GE Dash 8000 Monitor Central Information Center CIC Nursing

GE Dash 8000 Monitor/Central Information Center (CIC) Nursing Continuing Education Program Staten Island University Hospital

Objectives ¨ At the end of the program, the participant will be able to: ¨ Discuss the features of the GE Dash 8000 patient monitoring system ¨ Identify alarm levels ¨ Identify function tabs of the CIC and describe their use ¨ Identify functions of the bedside monitor

Objective #1 Discuss the features of the GE Dash 8000 monitor system.

GE Dash 8000 Monitor System ¨ The monitor system consists of the Central Information Center (CIC) and the bedside monitor. ¨ Components of the CIC include the screen, mouse, keyboard, speaker and printer. ¨ The bedside monitor consists of the “rack”, “tram”, screen, and remote control. ¨ Parameters and alarms are pre-set by default and are activated upon admission.

CIC Multiple Patient Viewer ¨ The CIC multiple patient viewer is a windows based, mouse driven application. ¨ Screen is navigated using the “mouse” ¨ Functions are engaged by “left” clicking the mouse. ¨ Each multiple patient viewer can display up to 10 patients

Print strip annotates all currently monitored data and up to 4 waveforms. Each individual window displays currently monitored information. To obtain a rhythm strip, “left click” on the heart rate box to the right of the window. The printer will print the strip until the mouse is “clicked” again or the “start/stop” button on the printer is pressed.

“Left click” anywhere in the large patient display to engage the patient’s file and all the function tabs. All patients will continue to be displayed, but the selected patient’s file will appear at the bottom of the CIC.

GE Dash 8000 Bedside Cardiac Monitor

Components of the Bedside Monitor “Trim Knob” allows operator to navigate the monitor screen. Trim knob is then depressed to engage the function. Alternatively, “fast keys” displayed above allow immediate access to their function.

Remote Control panel contains all the same buttons as the front monitor panel and also has a “trim’ knob to allow navigation on the monitor screen.

The “tram” fits into the monitor “rack”. Color coded cables attach to corresponding colored slots on “tram”. Once a cable is attached to the “tram” the function is automatically activated. Green = ECG Red = Pressure cable input Black = Non-invasive BP Brown = CO input Blue = Sp. O 2 monitor

Objective #2: Identify alarm levels. There are two types of alarms: Patient status alarms System status alarms

Patient Status Alarms There are four levels of alarms: Crisis, Warning, Advisory, and Message alarm provides visible message only, No audible tone No beeps

Patient Status Alarm parameters and limits have been set by default for all units but can be individualized as necessary. Exception: Asystole and ventricular fibrillation/tachycardia are always in “Crisis” and cannot be changed. Crisis alarm must be silenced by the user.

System Status Alarms You cannot change system status alarms and parameters.

Silencing Alarms Silencing alarms on the CIC

Objective #3 Identify function tabs of the CIC and describe their use.

The Individual Display on the CIC has 10 function tabs ¨ Monitor: Displays all beside monitored information, i. e. . Cardiac rhythm, vital signs, pulse oximetry ¨ Admit/Discharge: Allows operator to admit/discharge patient or change/modify admission information ¨ ECG: Allows operator to select lead, size, pacer filter, arrhythmia alarms, PVC limits, relearn, print

CIC Function Tabs ¨ Sp. O 2/Respiration: Allows operator to view and modify pulse oximetry and respiratory displays. ¨ Pressures: Allows operator to view and modify invasive and non-invasive pressure displays. ¨ Alarm: Allows operator to change default and “tailor” alarm settings to patient needs

CIC Function Tabs ¨ Alarm History: Displays arrhythmia events. Can be reviewed, printed or deleted. – Monitor stores 36 – 10 second events and 24 hours of vital signs ¨ Graphic Trends: Displays monitored data in graphic format. ¨ Vital Signs: Displays trend data in a spreadsheet format. ¨ Full Disclosure: Stores 72 hours of continuous monitored data.

Objective #4 Identify functions of the bedside monitor.

