Sensis Vibe - How to Improve ECG Signal Acquisition

Sensis Vibe How to improve ECG signal acquisition siemens-healtineers.com/sensis The acquisition of the ECG signals is, without a doubt, Within this document you will find guidance an essential part of every hemodynamic procedure. to maximize your ECG quality. Ensuring an accurate diagnosis of the patient, as well as, setting up a suitable therapy and follow up care 1. Selection of electrodes would not be possible without it. 2. Skin preparation 3. Application of electrodes 4. ECG Filter settings 5. Troubleshooting SIEMENS Effective Date 15-Nov-2020 | HOOD05162003145593 Healthineers 1. Selection of the electrodes The electrodes are a crucial part to acquire good Following these steps helps to improve the ECG signals. A wide selection of disposable electrodes signal quality: are available. • Select electrode for short-term application with wet gel to moisten the skin. Electrodes for long-term monitoring and with solid gel are not preferred because of higher skin impedance. • Recently opened packaging need to be used shortly after. • Re-seal opened packaging as exposure to air can affect the electrodes conductivity, hence, the signal quality. • Never use electrodes after their expiration date or if the gel has dried out. • Please refer to manufacturer’s instructions to ensure optimal electrode quality. 2. Skin preparation The human skin is a bad electricity conductor. These steps help to improve the signal quality: Although the skin preparation requires some extra time, • it does improve the ECG quality and subsequently Shaving the affected area. the patient assessment and care. • Cleaning the skin with non-irritating solution which A little care taken as you apply the patches can make removes soap, oil and moisturizer residue. a big difference in the clarity of the tracing you obtain. • Cleaning the skin. • Roughing up the skin with slightly abrasive material. 2 Effective Date 15-Nov-2020 | HOOD05162003145593 3. Application of electrodes Proper application and placement of the Following steps help improving the signal quality: ECG electrodes are necessary to obtain strong • signals with minimal artifacts. The ECG lead cable should be attached to each electrode patch prior to applying on the patient. This will promote proper gel to skin contact and potentially reduce any patient discomfort. • The placement of the RA and LA (right and left forearm) electrodes can be modified by placing the electrodes on the right and left shoulder (front or back). • The placement of the RL and LL (right and left ankle) can be modified by placing the electrode on the right and left hip. • Avoiding bony structures for electrode application. RA (right forearm) LA (left forearm) RED lead (Standard) YELLOW lead (Standard) OLA WHITE lead (US) RAG BLACK lead (US) LL (left leg) or F (foot) RL (right leg) or N (neutral) GREEN lead (Standard) BLACK lead (Standard) RED lead (US) GREEN lead (US) RL Ò & LL Graphic represents electrode placement for limb leads 3 Effective Date 15-Nov-2020 | HOOD05162003145593 4. ECG filter settings Depending on the shielding within the lab or the The recommended 0.05 Hz and 150 Hz settings will surroundings, electrical interference can result from help to provide a stable ECG baseline and filter out many sources. With modern ECG devices, appropriate high frequency noise, while preserving the essential filters can be activated to reduce technical artifacts. frequencies necessary to facilitate ECG diagnosis. If ECG signals are used for diagnostic analysis, they must have a frequency range of at least 0.05 Hz – 150 Hz. Applying the high-pass filter will avoid wandering of the baseline. Interferences induced by breathing, body movement, Following measures should resolve the issue: air conditioning will be filtered by the high pass filter. • Attach new electrodes Undirected wandering of baselines or long recovery • times of the ECG waveform induced by patient Check cable and plug connections positioning, sterile draping, interaction with the • Increase the high-pass filter frequency to 0.05 Hz, patient table, or patient breathing. 0.15 Hz, or 0.5 Hz • Do not use the 0 Hz high-pass filter setting An increased high-pass filter can distort the detection of the ST elevation. I 50 mm/mV II 50 mm/mV Example for “respiration” disturbance 4 Effective Date 15-Nov-2020 | HOOD05162003145593 Applying the low-pass filter will avoid noisy ECG signal Interferences induced by RF devices, anodes, Following measures should resolve the issue: mapping, etc. will be filtered by the low pass filter. • Attach new electrodes High frequency noise may be introduced by other • electrical equipment around the patient like the Check cable and plug connections anode drive of the x-ray tube or EP mapping system. • Minimize loops and keep ECG electrode cables together. • Keep ECG cables away from other cables (e.g. mains cables). • Decrease the low-pass filter frequency to 200 Hz, 100 Hz, or 50 Hz Low-pass filtering has a noticeable effect on the QRS complex and can hide sharp signals like pacemaker spikes. I 50 mm/mV II 50 mm/mV Example for „muscular“ distrubance Disturbance: Power line interference The mains supply of equipment around the patient Following measures should resolve the issue: can induce a constant line noise to the ECG leads and • trunk cables. It can be identified by its constant sinus Place ECG cables as closely together as possible wave interference with a wavelength of 20 ms (50 Hz) • Keep ECG cables away from other cables or 16 ms (60 Hz). (e.g. mains cables) • Use shielded ECG leads • Activate the notch filter I 50 mm/mV II 50 mm/mV Example for power line interference “50 Hz” disturbance 5 Effective Date 15-Nov-2020 | HOOD05162003145593 5. Troubleshooting for ECG cable specific issues Following experiences during the hemodynamic procedure may occur: • Intermittent loss of ECG waveforms • Coiling and bending of ECG Cable • ECG signal will be present even when no patient is connected Disturbance: Intermittent loss of ECG waveforms If an ECG electrode has bad or no connection, When all ECG lead waveforms are flat: the signal connection status icon in the status bar • indicates a signal failure. Ensure proper connection of the Right Leg Neutral electrode • Strain on the ECG leads can pull at the electrodes and result in poor electrode contact • Identify optimal cable placement Graphic represents Intermittent loss of ECG waveforms Disturbance: Coiling and bending of the ECG trunk cable Coiling typically starts at the yoke where the lead sets Following measures should be considered to avoid meet the trunk cable and diminishes over the length and resolve the issue: of the cable. • Review cable management system in lab • Don’t pull the cable when cleaning it • Periodic replacement of the ECG cable Excess length Strap Cable Double folding Circle winding Graphic represents cable routing Graphic represents ECG and CIP placement and cable arrangement 6 Effective Date 15-Nov-2020 | HOOD05162003145593 Disturbance: ECG signal will be present even when no patient is connected A) Reason: Contaminant in ECG trunk? Solution: Check if contrast media or other contaminants Replace the entire ECG trunk cable and lead set. can enter the ECG trunk cable where the lead sets connect to the trunk cable. V Use the red trunk cable plug to protect the contacts when lead cables are not connected V Please be aware: When only the trunk cable is replaced, the lead set may re-introduce the contaminant when re-inserted into the new trunk cable. B) Reason: Non-radio translucent electrodes used with radio translucent leads Do you use the right electrodes? Sometimes non-radio translucent electrodes are used with radio translucent leads. One or more electrode connections become intermittent. Rapid degradation of the radio translucent leads. C) Reason: Intermitting contact between lead set and electrode Stainless steel ECG electrode snaps cause rapid degradation of the radio translucent lead sets resulting in intermittent contact between the lead set and electrode. This paper is a general guidance. For comprehensive details read and understand all the instructions in the Operator Manual of your system. For more information in regards to Siemens Healthineers Sensis Vibe recording system or cardiovascular care solutions please contact your sales representative. 7 Effective Date 15-Nov-2020 | HOOD05162003145593 Effective Date 15-Nov-2020 | HOOD05162003145593 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens Healthineers sales organization worldwide. Availability and packaging may vary by country and are subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States or other countries. The information in this document contains general technical descriptions of specifications and options as well as standard and optional features which do not always have to be present in individual cases. Siemens reserves the right to modify the design, packaging, specifications, and options described herein without prior notice. Please contact your local Siemens sales representative for the most current information. The statements by Siemens’ Healthineers customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve t he same results. Not all features shown in this brochure are necessarily standard and available in all countries. The configuration of display, keyboard and mouse shown in this brochure is only a room example. A similar or alternative configuration can be delivered. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · 9858 1120 online · ©Siemens Healthcare GmbH, 2020