Coro 250CX - URM Rev C-Dikonversi

GE
Healthcare
Corometrics™ 250cx Series Monitor

Operator’s Manual
Corometrics 250cx Series Monitor

English
2036946-001 C (paper)
© 2007 General Electric
Company. All Rights Reserved.
GE
Healthcare
Corometrics™ 250cx Series Monitor

Operator’s Manual
Corometrics 250cx Series Monitor

English
2036946-001 C (paper)
© 2007 General Electric
Company. All Rights Reserved.
GUARANTEE
All equipment sold by GE Medical Systems Information Technologies, is fully
guaranteed as to materials and workmanship for a period of 1 year. GE Medical
Systems Information Technologies reserves the right to perform guarantee service
operations in its own factory, at an authorized repair station, or in the customer’s
installation.
Our obligation under this guarantee is limited to repairing, or, at our option, replacing any
defective parts of our equipment, except fuses or batteries, without charge, if such
defects occur in normal service.
Claims for damage in shipment should be filed promptly with the transportation
company. All correspondence covering the instrument should specify the model and
serial numbers.
GE MEDICAL SYSTEMS Information Technologies

A GE Healthcare Company
GE Medical Systems Information Technologies will make available on request such circuit diagrams,
component diagrams, component parts lists, descriptions, calibration instructions, or other information which
will assist the users or appropriately qualified technical personnel to repair those parts of the equipment
which are classified by GE Medical Systems Information Technologies as repairable. Refer to the 250/250cx
Series Service Manual for further information.
NOTE: In addition to software version 4.50, the information in this manual also applies to previous
software revisions of Corometrics 250cx Series Monitor. There are no user-apparent differences among these
software versions. Due to continuing product innovation, specifications in this manual are subject to change
without notice.
NOTE: For technical documentation purposes, the abbreviation GE is used for the legal entity name, GE
Medical Systems Information Technologies
Ohmeda Oximetry and other trademarks (OxyTip+®, PIr™, TruSat™, TruSignal™, TruTrak+®, SuperSTAT™) are the
property of GE Medical Systems Information Technologies, a division of General Electric Corporation. All other
product and company names are the property of their respective owners.
MASIMO SET® is a trademark of Masimo Corporation. Possession or purchase of this device does not convey any
express or implied license to use the device with replacement parts which would, alone, or in combination with this
device, fall within the scope of one or more of the patents relating to the device.
NELLCOR®, OxiMax®, C-LOCK® and SatSeconds™ are trademarks of Nellcor Puritan

Bennett. TAT-5000™, Exergen® and TemporalScanner™ are trademarks of Exergen
Corporation.
CAUTION: In the United States of America, Federal Law restricts this device to
sale by or on the order of a physician.
any. All other product and brand names are trademarks or registered trademarks of their respective companies. ©2005, 2006, 2007 GE Medical Systems
CE Marking Information
0086
Compliance
A GE brand Corometrics 250cx Series Monitor bears CE mark CE-0086
indicating its conformity with the provisions of the Council Directive 93/
42/EEC concerning medical devices and fulfills the essential
requirements of Annex I of this directive.
The device is manufactured in India; the CE mark is applied

under the authority of Notified Body BSI (0086).
The country of manufacture and appropriate Notified Body can be

found on the equipment labeling.
The product complies with the requirements of standard EN

60601-1-2 “Electromagnetic Compatibility—Medical Electrical
Equipment” and standard EN 60601-1 “General Requirements for
Safety.”
Components of the Certified Systems

The IEC electromagnetic compatibility (EN) standards require
individual equipment (components and accessories) to be
configured as a system for evaluation. For systems that include a
number of different equipments that perform a number of
functions, one of each type of equipment shall be included in the
evaluation.
The equipment listed below is representative of all possible

combinations. For individual equipment certification, refer to
the appropriate declarations of conformity.
Component Description:
 250cx Series Maternal/Fetal Monitor
 Model 146 Fetal Acoustic Stimulator
 Intrauterine Pressure Transducer
 TOCO Transducer
 FECG Cable/Legplate
 Ultrasound Transducers (x2)
 Blood Pressure Hose and Cuff
 MSpO2 Interconnect Cable and Sensor
 MECG Cable
 FECG/MECG Adapter Cable
 Remote Event Marker
 RS-232C Interconnect Cables (x3)
 Central Nurses Station Interconnect Cable
 Model 2116B Keyboard and Interconnect Cable
 Model 1563AAO Telemetry Cable
 Exergen TemporalScannerTM TAT-5000 Assembly 2036641-001
Revision C 250cx Series Maternal/Fetal Monitor CE-1

2036946-001
Exceptions
The Monitor System EMC: Immunity Performance
None
Be aware that adding accessories or components, or modifying the

medical device or system may degrade the EMI performance.
Consult with qualified personnel regarding changes to the system
configuration.
Contents
1 Safety.....................................................................................1-1
General Information..................................................................................................... 1-3
General Use................................................................................................1-3
Responsibility of the Manufacturer..............................................................1-3
Responsibility of the User............................................................................1-3
Definitions of Terminology.......................................................................................... 1-4
Monitor Contraindications, Warnings, and Precautions...........................................1-5

Warnings.....................................................................................................1-5
Cautions......................................................................................................1-8
Electromagnetic Interference.......................................................................1-9
Equipment Symbols................................................................................................... 1-10
2 Introduction...........................................................................2-1
About the Manual......................................................................................................... 2-3
Purpose.......................................................................................................2-3
Intended Audience.......................................................................................2-3
Illustrations..................................................................................................2-3
Fetal Monitoring Indications for Use..........................................................................2-3

Surveillance.................................................................................................2-3
Maternal Monitoring Indications for Use....................................................................2-3

Blood Pressure.....................................................................................2-3
Pulse Oximetry.....................................................................................2-4
Heart/Pulse Rate..................................................................................2-4
Series Overview............................................................................................................ 2-4

The 250cx Series Monitor Features............................................................2-4
System Parameters (256cx and 259cx)...............................................2-4
Fetal Parameters..................................................................................2-5
Maternal Parameters (259cx only).......................................................2-6
Adding Fetal Movement Detection and/or Spectra Alerts............................2-6
3 Controls, Indicators, and Connectors................................3-1

Front Panel Description............................................................................................... 3-3
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Front Panel Displays.................................................................................................... 3-6
Display Example..........................................................................................3-7
Primary Labor Parameters........................................................................................... 3-8

FHR Display................................................................................................3-8
UA Display.................................................................................................................... 3-9
Additional Parameters...............................................................................................3-10
Maternal NIBP.............................................................................3-10
MHR/P Area................................................................................................................. 3-11
MSpO2 Area................................................................................................................. 3-12

Waveform Area..........................................................................................3-12
Time and Waveform Message Area..........................................................3-12
Battery-Backed RAM Status......................................................................3-13
Softkeys...................................................................................................................... 3-13
Mode Title Softkeys...................................................................................3-13
Waveform Softkeys...................................................................................3-13
Dedicated Softkey Area.............................................................................3-14
Rear Panel Description.............................................................................................. 3-16
4 Setup Procedures.................................................................4-1
Loading Strip Chart Recorder Paper..........................................................................4-3
Power............................................................................................................................. 4-6
Interruption of Power...................................................................................4-6
Self-Test Routine.......................................................................................................... 4-7
Setup Screens.............................................................................................................. 4-7

Using the Trim Knob Control.......................................................................4-8
General Setup Screen.................................................................................................. 4-9

Play Song....................................................................................................4-9
Song Volume...............................................................................................4-9
Temp Done Volume.....................................................................................4-9
Brightness....................................................................................................4-9
Paper Speed..............................................................................................4-10
Date...........................................................................................................4-10
Time...........................................................................................................4-10
MSpO2 Print Interval..................................................................................4-10
FSpO2 Print Interval...................................................................................4-10
FSpO2 Trace..............................................................................................4-10
Service.......................................................................................................4-10
Preparing the Monitor for Patient Use......................................................................4-11
ii 250cx Series Maternal/Fetal Monitor Revision C

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5 Fetal Heart Rate Monitoring.................................................5-1
Ultrasound (External Method).....................................................................................5-3
Methodology................................................................................................5-3
US/US2 Setup Screen..........................................................................5-3
Volume........................................................................................................5-3
Alert.............................................................................................................5-4
Alarm Volume..............................................................................................5-4
FECG (Internal Method)............................................................................................... 5-4

Methodology................................................................................................5-4
Artifact Elimination.......................................................................................5-4
FECG Setup Screen...................................................................................................... 5-5

Volume........................................................................................................5-5
Alarms.........................................................................................................5-5
Audio Alarms...............................................................................................5-5
Alarm Volume..............................................................................................5-5
Fetal Heart Rate Alarms...............................................................................................5-6

FHR Threshold Alarms................................................................................5-6
FHR High Alarm...................................................................................5-7
Sample Clinical Exceptions..................................................................5-8
Active Signal Quality Alarm..................................................................5-8
Resolved Signal Quality Alarm.............................................................5-8
100% Signal Loss.................................................................................5-9
Silencing an Audio Alarm............................................................................5-9
Summary...................................................................................................5-10
Single Fetal Heart Rate Monitoring...........................................................................5-10
Dual Fetal Heart Rate Monitoring..............................................................................5-10

Heartbeat Coincidence..............................................................................5-11
Fetal Heart Rate Offset..............................................................................5-11
Activating the Fetal Heart Rate Offset Feature..................................5-11
De-Activating the Fetal Heart Rate Offset Feature.............................5-12
6 Uterine Activity Monitoring..................................................6-1

Tocotransducer (External Method).............................................................................6-3
Methodology................................................................................................6-3
Establishing a Baseline...............................................................................6-3
Initial Referencing.................................................................................6-3
Accounting for Belt Tension.................................................................6-4

More About Referencing..............................................................................6-4
Out of Range Condition........................................................................6-4
Manually Setting the Baseline at the Default Value.............................6-4
Manually Overriding the Baseline Default Value..................................6-4
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Automatic Baseline “Zeroing”...............................................................6-4
Internal Method - Intrauterine Pressure (IUP)............................................................6-5

Methodology................................................................................................6-5
Why You Must Zero the System..................................................................6-5
7 Maternal Heart/Pulse Rate Monitoring................................7-1

MHR/P Source............................................................................................................... 7-3
MHR/P Setup Screen.................................................................................................... 7-4