Trim Knob: Allows the operator to navigate the main screen and engage the functions/menu. “Fast Keys” allow the operator to engage a function directly without navigating through the screen.

Admit a Patient to the Monitor The patient must be admitted to the bedside monitor in order to activate the alarms and send the information to the CIC. To admit the patient press the Admit Patient button on the keypad or remote. Enter the patient’s demographics by selecting “change admit info”. Height and weight information must be entered at the bedside. Other information can be added at the CIC. Scroll to “return” to exit the menu. Be sure to save when prompted!

Silence Alarm Key ¨Silences alarm at the bedside for 2 minutes when depressed once, 5 minutes when depressed twice in succession. ¨To reset before elapsed time frame, depress once. ¨Alarms automatically reset after time elapse.

Zero All Key “Zeros” invasive pressure lines when the transducer is interfaced with atmospheric pressure.

All Limits Key ¨Displays all currently monitored physiologic parameter limits as well as current alarm levels.

“Graph Go/Stop” Key ¨Engages the bedside printer. Prints until depressed a second time. ¨Printer can display up to four waveforms and can be configured at the beside or the CIC.

“Main Menu” Key Main menu key returns operator to the main screen of the monitor. “Home”

“Fast” Keys “Fast “ keys engage function without scrolling through the main screen.

“Fast Keys” ¨ Keys #1, #2, #3 engage non-invasive blood pressure function – 1 “Go/Stop” initiates a B/P measurement – 2 “Auto” initiates automatic B/P measurement at desired time intervals • Cannot be set at CIC, must be set at bedside – 3 “Stat” initiates 5 minute continuous B/P measurement ¨ Key #4 engages cardiac output by thermodilution program

“Fast Keys” ¨ Key #5 engages cardiac calculation menu ¨ Key #6 engages pulmonary artery capillary wedge pressure (PCWP) measurement ¨ Key #7 engages stored vital sign data ¨ Key #8 engages stored graphic trend data ¨ Key #9 engages 12 lead ECG menu ¨ Key #0 allows viewing of an additional monitored bed

Bedside Monitor Display: ECG

ECG Monitoring ¨ Monitor default set to “multiple lead analysis. – Allows monitoring in more than one lead at a time. – If one lead becomes loose, rhythm monitoring continues but message alarm is seen. ¨ Default set to Lead II and V 1. Can be changed at bedside or CIC.

ECG DISPLAY WINDOW

ECG Functions ↑ Allows monitoring in alternate lead if one electrode becomes loose/falls off

Electrode Placement

ECG Functions: 12 Lead ECG To perform a 12 lead ECG, Select ECG With the trim knob to engage the ECG function. Then select 12 Lead ECG analysis. (May also use “fast” key. ) Additional monitoring cable must be attached.

12 Lead ECG: Additional Lead Placement information is also available in the “Help” menu of the 12 Lead function

Select “Detect Pace” from ECG function to turn on pacing filter. Can also be selected from CIC.

ST Segment Monitoring

Respirations ¨ Respiratory monitoring functions can be selected from the bedside monitor by scrolling with the trim knob to highlight the function and then pressing the trim knob to engage it. ¨ Respiratory monitoring functions can also be accessed at the CIC.

Non-Invasive BP Monitoring

Cuff selection and application are important! Inappropriate selection or application can result in erroneous measurement.

SPO 2 Monitoring

Invasive Pressure Monitoring

PCWP Measurement

PCWP Monitoring

Cardiac Output (CO) measurement Connect BROWN monitor cable to tram. Use “co-set” closed CO tubing and 10 cc room temperature D 5 W solution. Select automatic for “co-factor”. Catheter Baxter size 7. 5 Fr

Cardiac Output by Thermodilution

Select Cardiac Calcs from menu to complete calculations. Monitored parameters will automatically be entered.

This completes the monitor program. Please complete the post-test and evaluation and return to your PCUM or Staff Development Instructor for your continuing education certificate. This continuing nursing education activity has been approved by Staten Island University Hospital, an accredited provider by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation