will still turn off the audible alarms temporarily (for 2 minutes),
as previously.
3. Once parameter standby is activated, the following will take place: In this mode, CO2 and/or SpO2 alarms do
not exist, so neither audible alarms, the flashing yellow LED on the Capnostream front panel, storage of
these alarms in any data storage method, nor transfer of these alarms to central stations, nurse call
indications, etc., will take place.
4. To access both parameter standby modes at the same time, enter them one at a time, or press the Alarm
Silence button ( ) while the FilterLine is disconnected and the SpO2 sensor is not connected to a patient
or device, to enter both at the same time.
To exit the capnography parameter standby mode, reattach a FilterLine. To exit the pulse oximetry parameter
standby mode, reattach the SpO2 sensor to the patient and device. (Thus, if the user is unaware that the monitor
is in the Parameter Standby mode, simply reattaching a FilterLine to the monitor or SpO2 sensor to the patient
will cause the monitor to exit the Parameter Standby mode and monitoring to resume.)
Table 19 - Message and Alarm Status during Different Parameter Standby Situations
Feature Status when Status when Status when Parameter
Parameter Standby Parameter Standby Standby mode enabled and
mode disabled mode enabled but not Parameter Standby activated
activated
FilterLine disconnected (from Yes Yes Yes
device) on-screen message /
SpO2 sensor disconnected
(from device) on-screen
message
FilterLine disconnected (from No Yes No
device) alarm / SpO2 sensor
disconnected (from device)
alarm
SpO2 Sensor not on Patient Yes Yes No
Medium Priority audible alarm
SpO2 Sensor not on Patient Yes Yes Yes
on-screen message
CO2 Standby message / SpO2 No No Yes
Standby message
High Priority (patient) alarms Yes Yes No(for the parameter in standby)
Flashing red and yellow LEDs Yes Yes No, for the parameter in standby
on the Capnostream front (since high priority [patient]
panel during high Priority alarms related to the parameter
(patient) alarms in standby do not exist in this
case)
Storage or transfer to remote Yes Yes No, for the parameter in standby
stations of high priority (since high priority [patient]
(patient) alarms alarms related to the parameter
in standby do not exist in this
case)
Alarm Silence
To temporarily silence/disable an alarm, press the alarm silence button: .

When the alarm silence button is pressed, all audible alarms are silenced for 2 minutes. This includes both
alarms that were already sounding and also alarms that may occur during the 2 minute period. The 2-minute
alarm silence can be cancelled by a second press of the alarm silence button.
Visual alarms are still present. While the alarm silence period is active, a bell with crossed dashed lines through
it ( ) is displayed on the screen. A crossed bell with solid lines symbol ( ) is shown if audio alarms are
permanently disabled in the institutional settings.
If permanent alarm silence has been set in the Institutional Defaults (by clicking SYSTEM>SERVICE>Input
Service password>INST DEFAULTS>AUDIO ALARM VOLUME >AUDIO OFF, see Changing
Institutional Defaults on page 115), this alarm silence button ( ) does not set temporary alarm silence.
Instead, while permanent alarm silence has been set in the Institutional Defaults, this button does not affect
alarm silence; it will emit a wrong-key beep when pressed. When permanent alarm silence is set, the bell icon (
) will flash periodically.
WARNING: Do not silence the audible alarms until you verify that the patient is being monitored by
other means.

Alarm limits differ for Adult/Pediatric (for adults and all pediatric patients) and Infant/Neonatal patients. Each
set of alarms is set separately.
Alarm limits can be changed for high priority patient alarms (urgent alarms) and caution alarms on the Alarm
Limits screen. The Alarm Limits screen is accessed from the Alarm Review screen. On the Alarm Limits
screen, the caution alarms can be enabled or disabled. (If caution alarms are disabled, the values in the Caution
Alarm column will be grayed out.) The limits can also be reset to Institutional Default settings, using the
DEFAULT RESET button on the screen.
Note: In high-altitude environments, EtCO2 values may be lower than values observed at sea level, as
described by Dalton's law of partial pressures. When using the monitor in high-altitude environments, it
is advisable to consider adjusting EtCO2 alarm settings accordingly.
Figure 30 - Alarm Limits Screen

 TO CHANGE ALARM LIMITS:

1. Open the Alarm Limits screen by selecting the ALARM LIMITS button on the Menu bar at the bottom of the
Alarm Review screen.
2. To modify a setting, scroll to the individual limit setting using the control knob. Click the control knob to
select that setting, and then turn the control knob to select a new value. Click the control knob again to set
the new value.
3. To enable caution alarms, click the CAUTION ENABLE button on the screen, using the control knob. The
caution alarm limit values will now become active, and can be changed on this screen in the same manner as
high priority patient (urgent) alarm limits can be changed. The CAUTION ENABLE button will show
CAUTION DISABLE when the caution alarms are enabled, and clicking the CAUTION DISABLE button
will disable the caution alarms.
4. Use the control knob to select HOME and click the control knob again to return to the Home screen.
Changing the high alarm limit towards the low alarm limit will force the low alarm limit down if necessary, in
order to maintain a difference of at least 5 units between high and low alarm limits. This type of adjustment
causes the low alarm limit to also change in color to make it obvious that it is active. Similarly, if you change
the low alarm limit towards the high alarm limit, the high alarm limit is forced up if necessary, in order to
maintain a difference of at least 5 units between high and low alarm limits. This type of adjustment causes the
high alarm limit to also change in color to make it obvious that it is active.
The alarm will go off if it exceeds the High Limit value or goes below the Low Limit, not if it only reaches the
value.
Alarm limits will reset to their factory default when the power is turned off. To make the changes permanent,
use the Service Mode to change the Institutional Settings for the alarm limits (see Institutional Defaults on
page 115).
Note: When the SpO2 alarm limit is set below 85%, a message reading SpO2 LOW ALARM LIMIT: xx will
appear in the header area, indicating the level of the SPO2 LOW alarm limit.

In order to test the NO BREATH alarm, establish a display of normal breathing on the device. Once normal
breathing is displayed, remove the sampling line from the patient's mouth to create a no breath situation. The
device should then display a NO BREATH alarm.
In order to test the pulse oximetry SENSOR NOT ON PATIENT alarm, establish a display of SpO2 values on
the Monitor. Once SpO2 values are displayed, remove the sensor from the test subject to create a SENSOR
NOT ON PATIENT situation. The monitor should then display a SENSOR NOT ON PATIENT alarm.
SpO2 Alarms and SatSeconds

Capnostream uses Nellcor’s SatSeconds technology to help reduce the number and frequency of false SpO2
alarms.
When monitoring upper and lower alarm limits of oxygen saturation, an audible alarm is triggered when one of
these limits is violated by as little as one percentage point. In traditional alarm management, whenever the
%SpO2 level crosses the alarm limit, the alarm sounds every time the limit is exceeded.
If such frequent alarms are not desired, they can be prevented by using the SatSeconds technique developed by
Nellcor. Using this technique, upper and lower alarm limits are set in the same way they are set in traditional
alarm management. A SatSeconds limit can also be set, in order to sound an alarm while taking into account not
only the crossing of the %SpO2 alarm limit, but also the time for which the patient's %SpO2 reading is above or
below the limit.
The method of calculation is as follows:

SatSeconds is calculated by multiplying the number of percentage points that the %SpO2 falls outside of alarm
limit by the number of seconds that the %SpO2 level remains outside that limit. This can be stated as an
equation:
Points x Seconds = SatSeconds
Where:
Points = %SpO2 percentage points outside of the limit
Seconds = number of seconds the %SpO2 remains at that point outside of the limit.
The alarm response time, assuming a SatSeconds limit set at 50 and the SpO2 LOW alarm limit set at 90, is
described and illustrated below.
In this example, the %SpO2 level drops to 88 (2 points) and remains there for a period of 2 seconds
(2 points x 2 seconds = 4 SatSeconds).
The %SpO2 then drops to 86 for 3 seconds and then to 84 for 6 seconds.
The resulting SatSeconds are:
%SpO2 Seconds SatSeconds
2 x 2 = 4
4 x 3 = 12
6 x 6 = 36
Total SatSeconds = 52
After approximately 10.9 seconds the SpO2 alarm would sound, because 50 SatSeconds had been exceeded
(note the arrow in the figure below).
Saturation levels may fluctuate rather than remain steady for a period of several seconds. Often, the %SpO2
levels may fluctuate above and below the alarm limit, re-entering the non-alarm range several times.
During such fluctuations, the Capnostream integrates the number of %SpO2 points, both positive and negative,
until either the SatSeconds limit (SatSeconds time setting) is reached, or the %SpO2 level returns to within a
normal range and remains there.
SatSeconds Alarm Display

17B
SatSeconds are displayed in the SpO2 display area on the monitor screen. When SatSeconds is enabled and the
SpO2 reading is below the minimum, the SatSeconds counter will begin. If the SatSeconds limit is been reached,
an audible alarm sounds and the displayed %SpO2 numeric rate flashes. As with standard alarm management,
the audible alarm may be silenced by pressing the ALARM SILENCE button ( ).


The factory defaults for the Adult and Neonatal alarm limits are given in Table 29 - Factory Default
Alarm/Indicator Limits on page 118.
Caution Alarms are disabled by default.

Introduction
final document
Chapter 10
Using Trends
Introduction
The Trend Display Screens
Graphical Trend Display Screen
Tabular Trend Display Screen
Choosing Trend Parameters
Important Notes Regarding Trend Reports
Specific Events as seen in Trend Data
Using the Graphical Trend Screen for Monitoring Patients
Printing the Trend Data
Clearing Trend Memory
Configuring Trends
Introduction
Capnostream stores patient data that provides detailed information on the history of the patient during
monitoring.
The trend displays allow you to look at the patient history as part of the medical analysis to aid in patient
assessment.
The institution can define the trend storage to be: 12 hours of data at 5 seconds resolution, 24 hours of data at
10 seconds resolution, or 72 hours of data at a resolution of 30 seconds. Once trend contents reach maximum
capacity, new data will overwrite the data recorded at the beginning of the stored trend data.
The trend data stores the following parameters:
• Time, Date, EtCO2, RR, SpO2, PR, IPI (where relevant)
• High priority red urgent alarms and yellow caution alarms
• Equipment-caused events such as CLEARING FILTERLINE or other monitor-related messages.
• Event markers input by the user, along with any event label.
• CASE START marker to indicate start of case
• Count of alarm occurrences (for all High Priority red urgent and yellow caution alarms)
Please note that A/hr and ODI (even if available) do not appear on the Trend screens or printouts. A/hr and ODI
are recorded, and can be viewed, on the Apnea and O2 Desaturation Report screen and printout. For more
details, see Apnea and O2 Desaturation Report on page 89.
Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only (See
Institutional Defaults on page 115).
Note: Changing the resolution setting will clear the trend data previously stored in memory.
The trend data can be viewed on the monitor, printed, and downloaded via an RS-232 connection or a USB
flash memory device for transfer to a computer for further analysis.
If the patient will be monitored for a longer period than can be stored in the monitor memory, it is
recommended to regularly download patient data using the USB interface as described in Chapter 12
Downloading Patient Data on page 99.


Trend data is displayed in two different formats; graphical and tabular. The Graphical Trend screen allows you
to view the patient data over a longer time scale (2, 4 or 12 hours at a time) and scroll through the data looking
for patterns, specific events or alarms.
Once you have located the data of interest, you can zoom in to the specific event, or examine the messages and
data using the Tabular Trend screen. Tabular Trend presents the data in an easy to read table format.
In order to change the order of the displayed parameters on the Trend screens, see Changing Parameters Order
on the Trend Display on page 119.

 TO VIEW THE GRAPHICAL TREND DISPLAY SCREEN:
1. From the Home screen, use the control knob to select TREND from the soft buttons in the menu bar at the
bottom of the screen. The Graphical Trend screen, seen in Figure 31 - Graphical Trend Display, below, is
shown.
Time and date Yellow cursor

of cursor line
location
Zoom level
Real time
Patient data at patient
cursor location data
Event
indicator
Figure 31 - Graphical Trend Display
2. Please note that the Trend screens display both Trend information (described below) and real time patient
numerics, which are displayed on the right hand side of the screen. The Trend data displayed is historic data
from the trend memory. When the screen is first opened, it shows the cursor line in the middle of the
graphical display, which is the middle point of the displayed data. Data regarding the patient at the point in
time indicated by the cursor is displayed at left. Details regarding the graphical trend display appear in the
next section.
Graphical Trend Display

In the center of the screen are the graphic trend displays. The upper two graphs show historic trend capnography
data: etCO2 in white and respiration rate values in blue. Similarly, the two middle graphs show the patient's

historic trend pulse oximetry data: SpO2 data in pink and pulse rate values in green. The bottom graph shows IPI
values in an orange-colored graph.
On the left hand side of the screen is the historic patient data at the date and time where the cursor is located.
The exact recorded date and time of the cursor location are displayed.
• Zoom level: Can be set to 2, 4 or 12 hours using the ZOOM key
• Yellow cursor line: The vertical yellow line extends through all four graphs and is movable with
the control knob when the SCROLL option is selected. The cursor line shows the current location
in the trend data, with the exact date and time listed under the CURSOR LOCATION heading
near the top left of the screen as shown in Figure 31 - Graphical Trend Display on page 81.
• Alarm indicator: wide vertical red lines (for red urgent alarms) and yellow lines (for yellow caution
alarms) that may appear in the four graphs showing where in time an alarm occurred. For EtCO2, SpO2,
RR, and PR alarms, the red line is drawn through the respective graph of the waveform for that parameter.
In the case of NO BREATH alarms, the red line extends though both the etCO2 and RR graphs. The
actual alarm details can be viewed in the Tabular Trend display screen, described in Tabular Trend
Display Screen seen on page 84.
• Event indicator: the small vertical pink line along the bottom of the graph shows when an event was
registered. The actual event can be viewed in the Tabular trend display screen, described in Tabular Trend
Display Screen on page 84.
The following controls for viewing graphical trend are selected from the Menu Bar.
• TABULAR – switches the display from Graphical to Tabular display (in the Tabular trend display, this
control changes the display to Graphical). See Tabular Trend Display Screen on page 84 for an
explanation of the tabular trend display.
• SCROLL – allows you to scroll through the patient data. The date and time of the cursor location are
indicated under CURSOR LOCATION.
• ZOOM – allows you to increase or decrease the time segment being looked at.
• PRINT TREND – provides a printout of the trend display currently seen on the screen.
• ALARM LIMITS – displays the Alarm Limits screen allowing you to see what the settings are, and
modify them if necessary.
Using SCROLL and ZOOM

There are many ways in which the Trend screens can be used to examine patient data. The following is a brief
overview of a general method of searching for and displaying specific events in the graphical Trend screen.
 TO VIEW TREND DATA IN SCROLL MODE:
1. In the graphical trend mode, use the control knob to select SCROLL from the Menu Bar. The box around
the word SCROLL in the Menu Bar and the time/date heading both turn yellow, indicating that you are in
scrolling mode.

Figure 32 - Scroll mode in the Graphical Trend
2. When you scroll to the end of the screen and continue to scroll, the screen will change to add the next or
previous 1/2 time period to the display (for example, if you are viewing a 2 hour display, from 4 PM to
6 PM, and you scroll backward to reach 4 PM, the yellow line will return to the middle of the screen and you
will see 3 PM to 5 PM instead on the screen). Scrolling all the way to the right and getting a beep means you
are at the current time. Scrolling all the way to the left and getting a beep means that you are at the beginning
of the recorded data.
3. To see a longer or shorter time period on the display, select ZOOM on the Menu Bar and turn the control
knob to change the resolution to 2, 4 or 12 hours. The box on the Menu Bar around ZOOM turns yellow to
indicate that you are changing the zoom level. Click the control knob again to exit the Zoom function. You
can then return to Scroll mode to continue inspecting the patient's recorded data.
To see the greatest amounts of patient data, change the resolution to 12 hours. To do this, use the control
knob to select and click on ZOOM on the Menu Bar. The box around ZOOM will turn from blue to yellow
and the title area showing the display resolution will also turn yellow. Turn the control knob to select 12 HR
DISPLAY, and then click the control knob.
Now use the control knob to select and click on SCROLL on the Menu Bar. The box around SCROLL will
turn from blue to yellow, and the time and date heading under CURSOR LOCATION will also turn yellow.
Turn the control knob to move the cursor to the left or right. As you turn the control knob, the time changes,
and the patient data on the left hand side of the screen also changes to show the readings at that point in time.
To find an event or alarm occurrence, scroll the graphic display to look for event and alarm markers as
shown above in Figure 31 - Graphical Trend Display on page 81. Place the yellow cursor line on the red
alarm marker, then exit the scroll mode by clicking the control knob. When you zoom to a different time
display, the cursor will appear in the middle of the graphical screen at the appropriate time that it marked on
the previous screen.
Use the ZOOM button to select a Zoom option (i.e., to go to lower zoom level, 4, 2, or 1 hours) and scroll
again until you have found your specific area of interest.
To exit from Zoom change mode, click the control knob.
4. To exit from Scroll mode, click the control knob.

To view more information about the displayed patient, use the control knob to select the TABULAR trend
display on the Menu Bar, and see the instructions below in the section Tabular Trend Display Screen on
page 84.

 TO VIEW THE TABULAR TREND DISPLAY SCREEN:
1. In the graphical trend mode, use the control knob to select TABULAR from the Menu Bar. The Tabular
Trend display screen will appear. To enter the Tabular Trend mode from the Home screen, click TREND on
the Menu bar and then TABULAR on the Menu bar.
Figure 33 - Tabular Trend Display
2. Note that the real time patient data is displayed on the right hand side of the screen, while the left side of the
screen displays the Tabular Trend with detailed historic patient data.
3. Click ZOOM on the Menu bar to change the time resolution from the current display to 60, 15, 3 or 1.5
minutes or the MINIMUM setting. The MINIMUM setting is defined as the trend recording resolution and
can be 5, 10 or 30 seconds (see Institutional Defaults on page 115 for instructions on how to change the
recording resolution).
The controls for viewing tabular data are:
• GRAPHICAL – switches the display from to Graphical from Tabular display (in the Graphical trend
display, this changes to Tabular)
• SCROLL – allows you to scroll through the table of patient data.
• ZOOM - allows you to increase or decrease how much time is averaged into each data point shown in the
table. At the lowest setting, the zoom allows you to examine detailed alarms and events.
• PRINT TREND – provides a printout of the trend display currently seen on the screen.
• ALARM LIMITS – displays the Alarm Limits screen to allow you to see what the settings are, and change
them if necessary.

The table below gives a sample of the tabular display at a resolution of 1.5 minutes.
Table 20 - Tabular Display Example

TIME EtCO2 RR SpO2 PR IPI EVENTS
mmHg bpm % bpm
12:23 AM May 23 10
10 41 17 98 71 9 2*
12:24 AM May 23 10
40 48 16 98 71 7 5*
12:26 AM May 23 10
10 49 16 98 70 7 1 21*
12:27 AM May 23 10
40 35 17 98 71 7 22*
12:29 AM May 23 10
10 29 16 98 71 8 1 22*
12:30 AM May 23 10
Events are indicated by a triangle (similar to the event button located on the front panel of the monitor) and
alarms are indicated by an asterisk. The number beside each indicates how many alarms or events occurred
during that time period.
4. To see the specific events and alarms, change the ZOOM setting to the MINIMUM value, which changes the
zoom level to the lowest time interval. Specific events and high priority red urgent and yellow caution
alarms will now appear in the table and you can use the Scroll option to scroll up and down the table. The
table below gives a sample of the tabular display at the MINIMUM resolution (in this case the minimum
resolution is set at 5 seconds).
Table 21 - Detailed Tabular Display Example

TIME EtCO2 RR SpO2 PR IPI EVENTS
sec mmHg bpm % bpm
3:23 AM May 23 10
05 29 22 99 74 8 PROPOFOL
10 29 20 99 73 8
15 29 20 100 71 8
20 27 16 92 66 4
25 26 14 88 64 4
30 26 14 88 65 4
35 26 14 88 65 4
40 26 14 88 65 4
45 26 14 88 65 4
50 26 14 88 65 4
In the above example, oxygen was given to the patient during the period between 3:23:05 and 3:23:10 AM
followed by a rise in respiration rate to a level that triggered the high value alarm. This is indicated by the
red up arrow. Similarly, a low respiration rate alarm would have a red down arrow.
If the Event Marking Mode is set to QUICK, no text information is available at the lowest zoom level, but
a triangle will still appear to indicate that an event was marked.
5. The monitor will hold up to 72 hours of patient data. If there is more data than you can see on the screen,
then scrolling up will change to display earlier data (if you scroll up) or later data (if you scroll down).


The device displays the following trend parameters: EtCO2, RR, SpO2, PR, and IPI. The desired order of the
parameters can be set by the user using the Trend: Display Configuration screen (see Changing Parameters
Order on the Trend Display on page 119 for details). If you do not want to view these parameters in Trend
Reports, choose the BLANK option for some slots in the Trend: Display Configuration screen.
Important Notes Regarding Trend Reports

Please note the following issues regarding trend reports, including on-screen tabular trend reports, printed trend
reports, and downloaded trend reports:
• Each number displayed in the trend memory is an average of the results for each second over the
sampling period. For example, for a 30-second sampling period, the displayed result each 30 seconds is
an average of the data points for each of the 30 seconds within the sampling period.
• If an alarm took place anywhere in the sampling period (i.e., at some point during the 30 seconds of a
30-second time period, when data is being recorded every 30 seconds) it will be noted, even if the
averaged number recorded does not indicate a cause for an alarm.
• “EtCO2 not available” is generated whenever a CO2 self-maintenance occurs. This occurs one hour after
turn-on, every 12 hours after that, and after a significant change in temperature or altitude. The CO2 self-
maintenance lasts approximately 10 seconds. During this process, etCO2 and other physiological values
are held at their values prior to the CO2 self-maintenance.
Specific Events as seen in Trend Data

 TO SEARCH FOR SPECIFIC EVENTS IN TREND DATA:
1. Use the cursor in the graphical trend screen to locate an area of interest.
2. Use ZOOM to get as close as possible to the specific area.
3. Switch to the Tabular trend display.
4. Use SCROLL to find the area of interest.
5. Zoom to minimum resolution to see detailed alarm and event information.
Using the Graphical Trend Screen for Monitoring Patients

It is possible to use the Graphical Trend screen as the main monitoring screen, rather than the Home screen.
Instead of seeing the real time waveforms, the Graphical Trend gives you the ability to easily track changes in
the patient's condition. The real time numeric data is shown on the right hand side of the screen for both the
Trend and Home screens.
When using the Graphical Trend screen as the main monitoring screen, it is important to ensure that the graphs
are updated with the latest data. This will happen automatically as long as the Scroll function has not been used
since you entered the Graphical Trend screen. While in automatic update mode, the screen will automatically
update new data to the right of the yellow cursor line. When the area to the right of the cursor is filled, the
graphs will shift, allowing more data points to be plotted.
If you use the Scroll feature and then want to return to using the Graphical Trend to monitor the patient, simply
go to the Home screen and then select TREND again.
Printing the Trend Data

If the optional printer is installed, you can obtain a printout of the trend data that is displayed on the screen by
selecting PRINT TREND in the Menu Bar.


It is recommended to erase trend memory when the monitor is switched to a new patient, in order to avoid
mistaking the earlier data for the present patient's data. If you are working with cases, and the current case is
ended, the trend memory is automatically cleared.
 TO ERASE TREND MEMORY:
1. To erase the trend data from the monitor memory, use the control knob to go to the Home screen and select
SYSTEM on the menu.
2. On the System screen, select CLEAR TREND. The word CONFIRM? will appear just above the Menu Bar.
3. If you are certain that you want to erase the trend memory, click the control knob. If you do not want to
erase the trend memory, turn the knob to the left or right to cancel.
4. When the machine is turned on, a message appears, suggesting that you erase the trend memory in order to
start a new patient without information from previous patients in the trend memory. This screen appears in
Figure 34 - Trend Memory Message, below. Click YES to erase the trend memory. If you intend to continue
measurement of the same patient as previously, you may want to retain the trend memory. In that case, click
NO. If you record patient data as part of a case, trend memory will always be erased when you close the
case.
Figure 34 - Trend Memory Message
Configuring Trends
To change the parameters for trend displays, go to the Home screen and select SYSTEM to see the System
Setup screen. The table below shows the options as they appear on the System Setup screen.
Table 22 - Monitor Parameters

DATE MAY 25, 2011
TIME 11:27:32 AM
LANGUAGE ENGLISH

Configuring Trends
EVENT MARKING MODE DETAILED

TREND GRAPHICAL DISPLAY [hour] 4 hour
TREND INCREMENT DISPLAY [min] 1.5 min
NURSE CALL DISABLED
HOME SCREEN STANDARD
HOME IPI DISPLAY (hour) 1 hour
IPI ALARM DISABLED
The Trend Data parameters are Event Marking Mode, Trend Graphical Display and Trend Increment Display.
The Trend Display settings refer to how the screen will be initially be displayed when you enter the Trend
mode. Once you are on the Trend screen, these views can be easily changed using the Zoom feature. These
settings will remain until the monitor is powered off.
Event Marking Mode

• Detailed Event Marking: When the Event button is pushed, you can enter a specific description of the
event from a table of 30 user definable values (see the section Entering Patient Events on page 45).
• Quick Event Marking: Marks that an event occurred when the Event button is pushed, but does not give
any details.
If the monitor is set to Detailed event marking mode, but you don't have time to enter the detailed event, a
quick event mark can be entered by pushing the Event button twice.
Trend Graphical Display

Trend Graphical Display options are 2, 4 and 12 hours. The factory default is 4 hours.
Trend Increment Display

Trend Increment Display options for the Tabular Trend Display are MINIMUM, 1.5, 3, 15 or 60 minutes. The
factory default is 1.5 minutes. The MINIMUM setting is defined as the trend recording resolution and can be 5,
10 or 30 seconds (see Changing Institutional Defaults on page 115 for instructions on how to change the
recording resolution).

final document
Chapter 11
Reports
Printed Report Options
Printed Reports
Sample Reports
When the user clicks on the REPORTS button on the Home screen, the Apnea and O2 Desat (Desaturation)
Report will appear on the screen. See Apnea and O2 Desaturation Report, below for more information. To print
other patient reports, click on the PRINT REPORT button on the Apnea and O2 Desat Report screen. For more
information, see Printed Reports on page 93.
If A/hr and ODI display is not available or disabled (either in Institutional Defaults or in the System Setup
screen), or if the Patient Type is set to Infant/Neonatal or one of the Pediatric patient types, the REPORTS
button will not appear. Instead, clicking the PRINT button on the Home screen will open the Print screen. For
more information, see Printed Reports on page 93.

The on-screen and printed Apnea and Desat reports show a comprehensive picture of the number of apnea and
O2 desaturation events over a set time period of 2, 4, 8, or 12 hours. They show the average A/hr and ODI score
for the whole period as well as listing the number of events during each part of the set time period, with the
apnea events listed by the number of seconds each event lasted. The sum of events in each row over the entire
time period (2, 4, 8, or 12 hours, as chosen by the user) is also shown. These reports provide both details
regarding the A/hr and ODI status of the patient and a general picture which can help the caregiver spot patient
trends in these areas.
This report is available only for adult patients, since A/hr and ODI are available only for adult patients.
In situations in which part of the information for the set period is missing (for example, SpO2 was not measured
during a particular half hour during the 12 hours seen on the screen, so ODI could not be measured for that half
hour) the relevant time section will be shaded in grey, to indicate the presence of missing data. If the first hour
of monitoring has not yet been completed, the relevant time section on this screen will also be shaded in grey
(since A/hr and ODI are per-hour indicators, they cannot be calculated and thus cannot be displayed if less than
one hour of data is available).
Note: This report is updated every 60 seconds. Since the A/hr and ODI numerics on the Home screen are
updated once a second, there may be a slight temporary discrepancy between the numerics on the two
screens from time to time.
Note: The recommended use for this screen is that it be viewed when the caregiver wants to know more about
the patient’s apnea and O2 desaturation events, or when an indicator on the Home screen indicates that
the report should be viewed. While the report is being displayed on the monitor screen, the display is not
updated, so it is best not to continually view this report on the monitor, but to continuously view the
Home screen while monitoring a patient. The EtCO2, FiCO2, RR, SpO2, and PR numerics are all updated
continuously on all screens, including the A/hr and O2 Desat Report screen.
The Apnea and O2 Desat Report screen is reached with the REPORTS button on the menu on the Home screen.
The Print Report seen on the Print Report screen may be printed from the Apnea and O2 Desat Report screen
with the built-in Capnostream printer (using the START PRINTER button), or saved to a USB flash memory
drive (using the START USB button).
Soft buttons on the Apnea and O2 Desat Report screen are as follows:

• TREND – to graphical trend screen

• PRINT – brings user to the standard print screen
• ZOOM – changes the time period viewed on the screen to another option. Options are 2, 4, and 12
hours.
• SCROLL – moves the cursor across the screen so that different time intervals can be viewed
• PRINT REPORT – brings user to the Apnea and O2 Desat Report: Print Report screen.
The information provided in the Apnea and O2 Desat Report saved to a USB flash memory drive is as follows:
Report Name Description Fields Included
Apnea and O2 Desat Tab delimited file with the suffix DATE, TIME, CASE ID, Patient type, ZOOM selected
Report .txt. Reports A/hr and ODI data Apnea Count and Desat Count for each of the time periods
and all trend data for the previous
on the report, summation of Apnea count and Desat Count
2, 4, 8, or 12 hours (depending on for the entire period, and average A/hr and ODI scores
selected ZOOM level).
Patient Readings: EtCO2, RR, SpO2, PR, IPI
Patient Urgent Alarm Occurrences: EtCO2 HIGH, EtCO2
LOW, RR HIGH, RR LOW, NO BREATH, SpO2 HIGH,
SpO2 LOW, PR HIGH, PR LOW, IPI LOW
Equipment Advisory Message Occurrences:
Events: EVENT 1, EVENT 2, EVENT 3
The printed Apnea and O2 Desat Report includes the following information:
Apnea and O2 Desat A/hr and ODI data along with DATE, TIME, CASE ID, Patient type, ZOOM selected,
Report patient readings (as seen in trend summation of Apnea count and Desat Count for the entire
report) and graphical trend data. period, average A/hr and ODI scores for the period, and
Report with show data for the Apnea Count and Desat Count for each of the time periods
previous 2, 4, 8, or 12 hours on the report.
(depending on selected ZOOM Patient Readings: EtCO2, RR, SpO2, PR, IPI
level).
Patient Graphical Trend graphs: EtCO2, RR, SpO2, PR, IPI
An example of the printed Apnea and O2 Desat Report appears in Figure 36 - Apnea and Desat Printed Report
on page 92.
An example of the Apnea and O2 Desat Report screen is seen in Figure 35 - Apnea and Desat Report Screen on
page 91.

Average
Apnea Per
Hour
Apnea
Counts and
Apnea
Sums
Desat
Count
Desat Sum
ODI
Figure 35 - Apnea and Desat Report Screen
Patient Information Explanation

Seen on Screen
A/hr Average A/hr per hour over entire time period which
(Apneas per Hour) appears on the screen
Apnea Count Sum of all instances of No breath (apnea) in each time
category (≥10 seconds, 10-19 seconds, 20-29 seconds)
over the entire time period which appears on the screen
SUM(Apnea sum) Number of instances of no breath (apnea) in each time
category (≥10 seconds, 10-19 seconds, 20-29 seconds) in
each of the intervals within the relevant time period (in this
case, 12:00 AM to 1:00 AM)
Desat Count Sum of all instances of Desat over the entire time period
which appears on the screen
SUM(Desat sum) Number of instances of Desaturation in each of the
intervals within the relevant time period (in this case, 12:00
AM to 1:00 AM)
ODI Average ODI per hour over entire time period which
appears on the screen

Figure 36 - Apnea and Desat Printed Report


Capnostream can be purchased with a built-in thermal strip printer. The report printing menu in Capnostream is
for use with the optional printer.
To print a report on an external printer, the recommended procedure is to transfer the data to a computer using a
USB flash memory device (see Data Transfer via the USB Data Port on page 99). The report can then be
formatted and printed using the computer.
The following printed reports are available:
• Tabular Case Report
• Graphical Case Report
• Tabular Trend Report
• Graphical Trend Report
• Real Time Continuous Waveforms
• Real Time Continuous CO2 Waveform
• Real Time Continuous Tabular
The printed Apnea and O2 Desat Report (if available) is discussed above.
The data printed for the trend reports is the data that was last displayed on the Trend screen at the time PRINT
TREND was selected. The resolution of the case report is always the minimum resolution (maximum detail).
Real Time Continuous Tabular data is printed at the same interval that the numerics on the screen are updated.
The Real Time Continuous Waveform graph/s are printed as displayed on the screen.
Please note that all Trend and Case reports must be printed before the case is ended. Once a case is ended, the
case and trend data is deleted from the memory, and printing is no longer possible.
Printed Reports
The Print screen is accessed from the Apnea and O2 Desat Report screen (if A/hr and ODI are enabled) or the
Home screen (if A/hr and ODI is not available or not enabled).
The Print screen allows you to choose what report to print, and also to start and stop the printing of a report.
 TO PRINT A REPORT:
1. From the Home screen, select REPORTS.
2. On the Apnea and O2 Desat screen which will appear, select PRINT to display the Print screen seen in
Figure 37 - Print Screen on page 94.
3. For Infant/Neonatal patients, select PRINT on the Home screen to view the Print screen.
4. Use the control knob to select the type of report to print. Only one type of report can be selected at a time.
An asterisk (*) will indicate the report that has been selected. If you choose a case report and no case is
currently active, the field to the right of the report name will read NO CASES.

Printed Reports
Figure 37 - Print Screen
5. Choose data to be printed:

Select the PRINT FORMAT option from the Print screen. On the Print Format screen, select the parameters
that you want to print on the report.
Three columns of data appear in one printed report in the tabular formats and two graphs appear in one
printed report in the graphical formats. The print format selected applies to all reports to be printed.
For tabular reports, EtCO2, FiCO2, RR, SpO2, PR, IPI, and blank are available for selection. For graphical
reports, EtCO2, RR, SpO2, PR, IPI, and blank are available for selection. Selecting blank means that nothing
will be printed in that column.
6. Click BACK on the Menu bar at the bottom of the screen to return to the Print screen.
7. Click START PRINTER on the Print screen to begin printing. To stop printing, in order to stop continuous
printing or abort other reports that have not completed, click the STOP PRINTER button on the screen.
Table 23 - Printed Reports – Parameters

Report Name Description Fields Included Time Frame of Report
All reports CS20P (this indicates that the report was
generated by a Capnostream20P)
Serial number of the device on which the
report was printed
Name of Report (TREND REPORT, CASE
REPORT or REAL TIME REPORT)
Patient Type (ADULT, PEDIATRIC [3 age
ranges] or INFANT/NEONATAL)
Case ID
DATE, TIME
Tabular Case Patient readings of Patient Readings at start and end of From start of case until
Report recorded case in tabular recording period: EtCO2, FiCO2, RR, SpO2, current time; once case is
format. The time PR, IPI. stopped, data is not

Printed Reports

between data entries is Patient Readings: Three of the following available
the lowest resolution parameters (according to parameters
available for trend chosen in the PRINT FORMAT screen, see
increment display To print a report on page 93): EtCO2,
(30 seconds). FiCO2, RR, SpO2, PR, IPI.
Patient Urgent and Caution Alarm
Occurrences All patient urgent and caution
alarms
Equipment Advisory Message Occurrences
Graphical Case Patient readings of Patient Readings at start and end of From start of case until
Report recorded case in recording period: EtCO2, RR, SpO2, PR, current time; once case is
graphical format. The IPI. stopped, data is not
time between data available
Graphs of levels of two of the following
entries is the lowest parameters (according to the parameters
resolution available for chosen in the PRINT FORMAT screen, see
trend increment display
To print a report on page 93) at 30-second
(30 seconds).
intervals: EtCO2 (mmHg), RR (bpm), SpO2
(%), PR (bpm), IPI.
Tabular Trend Patient readings of trend DATE, TIME Trend data as appears on
Report memory in tabular the trend screen which is
format. The time currently displayed, or, if
between data entries is printing from the PRINT
Patient Readings at start of recording
the resolution set for screen, the trend screen
period: EtCO2, FiCO2, RR, SpO2, PR, IPI.
trend increment display which was most recently
(MINIMUM [30 displayed. Only the data
seconds], 1.5 minutes, Patient readings at intervals set for trend points currently visible on
3 minutes, 15 minutes, increment display: Three of the following the screen (approximately
60 minutes). parameters (according to parameters ten data points) will be
chosen in the PRINT FORMAT screen, see printed. Thus, the ZOOM
To print a report on page 93): EtCO2, level on the trend screen
FiCO2, RR, SpO2, PR, IPI. (choices are 2, 4, and 12
hours), will determine the
Patient Urgent and Caution Alarm
number of minutes/hours of
Occurrences
data seen in the printout.
Equipment Advisory Message Occurrences Once trend is erased, data
is not available.
Graphical Trend Patient readings of trend Patient Readings at start of recording Trend data as appears on
Report memory in graphical period: EtCO2, RR, SpO2, PR, IPI. the trend screen which is
format. The time Graphs of levels of two of the following currently displayed, or, if
between data entries is parameters (according to the parameters printing from the PRINT
the resolution set for chosen in the PRINT FORMAT screen, see screen, the trend screen
trend increment display To print a report on page 93) at interval set which was most recently
(MINIMUM [30 for trend increment display: EtCO2, RR, displayed. Thus, the ZOOM
seconds], 1.5 minutes, SpO2, PR, IPI. level on the trend screen
3 minutes, 15 minutes, (choices are 2, 4, and 12
60 minutes). hours), will determine the
number of hours of data
seen in the printout. Once
trend is erased, data is not
available.
Real Time Graphical presentation Patient Readings at start of recording Real-time data from time
Continuous of levels of etCO2 and period: EtCO2, FiCO2 , RR, SpO2 , PR START PRINTER is
Waveform SpO2, with a data point Graphs of levels of EtCO2 and SpO2. pressed to time STOP
every 50 milliseconds
PRINTER is pressed

Printed Reports

Real Time Graphical presentation Patient Readings at start of recording Real-time data from time
Continuous CO2 of levels of etCO2, with a period: etCO2, FiCO2 , RR, SpO2 , PR. START PRINTER is
Waveform data point every 50 pressed to time STOP
milliseconds
PRINTER is pressed
Real Time Tabular presentation of Patient Readings at start of recording Real-time data from time
Continuous EtCO2, RR, and PR, period: EtCO2, FiCO2, RR, SpO2, PR, IPI. START PRINTER is
Tabular with a data line every Three of the following parameters pressed to time STOP
2 seconds (according to parameters chosen in the PRINTER is pressed
PRINT FORMAT screen, see To print a
report on page 93): EtCO2, FiCO2, RR,
SpO2, PR, IPI.
* Please note that, in all cases, EtCO2 and FiCO2 are displayed in selected units, SpO2 in percentages, and RR and PR in
bpm (beats per minute).

Sample Reports
Sample Reports
Sample Case Reports
The following are examples of tabular and graphical case reports as described above.
Figure 38 - Sample Case Reports Printout

Sample Reports
Sample Trend Reports

The following are examples of tabular and graphical trend reports as described above.
Figure 39 - Printed Trend Reports

final document
Chapter 12
Downloading Patient Data

Introduction
Data Transfer via the USB Data Port
Data Transfer via the RS-232 Port
Analog Data Output with Capnostream
Nurse Call Operation
Types of Nurse Call Systems
Operation with Hospital Patient Data Systems
Operation with Nuvon VEGA Systems
Introduction
Capnostream can export stored and current data to external devices by the following methods:
• Data transfer to a USB flash memory device for later transfer to a computer
• Direct connection to a computer via the RS-232 port
• 7-channel analog output (this feature is no longer available)
The occurrence of an alarm condition can also be indicated to an external system via the Nurse Call feature.

There are seven types of reports that can be transferred to a USB flash memory device, as described in the table
below. Five report types are in text format and are suitable for use in applications such as Microsoft Excel. The
two binary data report types are for advanced programming applications.
In addition, the Apnea and O2 Desat Report (if A/hr and ODI are available) can be downloaded to a USB flash
memory device. See Apnea and O2 Desaturation Report on page 89 for more information.
All A/ hr and ODI alarms will not be recorded when A/hr and ODI are not available.
Table 24 - Data Transfer Types

Tabular Case Report Tab delimited file with the suffix .txt. (Tab DATE, TIME
delimited files can be exported into Excel Patient Readings: EtCO2, RR, SpO2, PR, IPI.
using “tab” as the delimiter.) Reports the
data stored in trend memory that is Patient Urgent and Caution Alarm Occurrences
assigned to the selected case. The time Equipment Advisory Message Occurrences
between data entries is the resolution set
for trend storage (5, 10 or 30 seconds). Events: EVENT 1, EVENT 2, EVENT 3
Tabular Trend Report Tab delimited (.txt) file. Reports all the data DATE, TIME
stored in trend memory. The time between Patient Readings: EtCO2, RR, SpO2, PR, IPI.
data entries is the resolution set for trend
storage (5, 10 or 30 seconds). Patient Urgent and Caution Alarm Occurrences


Real Time Continuous Tab delimited (.txt) file with data entries DATE, TIME
CO2 Waveform every 50 milliseconds.
Patient Reading every 50 milliseconds (for
creating CO2 waveform): CO2*
Real Time Continuous Tab delimited (.txt) file, similar to the DATE, TIME
Tabular Tabular Trend report, but transmitted line Patient Readings: EtCO2, FiCO2, RR, SpO2, PR,
by line in real time.
IPI, A/hr, ODI.
Patient Urgent and Caution Alarm Occurrences
Real Time Continuous Tab delimited (.txt) file, similar to the real DATE, TIME
Tabular with real-time time continuous tabular report, transmitted Patient Readings (at trend storage resolution):
continuous waveform line by line in real time, but with data entries EtCO2, FiCO2, RR, SpO2, PR, IPI, A/hr, ODI
(shortened name is every 50 milliseconds (20 times a second).
FULL CONTINUOUS CO2 data which can be used to create a Patient Urgent and Caution Alarm Occurrences
TRANSFER) real-time continuous waveform is shown, Equipment Advisory Message Occurrences
with data entries every 50 milliseconds.
Tabular data is recorded at data points Events: EVENT 1, EVENT 2, EVENT 3
based on the resolution set for trend Patient reading every 50 milliseconds (for
storage (5, 10 or 30 seconds), so data creating CO2 waveform): CO2 wave
between these points is repeated on
additional rows.
Full Binary Continuous See the document Capnostream Data Transfer Protocols
Transfer
Full Binary Trend See the document Capnostream Data Transfer Protocols
Transfer
* CO2 in mm/Hg (millimeters of mercury)
Note that in the .txt files, the first six lines of data are as follows:
Line 1 – The name of the report type.
Line 2 – Blank, or Patient ID if the report is a case report
Line 3 – Patient type (see Setting the Patient Type on page 42 for information on patient types)
Line 4 – Blank
Line 5 – Column headings
Line 6 – Column headings second line
Capnostream recognizes flash memory drive devices manufactured by SanDisk, Lexar, and PNY Technologies.
It will not recognize flash memory drives that have advanced capabilities which require the installation of
additional drivers, such as the SanDisk U3. The capacity limit for a USB drive that can be used with
Capnostream is 8 GB. A typical flash memory device is shown below.
Figure 40 - Typical Flash Memory Device

 TO RECORD CAPNOSTREAM DATA ON A USB DEVICE:
1. Insert a USB Flash Memory drive into the USB port on the back side of the Capnostream.

2. When the Flash Memory drive is detected the USB icon will appear in the top right-hand corner of the
display beside the alarm symbol. Depending on the type of drive, this may take up to 40 seconds.
USB port icon
Figure 41 - USB Icon
Note: The USB port on the Capnostream monitor is for use with a Flash Memory device only. It is not a full
service USB port. Do not attempt to connect the monitor to a computer via the USB port.
Note: The USB Flash Memory drive must be inserted with care in the USB port, without using excessive force.
If the Flash Memory drive cannot be inserted easily into the port, do not use the drive.
3. After the USB icon appears, the monitor is ready to begin outputting data to the USB flash memory device.
4. From the Home screen select the SYSTEM button on the menu bar to open the System screen, and then
select DATA OUTPUT.
5. Use the control knob to select the desired report from the DATA OUTPUT table as shown below. Please
note that the Tabular Case and Tabular Trend options are only available while a case is active. If the current
case is closed, the case and trend memory are deleted, and this information will no longer be available.
Table 25 - Select Data Output Type

TABULAR CASE
TABULAR TREND
REALTIME CONTINUOUS CO2 WAVEFORM
REALTIME CONTINUOUS TABULAR
FULL CONTINUOUS TRANSFER
FULL BINARY CONTINUOUS TRANSFER
FULL BINARY TREND TRANSFER
6. An asterisk will appear to the left of the selected report name. If no case is active, the text NO CASES will
appear to the right of the Tabular Case option when that option is selected.
7. Turn the control knob to select START USB on the Menu Bar and click to begin data transfer. Data output
can be aborted by clicking again to select STOP USB.
CAUTION: If the Flash Memory disk drive is removed from the Capnostream when data transfer is in
progress, the data may not be readable. Before removing the Flash Memory drive, data
transfer should be completed or stopped by selecting STOP USB on the Menu Bar.
Note: If the Capnostream does not detect the Flash Memory drive, remove and re-insert the Flash Memory
drive. If the Flash Memory drive is still not detected, check that drive being used is from a supported
manufacturer.
Note: If free disk space on the Flash Memory drive is less than 100 kb, writing to the USB disk drive is not
allowed. Under this condition, if data transfer is already in progress, it will be aborted. Any new data
transfer CANNOT be initiated under the low disk space condition.
Note: Please note additional details regarding trend reports in Important Notes Regarding Trend Reports on
page 86.
The maximum amount of data that can be transferred in a single file is 65,536 rows (this corresponds to the
maximum sheet size for an Excel file for Excel 2003 and lower). If the data exceeds 65,536 rows, a new file is
automatically opened and the data continues to transfer into the new file. In this situation, the new file name is
indexed as described below in Table 26 - File Naming Conventions.
The following are estimates of the approximate sizes of the files that can be expected to be generated. For
patient cases where events and alarms are recorded extensively, the file sizes will be larger.
Tabular Case: 1 hour @30s resolution: 21kB

Tabular Trend: 1 hour @30s resolution: 24kB

Real time Continuous CO2 Waveform: 1 hour @50ms resolution: 4.2MB
Real time Continuous Tabular: 1 hour @2s resolution: 264kB
Full Continuous Transfer: 1 hour @50ms resolution: 12MB
Full Binary Continuous Transfer: 1 hour @50ms resolution: 732kB
Full Binary Trend Transfer: 1 hour @30s resolution: 5kB
USB File Naming Convention

For the different report types, the following file naming convention is used.
<REPORT TYPE>_<PATIENT TYPE >_<REPORT DATE >_<REPORT TIME>_<PATIENT ID >_<FILE NO>.ext
Where:
• REPORT TYPE - three-letter report type identifier (see Table 26 - File Naming Conventions).
• PATIENT TYPE – patient type (Adult, Pediatric 6-12 yrs, etc).
• REPORT DATE - Start date on which the report was made in yymmdd format.
• REPORT TIME - Start time at which the report was made in hhmmss format.
• PATIENT ID – Patient ID as inputted into the device (or automatically supplied by the device).
• FILE NO - a running serial number that indicates if the data was split into multiple files.
• File extension .ext is .txt (tab delimited file type) or .bin (binary file type).
The Patient ID field in the monitor contains the '/' character, which is not a valid character for file names. It is
replaced with a hyphen '-' for file names. The '/' character is used by the monitor to indicate multiple files with
the same Patient ID (e.g.- Smith/1, Smith/2, Smith/3).
File Name Examples:

For different reports taken on January 15, 2011 at 5:23:57 for the patient with Patient ID "20090115035705",
the file names would be:
Table 26 - File Naming Conventions

Report type File name
Tabular Case Report TCR_ADULT_110115_052357_20110115035705_1.txt
Tabular Trend Report TTR_ ADULT _110115_052357_20110115035705_1.txt
Real-time Continuous CO2 Waveform RCW_ ADULT_110115_052357_20110115035705_1.txt
Real-time Continuous Tabular RCT_ ADULT _110115_052357_20110115035705_1.txt
Full Continuous Transfer FCTR_ ADULT _110115_05235720110115035705_1.txt
Full Binary Continuous Transfer FCT_ ADULT _110115_052357_20110115035705_1.bin
Full Binary Trend Transfer FTT_ ADULT _110115_052357_20110115035705_1.bin
Apnea and O2 Desat Report (if available) ADR_ ADULT _110115_052357_20110115035705_1.txt
Examples
Taking the same example described above, multiple files for the same Real-time Continuous Tabular report
would look like this:
Report type File name
Real-time Continuous Tabular RCT_110115_052357_1.txt RCT_110115_052357_2.txt
RCT_110115_052357_3.txt RCT_110115_052357_4.txt ...
RCT_110115_052357_10.txt ... RCT_110115_052357_100.txt ...
RCT_110115_052357_1000.txt
Note: Binary files are never split into multiple files because they do not have the length limitation imposed by
MS Excel.

USB Error Messages

The following messages may appear in the message area of the monitor:
NO USB DEVICE FOUND: Advisory displayed if a USB operation is tried in the absence of a USB device.
USB DEVICE FAILED: Displayed when the USB device has been detected, but the data transfer operation
cannot be successfully completed.
USB FLASH FULL: Advisory displayed when data can no longer be downloaded into a USB memory stick
due to the memory being full.
USB TIME OUT: Advisory displayed when monitor is unable to establish communication with USB device.
Reading Patient Data from Saved Capnostream Files

The USB report types that have a .txt (tab delimited) file type are text files. This makes them easy to read in
most spreadsheet and database software applications. In this case, the .txt format type means that there is a tab
in between each piece of data in every line of the file. The Patient Data Transfer Application Note, explaining
the utilization of the transferred data, can be found on the Operator's Manual CD.
The two USB report types that have a .bin file type are binary files. These files are intended for use by
programmers who are creating application programs for use with the Capnostream. The binary file formats are
described in the document Capnostream Data Transfer Protocols that can be found on the Operator's Manual
CD.

Capnostream is equipped with a 9-pin RS-232 connection on the back of the monitor. For detailed information
on the use of this feature, please refer to the document Capnostream Data Transfer Protocols, available on the
Operator's Manual CD. The data transfer rate for the RS-232 interface is set in the Institutional Defaults:
Monitor screen. The factory default is automatic detection of the data transfer speed. See Changing Institutional
Defaults on page 115 for information on how to change the data transfer rate.
Data transfer via RS-232 can take place at the same time as data transfer with a USB Flash Memory drive.
Note: The RS-232 port has electrical isolation according to IEC 60101-1-1. Non-medical devices such as PCs
and printers may be connected to this port without additional electrical isolation. These devices must be
placed at least 1.5 meters from the patient environment.
The RS-232 port can be used for data transfer to a PC using Profox. For more details, contact Profox Associates,
Inc. at http://www.profox.net/.
Analog Data Output with Capnostream

A digital/analog connection feature is no longer available with Capnostream. Please disregard the digital/analog
(D/A) screens in the device software.
Nurse Call Operation

The Capnostream monitor allows connection to an external Nurse Call system. When connected, the monitor
sends information to the institutional nurse call system that an alarm condition has occurred, alerting medical
personnel that the patient requires medical care. The only data transferred to a Nurse Call system is alarm data,
as described in Table 28 - Nurse Call Indicators on page 105.
The nurse call alarm output becomes active simultaneously with the occurrence of an alarm on the monitor, and
remains active while the alarm condition is present. When the alarm condition is no longer present (that is, when
the alarm on the monitor ceases) the Nurse Call alarm output also becomes inactive.
A Nurse Call cable (3.5 m) can be purchased from Oridion (part number 011149). One end of the Nurse Call
Cable attaches to the Capnostream monitor. The cable is supplied un-terminated so it can be built to fit your
nurse call system.


From an alarm activation / deactivation perspective, Nurse Call Systems can usually be configured in two ways,
latching and non-latching.
Latching systems: the nurse call light/alarm will remain active until the connected device ceases to alarm and
until the nurse cancels the alarm by pressing the nurse call system’s CANCEL ALARM button.
Non-latching systems: the nurse call light/alarm remains active until the connected device ceases to alarm.
User intervention is NOT required if the alarm condition clears. This means that if the alarm condition corrects
itself, the nurse call light and tone will automatically cease.
When interfacing between Capnostream and a Nurse Call system, a non-latching configuration should be used.
Please note that both types of Nurse Call Systems will not permit a Nurse Call alarm to be silenced while there
is an active alarm from a connected device such as the Capnostream monitor.
The Nurse Call Cable
The monitor has a built-in relay that can be connected to a hospital nurse call system using the nurse call cable.
Details about the Nurse Call cable appear below.
Table 27 - Nurse Call Specs

Parameter Value
Rated Carrying Current 2A
Max Allowable Current 2A
Max Allowable Voltage 24V DC
Stereo Phono-Jack 1/8” (3.5 mm)
Figure 42 - Stereo Phono Plug for Nurse Call
A diagram of pin-out of mating stereo phono plug appears in Figure 42 - Stereo Phono Plug for Nurse Call,
above. Please note the following:
• N1 (COMMON) - N2 (NORMALLY CLOSED): Normally Closed relay configuration
• N1 (COMMON) - N3 (NORMALLY OPEN): Normally Open relay configuration
 TO SET UP NURSE CALL DATA TRANSFER:
1. To use the Nurse Call function, plug the Nurse Call cable into the Nurse Call socket on the back of the
monitor as shown below.
2. Connect the other end of the cable to the institution's system as determined by the institution's requirements.
3. Enable the Nurse Call connection as described in Activating Nurse Call, below.

Nurse Call
Connection
Figure 43 - Connection Point for Nurse Call
Activating Nurse Call

The factory default setting for Nurse Call is disabled, and to operate the feature it must be enabled. This can be
done using the System Setup screen, however, it will reset to disabled again when the monitor is turned off. To
permanently enable the Nurse Call feature, enable it using the monitor screen in the Institutional Defaults
section of the Service mode as follows:
 TO ACTIVATE NURSE CALL:
1. Turn on the monitor and wait for the Home screen to appear. Use the control knob to select the SYSTEM
button to open the System screen, then select SERVICE and enter the service password (see Capnostream
Service Password on page 134).
2. From the SERVICE screen, select INST DEFAULTS (Institutional Defaults) and then select MONITOR.
3. Use the control knob to select NURSE CALL, and change the option to ENABLED.
4. Select BACK, BACK and HOME to exit the Service mode. The new setting is now stored.
5. Test the Nurse Call system as described in Testing Nurse Call, below.
6. Please note that Nurse Call data will not be transferred if alarms have been silenced temporarily (by the
Alarm Silence button at the front of the monitor). See Alarm Silence on page 75 for details regarding this
feature. Nurse Call data will still be transferred if alarms are silenced through Institutional Defaults (see
Testing Nurse Call

Verify that the system is functioning by forcing a test alarm occurrence (such as breathing into the FilterLine for
a few seconds, then stop breathing into it to create a NO BREATH alarm). Confirm that the expected result was
received according to the standard for the institution's nurse call system. This may be a warning light turned on
or an audio signal generated when the alarm event occurs.
The following table describes which alarms are indicated by the Nurse Call output.
Table 28 - Nurse Call Indicators

Alarm Type Activates Nurse Call
High Priority (Red) Urgent Patient Alarms YES
(Yellow) Caution Alarms NO

Medium Priority Alarms YES

Advisories NO
Silent Advisories NO

The Capnostream monitor provides connectivity with hospital patient data systems (Bernoulli® and Oxinet® III)
produced and/or marketed by Cardiopulmonary Corporation (CPC). This option permits regular, real-time
transfer of data from the monitor to hospital patient data systems. Eight-bed or 12-bed configurations are
available.
Before beginning the connection process, ensure that the following equipment is available:
• Bernoulli® or Oxinet® III system installed in the hospital
• Bernoulli-MSM or Oxinet Client Bridge terminated with a 9 pin D connector cable
• Capnostream monitor
Connect the system as described in the DFU supplied with the Bernoulli-MSM or Oxinet Client Bridge. The
system is used with a Y-cable attaching the client bridge, the Capnostream, and wall power. Ensure that all
connectors are securely attached so that the Capnostream continues to receive wall power during operation with
this system.
Once the connection between the devices is made as described above, data in binary format will be transferred
automatically from the Capnostream monitor to the Bernoulli®/Oxinet® III system. No additional setting of the
monitor is required.
The following measurement data is transferred:
• Instantaneous CO2
• EtCO2
• FiCO2
• Resp rate
• SpO2
• Pulse
In addition, information regarding patient type, alarm data, and device settings (alarm limits, etc.) are
transferred.
An outbound vital signs interface to a clinical information system as well as an ADT (admit, discharge &
transfer) inbound interface is also available from the Bernoulli system.
For more information regarding the Bernoulli®/Oxinet® III system, or for troubleshooting the setup procedure,
contact your local distributor.
CAUTION: If connectivity with the Hospital Patient Data System fails as a result of a fault in the
Hospital Patient Data System or its cabling, Capnostream will not send data to the system.
CAUTION: Only turn off the Capnostream audible alarm indication after assuring that the patient will
be continuously monitored by other acceptable means.
Operation with Nuvon VEGA Systems

The Capnostream can also connect with the VEGA system from Nuvon for the purposes of interfacing to
clinical information systems to electronically chart patient vital signs.
Capnostream connection to the VEGA system is completely accomplished by the Nuvon implementation
specialist on site with the assistance of an assigned hospital IT department representative. All physiologic
patient data developed by the Capnostream is sent to the VEGA system to be used by the clinical information
system. For more information regarding the Nuvon VEGA system contact an Oridion sales representative or a
Nuvon sales representative directly.

Introduction
final document
Chapter 13
Maintenance and Troubleshooting

Introduction
Determining Monitor Service Hours
CO2 Calibration
CO2 Calibration Check
Maintenance
Replacing the Fuses
Replacing the Printer Paper Roll
Cleaning
Troubleshooting
Returning the Monitor
Technical Assistance
Introduction
Capnostream requires no routine service other than any performance testing mandated by the operator’s
institution. The monitor requires servicing by qualified service personnel only once every 30,000 operating
hours.
The monitor's CO2 detection mechanism should be periodically calibrated as detailed below in CO2 Calibration
on page 108. CO2 calibration can be checked at any time to ensure the calibration is within proper operating
limits.
Troubleshooting on page 112 discusses potential difficulties, possible causes and suggestions for resolving
them.
Note: Contact your local distributor or refer to the Service Manual for service instructions and performance
tests and checks.
Determining Monitor Service Hours

The information on the Service screen gives the number of hours remaining until servicing or calibration is
required. To access the Service screen, select SYSTEM from the Menu bar at the bottom of the Home screen,
and then select SERVICE. No password is required to see the number of hours before servicing is required. The
main service screen is shown below.

CO2 Calibration
Figure 44 - Service Screen
When the monitor reaches 30,000 hours of use, send it to an authorized service center. Contact your local
representative for shipping instructions.
CO2 Calibration
Note: The unit is calibrated when it leaves the factory.
The monitor should be calibrated by qualified service personnel after the first 1,200 operating hours of use or
12 months, whichever comes first. After that, calibration should be performed every 12 months or after
4,000 operating hours, whichever comes first.
To help you plan in advance for the upcoming calibration process, the monitor stores both the number of
operating hours before calibration is due and the date of the last calibration.
When calibration is due the monitor will display the advisory message CALIBRATION REQUIRED in the
message area.
The number of operating hours remaining before calibration appears on the salutation screen every time the
monitor is turned on (see Figure 9 - Salutation Screen on page 31). After the operating hour limit has been
exceeded, the message will change to CALIBRATION OVERDUE. The number of operating hours before
calibration can also be viewed on the service screen, and this will also change to CALIBRATION OVERDUE
in the same manner as the salutation screen if the limit has been reached. The data on the service screen is
updated when the monitor is turned on, and also each time the password is entered to enter Service Mode.
Note: It is recommended that you calibrate the monitor within two weeks of the CALIBRATION REQUIRED
message appearing on the monitor.
Note: CO2 monitoring on the Capnostream monitor will enter standby mode automatically in cases when the
Capnostream monitor is left on for 30 minutes or longer without a FilterLine attached. This automatic
standby mode reduces the need for frequent calibration in use cases in which the monitor is left on for
long periods of time without a FilterLine attached. In these cases, time periods in which a monitor is
turned on but a FilterLine is not attached will not count towards time to calibration, thus preventing the
need for unnecessary calibrations.

To display the date of the last calibration, enter the service mode and go to the Calibration Screen. From the
Home screen select the SYSTEM button to open the System screen and then select the SERVICE button to
open the Service screen. Enter the service password, and then select CO2 CAL. This screen shows the number
of hours left before service is due, the date of the last calibration performed, and the date on which the next
calibration should take place (one year after the most recent calibration). Use of the password required to enter
Service Mode is needed to view this screen.

Depending on institutional policy and procedure, the monitor can be checked at any time to determine if CO2
detection is within the accepted limits. The Calibration Check Procedure below gives the step-by-step
instructions to perform a Calibration Check.
CAUTION: The calibration check must be performed with a manufacturer authorized Calibration Kit
containing a gas mixture of 5% CO2 21% O2 and Bal N2 and the authorized connecting
means (“T” piece).
A manufacturer-approved Calibration Kit can be purchased from Scott Medical (part numberT4653ORF-2BD).
It includes:
• Calibration Gas containing 5% CO2, 21% O2 Bal N2
• Tubing Adapter (“T” Piece)
• Calibration Line (Calibration FilterLine)
Note: If this process is performed while a battery powers the monitor, make sure that the battery is fully
charged.
Note: Prior to checking the calibration, verify that the Calibration Line supplied with the Calibration Kit is firmly
attached.
Calibration Check Procedure

Note: At any stage in the Calibration Check procedure, you can go back to the first screen by clicking the
BACK button.
 TO PERFORM CALIBRATION CHECK:
1. Use the control knob to navigate to the CO2 CALIBRATION CHECK screen. From the Home screen select
the SYSTEM button on the menu and then select CAL CHECK. Or, from the Service screen select CO2
CAL and then select CAL CHECK.
The CO2 CALIBRATION CHECK screen is displayed. On–screen instructions will guide you through a
number of Calibration Check steps.
2. The screen displays the message: CONNECT FILTERLINE TO MONITOR. Connect the Calibration Line
to the monitor and select START to start the calibration check.
3. The screen displays the message: CONNECT CALIBRATION GAS [5% CO2 21% O2 BALANCE N2].
Connect the other end of the Calibration Line to the gas canister, and then select CONTINUE.
4. The screen displays the message: OPEN GAS SUPPLY FROM CYLINDER. Open the gas canister and
select CONTINUE.
At this time, the module performs a calibration check. While doing so, it displays a message
CALIBRATION CHECK IN PROGRESS. If the CO2 Module is still warming up, the monitor displays the
message NOT READY TO CALIBRATE. Wait until module is ready and then select CONTINUE.
5. When the module has completed the calibration check measurements and is processing data, it displays the
message:
CALCULATING RESULTS, GAS SUPPLY MAY BE CLOSED.
6. Close the calibration check gas supply. If you have to stop the calibration check before it is complete, use the
control knob to select STOP.

Maintenance
7. The screen displays the message: DISCONNECT CALIBRATION GAS AND FILTERLINE and
CONTINUE.
The module then displays:
CALIBRATION CHECK COMPLETE
MEASURED CO2 X.X%
ACCURACY SPECIFICATION FOR A 5% GAS IS 4.7–5.3%.
Select BACK to return to the Home screen, or START to perform the calibration check again.
8. If the calibration check result indicates that the monitor is out of calibration, the message MEASURED CO2
NOT WITHIN SPECIFICATIONS. CALIBRATION RECOMMENDED is displayed. In this case, the
Calibration Procedure must be performed. Refer to the Service Manual or to authorized Oridion Service
personnel.
9. If the monitor is unable to complete the calibration check, a CALIBRATION FAILED message appears with
one of the following error messages:
FILTERLINE NOT CONNECTED
CALIBRATION FAILED: NO GAS, WRONG GAS CONCENTRATION, OR UNSTABLE GAS
MEASUREMENT ERROR; CHECK ALL CONNECTIONS AND TRY AGAIN
CALIBRATION ABORTED BY USER
CO2 MODULE INTERNAL SELF–TEST FAILED
Maintenance
The monitor requires no routine service other than any performance testing mandated by the operator’s
institution. The Troubleshooting section on page 112 discusses potential difficulties, their possible causes, and
suggestions for resolving them.
Periodic maintenance is recommended according to operating hours:
• The CO2 Pump should be replaced every 30,000 operating hours.
• A calibration should be performed after the initial 1,200 hours of use, and following that calibration
once a year or every 4,000 operating hours, whichever comes first (see CO2 Calibration on page 108).
• The monitor’s number of hours remaining until the 30,000 hour operating limit before service is
required is displayed each time when the unit is powered on. This can also be viewed in the Service
Screen.
• Battery back-up time of the Li-ion battery may degrade over a period of time. To avoid degradation of
battery capacity, it is recommended that the battery pack be replaced every two years.
Note: Contact your local representative to order spare parts, calibration kits, or to get answers to any
questions regarding service and periodic maintenance.
Replacing the Fuses

The monitor is protected from electrical surges by two fuses. If the fuses blow, the monitor will not turn on and
the battery pack will not charge.
To replace the fuses, turn the monitor off and disconnect the power cord from the monitor.
The fuses are located in the back of the monitor below the electrical cord connection. Use a flat screwdriver to
pry out the fuse housing cover, and replace the fuses with fuses of the same rating only (F3.15A 250 Volt). Push
the fuse housing cover closed, then reconnect the power cord and turn the monitor on.
Note: Blown fuses indicate that an abnormal electrical condition occurred. If the cause is not known, contact
your representative to determine if servicing is required.


If the printer runs out of paper, replace it with a roll of thermal printer paper (Oridion part # 010516) or similar
paper which meets the specifications outlined in the specifications in Internal Thermal Printer (optional) on
page 127.
 TO REPLACE THE PRINTER PAPER:
1. Open the plastic cover on the printer.
2. Remove the empty spindle inside the paper compartment.
3. Insert a new roll of paper in the direction shown in the figure below, so that the loose end of the paper comes
out at the top of the plastic cover as shown.
Feed Button
Figure 45 - Insert Paper Roll into printer
4. Close the door so that it clicks shut. Briefly press the Feed button to verify that the paper is aligned properly
and is not caught on the edge of the cover.
Cleaning
To clean the monitor’s surfaces, lightly dampen a cloth with a 70% alcohol solution and wipe all surfaces.
Alcohol wipes may also be used. Frequency of the cleaning procedure should be in keeping with hospital
policy.
To clean the screen, use a damp, lint-free cloth.
To clean Nellcor reusable sensors, first remove the sensor from the patient and disconnect it from the
Capnostream device. The sensor may be surface-cleaned with a solution such as 70% isopropyl alcohol. If low-
level disinfection is required, use a 1:10 bleach solution. Do not use undiluted bleach (5%~5.25% sodium
hypochlorite) or any cleaning solution other than those recommended here, because permanent damage to the
sensor could occur. The ear clip sensor may be cleaned by wiping or soaking it (for 10 minutes) in isopropyl
alcohol (70%). If the ear clip is soaked, be sure to rinse it with water and air dry it prior to use on the next
patient. Do not sterilize the ear clip by irradiation, steam, or ethylene oxide. Please refer to the DFU for each
reusable sensor for specific instructions.
WARNING: Do not autoclave or sterilize this device.

Troubleshooting
CAUTION: Do not spray or pour any liquid directly on the monitor, accessories or consumables.
CAUTION: Do not use caustic or abrasive cleaners, or harsh solvents, including petroleum-based or
acetone solutions, to clean the device.
CAUTION: Microstream® etCO2 consumables are designed for single patient use and are not to be
reprocessed. Do not attempt to clean, disinfect or blow out the FilterLine as the monitor can
be damaged.
CAUTION: Do not expose SpO2 sensor connector pins to cleaning solution as this may damage sensor.
CAUTION: If a 1:10 bleach dilution (0.5% to 1% Sodium Hypochlorite solution) in the form of wipes is
used to disinfect external surfaces of the monitor, exposure of the connectors and the
display to the bleach solution should be avoided. Repeated cleaning with bleach over time
may cause discoloration and residue on the surfaces.
Troubleshooting
This section lists potential problems you may experience while using the monitor and suggestions for resolving
them. If you are unable to correct the problem, contact qualified service personnel or your local representative.
Electrical
Problem Cause Action
Monitor does not turn Internal battery is totally discharged Check power cable connection.
on. and power cable improperly
attached or disconnected, or cable
has faulty electrical connection.
AC wall outlet has no power and Check connections and correct problem.
internal battery is not charged.
Blown fuses. Replace the fuses. Contact your
representative to determine the reason for the
electrical problem.
AC mains power and Battery pack not plugged in to Open the battery housing and check that the
monitor on indicator monitor. battery pack cable is firmly connected to the
lights are on, but unit battery socket. (See Installing the Battery
will not operate on Pack on page 22)
battery power when the
AC mains power cable
is disconnected.
Monitor is plugged in, AC power not getting to the monitor. Check if the orange power indicator light is on.
but does not appear to If not, check that the AC power cord is
charge the battery. properly plugged in to a live AC mains socket.
Battery is not fully Battery pack has not recharged Unplug the monitor from AC power for 3-4
charged after being completely. hours, and then plug in again. The battery
plugged in for 24 hours. pack will now recharge completely when
connected to AC power.
If the battery pack still does not recharge
completely, replace the battery pack.
CO2 Problems
NO BREATH message Physiological cause. Check patient.
appears constantly and Clogged or blocked FilterLine. Check FilterLine and replace if blocked.
red alarm indicator
flashes. FilterLine caught in something or Check the FilterLine from the monitor all the
tube is kinked. way to the patient to see if line is kinked,
twisted closed or caught in bed or equipment.
FilterLine connected FilterLine not plugged in properly. Check that the FilterLine plug is screwed into

Troubleshooting

but pump is not working the monitor.
and no CO2, EtCO2 or Gold ring worn or dirty. Check that the gold ring on the end of the
RR readings are
FilterLine connector is present and not
shown.
damaged or covered with dirt. Wipe off any
dirt or replace FilterLine as necessary.
EtCO2 values read Mechanically ventilated patient who No action needed.
erratically. breathes spontaneously.
A leak in the airway. Check for connection and line leaks to patient
and correct if necessary.
EtCO2 values are Improper calibration. Check calibration. See CO2 Calibration Check
consistently higher or on page 109.
lower than expected.
BTPS setting turned off. Check BTPS setting in the institutional
settings. See CO2 Parameters on page 122
for details.
SpO2 Sensor
No SpO2 signal: Zero Sensor not properly connected to Check that the sensor and extension cable (if
display appears for monitor or extension cable. used) are properly connected to the monitor.
oxygen saturation and
pulse rate.
Replace SpO2 sensor SpO2 board is not receiving Detach and reattach the SpO2 sensor and try
message appears on information from the cable. again.
Capnostream screen If the message still appears, replace the
cable or sensor.
Loss of pulse or SpO2 Sensor is improperly applied to Check sensor application.
signal: Zero display patient.
appears for oxygen Patient's perfusion may be too Check the condition of the patient.
saturation and pulse poor.
rate.
Sensor or sensor extension cable Replace sensor or sensor extension cable
may be damaged.
Excessive patient motion or If possible, keep patient still. Check whether
electrosurgical interference. the sensor is secure and properly placed.
Replace if necessary, move the sensor to a
new site, or use a sensor that tolerates more
motion.
Inaccurate SpO2 Excessive illumination. Check sensor placement or cover sensor
measurements appear. with a dark or opaque material.
Sensor placement on an extremity Check sensor placement.
that has a blood pressure cuff,
arterial catheter or intravascular
line, or nail polish.
Patient's condition. Check patient.
Excessive patient movement. If possible, keep patient still and use a
sensor that tolerates more motion.
Printer
Printer does not print. Printer cover is open. Open the plastic printer cover fully, ensure
Red Alarm light on the that a short length of printer paper is outside
printer is flashing. the monitor, and then close the cover so that
it clicks into place.

Printer paper is either not threaded Open the plastic printer cover and pull the
properly over plastic cover or paper so that a short length is outside the
caught in the plastic cover. monitor. Hold the paper so that the short
length of printer paper remains outside the
monitor, and then close the cover so that it
clicks into place.
Printer is out of paper. Open the plastic cover and insert a new roll
of paper.
Printer works, but Paper roll is placed backwards in Open the plastic cover, turn the roll of paper
output paper is blank. the printer compartment of the the other way, and replace the plastic cover,
monitor. taking care to leave a short length of paper
outside the monitor.
Nurse Call
Nurse Call output does Nurse Call not enabled. Enable the Nurse Call function from the
not work. system setup screen, or from the Institutional
Defaults screen in Service Mode.
Wiring problem on phono plug. Check the wiring of the cable and phono plug
connected to the Nurse Call socket on the
back of the monitor.
CO2 Calibration
CALIBRATION It has been more than one year since Perform a CO2 calibration.
REQUIRED message the last CO2 calibration.
appears on the monitor,
but salutation screen
shows there are still
hours remaining before
next calibration.

If it is necessary to return the monitor for repairs, contact your local representative for shipping instructions.
To repack the monitor, disconnect the accessories from the monitor. Pack the monitor in the original shipping
carton. If the original carton is unavailable, use a suitable box filled with the appropriate amount of packing
material. It is not necessary to return the sensors, Microstream® EtCO2 consumables, or power cords.
If the monitor malfunctions, carefully package the monitor with an unused consumable from the same box or lot
as the consumable used at the time of malfunction and return it with the monitor for inspection.
Technical Assistance
For technical information, contact your local Oridion representative or write to
[email protected].
The Service Manual includes information that is required by qualified personnel to service the monitor.
See also the Technical Service area in the Capnography section of our website http://www.oridion.com/.
If it is necessary to return the monitor for repairs, contact your local representative for shipping instructions.

final document
Appendix 1
Institutional Settings
Institutional Defaults
Changing Institutional Defaults
Resetting to Factory Defaults
Uploading or Downloading Institutional Defaults
Changing Monitor Settings
Institutional Defaults
Capnostream is shipped from the factory with all changeable settings configured according to the tables in the
section Changing Monitor Settings on page 116. These are called the Factory Default Settings. If the specific
environment of use indicates that other settings are preferable or required, or Institutional policy requires
different values than the Factory Defaults, then the default settings can be changed so that they are in effect
every time the monitor is turned on. This is more reliable than expecting staff members to change the settings
before each use.
Default settings can be changed manually by an authorized technician / biomedical engineer to produce
institutional defaults. Default settings are set from the Institutional Defaults screen, which is reached from the
Service screen. The Service Screen is password protected. The procedure is described in Changing Institutional
Defaults, below.
Changing Institutional Defaults

From the Home screen use the control knob to select the SYSTEM button, and then select the SERVICE
button on the menu to open the Service screen. The enter password box appears near the top of the screen.
ENTER PASSWORD
As described in Screen Navigation on page 37, use the control knob to select ENTER PASSWORD. Using the
control knob, enter the password and click the control knob again after the last letter. The password appears in
Capnostream Service Password on page 134. The service password page may be removed from the manual for
safekeeping.
Use the control knob to select INST DEFAULTS. You have the option of changing the default settings for
ALARM LIMITS, TRENDS, MONITOR, CO2 and SpO2.
WARNING: Changing the settings might adversely affect the monitoring of patients. Changes to the
Institutional settings must only be made by authorized personnel.
Note: Patients will not be monitored by the device while it is in service mode, even if the monitor is connected
to a patient while in service mode. (The monitor is in service mode once the service password is
inputted.) Therefore, you may want to remove the FilterLine from the patient or disconnect the FilterLine
from the monitor while putting the monitor into service mode. No data will be recorded while the monitor
is in service mode, and thus trying to monitor while in service mode will lead to missing data issues.


Each section of settings described below allows you to reset to the factory settings for that specific section. You
can also do a global reset of all settings in all sections to their factory defaults. To do this, select RESET when
you first select the Institutional Defaults screen.
Figure 46 - Institutional Defaults Screen
Uploading or Downloading Institutional Defaults

Capnostream provides the option of uploading institutional defaults from the monitor to a USB Flash Memory
drive or downloading institutional defaults from a USB Flash Memory drive to the monitor.
This utility is used, for example, to simplify the process when an institution wants all devices in a particular
group or section to use the same institutional defaults. In such a case, changes can be made to institutional
defaults on one device, and those defaults can be uploaded to a USB Flash Memory device as described below.
Then, those defaults can be downloaded to the other Capnostream devices in the section/institution using this
procedure.
 TO UPLOAD OR DOWNLOAD DEFAULTS:
1. For upload, insert a USB Flash Memory drive with at least 2 KB in free memory into the USB port on
Capnostream. For download, insert a USB Flash Memory drive with Institutional Defaults previously loaded
on it into the USB port on Capnostream.
2. Click the SYSTEM menu button to enter the main System screen.
3. Click the SERVICE menu button to enter the Service screen and input the Service password (see
Capnostream Service Password on page 134).
4. Click the SOFTWARE SUPPORT menu button to enter the Software Support screen. The Software
Support screen can be seen in Figure 47 - Software Support Screen on page 117.
5. Click the UPLOAD DEFAULTS button to upload defaults to a USB Flash Memory drive from
Capnostream, or click the DOWNLOAD DEFAULTS button to download defaults from a USB Flash
Memory drive to Capnostream. Downloading defaults will create a folder called settings on the USB Flash
Memory drive, which will contain files that can be used to upload defaults to another Capnostream. After
uploading defaults, the monitor will shut itself off; restart the monitor to resume operation.

Figure 47 - Software Support Screen

Alarm Limits
There are two sets of alarm limits that are stored in the monitor, for Adult/Pediatric and for Infant/Neonatal
patient types. (The Adult/Pediatric limits are relevant for adult patients and for all three pediatric patient types.)
The factory default settings for Adult and Neonatal alarm limits are given above in Table 29 - Factory Default
Alarm/Indicator Limits on page 118.
To change the alarm limits for each type of patient, open the Institutional Defaults screen. Select ALARM
LIMITS and then use the control knob to select SET INFANT/NEONATAL or SET ADULT/PEDIATRIC or
SET ALARM DELAY as required. You will then be presented with the Institutional Defaults: Alarm Limits:
Infant/Neonatal or the Institutional Defaults: Alarm Limits: Adult/Pediatric screen or the Alarm Delay screen.
To learn more about Alarm Delay options, see Alarm Delay on page 69.
Change the settings as described in the section Changing Alarm Limits on page 76.
By default, the Caution alarms are disabled, and in the Alarm Limits screen the numbers for the Caution alarm
settings appear in grey. Select CAUTION ENABLE if you want to enable the Caution alarms. When the
Caution alarms are enabled, the numbers for the Caution alarm settings change to white from grey.

Figure 48 - Institutional Defaults Alarm Limits Screen
The factory default settings for Adult/Pediatric and Infant/Neonatal alarm limits are given below.
Table 29 - Factory Default Alarm/Indicator Limits

Parameter Adult/Pediatric Adult/Pediatric Infant/Neonatal Infant/Neonatal Range
Red Urgent Yellow Caution Red Urgent Yellow Caution
Alarm Alarm Alarm Alarm
EtCO2 High 60 55 50 45 5-150 mmHg
EtCO2 Low 15 17 20 22 0-145 mmHg
FiCO2 High 8 8 5 5 2-98 mmHg
RR High 30 25 65 60 5-150 bpm
RR Low 5 7 25 28 0-145 bpm
No Breath 30 N/A 15 N/A 10-60 sec
Detected
SpO2 High 100 100 98 98 25-100%
saturation
SpO2 Low 85 90 85 90 20-95% saturation
Pulse Rate High 140 140 200 200 30-240 bpm
Pulse Rate Low 50 50 100 100 25-235 bpm
IPI Low Alert 3 5 N/A N/A 1-9 or OFF
SatSeconds 25 25 25 25 10, 25, 50, 100 or
Off

Alarm Delay
A number of alarms can be delayed by a choice of 10, 15, 20, or 30 seconds, or not at all (Alarm Delay
disabled). This option is available for all patient types.
The Alarm Delay can be set from the Institutional Defaults screen, which can be reached by
SYSTEM>SERVICE>INPUT SERVICE PASSWORD (see Capnostream Service Password on page 134)
>INST DEFAULTS>ALARM LIMITS>SET ALARM DELAY.
Table 30 - Factory Default and Optional Alarm Delay Settings

EtCO2 High Alarm Delay 10, 15, 20, or 30 seconds or Disabled DISABLED
RR High Alarm Delay 10, 15, 20, or 30 seconds or Disabled DISABLED
SpO2 Low Alarm Delay 10, 15, 20, or 30 seconds or Disabled DISABLED
PR Low Alarm Delay 10, 15, 20, or 30 seconds or Disabled DISABLED
PR High Alarm Delay 10, 15, 20, or 30 seconds or Disabled DISABLED
Trend Settings
Institutional Defaults can be set to change the Trend stored in the monitor, and how it is displayed on the screen.
For the specific trend settings for SpO2 and CO2, see the individual settings described below for the SpO2 and
CO2 parameters.
Table 31 - Factory Default and Optional Trend Settings

Trend Recording 5 seconds at 12 hours 30 seconds at 72 hours
Resolution 10 seconds at 24 hours
30 seconds at 72 hours
Tabular Increment MINIMUM, 1.5, 3, 15 or 60 minutes 1.5 Minutes
Display Default
Graphical View Default 2, 4 or 12 hours 4 hours
The Home IPI Display Default (see IPI Display on page 62) also appears in the Trend Settings defaults screen.
The default Trend Recording Resolution determines how many hours of patient information can be recorded.
The Tabular Increment Display enables the default to be set to the values in the table.
The Graphical View Default can be changed so that the Trend window will show a different time period of data.
Note: Changing the Trend resolution will clear the Trend memory, erasing any patient data that was in the
monitor.
To make changes to the Trend Defaults, click SERVICE>INST DEFAULTS>TREND on the menu bar. Use
the control knob to navigate to the parameters described above and click to view options. Chose an option using
the control knob and click again to record that option as the default.
Changing Parameters Order on the Trend Display

The Graphical and Tabular screens show five different patient parameters. The order of the trend parameters can
be changed in the Institutional defaults screen, in order to show the more relevant parameters on the first trend
display screen rather than the second screen. The process is as follows: Click SYSTEM>SERVICE>Enter
Service password (see Capnostream Service Password on page 134)>INST DEFAULTS>TREND>CONFIG.
DISPLAY to open the Institutional Defaults: Trend: Display Configuration screen.
For each position that you wish to change, move the cursor to that line with the control knob, click the control
knob, and then choose, from the Parameters Available column, the parameters which you wish to show in that
line. For example, in Parameter Position 1, the default is EtCO2. To change the trend display so that IPI appears
as the first parameter on the trend screen, move the cursor to Parameters Selected: EtCO2, click the control

knob, and then scroll with the control knob until you reach IPI in the Parameters Available column. Click with
the control knob to place IPI as the first parameters on the trend displays.
Click BACK>BACK>BACK>HOME to retain your choices once you are finished changing the trend display.
To return to the default display, click FACTORY DEFAULTS on the Institutional Defaults: Trend: Display
Configuration screen.
Event labels used in Trend recording can also be changed from the Institutional Defaults: Trend screen, using
the menu bar. A detailed explanation appears in Events, below.
Events
Up to 10 event names in each of three categories can be stored in Capnostream. This allows the attending health
care professional to describe the event that is inputted to the monitor's memory. The three categories are
medication, patient actions and clinician intervention actions.
Most event names are provided as factory defaults with several left blank in each of the three categories.
However, all 30 event names can be edited to provide the most appropriate descriptions for the environment that
the monitor will be used in.
Each event name can be up to 11 alphanumeric characters. If an event name is left blank, a selection of that
event will be stored in trend memory as a Quick event (see Entering Patient Events on page 45 for information
on using Events).
Medication Events
Allows the institution to enter a set of 10 event labels which the operator can use to mark the administration of
medicine at the time of monitoring. The default medicines are: FENTANYL, VERSED, MIDAZOLAM,
MORPHINE, DEMEROL, PROPOFOL, SURFACTANT, and OTHER. The last three settings are blank. All
settings are changeable. To reset the Medication Events to the factory settings, use the control knob and select
FACTORY DEFAULTS.
Patient Events
Allows the institution to enter a set of 10 event labels which the operator can use to mark events that happen to
the patient at the time of monitoring. The default Patient Events are: EATING, DRINKING, COUGHING,
AMBULATING, CHEST PT, TURNED, SNORING and OTHER. The last two settings are blank. All settings
are changeable. To reset the Patient Events to the factory defaults, use the control knob and select FACTORY
DEFAULTS.
Intervention Events
Allows the institution to enter a set of 10 event labels which the operator can use to mark events where a
physical or other intervention occurred during the time of monitoring. The default Intervention Events are:
OXYGEN, SUCTION, ADJ AIRWAY, NARCAN, ROMAZICON, NEB TX, STIMULATED, CO2 INSUFFL
(CO2 Insufflation), ABG, and OTHER. The last two settings are blank. All settings are changeable. To reset the
Intervention Events to the factory defaults, use the control knob and select FACTORY DEFAULTS.
How to Change Event Defaults

From the Service screen, select the INST DEFAULTS screen, and then the TREND screen. In the Menu Bar of
the Institutional Settings: Trend screen are the options to select MED to change medication events settings, PAT
to change patient events settings, and INT to change intervention events settings. To change an event, scroll to a
particular event label and click it so as to clear the field and enter another event name.
Monitor Settings
From the Institutional Defaults screen, select MONITOR.

Figure 49 - Institutional Defaults: Monitor

The Institutional Defaults that can be set for the monitor are as follows:
Date Format dd mmm yy or mmm dd, yy
mmm dd, yy
Time Format 12 or 24 hour 12 hour
Language English, Spanish, French, German, English
Italian, Dutch, Portuguese, Russian,
Swedish, Norwegian, Japanese
Audio Alarm Silence Maximum, Last Setting, Audio Off MAXIMUM
Event Marking Mode Quick/Detailed DETAILED
RS-232 Baud Rate AUTO; 9600 ; 19.2K; 57.6K; AUTO
115.2K
Nurse Call Enabled, Disabled DISABLED
Home Screen Standard, Numeric STANDARD
IPI Display (on HOME, trend and Enabled, Disabled ENABLED*
alarm review screens)
IPI Alarm Enabled, Disabled DISABLED
RS232 FUNCTION VueLink: IPI, A/hr, ODI Standard; VueLink is no
VueLink:IPI longer available with
VueLink: CO2 ONLY Capnostream
Standard
A/hr and ODI Display (if available) Enabled, Disabled ENABLED*
Parameter standby mode Enabled, Disabled DISABLED
* Please note that IPI is not available for Infant/Neonatal patients, and thus is automatically disabled for
Infant/Neonatal patients. Additionally, A/hr and ODI are not available for infant/neonatal or for pediatric patients.

CO2 Parameters
Institutional Defaults can be set for all CO2 parameters that are settable in the monitor. To change the
parameters, select CO2 in the Institutional Defaults screen.
CO2 Units mmHg, kPa, Vol% mmHg
BTPS* On/Off On
FiCO2 Display On/Off On
Pump-Off Timeout (minutes) 5, 10, 15 or 30 15
CO2 Waveform Scale (mmHg) 50, 100, 150, Auto Auto
EtCO2 Scale for Trend Display 50, 100, 150 50
RR Scale for Trend Display 50, 100, 150 50
Sweep Speed Adult/Pediatric (mm/sec) 3, 6.3, 12.5, 25 6.3
Sweep Speed Infant/Neonatal (mm/sec) 3, 6.3, 12.5, 25 6.3
* BTPS denotes the standard correction used during measurement for body temperature, pressure, and saturation.
BTPS should be set to ON during all measurement procedures. The device automatically turns off the BTPS
correction during calibration procedures and turns it on again following these procedures. There is no need for the
user to make any changes to the BTPS setting.
SpO2 Parameters
Institutional Defaults can be set for all SpO2 parameters that are settable in the monitor. To change the
parameters, select SpO2 in the Institutional Defaults screen.
Pulse Tone On/Off Off
Sat-Seconds On/Off On
SpO2 Scale for Trend Display 0-100, 50-100 50-100
PR Scale for Trend Display 150, 300 150
Sweep Speed Adult/Pediatric (mm/sec) 3, 6.3, 12.5, 25 25
Sweep Speed Infant/Neonatal (mm/sec) 3, 6.3, 12.5, 25 25

final document
Appendix 2
Specifications
Power Supply
Battery
Controls
Display
Microstream® Capnography
Nellcor Oximax® Pulse Oximetry
Alarms
Outputs
Internal Thermal Printer (optional)
General Characteristics
Equipment Classification
Compliance
Power Supply
Item Value
Input Voltage 100-240VAC, 50/60Hz
Fuses Two F3.15A 250 Volt
Input Power 90 VA
Battery
Item Value
Battery Type 14.8V, 4Ah Lithium-Ion
Battery Operation 2.5h (without thermal recorder)
Battery Charging Time 100% in 12h
Controls
Item Value
Front Panel 1 Switch for monitor On/Off control
4 specific function keys
1 optical encoder with switch

Display
Display
Item Value
Screen 162mm (6.4in) Color TFT Display
Pixel Pitch: 0.204 (H) x 0.204(V) mm (0.008in)
Active Display Area: 130.56 (H) x 97.92 (V) mm (5.14in x 3.86in)
Resolution 640 x 480 pixels
Viewing angle (vertical) 110°
Viewing angle (horizontal) 140°
Trace Speed 3.0, 6.3, 12.5 and 25 mm/sec
Waveform sampling rate 75.7 samples/sec for SpO2 (fixed)
20 samples/sec for Capnography (fixed)
Trend Storage 8640 point storage
- 12h at 5s resolution
Trend Display Graphical Display:
- 2h, 6h, 12h views
Tabular Display
- 60 min, 15 min, 3 min, 1.5 min, and minimum resolution
(minimum resolution settable to 5, 10, or 30 seconds)
Microstream® Capnography
Item Value
CO2 Units mmHg or kPa or Vol%
CO2, EtCO2, FiCO2 Range 0-150 mmHg
CO2 Waveform Resolution 0.1 mmHg
EtCO2, FiCO2 Resolution 1 mmHg
CO2 Accuracy 0-38 mmHg: ± 2 mmHg
39-150 mmHg: ± (5% of reading + 0.08 x (expected reading in
mmHg –39mmHg)
Accuracy applies for breath rates of up to 80 bpm. For breath
rates above 80 bpm, accuracy is 4 mmHg or ±12 % of reading
whichever is greater, for etCO2 values exceeding 18 mmHg.
Respiration Rate Range 0-150 bpm
Respiration Rate Accuracy 0-70 bpm: ±1 bpm
71-120 bpm: ±2 bpm
121-150 bpm: ±3 bpm
CO2 Alarms No breath, etCO2 high, etCO2 low, RR high, RR low, IPI low (IPI
also requires pulse oximetry information)
Flow Rate 50 (42.5 ≤ flow ≤ 65) ml/min, flow measured by volume
Waveform Sampling 20 samples/s
Response Time 2.95 s (typical); when used with long sampling lines, ~5.0 s
Initialization Time 40 s (typical)
Calibration Interval Initially calibrate after 1,200 operating hours, then once a year or
after 4,000 operating hours, whichever comes first


Item Value
SpO2 Measurement Range 0-100%
SpO2 Accuracy*
Adult and Pediatric Modes
SpO2 range 70% - 100% ± 2 digits
SpO2 range 0 - 69% Unspecified
Infant/Neonatal Mode
SpO2 range 70% - 100% ± 3 digits
SpO2 range 0 - 69% Unspecified
Pulse Rate Range 20-250 bpm
Pulse Rate Accuracy ± 3bpm
Alarms Adjustable Alarm Limits
SpO2 high, SpO2 low, Pulse Rate high, Pulse Rate low
Sat Sec Range 10, 25, 50, 100

* Reading accuracy in the presence of low perfusion (detected IR pulse modulation amplitude between
0.03% and 1.5%) was validated using signals supplied by a patient simulator. SpO2 and pulse rate values
were varied across the monitoring range over a range of weak signal conditions and compared to the
known true saturation and pulse rate of the input signals.
Alarms
Item Value
High Priority Patient Warning Flashing Red LED
Alarms Flashing Red Numeric
Repeated beep pattern
Alarm Indication on Screen
Nurse Call
Patient Caution Alarms Flashing Yellow LED
Flashing Yellow Numeric
Repeated beep pattern
Medium Priority Alarm Flashing Yellow LED
Triple beep every thirty seconds
Alarm Indication on Screen
Nurse Call
Advisories Beep once
Advisory Indication on Screen
Silent Advisories Advisory Indication on Screen
Alarm Volume Control 5 steps
Alarm sound pressure level range 50 to 85 dB(A)
Temporary Alarm Silence All audible alarms silenced for 2 minutes
Outputs
Analog Output
15-pin female D-type connector
Pinout:

Outputs
Pin Assignment Pin Assignment

1 Ground 9 Ground
2 Ch 1 Signal 10 Ground
3 Ground 11 Ch 5 Signal
8 Ch 4 Signal
Nurse Call
Normally Open/ Normally Closed Relay
Rated Carrying current : 2A
Max Allowable Current : 2A
Max Allowable Voltage : 24V DC
Contact Capacity: 2A @ 24V DC.
1/8” stereo phono-jack

Pin out of mating stereo phono plug
N1 - N2: Normally Closed relay

N1 - N3: Normally Open relay

RS-232
9-pin female D-type connector
Pinout
Pin Assignment
1 --
2 PC_RX
3 PC_TX
4 5V
5 Isolated Ground
6 --
7 5V
8 --
9 --
USB
USB Type A Host connector (female)
For use only with flash memory drives.
Pinout
Pin Assignment
1 VBUS
2 Data -
3 Data +
4 Ground

Item Value
Type Two Channel
Printing Method Thermal Recording
Dot Density 203 dpi
Paper Width 58mm (2 ¼ in)
Paper Roll Diameter (maximum) 40mm (1 1/2 in)
Paper Length (maximum) 15.2 meters (50 ft)
Speed 25mm/s

Item Value
Unit Dimensions 167mm(h) x 220mm(w) x 192mm(d)
(6.6in (h) x 8.7in (w) x 7.6in (d))
Unit Weight 3.6kg (7.94lb)
Operating Temperature 0°C to 35°C (32°F to 95°F)
Operating Pressure and Altitude Pressure: 430 mmHg to 795 mmHg
Altitude: -381m to 3000m (-1,250 feet to 9,843 feet)
Operating Humidity 10% to 95% non-condensing

Storage and Transport Until lower limit of -20°C (-4°F)
Temperature Up to upper limit of 60°C (140°F)
Storage and Transport Pressure Pressure: 430 mmHg to 795 mmHg
and Altitude Altitude: -381m to 4572m (-1,250 feet to 15,000 feet)
Storage and Transport Humidity 10% -95% non-condensing

Packaged Dimensions 315mm(h) x 340mm(w) x 285mm(d)
(12.4in (h) x 13.4in (w) x 11.2in (d))
Packaged Weight 6.6kg (14.55lb)
Equipment Classification
Item Value
Types of Protection against Electric Class 1
Shock
Degree of Protection against Type BF defibrillation proof applied parts
Electric Shock
Mode of Operation Continuous
Degree of Protection against IEC 60601-1, sub-clause 11.6.5 for class IPX1 Drip-proof
Ingress of liquids equipment*
* IPx1 indicates that the device is protected against harmful effects of vertically falling drops of water.
Compliance
This product is designed to conform to the following standards:
IEC/EN60601-1
UL 60601-1
CSA C22.2 No 601.1-M90
IEC/EN60601-1-2 Class A Radiated and Conducted Emission
IEC 60601-1-8 (Audible and Visual Alarms)
ISO 80601-2-55 (Capnography)
ISO 80601-2-61 (Pulse Oximetry)
IEC 60601-2-49 Particular requirements for the safety of multifunction patient monitoring equipment
Electromagnetic Immunity
The monitor is suitable for use in the specified electromagnetic environment. The user of the monitor should
assure that it is used in an electromagnetic environment as described below.

Compliance
Table 32 - Guidance and Manufacturer's Declaration - Electromagnetic Emissions

Emissions Test Compliance Electromagnetic Environment – Guidance
The Capnostream20P uses RF energy only for its
internal function. Therefore, its RF emissions are
RF emissions EN 55011 Group 1
very low and are not likely to cause any interference
in nearby electronic equipment.
RF emissions Class A The monitor is suitable for use in hospitals
EN 55011
Harmonic emissions IEC

Class A
61000-3-2
Voltage fluctuations/
flicker emissions EN Clause 5
61000-3-3
Table 33 - Guidance and Manufacturer’s Declaration – Electromagnetic Immunity

Immunity Test IEC 60601 Compliance Electromagnetic Environment –
test level level Guidance
Electrostatic discharge ± (2, 4, 6) kV contact ± (2, 4, 6) kV contact Floors should be wood, concrete or
(ESD) ± (2, 4, 8) kV air ± (2, 4, 8) kV air ceramic tile. If floors are covered with
EN 61000-4-2 synthetic material, the relative humidity
should be at least 30 %.
Electrical fast ± 2 kV for power ± 2 kV for power Mains power quality should be that of a
transient/burst supply lines supply lines typical commercial or hospital
EN 61000-4-4 ± 1 kV for environment.
input/output lines
Surge ± 1 kV differential ± 1 kV differential Mains power quality should be that of a

EN 61000-4-5 mode mode typical commercial or hospital
± 2 kV common mode ± 2 kV common mode environment.
1
Voltage dips, short <5 % UT <5 % UT Mains power quality should be that of a
interruptions and (>95 % dip in UT) (>95 % dip in UT) for typical commercial or hospital
voltage variations on for 0,5 cycle 0,5 cycle environment. If the user of the
power supply input Capnostream20P requires continued
lines 40 % UT 40 % UT operation during power mains
EN 61000-4-11 interruptions, it is recommended that
(60 % dip in UT) (60 % dip in UT)
the monitor be powered from an
for 5 cycles for 5 cycles uninterruptible power supply or a
70 % UT 70 % UT battery.
(30 % dip in UT) (30 % dip in UT)
for 25 cycles for 25 cycles
<5 % UT <5 % UT
(>95 % dip in UT) (>95 % dip in UT)
for 5 ses for 5 sec
Power frequency 3 A/m 3 A/m Power frequency magnetic fields
(50/60 Hz) magnetic should be at levels characteristic of a
field typical location in a typical commercial
EN 61000-4-8 or hospital environment.

Compliance
Immunity Test IEC 60601 Compliance Electromagnetic Environment –

test level level Guidance
Conducted 3 Vrms 150 kHz to 3V Portable and mobile RF
RF IEC 61000-4-6 80 MHz communications equipment should be
used no closer to any part of the
Capnostream20P, including cables,
than the recommended separation
distance calculated from the equation
applicable to the frequency of the
transmitter.
Recommended separation distances:
d= 1.2√𝑃
d= 1.2√𝑃 80 MHz to 800 MHz:
d= 2.3√𝑃 800 MHz to 2.5 GHz:
where P is the maximum output power
rating of the transmitter in watts (W)
according to the transmitter
manufacturer and d is the
recommended separation distance in
2
metres (m).
Field strengths from fixed RF
transmitters, as determined by an
electromagnetic site survey, should be
Radiated 3 V/m 80 MHz to 3 V/m less than the compliance level in each
RF IEC 61000-4-3 2.5 GHz frequency range.
ab
Interference may occur in the vicinity of

equipment marked with the following
symbol:
1
UT is the a.c. mains voltage prior to application of the test level.
2 At 80 MHz and 800MHz, the higher frequency range applies
NOTE: These guidelines may not apply in all situations. Electronmagnetic propogation is affected by absorption and reflections from
structures, objects and people.
a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast
and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site
survey should be considered. If the measured field strength in the location in which the Capnostream20P is used exceeds the applicable RF compliance level above, the
Capnostream20P should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or
relocating the Capnostream20P.
b Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [V1] V/m.
The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are
controlled. The customer or the user of the monitor can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment (transmitters)
and the monitor as recommended below, according to the maximum output power of the communications
equipment.

Compliance
Table 34 - Recommended Separation Distances between Portable and

Mobile RF Communications Equipment and the Monitor
Rated maximum output Separation distance according to frequency
1
power of transmitter W f transmitter in m
150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz
d= 1.2√𝑃 d= 1.2√𝑃 d= 2.3√𝑃
0.01 0.12 0.12 0.23

0.1 0.38 0.38 0.73
1 1.2 1.2 2.3
10 3.8 3.8 7.27
100 12 12 23
For transmitters rated at a maximum output power not listed above, the recommended separation distance d
in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is
the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
1
At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from
structures, objects and people.

final document
Appendix
3

H Products (for use in humidified environments) are marked with an asterisk (*) in the table below.
Microstream Consumables
Intubated Consumables
FilterLine Set Adult/Pediatric XS04620
FilterLine Set Adult/Pediatric 100 unit 010579
FilterLine H Set Adult/Pediatric* XS04624
FilterLine H Set Adult/Pediatric 100 unit* 010580
FilterLine H Set Infant/Neonatal* 006324
FilterLine Set Adult/Pediatric Long 007768
FilterLine H Set Adult/Pediatric Long* 007737
FilterLine H Set Infant/Neonatal Long* 007738
VitaLine H Set Adult/Pediatric* 010787
VitaLine H Set Infant/Neonatal* 010807
Non-intubated Consumables
Smart CapnoLine Plus (O2 connector) 009818
Smart CapnoLine Plus (O2 connector) 100 unit 010209
Smart CapnoLine Plus Long (O2 connector) 010340
Smart CapnoLine Plus Long (O2 conn) 100 unit 010339
Smart CapnoLine Plus O2 (O2 tubing) 009822
Smart CapnoLine Plus O2 (O2 tubing) 100 unit 010210
Smart CapnoLine Plus O2 Long (O2 tubing) 009826
Smart CapnoLine Plus O2 Long (O2 tubing) 100 unit 010341
Smart CapnoLine Pediatric 007266
Smart CapnoLine O2 Pediatric (O2 tubing) 007269
Smart CapnoLine O2 Ped Long (O2 tubing) 007743
Smart CapnoLine H Plus O2 (O2 tubing)* 010433
Smart CapnoLine H Plus O2 (O2 tubing) 100 unit* 010625
Smart CapnoLine H Plus O2 Long (O2 tubing)* 012463
Smart CapnoLine H O2 Pediatric (O2 tubing)* 010582
Smart CapnoLine H O2 Pediatric Long (O2 tubing)* 012464
Smart CapnoLine Guardian (O2 connector) 012528
Smart CapnoLine Guardian (O2 connector) 100 unit 012537
Smart CapnoLine Guardian O2 (O2 tubing) 012529
Smart CapnoLine Guardian O2 (O2 tubing) 100 unit 012538

Smart CapnoLine Guardian O2 long (O2 tubing) 012530
Smart CapnoLine Guardian O2 long (O2 tubing) 100 unit 012539
Hook and Loop Strap 012542
O2/CO2 Nasal FilterLine Adult (O2 tubing) 006912
O2/CO2 Nasal FilterLine Adult (O2 tubing) 100 unit 010304
O2/CO2 Nasal FilterLine Adult Long (O2 tubing) 007739
O2/CO2 Nasal FilterLine Adult Long (O2 tubing) 100 unit 010344

Capnostream Service Password
final document
Appendix
4
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OpsManual - (Capnostream20P) - 015458 - RMS1C01

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Capnostream®20p

Portable Bedside Monitor

Copyright © 2014 Oridion Medical 1987 Ltd. All rights reserved.

Portable Bedside Capnograph/Pulse Oximeter 1

2 Portable Bedside Capnograph/Pulse Oximeter

Portable Bedside Capnograph/Pulse Oximeter 3

Portable Bedside Capnograph/Pulse Oximeter 5

6 Portable Bedside Capnograph/Pulse Oximeter

Portable Bedside Capnograph/Pulse Oximeter 7

Portable Bedside Capnograph/Pulse Oximeter 9

10 Portable Bedside Capnograph/Pulse Oximeter

Portable Bedside Capnograph/Pulse Oximeter 11

Monitor Use with Defibrillators

12 Portable Bedside Capnograph/Pulse Oximeter

Portable Bedside Capnograph/Pulse Oximeter 13

14 Portable Bedside Capnograph/Pulse Oximeter

About this Manual

Portable Bedside Capnograph/Pulse Oximeter 15

Specific Indications for Use

Who Should Read This Manual

Contacting Technical Support

Table 1 - Symbols that Appear on the Monitor

Monitor ON/OFF button

16 Portable Bedside Capnograph/Pulse Oximeter

General warning sign

USB flash memory

For prescription use only

Follow instructions for

Portable Bedside Capnograph/Pulse Oximeter 17

18 Portable Bedside Capnograph/Pulse Oximeter

What is Pulse Oximetry?

Portable Bedside Capnograph/Pulse Oximeter 19

The Capnostream Monitor

Unpacking and Inspection

Portable Bedside Capnograph/Pulse Oximeter 21

Installing the Battery Pack

Figure 1 - Installing the Battery Pack

Figure 2 - Battery Pack Close-up

22 Portable Bedside Capnograph/Pulse Oximeter

Testing the Battery and AC Connections

Handling the Battery Pack

Portable Bedside Capnograph/Pulse Oximeter 23

Storing the Battery

Disposing of the Battery

Battery and Power Usage

24 Portable Bedside Capnograph/Pulse Oximeter

Mounting the Monitor

Figure 4 - Monitor Bottom View

Setting up Periodic Maintenance

Table 2 - Capnostream Accessories

Portable Bedside Capnograph/Pulse Oximeter 25

Accessory Oridion Part Number Use

Monitor Mounting Plate

Table 3 - Printer Paper Specifications

Buttons, Indicators and Connections

26 Portable Bedside Capnograph/Pulse Oximeter

Monitor Front View

Table 4 - Capnostream Front View lists the numbered labels.

Portable Bedside Capnograph/Pulse Oximeter 27