Source.........................................................................................................7-4
HR/PR Trace...............................................................................................7-5
Volume........................................................................................................7-5
Alarms.........................................................................................................7-5
Alarm Volume..............................................................................................7-5
MECG Lead.................................................................................................7-5
MECG Pacer...............................................................................................7-6
Maternal ECG Monitoring............................................................................................ 7-7

Theory and Methodology.............................................................................7-7
Pacemaker Safety Information....................................................................7-7
MECG Waveform........................................................................................7-8
8 Maternal Non-Invasive Blood Pressure Monitoring..........8-1

Blood Pressure Safety Precautions............................................................................8-3
Warnings....................................................................................................................... 8-4
NIBP Determination...................................................................................................... 8-5
SuperSTAT NIBP Determination.................................................................................8-5

Accelerated Determination...................................................................8-6
Systolic Search............................................................................................8-6
NIBP Setup Screen....................................................................................................... 8-7

Mode............................................................................................................8-7
Target..........................................................................................................8-7
NIBP Done Volume.....................................................................................8-8
Alarms.........................................................................................................8-8
Alarm Volume..............................................................................................8-8
NIBP Monitoring........................................................................................................... 8-8

Checklist......................................................................................................8-8
Patient Preparation......................................................................................8-8
Blood Pressure Methodology......................................................................8-9
Hydrostatic Effect......................................................................................8-10
Manual Mode.............................................................................................8-10
Automatic Mode.........................................................................................8-10
Taking a Manual Reading Between Auto Determinations..................8-11
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Venous Return in Auto Mode.............................................................8-11
Adjusting the Interval Time Between Automatic Determinations........8-11
NIBP Interval Button Shortcut............................................................8-12
Terminating a Determination in Progress..................................................8-13
Smart BP Feature....................................................................................................... 8-13

Enabling/Disabling Smart BP....................................................................8-13
Methodology..............................................................................................8-13
9 Maternal Pulse Oximetry Monitoring..................................9-1

MSpO2 Technology...................................................................................................... 9-3
Which Module is Installed?..........................................................................9-3
Theory of Operation.....................................................................................9-4
Ohmeda TruSignal™ Oximetry............................................................9-4
TruSignal™ Enhanced SpO2........................................................9-4
Signal processing..........................................................................9-4
Masimo SET®......................................................................................9-4
Signal Processing.........................................................................9-4
Nellcor OxiMax®..................................................................................9-5
Automatic Calibration....................................................................9-6
SatSeconds™...............................................................................9-6
SatSeconds “Safety Net”...............................................................9-8
Using SatSeconds.........................................................................9-8
MSpO2 Setup Screen.................................................................................................... 9-9

Response Time (Nellcor 506 Technology Only)..........................................9-9
Response Time (Nellcor NELL-3 Technology Only)....................................9-9
Sensitivity (Masimo Technology Only)........................................................9-9
Averaging Time (Masimo Technology Only).............................................9-10
Print Interval..............................................................................................9-10
%O2 Trace................................................................................................9-10
Alarms.......................................................................................................9-10
Alarm Volume............................................................................................9-10
MSpO2 Methodology................................................................................................... 9-10

MSpO2 Pulse Beat Audio..........................................................................9-11
The MSpO2 Waveform...............................................................................9-11
Module and Probe Compatibility...............................................................................9-11

Modules and Sensors................................................................................9-12
No Implied License....................................................................................9-12
Sensors.......................................................................................9-12
10 Alarms.................................................................................10-1
Introduction................................................................................................................ 10-3
Alarm Setup................................................................................................................ 10-3

Master Alarm Setup Screen......................................................................10-3
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Alarms................................................................................................10-3
Alarm Volume.....................................................................................10-4
Alarm Silence.....................................................................................10-4
Alarm Setting Indicators............................................................................10-5
Maternal Alarm Occurring During Setup....................................................10-5
Alarm Behavior...................................................................................10-5
Fetal Heart Rate Alarms............................................................................................. 10-6

FHR Patient Alarms...................................................................................10-6
Active Patient Alarm...........................................................................10-6
Resolved Patient Alarm......................................................................10-6
FHR Signal Quality Alarms........................................................................10-6
Active Signal Quality Alarm................................................................10-6
Resolved Signal Quality Alarm...........................................................10-7
Silencing an FHR Audio Alarm..................................................................10-7
Maternal Alarms......................................................................................................... 10-7

Maternal Patient Alarms............................................................................10-7
Active Patient Alarm...........................................................................10-7
Resolved Patient Alarm......................................................................10-7
Signal Quality Alarms................................................................................10-7
Active Signal Quality Alarm................................................................10-8
Resolved Signal Quality Alarm...........................................................10-8
Silencing a Maternal Audio Alarm.............................................................10-8
Alarms Summary........................................................................................................ 10-9
11 Recorder Modes.................................................................11-1
Modes.......................................................................................................................... 11-3
Off Mode...................................................................................................................... 11-3
On Mode...................................................................................................................... 11-3
Maternal-Only Mode................................................................................................... 11-3

What is the Maternal-Only Mode?.............................................................11-3
Printing Style.............................................................................................11-3
Changing Recorder Modes........................................................................................11-4
Functionality with a QS System................................................................................11-5

Paper Versus Electronic Strip Charts........................................................11-5
Fetal Heart Rate Alarms............................................................................11-6
Trends......................................................................................................................... 11-6
Multiple Trends..........................................................................................11-6
SpO2 Scale................................................................................................11-7
Annotations................................................................................................................ 11-7
Standard Annotations................................................................................11-8
Blood Pressure Annotations......................................................................11-8
Maternal Pulse Oximetry Annotations.......................................................11-9
vi 250cx Series Maternal/Fetal Monitor Revision C
2036946-001
Annotations from a Central Information System........................................11-9
Multiple Annotations..................................................................................11-9
Summary of Annotations......................................................................................... 11-10
Adjustable Recorder Font Size................................................................................11-13
Chart Style Vital Signs Printing...............................................................................11-14

Enabling/Disabling Chart-Style Printing...................................................11-14
Examples of Printing Styles.....................................................................11-15
Chart-Style Printing Examples.........................................................11-15
Real-Time Printing Example.............................................................11-15
Chart-Style 7-Minute Exception for NIBP.........................................11-15
Strip Chart Paper...................................................................................................... 11-16
Paper-Low, Paper-Out, and Paper-LoadING Error Conditions.............................11-18
12 Maternal Vital Signs History..............................................12-1

What is the Maternal Vital Signs History Screen?...................................................12-3
Using the Maternal Vital Signs History Screen........................................................12-4

Displaying the Screen................................................................................12-4
Selecting the HX Interval...........................................................................12-4
Printing the Maternal Vital Signs History Screen.......................................12-5
Printing the Entire Vital Signs History.................................................12-5
Printing a Page of the Vital Signs History...........................................12-5
Stopping the Printing of Maternal Vital Signs History.........................12-5
13 Heartbeat Coincidence.......................................................13-1
Heartbeat Coincidence Theory..................................................................................13-3
Using the Heartbeat Coincidence Feature................................................................13-3

Enabling/Disabling Heartbeat Coincidence Detection...............................13-3
Display Indicator........................................................................................13-3
Strip Chart Annotation...............................................................................13-5
14 Waveforms..........................................................................14-1
Waveform Area........................................................................................................... 14-3
Selecting the Waveform............................................................................14-3
Waveform Speed.......................................................................................14-3
ECG Size...................................................................................................14-3
MECG Lead Select....................................................................................14-3
MECG Pacer Label....................................................................................14-3
Moving Gap...............................................................................................14-4
Freezing Waveforms.................................................................................14-4
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Printing a Waveform Snapshot.................................................................................14-5
Recorder On..............................................................................................14-5
Recorder in Maternal-Only Mode..............................................................14-6
Recorder Off..............................................................................................14-6
Stopping a Print Command.......................................................................14-6
15 Maintenance........................................................................15-1
Cleaning...................................................................................................................... 15-3
Monitor Exterior.........................................................................................15-3
Display.......................................................................................................15-4
Tocotransducer and Ultrasound Transducer.............................................15-4
Leg Plates and MECG Cables...................................................................15-4
Maternal NIBP Cuffs and Hoses................................................................15-5
General...............................................................................................15-5
Materials......................................................................................15-5
Procedure....................................................................................15-5
SpO2 Sensors...........................................................................................15-6
Maternal SpO2 Calibration......................................................................................... 15-6
NIBP Maintenance...................................................................................................... 15-6
Disposal of Product Waste........................................................................................15-7

Patient Applied Parts.................................................................................15-7
Packaging Material....................................................................................15-7
Monitor.......................................................................................................15-7
16 Troubleshooting.................................................................16-1
General Troubleshooting...........................................................................................16-3
Ultrasound Troubleshooting.....................................................................................16-4
FECG Troubleshooting.............................................................................................. 16-5
External Uterine Activity Troubleshooting...............................................................16-5
Internal UA Troubleshooting.....................................................................................16-6
MECG Troubleshooting.............................................................................................16-7
Blood Pressure Troubleshooting..............................................................................16-7
Maternal Pulse Oximetry Troubleshooting..............................................................16-8
17 Technical Specifications....................................................17-1
General Monitor.......................................................................................................... 17-3
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Operating Modes........................................................................................................ 17-4
Strip Chart Recorder................................................................................................ 17-11
18 Supplies & Accessories.....................................................18-1

General Add-Ons Ordering Information...................................................................18-3
Paper Supplies Ordering Information.......................................................................18-3
Ultrasound Ordering Information..............................................................................18-3
FECG Ordering Information.......................................................................................18-4
Tocotransducer Ordering Information......................................................................18-4
IUPC Ordering Information........................................................................................18-4
MECG Ordering Information......................................................................................18-5
NIBP Ordering Information........................................................................................18-5
MSpO2 Ordering Information.....................................................................................18-6
Peripheral Device Ordering Information...................................................................18-6
A Factory Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1
Table of Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3
B Fetal Movement Detection . . . . . . . . . . . . . . . . . . . . . . . . .B-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3
Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .B-3
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .B-3
Using Fetal Movement Detection While Monitoring . . . . . . . . . . . . . . . . . . . . . . . . B-3

Enabling/Disabling Fetal Movement Detection . . . . . . . . . . . . . . . . . . . . . . .
. . . .B-3 Display Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . .B-4
Strip Chart Annotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .B-4
Using the FM Remote Marker to Complement the Patient Record . . . . . . . . . .
. .B-4
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C Spectra Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1
Important Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3
x 250cx Series Maternal/Fetal Monitor Revision C

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Using the Spectra Alert Option...................................................................................C-4
Enabling/Disabling Spectra Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-4
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-4
Alert Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-6

Active Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-6
Silencing Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-6
Resolved Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-7
Alert Suspension Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-7
Enabling/Disabling the Alert Suspension Feature . . . . . . . . . . . . . . . . . .
. . .C-7 Suspending Audio Alerts (and the Nurse Call Interface) . . . . . . .
. . . . . . . . .C-7 Restoring Audio Alerts (and the Nurse Call Interface) . . .
. . . . . . . . . . . . . . .C-7
Alert Parameters Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-9
Resetting Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-12

False Pattern Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-12
Mode Switching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-12
Trend Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-13
Uterine Contraction Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-13

Enabling/Disabling UC Frequency Display . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-14
UC Frequency in UA Display Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-14
UC Frequency Histogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-15
Enabling/Disabling UC Chime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.C-15
Nurse Call Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-16
Alert Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-17
D Frequently Asked
Questions D-1
FAQs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.D-3
1 Safety
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Safety:
For your notes

General Information
General Use
If the monitor is cold to the touch or below ambient temperature, allow it to stabilize
before use.
To ensure patient safety, use only parts and accessories manufactured or

recommended by GE Medical Systems Information Technologies. Parts and
accessories used shall meet the requirements of EN60601-1-1.
Disposable devices are intended for single use only. They should not be reused.
Test all functions periodically and whenever the integrity of the monitor is in
doubt.
Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual” for

information concerning the limitations of internal and external fetal heart rate
monitoring techniques.
Responsibility of the Manufacturer

GE Medical Systems Information Technologies is responsible for the effects on
safety, reliability, and performance if:
 assembly operations, extensions, readjustments, modifications, or repairs are
carried out by persons authorized by GE Medical Systems Information
Technologies;
 the electrical installation of the relevant room complies with the requirements
of appropriate regulations; and
 the monitor is used in accordance with the instructions of use.
Responsibility of the User

This device is intended for use by clinical professionals who are expected to know
the medical procedures, practices, and terminology required to monitor obstetrical
patients. This manual documents all possible parameters available in the 250cx
Series monitor. It is the responsibility of each hospital to ensure that the Labor and
Delivery staff is trained in all aspects of the selected model.
The 250cx Series monitor is only one clinical indicator of fetal status during labor.
The monitor is designed to assist the perinatal staff in assessing the status of a
patient. The monitor does not replace observation and evaluation of the mother and
fetus at regular intervals by a qualified care provider, who will make diagnoses and
decide on treatments or interventions. Visual assessment of the monitor display and
strip chart must be combined with knowledge of patient history and risk factors to
properly care for the mother and fetus.

2036946-001
Safety: Definitions of Terminology
Definitions of Terminology
Six types of special notices are used throughout this manual. They are: Danger,
Warning, Caution, Contraindication, Important, and Note. The warnings and
cautions in this Safety section relate to the equipment in general and apply to all
aspects of the monitor. Be sure to read the other chapters because there are
additional warnings and cautions which relate to specific features of the monitor.
When grouped, warnings and cautions are listed alphabetically and do not imply
any order of importance.
Definitions of Terminology
Danger A DANGER notice indicates an imminently
hazardous situation which, if not avoided, will
result in death or serious injury.
Warning A WARNING indicates a potentially hazardous
situation which, if not avoided, could result in
death or serious injury.
Caution A CAUTION indicates a potentially hazardous
situation which, if not avoided, may result in
minor or moderate injury. Cautions are also used
to avoid damage to equipment.
Contraindication A CONTRAINDICATION describes any special

symptom or circumstance that renders the use
of a remedy or the carrying out of a procedure
inadvisable, usually because of a risk.
Important An IMPORTANT notice indicates an

emphasized note. It is something you should
be particularly aware of; something not
readily apparent.
Note A NOTE indicates a particular point of information;
something on which to focus your attention.
Monitor Contraindications, Warnings, and
Precautions
Warnings
WARNINGS
ACCIDENTAL SPILLS—In the event that fluids are accidentally
spilled onto the monitor, remove the monitor from operation and
inspect for damage.
APPLICATION—This monitor is not designed for direct cardiac

connection.
CONDUCTIVE CONNECTIONS—Avoid making any

conductive connections to applied parts (patient connection)
which are likely to degrade safety.
CONDUCTIVE PARTS—Ensure that the conductive parts of the

lead electrodes and associated connectors do not contact other
conductive parts including earth.
CONNECTIONS—The correct way to connect a patient to the

monitor is to plug the electrode leads into the patient cable which
in turn connects to the monitor. The monitor is connected to the
wall socket by the power cord. Do not plug the electrode leads
into the power cord, a wall socket, or an extension cord.
DEFIBRILLATION—During defibrillation, all personnel must avoid

contact with the patient and monitor to avoid a dangerous shock
hazard. In addition, proper placement of the paddles in relation to the
electrodes is required to minimize harm to the patient.
DEFIBRILLATION PROTECTION—When used with the GE

Medical Systems Information Technologies-recommended
accessories, the monitor is protected against the effects of
defibrillator discharge. If monitoring is disrupted by the
defibrillation, the monitor will recover.
ELECTRICAL SHOCK—To reduce the risk of electrical shock,

do not remove monitor cover. Refer servicing to qualified
personnel.
ELECTROMAGNETIC INTERFERENCE—Be aware that

strong electromagnetic fields may interfere with monitor
operation.
Interference prevents the clear reception of signals by the monitor.
If the hospital is close to a strong transmitter such as TV, AM or
FM radio, police or fire stations, a HAM radio operator, an
airport, or cellular phone, their signals could be picked up as
monitor signals. If you feel interference is affecting the monitor,
contact your Service Representative to check the monitor in your
environment. Refer to “Electromagnetic Interference” on page 1-9 for
additional information.

2036946-001
Safety: Monitor Contraindications, Warnings, and
Precautions
WARNINGS
ELECTROSURGERY—The monitor is not designed for use with
high-frequency surgical devices. In addition, measurements may
be affected in the presence of strong electromagnetic sources such
as electrosurgery equipment.
EQUIPMENT USE—The use of this equipment is restricted to

one patient at a time.
EXPLOSION HAZARD—Do not use this equipment in the

presence of flammable anesthetics or inside an oxygen tent.
GROUNDING—Do not defeat the three-wire grounding feature

of the power cord by means of adaptors, plug modifications, or
other methods. A dangerous shock hazard to both patient and
operator may result.
INOPERABLE MECG—The MECG trace is not visible during a

MECG LEADS OFF condition or an overload (saturation) of the
front- end amplifier during differential input voltage of more than
± 300mV.
INSTRUCTIONS—For continued and safe use of this equipment,
it is necessary to follow all listed instructions. However, the
instructions provided in this manual in no way supersede
established medical procedures concerning patient care. The
monitor does not replace observation and evaluation of the
patient, at regular intervals, by a qualified care provider who will
make diagnoses and decide on treatments and interventions.
INTERFACING OTHER EQUIPMENT—Monitoring equipment

must be interfaced with other types of medical equipment by
qualified biomedical engineering personnel. Be certain to consult
manufacturers’ specifications to maintain safe operation.
LEAKAGE CURRENT TEST—The interconnection of auxiliary

equipment with this device may increase the total leakage current.
When interfacing with other equipment, a test for leakage current
must be performed by qualified biomedical engineering personnel
before using with patients. Serious injury or death could result if
the leakage current exceeds applicable standards. The use of
accessory equipment not complying with the equivalent safety
requirements of this equipment may lead to a reduced level of
safety of the resulting system. Consideration relating to the choice
shall include: use of the accessory in the patient vicinity; and
evidence that the safety certification of the accessory has been
performed in accordance with the appropriate EN60601.1 and/or
EN60601.1.1 harmonized national standard.
LINE ISOLATION MONITOR TRANSIENTS—Line isolation

monitor transients may resemble actual cardiac waveforms, and
thus cause incorrect heart rate determinations and alarm
activation (or inhibition).
WARNINGS
MRI USE—Do not use the electrodes during MRI scanning;
conducted current could potentially cause burns.
PATIENT CABLES AND LEADWIRES—Do not use patient

cables and electrode leads that permit direct connection to
electrical sources. Use only “safety” cables and leadwires. Use of
non-safety patient cables and lead wires creates risk of
inappropriate electrical connection which may cause patient shock
or death.
PACEMAKER PATIENTS—Rate meters may continue to count

the pacemaker rate during occurrences of cardiac arrest or some
arrhythmias. Do not rely entirely upon rate meter alarms. Keep
pacemaker patients under close surveillance. Refer to Chapter 16,
“Troubleshooting” for disclosure of the pacemaker pulse rejection
capability of the 250cx Series Monitor.
RF INTERFACE—Known RF sources, such as cell phones, radio

or TV stations, and two-way radios, may cause unexpected or
adverse operation of this device.
SIMULTANEOUS DEVICES—Do not simultaneously connect

more than one device that uses electrodes to detect ECG and/or
respiration to the same patient. Use of more than one device in
this manner may cause improper operation of one or more of the
devices.
STRANGULATION—Make sure all patient cables, leadwires,

and tubing are positioned away from the patient’s head to
minimize the risk of accidental strangulation.
WATER BIRTHS—Do not use the monitor to directly monitor

patients during water births, in whirlpool or submersion water
baths, during showers, or in any other situation where the mother
is immersed in water. Doing so may result in electrical shock
hazard.
EXTERNAL VGA CONNECTIONS—Connect only to

GE recommended display. ONLY remove cover plate if
external display is used.
TELEMETRY CONNECTIONS—Connect only to GE

recommended telemetry systems. Contact your GE service
representative for more information.
WARNINGS
COLOR DISPLAY—Certain colors may have limited visibility at
a distance. Color-blind individuals may experience this more
often.
EXERGEN® TAT-5000™ —Cable assembly 2036641-001

cannot be field serviced. Do NOT attempt any repairs to this
assembly. This assembly must be returned to the factory for any
repairs. This assembly, as shipped, is important to patient safety.
DISPOSAL—This product consists of devices that may contain

mercury, which must be recycled or disposed of in accordance
with local, state, or country laws. (Within this system, the
backlight lamps in the monitor display contain mercury.)
Cautions
CAUTIONS
STATIC ELECTRICITY—This assembly is extremely static
sensitive and should be handled using electrostatic
discharge precautions.
ANNUAL SERVICING—For continued safety and performance

of the monitor, it is recommended that the calibration, accuracy,
and electrical safety of the monitor be verified on an annual basis
by a GE Medical Systems Information Technologies Service
Representative.
DAILY TESTING—It is essential that the monitor and

accessories be inspected every day. It is recommended practice to
initiate the monitor’s self-test feature at the beginning of each
monitoring session; follow the instructions in Chapter 4, “Setup
Procedures”.
ENVIRONMENT—The performance of the monitor has not

been tested in certain areas, such as x-ray and imaging suites.
The monitor is not recommended for use in these environments.
EQUIPMENT CONFIGURATION—The equipment or system

should not be used adjacent to, or stacked with, other equipment.
If adjacent or stacked use is necessary, the equipment or system
should be tested to verify normal operation in the configuration in
which it is being used.
PERFORMANCE—Report all problems experienced with the

monitor. If the monitor is not working properly, contact your
Service Representative for service. The monitor should not be
used if it is not working properly.
Electromagnetic Interference
This device has been tested and found to comply with the Medical Electrical
Equipment-General Requirements for Safety-Collateral Standard: Electromagnetic
Compatibility, EN60601-1-2:2001, Medical Device Directive 93/42/EEC. These
limits are 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 the health-care and home environments (e.g.
cellular phones, mobile two-way radios, electrical appliances), it is possible that
high levels of such interference due to proximity or strength of a source, may result
in disruption of performance of this device.
Refer to the Electromagnetic Immunity information in this product’s service manual

for EN 60601-1-2 (2001) compliance information and safety information for this
product.
This equipment generates, uses, and can radiate radio frequency energy and, if not
installed and used in accordance with these instructions, may cause harmful
interference with other devices in the vicinity. Disruption or interference may be
evidenced by erratic readings, cessation of operation, or incorrect functioning. If
this occurs, the use site should be surveyed to determine the source of this
disruption, and actions should be taken to eliminate the source.
The user is encouraged to try to correct the interference by one or more of the
following measures:
 Turn equipment in the vicinity off and on to isolate the

offending equipment.
 Reorient or relocate the other receiving device.
 Increase the separation between the interfering equipment and
this equipment.
 If assistance is required, contact your GE Medical Systems Service
Representative.
Safety: Equipment Symbols
Equipment Symbols
The following is a list of symbols used on products manufactured by GE Medical
Systems Information Technologies. Some symbols may not appear on your unit.
Equipment Symbols
ATTENTION: Consult accompanying documents.
WASTE OF ELECTRICAL AND ELECTRONIC

EQUIPMENT (WEEE): This symbol indicates
that the waste of electrical and electronic
equipment must not be disposed as unsorted
municipal waste and must be collected
separately. Please contact an authorized
representative of the manufacturer for
information concerning the decommissioning of
your equipment.
TYPE B EQUIPMENT: Type B equipment is
suitable for intentional external and internal
application to the patient, excluding direct
cardiac application.
TYPE BF EQUIPMENT: Type BF equipment

is suitable for intentional external and
internal application to the patient, excluding
direct cardiac application. Type BF equipment
has an F-type applied part.
DEFIBRILLATOR-PROOF TYPE BF
EQUIPMENT:
Type BF equipment is suitable for
intentional external and internal application to
the patient, excluding direct cardiac
application. Type BF equipment is type B
equipment with an F-type isolated (floating)
part. The paddles indicate the equipment is
defibrillator proof.
TYPE CF EQUIPMENT: Type CF equipment is
suitable for intentional external and internal
application to the patient including direct
cardiac application. Type CF equipment is F-
type applied part that provides a higher
degree of protection against electric shock
than that provided by Type BF applied parts.
ALTERNATING CURRENT (AC).
EQUIPOTENTIALITY.
1-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001
Equipment Symbols
O POWER OFF: disconnection from the mains.
I POWER ON: connection to the mains.
VGA connection.
2 Introduction

2036946-001
Introduction:
For your notes

About the Manual
Purpose
This manual documents all possible parameters so that when your equipment is
upgraded, new documentation will not be required. Also, the manual provides an
opportunity to read about features you may not have, to assist you with your
upgrade decisions. Some sections will not apply to your unit’s monitoring
capabilities.
Intended Audience
This manual is intended for physicians, nurses and midwives. Clinical
professionals are expected to know the medical procedures, practices, and
terminology required to monitor obstetrical patients.
Illustrations
All illustrations are provided as examples only. Your monitor may not be equipped
with the specific feature shown. In addition, unless explicitly stated, the display
examples do not represent your equipment setup or displayed data.
Fetal Monitoring Indications for Use

A Corometrics 250cx Series Fetal Monitor is used for fetal surveillance.
Surveillance
A Corometrics 250cx Series monitor can be used for routine non-invasive and
invasive fetal monitoring throughout labor and delivery.
Maternal Monitoring Indications for Use

A Corometrics 250cx Series Maternal/Fetal Monitor is intended for monitoring
maternal vital signs to help assess maternal well-being. The vital signs which can be
measured are summarized below.
NOTE: Maternal vital signs provided by the monitor should only be

used as an adjunct to patient assessment and must be used in
conjunction with clinical signs and symptoms.
Blood Pressure
The monitor is intended for use only in the non-invasive monitoring of maternal
blood pressure (NIBP). This monitor is not intended for use in neonatal or pediatric
blood pressure monitoring.

2036946-001
Introduction: Series Overview
Pulse Oximetry
The monitor is intended for use in the non-invasive monitoring of the functional
oxygen saturation of maternal arterial blood (MSpO2).
Heart/Pulse Rate
The monitor is intended for use in the non-invasive monitoring of the maternal
heart/pulse rate (MHR/P).
NOTE: The Corometrics 250cx Series provides both maternal heart rate
and maternal pulse rate data; the heart rate data is derived from
the MECG section of the monitor while the pulse rate data is
derived from the NIBP or MSpO2 sections of the monitor.
Series Overview
The Corometrics 250cx Series monitor provides one solution for high-risk and low-
risk labors and deliveries. The monitor lets you start with a fetal or maternal/fetal
monitor and add the extended features later, as your clinical needs increase and your
budget allows. The model of the monitor determines which parameters are in your
monitor.
MODEL Fetal FECG TOCO NIBP MSpO2 MECG

Heart /IUP
Rate
(Twins)
US
256cx   
259cx      
The 250cx Series Monitor Features

The 250cx Series monitor offers the following features:
System Parameters (256cx and 259cx)

 The QVGA LCD display, with circularly polarized filter, removes glare;
its wide viewing angle provides sharp viewing at a distance.
 The large display area provides simultaneous display of fetal
parameters, maternal parameters, and maternal waveforms.
 The Brightness softkey permits clear viewing in all lighting conditions.
 Frequently used functions are controlled by your choice of front panel monitor
buttons—Volume, UA Reference, Alarm Silence, Mark [Offset], Record, and
Paper Advance.
 System setup options are easily accessed via a front panel Trim Knob control.
 Automatic mode selection is provided simply by inserting the appropriate
transducer plug into the front panel receptacle.
Introduction: Series Overview
 Transducer connectors are easy-to-use, color-coded, and durable.
 Annotations from an optional Model 2116B Keyboard are printed on the
strip chart recorder paper.
 The strip chart recorder is a quiet, easy-to-load, high-resolution thermal array
printer. The recorder prints continuous trends and alphanumeric data on one
strip chart.
 The Chart Light allows the room lights to be dimmed without
sacrificing visibility of the strip chart recorder.
 The system is compatible with Centricity® Perinatal Clinical Information
Systems, as well as with other information systems, to streamline capture and
archiving of patient data.
Following is a summary of the features.
Fetal Only Monitor (256cx) Maternal/Fetal Monitor (259cx)

 US  US
 US2  US2
 FECG  FECG
 TOCO  TOCO
 IUP  IUP
 NIBP
 MSpO2
 MECG
Fetal Parameters
 Dual ultrasonic heart rate monitoring allows for non-invasive monitoring of twins.
 Independent volume controls facilitate easy transducer placement
when monitoring twins.
 A +20 bpm heart rate offset option is provided for the secondary heart rate
(HR2) trend, when using dual ultrasound, or ultrasound and direct FECG,
to separate overlapping FHR trends for easy interpretation.
 A heartbeat coincidence detection feature can be enabled to inform you
when there is the possibility that you may be monitoring a duplicate signal.
 The FECG waveform can be optionally displayed and can be “frozen” on the
screen for review. In addition, a 6-second “snapshot” can be printed on the
strip chart paper.
 Fetal parameters are continuously displayed even during configuration
of system setup options.
 The ultrasound mode provides clean, accurate traces with few “dropouts”
because of Corometrics’ patented autocorrelation processing.
 Fetal heart rate alarm limits are user-defined, with pre-set defaults.
Signal quality has no user-defined parameters.
 Alarm limits are easily configured via setup screens.
 Alarm silencing is controlled by a brightly colored, easily recognizable
front panel monitor button.

2036946-001
 Alarm conditions have both audible and visual indications. Only fetal audible
alarms can be disabled. Fetal heart rate threshold and signal quality alarms can be
cancelled.
 Optional Spectra Alerts™ simultaneously analyzes FHR and UA
information and notifies clinicians of deviations from the norm.
Maternal Parameters (259cx only)

 Built-in maternal vital signs monitoring eliminates the need for separate blood
pressure and maternal pulse oximetry monitors.
 Maternal vital signs storage provides an 8-hour history of the maternal vital
signs in a spreadsheet format. The data can be displayed or printed on-
demand.
 A maternal-only recording mode is specifically designed for postpartum
monitoring of the mother.
 The monitor can be interfaced to the most widely used non-invasive blood
pressure monitors and pulse oximeters.
 Maternal non-invasive blood pressure readings can be taken on-demand or at
pre-programmed intervals. The use of unique, patented DINAMAP®
SuperSTAT blood pressure technology provides blood pressure accuracy and
faster, automated readings.
 Smart BP option prevents blood pressure readings from occurring
during contractions.
 Continuous non-invasive MSpO2 oxygen saturation and maternal pulse rate
can be reliably monitored using well-known user-preferred pulse oximetry
brands. Masimo SET, Nellcor OxiMax, or Ohmeda TruSignal MSpO2 may be
selected at the time of purchase or changed later as determined by hospital
needs.
 The MSpO2 pulsatile waveform can be optionally displayed and can be
“frozen” on the screen for review. In addition, a 6-second “snapshot” can
be printed on the strip chart paper.
 Continuous display/printing of the maternal pulse rate trend can be enabled.
 The MECG waveform can be optionally displayed and can be “frozen” on
the screen for review. In addition, a 6-second snapshot can be printed on the
strip chart paper.
 Built-in independent MECG monitoring is provided with selection of lead I, II, or
III.
 Selectable 3-lead maternal ECG with pacemaker detection and rejection
generates maternal heart rate, QRS waveform display and a 6-second
snapshot printout when requested.
 Twins and maternal monitoring can be accomplished simultaneously using
dual ultrasound and MECG, or by using ultrasound, FECG, and MECG.
 Maternal alarm limits are user-defined, with preset defaults; they are
easily configured via setup screens.
 Maternal alarm conditions have audible and visual indications, and can be
silenced for a user-specified time.
 Alarm silencing is controlled by a brightly colored, easily recognizable
front panel monitor button.
Adding Fetal Movement Detection and/or Spectra Alerts

The monitor can be upgraded to include Fetal Movement Detection and/or Spectra
Alerts. Contact your local sales representative for upgrade information.
3 Controls, Indicators, and
Connectors

2036946-001
Controls, Indicators, and Connectors: Front Panel
Description
For your notes

Front Panel Description
A B C D E F G H I
Y J
FECG FMD
US2 HBC TOCO
X
165 172 30 K
NIBP 15:00
MECG MSpO2
W 130/ 85 87 98%
MAP (107)
03:15
25 mm/s
V II 2x
L
U FECG 03:22:45
Print Freeze Alarms Setup VSHX
T S R Q P O N
Monitor Front Panel
Front Panel
# Name Description
A Display The monitor’s display is divided into several sections. The content and layout of
the display can change, depending on which functions are installed in the monitor
and the modes of operation in use.
B Trim Knob Control Operation of the monitor is controlled by using the front panel buttons in
conjunction with the Trim Knob control. This control selects softkeys on the display
and positions a cursor within a setup screen. Rotate the Trim Knob control left
or right to highlight items on the screen with a bar cursor. After highlighting
the desired item, press the Trim Knob control to make the selection. In summary:
rotate to move cursor; press to select an item.
C NIBP Start/Stop Button This button starts and stops both manual and automatic blood
pressure determinations. It also provides a “shortcut” for changing the auto
interval time (see 8-12).
D Test Button Pressing and holding this button for 1 second starts or stops a monitor self-test
routine.

2036946-001
Description
Front Panel
# Name Description
E Mark [Offset] Button The Mark [Offset] button is a multi-function button.
 Mark: Pressing this button prints an event mark on strip chart paper (on the
bottom two lines of the top grid).
 Offset: When the Heart Rate Offset mode is enabled, pressing and holding
this button shifts the secondary FHR trend +20 bpm for visibility purposes.
Refer to “Fetal Heart Rate Offset” on page 5-11.
F UA Reference Button The UA Reference button sets a baseline for uterine activity pressure monitoring.
Refer to Chapter 6, “Uterine Activity Monitoring”.
G Paper Advance Button Pressing this button advances chart paper at a rate of 40 cm/min for as long as
the button is held down.
H Record Button The Record button selects one of three recorder states: on, maternal-only mode, or
off. Refer to Chapter 11, “Recorder Modes”. Factory default is OFF.
I Power Indicator The indicator lights green when the monitor is turned on.
J Record Indicator Indicator Status Recorder Status
on on
off off
three short flashes maternal-only mode
every 5 sec
flashes on and off error condition
K Light Button Illuminates the strip chart paper for night time visibility. Factory default is ON.
L Recorder Door Latch Opens the strip chart recorder door to add, remove, or adjust the paper.
M Power Switch Moving the switch to the on position (I) turns the monitor on; moving the switch
to the
off position (O) turns the monitor off.
N Strip Chart Recorder Annotations and trends are printed on the strip chart paper. Two paper styles
are available. Refer to Chapter 4, “Setup Procedures”, for instructions on loading
strip chart paper into the recorder. Refer to Chapter 11, “Recorder Modes” for
additional information about trends and annotations.
O MATERNAL NIBP Connector Connect a pneumatic hose and blood pressure cuff assembly to this black twin
lumen receptacle.
P MATERNAL SpO2 Connector Connect a 250cx Series MSpO2 intermediate cable to this royal blue receptacle.
Use only Nellcor Maternal Oxygen Saturation Sensors if Nellcor technology is
installed in your monitor, Masimo Sensors if Masimo technology is installed in
your monitor, or Ohmeda Sensors if Ohmeda technology is installed in the
monitor.
Q FECG/MECG Connector Connect an FECG cable/legplate or MECG cable plug to the FECG/MECG
receptacle. Cables with rectangular plugs connect directly to the FECG/MECG
receptacle. Cables with round plugs require an FECG/MECG adapter. Refer to
“MECG Ordering Information” on page 18-5 for the adapter part number. This adapter
is used for dual ECG monitoring as well. The adapter branches into two
cables, each with a round receptacle at the end: one branch is labeled MECG;
the other branch is labeled FECG.
Front Panel
# Name Description
R UA Connector Connect a tocotransducer, IUPC, or strain gauge transducer plug to this
white receptacle. Contact your Sales Representative for information about
compatibility.
S US2 Connector Connect the secondary ultrasound transducer plug to this light gray receptacle.
T US Connector Connect the primary ultrasound transducer plug to this light gray receptacle.
U FHR2 Volume Decrease Button The four Volume buttons raise ( ) and lower ( ) the volume of sound emitted
by the rear panel speaker. The upper pair controls the volume for FHR1. The
V FHR2 Volume Increase Button lower pair controls the volume for FHR2. Volume settings have no effect on the
W FHR1 Volume Decrease Button processing used to determine heart rate. The Volume buttons work in
conjunction with the volume control settings on the US/US2 Setup screen (page
X FHR1 Volume Increase Button 5-3) and on the FECG Setup screen (page 5-5).
Y Alarm Silence Button Pressing this button removes the audible indication of an individual alarm.
(Refer to Re-Alarm in the “Alarms” Section for more information.)
Displays
Front Panel Displays

The monitor is divided into two main sections: patient information (the left-side of
the monitor) and monitor functionality (the right-side of the monitor). Refer to
“Monitor Front Panel” on page 3-3. The keys are ordered for user efficiency.The
content and layout of the display can change, depending on which functions are
installed in the monitor and the modes of operation in use.
Primary Labor
Parameters
(Fetal)
Additional
Parameters
(Maternal)
Maternal and Fetal Parameters
Display Summary
Display Section Item Mode
Fetal Heart Rate 1 (FHR1) US, US2, FECG, or INOP
Primary Labor Parameters
(upper portion of monitor) Fetal Heart Rate 2 (FHR2) US, US2, or INOP
Uterine Activity (UA) TOCO, IUP, or INOP
Maternal Blood Pressure NIBP
Additional Parameters
(Available in Maternal/Fetal Maternal Heart/Pulse Rate MECG, Pulse or INOP
Monitor only) Maternal SpO2 MSpO2
Waveform Fetal ECG Waveform, Maternal ECG Waveform, FECG, MECG, MSpO2, or Off
or Maternal SpO2 Pulsatile Waveform
Time Current Time, [Label] Frozen Message and Time of —

Activation
Softkeys System Configuration Softkey Controls —

2036946-001
Display Example
From the graphic below, you can determine the following:
 Blood pressure is not active as indicated by the absence of numerics.

 Maternal pulse oximetry is active by presence of pulse amplitude indicator.
 MECG is selected as the heart rates source as indicated by the MECG mode title
softkey—rather than Pulse.
 The MECG waveform is displayed at 25 mm/sec, at a size of 2x, with lead II
selected.
 Heartbeat coincidence is enabled as indicated by the HBC acronym in the
primary labor parameters area.
 All alarms are enabled as indicated by .
Maternal/Fetal Monitor Display Example

Controls, Indicators, and Connectors: Primary Labor
Parameters
Primary Labor Parameters

The primary labor parameters section displays FHR1, FHR2, and UA data.
FHR Display
The FHR1 and FHR 2 areas are summarized in the following figure and table.
C D
FHR Display
FHR Display
Name Description
FHR Value Up to three digits indicate the fetal heart rate
A
in beats per minute.
FHR Alarm Setting This symbol provides information about the
Indicator FHR audio alarm and the FHR high/low
alarm limit settings. See Chapter 10,
B “Alarms” for more information.
 : All alarm settings are enabled.
 At least one fetal alarm is disabled.
FHR Mode Title An abbreviation indicates the monitoring mode
in use: FECG, US, US2, or INOP. (FECG only
displays in the FHR1 area.) Select the mode
C
softkey to access the respective setup screen.
See “Connectors vs. Display Modes” Table
below for FHR connection options.
D FHR Heartbeat Indicator Flashes with each detected valid heartbeat.

2036946-001
Connectors vs. Display Modes
Active Connectors FHR1 Area FHR2 Area
FECG FECG INOP
FECG/US FECG US
FECG/US2 FECG US2
US US INOP
US/US2 US US2
US2 US2 INOP
— INOP INOP
FECG/US/US21 FECG US2
1
If three FHR transducers are plugged in, the FECG signal overrides the US signal.
UA Display
The UA area is summarized by the following figure and table.
UA Display
UA Display
Name Description
UA Value Up to three digits indicate the uterine activity
value—mmHg or kPa. Internal UA monitoring
A is absolute and external monitoring (Toco) is
relative. The units are consistent in both cases
and are user-selectable: mmHg or kPa.
UA Mode Title An abbreviation indicates the monitoring mode

B
in use: TOCO, IUP, or INOP.
Controls, Indicators, and Connectors: Additional
Parameters
Additional Parameters
The additional parameters area displays NIBP, MHR/P, and MSpO2 data.
Maternal NIBP
The maternal NIBP section is summarized in the following figure and table.
D E
C
NIBP 11:41
B 130/ 85MAP (107)

A 03:15
NIBP Display
NIBP Display
Name Description
NIBP Time Stamp The time (in 24-hour format) of the last
A
blood pressure measurement.
NIBP Values The systolic/diastolic and mean arterial
pressures (MAP) are each indicated by up to
three digits— displayed as XXX mmHg or
B XX.X kPa. All kPa readings are displayed to
1/10 kPa.
During a determination, the instantaneous
cuff pressure displays in place of the mean
arterial pressure and is denoted by the
title Cuff.
NIBP Alarm Setting This symbol provides information about the
Indicator NIBP audio alarm and the NIBP high/low
C
alarm limit settings. See Chapter 10, “Alarms”
for more information. Maternal alarms cannot
be disabled.
NIBP Mode Title Select the mode title to access the NIBP Setup
D
screen.
NIBP Countdown Timer The clock symbol represents activation of the
E auto mode. The countdown timer indicates the
minutes and seconds until the next automatic
reading.

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MHR/P Area
The MHR/P area is summarized by the following figure and table.
C
D
MHR/P Display
MHR/P Display
Name Description
MHR/P Value Up to three-digits indicate the MHR/P in beats
A
per minute.
MHR/P Alarm Setting This symbol provides information about the
Indicator MHR/P audio alarm and the MHR/P high/low
B
for more information. Maternal alarms cannot be
disabled.
MHR/P Mode Title The mode title MECG indicates MECG is the
MHR/P source; the mode title Pulse indicates
C MSpO2 or NIBP is used as the source. Select
the mode title softkey to access the MHR/P
Setup screen.
Maternal Heartbeat Flashes with each detected valid heartbeat—

D
Indicator for MECG only.
Controls, Indicators, and Connectors: MSpO2 Area
MSpO2 Area
The MSpO2 area is summarized in the following figure and table.
C D
B
MSpO2
A
97%
MSpO2 Display
MSpO2 Display
Name Description
MSpO2 Value Up to three digits indicate the percentage
A
of oxygen in the mother’s blood.
MSpO2 Alarm Setting This symbol provides information about the
Indicator MSpO2 audio alarm and the MSpO2 high/low
B
for more information. Maternal alarms cannot be
disabled.
MSpO2 Mode Title Select the mode title to access the MSpO2
C
Setup
screen.
MSpO2 Pulse Amplitude This vertical bar qualitatively indicates
D pulse amplitude.
Indicator
Waveform Area
The waveform area displays approximately 4 seconds of waveform data for: FECG,
MECG, or MSpO2. Refer to Chapter 14, “Waveforms” for more information.
Time and Waveform Message Area

The current time (in 24-hour format) always displays on the far right. When a
waveform is frozen, the message Frozen displays on the far left, bottom corner, along
with the time of activation.

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Battery-Backed RAM Status
Whenever you turn off a 250cx Series Monitor, a battery provides power to the
RAM (random access memory) that stores information such as time, date, default
settings, etc.
Low Battery Icon
The icon shown above will appear in the upper right-hand section of the monitor
under the following circumstances.
Battery-Backed RAM Status

Icon Appearance Reason Solution
Icon appears and then disappears Data corruption. Your monitor has Access setup screens and configure
after power cycle. reverted to factory settings. last- used settings.
Icon appears after multiple Battery requires service. Call GE Service to report.
power cycles.
SET TIME/DATE message prints on Failure of the battery-backed RAM to Reset the time and date then power
the strip chart paper. retain time and date. cycle the monitor. If message still prints,
call GE Service to report.
Softkeys
A softkey is an area on the screen that can be selected with the Trim Knob control.
When the softkey is activated by pressing the Trim Knob control, it may cycle
through available settings or it may display a setup screen.
Mode Title
Softkeys
Most of the mode titles in the display are also softkeys which give access to
corresponding setup screens: US, US2, FECG, NIBP, MECG, Pulse, and MSpO2.
Waveform Softkeys
The waveform title is a softkey used to select the waveform for display or to disable
the area. The ECG Scaling and MECG lead labels are softkeys used to configure the
waveform currently displayed.
Controls, Indicators, and Connectors: Softkeys
Dedicated Softkey Area

Softkeys are located at the bottom of each screen, as shown in “Maternal/Fetal
Monitor Display Summary” on page 3-14. Although there are many possible
softkeys which may appear in this area, a maximum of five are shown at a time.
US US2 HBC TOCO
165 172 30 A
MECG
130/ 85 89
NIBP 02:15 MSpO2
MAP (107)
97%
25 mm/s II Auto
03:15
B
C
MECG09:21:41Frozen09:22:06
I PrintFreezeAlarmsSetupVSHX
H F D
G E
Maternal/Fetal Monitor Display Summary
Display Summary
Name Description
Mode Title Softkeys Selects US, US2, FECG, NIBP, MHR/P, or SpO2
A
Setup screens.
B ECG Scale Softkey Selects 0.25x, 0.5x, 1x, 2x, 4x, or Auto.
MECG Lead Select Selects Lead I, II, or III.
C
Softkey
VSHX Softkey Displays maternal Vital Signs History screen.
D
(See illustration below.)
E Setup Softkey Displays General Setup screen
F Alarms Softkey Displays Master Alarm Setup screen.

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Display Summary
Name Description
Freeze Softkey Freezes waveform for analysis;
G
unfreezes waveform to return to real-
time display.
Print Softkey Prints 6-second snapshot of frozen waveform,
H
real- time waveform, or maternal vital signs
history.
I Waveform Softkey Selects FECG, MECG, MSpO2, or Off.
US US2 TOCO
154 135 Vital Signs History

17
Date: 24-Mar 24-Mar 24-Mar 24-Mar 24-Mar
Time: 12:00 12:10 12:20 12:30 12:40
NIBP
SYS 120 122 122 125 124
DIA 85 87 90 95 90
MAP 94 95 94 105 98
P 74 76 75 81 77
MSpO2
100 98
%02 98 99 99 81 78
P 76 77 75
MECG 75 74 75 81 78
HX Interval: 10 min
Print PrintAll View Exit
D
A B C
l Maternal Vital Signs History Screen Softkeys
Maternal Vital Signs History Screen Softkeys

Name Description
A Print Softkey Prints one page (screen) of the table.
B PrintAll Softkey Prints all pages (screens).
View Softkey Scrolls through the data:
C  Counterclockwise for newest data
 Clockwise for oldest data
D Exit Softkey Returns to the previous screen.
Controls, Indicators, and Connectors: Rear Panel
Description
Rear Panel Description
B D
F
A C E
J112 !
CAUTION: FEDERAL
LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN.
J103 J102
0086
PUSH
J101 J104
G
GE Medical Systems Inc
Munzinger Straße 3-5; D-79111 Freiburg Germany

100 -120V ~ 50-60HZ 100W European Representative
J109J110J11 RS232C RS232C RS232C
U.S. PATS. 3,982,528 4,533,926 4,573,479

CANADIAN PATS. 1,057,360 1,214,143
M K I
N L J
H Monitor Rear Panel Connectors (Standard and
Optional)
IMPORTANT: The Fetal Acoustic Stimulator and Remote Event

Marker connectors are identical in size and shape. Be sure you connect to
the proper connector to ensure accurate information.
250cx Series Rear Panel (Standard and Optional Features)

Name Description
Vent Provides ventilation for the monitor’s
A
internal circuitry.
J101 Telemetry Connector for Corometrics telemetry
B
Connector system interface.
J103 Data Entry Connector for data entry system interface.
C
Connector
J104 Nurse Call Connector for standard Nurse Call System
Connector interface. The connector’s maximum output is
D
50 Vdc at 100 mA; the maximum on
resistance is
0.5 Ω.

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Name Description
J102 Central Systems Connector for analog central station
E
Connector system interface.
J112 External VGA Connector for external VGA display. Use of
Connector recommended GE external display will allow
F monitor front panel display video to be
replicated remotely.
Speaker The rear panel speaker emits an audible tone

for heart rates, MSpO2 pulse with %O2-
G
dependent pitch, and alarms. It also provides
the sound for the song player feature.
J109, J110, and J111 Three serial RJ-11 connectors are provided for
RS-232C interfacing to peripheral equipment. Contact
H
Communications your GE Service Representative for more
Connectors information.
ECG Out Connector External recorder receptacle for MECG

I
signals. The standard output level is 1
V/mV.
Fetal Acoustic Receptacle for Corometrics Model 146 Fetal
Stimulator Connector Acoustic Stimulator (FAST). A musical note
J symbol prints on the strip chart paper each time
the Model
146 is used:
Remote Event Marker Receptacle for the Corometrics Remote Event
Connector Marker. When activated, one of the following
marks prints on the strip chart paper:
 The event marker is commonly used to
record
K an “event”:
 The fetal movement marker (default setting) is
commonly used as an indication that the
mother
has perceived fetal movement:

Refer to the “Coro 250/250cx Series
Monitor Service Manual” for more
information.
Equipotential Lug A binding post terminal is directly connected to
L
the chassis for use as an equipotentiality
connection.
Name Description
AC Voltage Selection This switch is intended for qualified
Switch service personnel to select a voltage range
for the AC input:
M  120: Accepts an AC input in the range of
100– 120 VAC.
 240: Accepts an AC input in the range of
220– 240 VAC
Power Entry Module AC line power cord receptacle. Refer to the

N rear panel markings to verify line voltage
and line frequency requirements.
CAUTION
NON-DESTRUCTIVE VOLTAGE—The maximum non-
destructive voltage that may be applied to the rear panel
connectors is 0 volts. Do not attempt to connect cables to these
connectors without contacting your Biomedical Engineering
Department or GE Medical Systems Information Technologies
Service Representative. This is to ensure the connectors comply
with leakage-current requirements of one of the following
applicable standards: Underwriters Laboratories UL-2601-1,
Canadian Standards Associations CSA 22.2 No. 125, or
International Electrotechnical Commission EN60601-1.
4 Setup Procedures

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Setup Procedures:
For your notes

Loading Strip Chart Recorder Paper
Refer to “Paper Supplies Ordering Information” on page 18-3 to order paper
required for use with the 250cx Series Monitor.
 (HR scale of 30–240 bpm); or
 (HR scale of 50–210 bpm).
Refer to Chapter 11, “Recorder Modes” for more information about the different
paper styles.
CAUTIONS
LOADING PAPER—The instructions for loading paper into the
250cx Series Monitor are different than the instructions for
loading paper into other Corometrics monitors. Improper loading
can cause paper jams. Follow the instructions carefully.
PAPER TYPE—Do not use non-Corometrics paper or paper

designed for use with other Corometrics monitors. Using
incorrect paper may produce inferior print quality, could result in
permanent damage to the recorder’s print head, and may void
your warranty. Refer to “Paper Supplies Ordering Information”
on page 18-3 for the correct monitor paper part number.
STORAGE/TRANSPORT—Paper should be installed in the

monitor’s strip chart recorder at all times. This reduces particle
build-up on the printhead and facilitates opening the recorder
door.
To install Corometrics chart paper in the 250cx Series Monitor, follow these steps:
1. Press down on the latch on the right side of the strip chart recorder door to
open the recorder door.
Opening the Recorder Door

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Setup Procedures: Loading Strip Chart Recorder
Paper
2. Fan the pack of Z-fold paper on all sides to loosen any folds and to ensure
proper feed of the paper through the recorder.
Fanning the Paper
NOTE: The black squares indicate the end of the recorder paper. When the
black squares appear, the strip chart recorder has approximately 20
minutes of paper remaining, when running at a speed of 3 cm/min.
3. Hold the package of paper so that:

 the black squares are on the bottom of the pack; and
 the Corometrics logo and page numbers are on the left side of the pack.
Orienting the Paper
NOTE: The paper is labeled, “This side up for the 120, 2120is, and 170
Series.” This paper is compatible with and required for the 250cx
Series.
4. Unfold two sheets from the top of the package so that they extend toward you.
Creating Paper Leader
5. Place the pack in the drawer so that the pack is laying flat in the recorder.
Inserting the Paper
6. Close the strip chart recorder door.
Closing the Recorder Door

Setup Procedures: Power
Refer to Chapter 11, “Recorder Modes” for information about paper-loading errors.
Power
1. Turn the monitor’s power off. The Power button is located in the lower
right- hand corner of the monitor.
2. Connect the detachable line cord to the rear panel power connector; plug the
other end into a hospital grade grounded wall outlet of appropriate voltage. (If
you are unsure about the voltage, contact your hospital Biomedical
Engineering Department or GE Service Representative.)
Attaching the Power Cord
3. Turn the monitor’s power on. The green indicator light, located near the upper
left-hand corner of the Light button, illuminates and a series of tones are heard,
indicating that the monitor has been turned on.
Interruption of Power
When the supply main to the monitor is interrupted for more than 30 seconds, the
following behaviors occur.
 Configuration Settings: The configuration settings are restored to the current

user-selected default setting: Factory or Hospital.
 Patient Data: The stored patient data—including vital signs history—are erased.
 NIBP: The NIBP parameter reverts to Manual Mode.

2036946-001
Self-Test Routine
The 250cx Series Monitor contains a self-test routine which checks the calibration
and internal circuitry of the monitor. Initiate the self-test routine at the beginning of
each monitoring session to print the results on the patient’s strip chart.
NOTE: To stop a self-test routine that 1. Ensure that strip chart is loaded.
is in progress, press the Test button or
2. Press the Test button.
open the recorder door.
3. Refer to the table below and ensure the test results are produced as expected.
At the successful completion of the self-test routine, the monitor is ready for
use.
Monitor Self-Test Routines

Test Routine Description
Display Test All display pixels extinguish for one second and then illuminate for one second. A green
horizontal line moves down on a red background followed by a blue vertical line moving from
left to right.
Lamp Test The yellow Record indicator illuminates.
Recorder Test The message TEST: ARE ALL DOTS PRINTED? prints followed by two vertical lines and four
horizontal lines. The two vertical lines should appear continuous and indicate a fully functional
printhead. The four horizontal lines align with the heart rate and uterine activity scales, i.e., 30
and 240 BPM or 50 and 210 BPM, and 0 and 100 mmHg (0.0 and 13.3 kPa).
Counting Test After the recorder test, the display returns to the main screen. The software generates a 120
bpm rate in the FHR1 area, a 180 bpm rate in the FHR2 area, and both mode titles display
Test.
Uterine Activity The monitor sets UA value to 50 mmHg and displays in the UA display area; the mode title
displays
Test.
Setup Screens
The 250cx Series Monitor provides a variety of options that are selected using the
setup screens shown on the display. (The illustrations in this section are
representative of all possible features. Your monitor screens may vary.) All
functions are performed easily using the front panel Trim Knob control. Setup
screens for FECG, US/US2, Maternal NIBP, MHR/P, and MSpO2 are detailed in
Chapter 5.
Setup Procedures: Setup
Screens
Using the Trim Knob Control

General instructions for using the Trim Knob control follow:
NOTE: When any setup screen 1. To display a parameter setup screen, rotate the Trim Knob control until the bar
(except the General Setup screen) is cursor highlights the title of the parameter (FECG, US, US2, NIBP, MECG, Pulse,
displayed, the primary labor parameters or MSpO2). To access the Master Alarm Setup screen or the General Setup screen,
remain displayed. rotate the Trim Knob control until the bar cursor highlights the Alarms softkey
or the Setup softkey, respectively, on the bottom of the screen.
2. Press the Trim Knob control once to display the selected setup screen.
3. While the screen is displayed, rotate the Trim Knob control until the desired
field is highlighted.
4. Press the Trim Knob control again to activate the selected field. The cursor
flashes to indicate the field is active.
5. Rotate the Trim Knob control in either direction to cycle through the available
choices for the field.
6. When the desired selection is made for the field, press the Trim Knob control
once to confirm the selection.
7. Repeat Steps 3 through 6 until all desired settings have been made.
8. Rotate the Trim Knob control until the bar cursor highlights the Exit softkey on
the bottom of the screen. This returns the monitor to normal operation.
IMPORTANT
EFFECTIVITY—All changes take effect immediately after a selection is
enacted in Step 6. Some changes take effect as the values are changed
without having to press the Trim Knob.

2036946-001
General Setup Screen
Following is a sample General Setup screen.You can access this screen from the
main screen by selecting Setup. Using the Trim Knob to go to the field you wish to
change. and select it by pressing the knob. Choose the desired setting.
0
2
3
4 2
5 3
General Setup 6
Off 4
7
Happy Birthday Brahms' Lullaby Rock-A-Bye Baby All 5
8
Play Song:
Off 9 6 2
Song Volume: Temp Done Volume:
5 7 3
Brightness:
5 8 4
Paper Speed:
5 9
3 cm / min 5
Temp Done Volume 6
Date01-Jan-2007 7
Time12:01:00 8
Paper Speed Selection: 1, 2, or 3 cm / min. 9
External Monitor Setups
OFF
MSpO2 Print Interval:5 min FSpO2 Print Interval:5 min 2 min
FSpO2 Trace:Off 5 min
On Off 10 min
15 min
30 min
60 min
Service Exit
General Setup Screen
Play Song
You can activate a song to be played from the monitor’s speaker to celebrate each
birth.
Song Volume
This field sets the volume of the song player.
Temp Done Volume

This field adjusts the temperature completion volume. This field is only available
when the Exergen protocol is configured.
Brightness
This field allows you to adjust the brightness of the backlight of the display.
The settings range from 1 to 9 with 9 being the brightest setting.
Setup Procedures: General Setup Screen
Paper Speed
The monitor offers a choice of paper speeds of the strip chart recorder.
 1 cm/min: paper saving.

 2 cm/min: a compromise between the 1 cm/min and 3 cm/min.
 3 cm/min: recommended for greater diagnostic capability.
Date
It is very important to set the date on your monitor prior to initial use. The month
field has a range from 01–12; the range for the day field varies according to the
selection for month and year1; the year field has a range of 00–99. A long-lasting
battery maintains the date even when the monitor is unplugged from AC power.
Time
It is also very important to set the monitor’s clock prior to initial operation and
during daylight-saving time changes. A long-lasting battery maintains the set time
even when the monitor is unplugged from AC power.
The time is represented by a 24-hour clock in hours, minutes, and seconds. The hour
field has a range of 00–23; the minutes field has a range of 00–59; the seconds field
resets when minutes change.
MSpO2 Print Interval

This field sets the time interval for printing MSpO2 values received from an
external maternal pulse oximetry monitor.
FSpO2 Print Interval

This field sets the time interval for printing FSpO2 values received from an external
fetal pulse oximetry monitor.
FSpO2 Trace
This field enables/disables FSpO2 trend trace printing of data received from an
external fetal pulse oximetry monitor.
Service
By choosing this option, you can view software revisions, what type of SpO2
technology your 250cx Monitor contains (i.e., Ohmeda, Nellcor, and Masimo etc.),
and allows service personnel to enter the password-protected Service Mode.
1
For example, February of 1996 has a day range of 01-29; February of 1997 has a range of 01-28;
August of 1997 has a day range of 01-31.

2036946-001
Preparing the Monitor for Patient Use
The following procedures should be performed before use on each patient:
1. Ensure an adequate supply of paper is in the recorder. The recorder will

automatically stop when paper runs out. If the recorder requires paper, refer
to “Loading Strip Chart Recorder Paper” on page 4-3.
2. Ensure the monitor power is on.
3. Connect the appropriate transducers for monitoring. Read the
“Maternal/Fetal Monitoring, Clinical Applications Manual” for instructions
on applying the transducers.
4. Ensure the setup menus are configured appropriately for use on this
patient. Refer to “Setup Screens” on page 4-7.
5. Turn the recorder on. Refer to Chapter 11, “Recorder Modes” for
more information.
CAUTION
PAPER MOVEMENT—Always ensure that the chart paper is
moving properly from the front of the recorder drawer when the
Record indicator light is on.
6. Press the Paper Advance button to create a paper leader.

7. Press the Test button to run the monitor’s self-test routines. Refer to “Self-Test
Routine” on page 4-7.
8. Check the time and date printed on the strip chart paper. Refer to
“General Setup Screen” on page 4-9 if you need to change the time/date
setting.
9. Annotate the patient name and ID# using the optional Corometrics
Model 2116B Data-Entry/Clinical-Notes Keyboard, if available.
Annotating Patient Information

Setup Procedures: Preparing the Monitor for Patient
Use

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5 Fetal Heart
Rate
Monitoring
Fetal Heart Rate Monitoring:
For your notes

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Ultrasound (External Method)
NOTE: Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual”
for patient application information.
Methodology
An ultrasound (US/US2) transducer placed on the maternal abdomen is used to
direct an ultrasonic beam toward the fetal heart; the transducer detects Doppler
shifted frequency changes in echoes created by moving cardiac structures. An
autocorrelation process is used to determine the time interval between successive
cardiac cycles.
The fetal heart rate is displayed in bpm and is continuously plotted on the strip
chart paper if the recorder is on. (Refer to the “US/US2 Setup Screen” figure
below.) The heartbeat indicator flashes for each detected heartbeat.
US/US2 Setup Screen

Select the US or US2 softkey to access the US/US2 Setup screen below. The title of
the screen (US vs. US2) is dependent on the mode selected when the screen is
activated.
US US2 IUP
120120 20 US Setup Alert Suspend: Off
FM Detect: Off
Volume:5
Applicable Spectra
alerts can appear in
this area
Alert: On Volume5
Trend
Exit
US/US2 Setup Screen
Volume
This field adjusts the volume for the FHR derived from the selected mode, US or
US2. This field works in conjunction with the front panel Volume buttons.
Fetal Heart Rate Monitoring: FECG (Internal
Method)
Alert
This field controls and shows Spectra Alerts. Refer to Appendix C for more
information.
Alarm Volume
This field controls the alarm volume for all fetal alarms.
FECG (Internal Method)

Methodology
This method uses an electrode attached directly to the fetal presenting part. The
electrode is connected to the cable/legplate secured to the mother. The fetal heart
rate is computed based upon the interval between successive R-wave peaks of the
fetal QRS complex.
The fetal heart rate is displayed in bpm and is continuously plotted on the strip
chart recorder paper if the recorder is on. (Refer to “US/US2 Setup Screen” on page 5-3.)
The heartbeat indicator flashes for each detected heartbeat.
Artifact Elimination
An FECG artifact elimination option is available behind the password-protected
Service Lock screen on all 250cx Series Monitors.

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FECG Setup Screen
Select the FECG softkey to access the FECG Setup screen.
FECG US TOCO
165 172
Volume: 5 FECG Setup
30
High Low
140-200, Off Off, 60-140
0 0
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 On Off 8
9 Alarms High 160 Low 9
FHR: 85bpm
Audio Alarms: On Volume: 5
Exit
FECG Setup Screen With Fetal Alarms Enabled
Volume
This field controls the volume for the FHR beeps derived from FECG. This field
works in conjunction with the front panel Volume buttons.
Alarms
These fields adjust the high and low alarm limits. The available ranges are shown in
the above figure; the factory default settings are listed in Appendix A, “Factory
Defaults”.
NOTE: The FHR1 and FHR2 alarm limits are set independently of each other.
Audio Alarms
This field enables/disables the audio alarm function for FHR when derived from
FECG.
 On: Visual and audible indications are provided during an FHR alarm condition.
 Off: Only a visual indication is provided during an FHR alarm condition.
Alarm Volume
This field controls the alarm volume for all alarms.
Fetal Heart Rate Monitoring: Fetal Heart Rate
Alarms
Fetal Heart Rate Alarms

FHR Threshold Alarms
A fetal heart rate threshold alarm occurs when any fetal heart rate falls outside of
the pre-defined alarm limits—greater than the high limit setting or less than the
low limit setting. These alarm limits are configured via the user setup mode; the
alarm can be completely disabled as well.
NOTE: The alarm enable/disable setting controls all FHR alarms: high, low, and
signal quality.
A threshold alarm is indicated both visually and audibly. Visual indications are
provided by the Alarm indicator and the respective heart rate numerics. The
audio alarm is described as alternating high-low tones.
CAUTION
Prior to monitoring each patient, it is recommended that you
check the alarm status and alarm limits to ensure they are
appropriate for the patient. The alarms are disabled if the Alarm
Disable indicator is lit; they are enabled if the indicator is
unlit.
Latching Alarms
Fetal heart rate threshold alarms are “latching.” This means that a clinician must
acknowledge the alarm using the monitor’s Alarm Silence button in order to clear the
alarm.
 Active Threshold Alarm: Press the Alarm Silence button to cancel the
audio component of an active threshold alarm. The visual indications remains
present until the FHR value returns to within the defined acceptable range.
 Unsilenced, Resolved Threshold Alarm: If a threshold alarm condition
resolves, prior to being silenced (clinical acknowledgment), the visual and
audible indications both remain present. Press the Alarm Silence button
to cancel both the audible and visual indications.

2036946-001
FHR High Alarm
The simplest example of a high FHR alarm occurs when the FHR value is
continuously greater than the threshold (high limit) for 5 minutes. When data
consistently violates the limit, the time-to-alarm is 5 minutes.
FHR (bpm)
alarm activates
high alarm limit (threshold)
Time (minutes)
High FHR Alarm Example
FHR Low Alarm The simplest example of a low FHR alarm occurs when the FHR value is
continuously less than the threshold (low limit) for 30 seconds. When data
consistently violates the limit, the time-to-alarm is 30 seconds.
FHR (bpm)
low alarm limit (threshold)

alarm activates
Time (minutes)
Low FHR Alarm Example

Sample Clinical Exceptions
The figure below provides an example of FHR fluctuations above and below the
high alarm limit setting.
FHR (bpm)
high alarm limit (threshold)
Time (minutes)
Fluctuations Near High Alarm Limit Example
Whether the pattern shown in the above figure generates an alarm depends on what
percentage of the data violates the limit. The monitor evaluates the data on an on-
going basis; the methodology can be simplified as follows:
 An FHR threshold alarm occurs if the FHR violates the alarm limit setting for
more time than it stays within the specified acceptable range.
 The time-to-alarm increases as a greater percentage of data stays within
the specified acceptable range.
Signal Quality Alarms

A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an
acceptable FHR signal.
Active Signal Quality Alarm

Signal quality alarms are indicated both visually and audibly. Dashes “– – –”
display in the affected fetal heart rate display. The audio alarm is described as
alternating high-low tones.
Resolved Signal Quality Alarm

As soon as an alarm condition is resolved, both the visual and audible indications
automatically disappear (unlatch).
100% Signal Loss
In cases where there is a complete absence of signal, the signal quality time-to-
alarm is 1.25 minutes.
FHR (bpm)
100% signal loss

1.25 min
alarm activated
Time (minutes)
100% Signal Loss Example
Intermittent Signal Loss In the clinical environment, a partial loss of signal is seen more frequently than a
complete loss of signal. The time-to-alarm will vary related to the percentage of
signal loss. Figure below shows an example where there is 70% signal loss resulting
in a signal quality alarm after 5 minutes.
FHR (bpm)
70% signal loss

5 min
end of “good” quality signal alarm activates
Time (minutes)
70% Signal Loss Example
Silencing an Audio Alarm

Press the Alarm Silence button to cancel the audio component of an alarm; the
visual indications remain until the alarm condition is resolved.
The silence function works on an alarm-by-alarm basis. An audio alarm will sound
if a new alarm condition occurs after the previous condition has been resolved.
Fetal Heart Rate Monitoring: Single Fetal Heart Rate
Monitoring
Summary
The alarm algorithms are intended to assist the perinatal staff in assessing the status
of a patient at bedside by recognizing vital signs data that falls outside the user-
defined normal range. The monitor does not replace observation and evaluation of
the mother and fetus at regular intervals by a qualified care provider, who will make
diagnoses and decide on treatments or interventions. A provider should determine
the status of the patient by visual assessment of the fetal monitor tracing at the
bedside and evaluation of fetal and maternal vital signs and progress in labor. The
absence of an alarm does not indicate fetal or maternal well-being.
Frequent assessment of the fetal monitor tracing is necessary to ensure recognition

of unusual, undefined, or suspicious patterns that may or may not generate a
threshold alarm.
Single Fetal Heart Rate Monitoring

The Corometrics 250cx Series monitor offers three options to monitor a single fetal
heart rate (FHR):
 US (external)
 US2 (external)
 FECG (internal)
Please refer to the “FHR Display and Trend Summary” Table for FHR display and
trend summary.
Dual Fetal Heart Rate Monitoring

The Corometrics 250cx Series monitor is capable of monitoring two fetal heart
rates. The discussion in this section is limited to methods of monitoring dual fetal
heart
rates; however, it is important to note that MECG monitoring can continue during
the monitoring of twins—even when one twin is monitored using FECG. Please
refer to the “FHR Display and Trend Summary” Table for FHR display and trend
summary.
There are three available options to monitor dual fetal heart rate (FHR).
 US/US2 (dual external)
 FECG/US (internal/external)
 FECG/US2 (internal/external)
The 250cx Series monitor offers two advanced features to aid in monitoring twins:
 heartbeat coincidence
 fetal heart rate offset

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FHR Display and Trend Summary
ACTIVE DISPLAY MODE TREND ANNOTATION

CONNECTORS FHR1 FHR2 FHR1 FHR2
US US US
US2 US2 US2
FECG FECG FECG
US, US2 US US2 US US2
FECG, US FECG US FECG US

FECG, US2 FECG US2 FECG US2
FECG, US, US2 FECG US2 FECG US2
NOTE: In the event that three transducers are plugged into the monitor, FECG
overrides the primary ultrasound connector (US).
Heartbeat Coincidence
When the heartbeat coincidence feature is enabled, the monitor alerts you when
there is the possibility that you may be monitoring a duplicate signal. Refer to
Chapter 13, “Heartbeat Coincidence” for more information.
Fetal Heart Rate Offset

When monitoring dual fetal heart rates, overlapping traces on the strip chart may be
difficult to interpret. The 250cx Series monitor provides a +20 bpm shift for the
secondary FHR trend to alleviate this problem—whether using dual ultrasound or
ultrasound and FECG. This field provides an alternative to using the front panel
Mark [Offset] button. Refer to the service manual for information on enabling/
disabling fetal HR offset.
Activating the Fetal Heart Rate Offset Feature

To shift the secondary FHR trend +20BPM:
1. Ensure the recorder is on and two HR channels are activated.

2. Press and hold the Mark [Offset] button for 3 seconds. (Or use the US/US2 Setup
screen.)
 When you use dual ultrasound or US2 and FECG, the US2 trace is shifted +20
bpm and the symbol prints on the upper portion of the top grid every
4.5 cm.
 When you use US and FECG, the US trace is shifted +20 bpm and the
symbol prints on the upper portion of the top grid every 4.5
cm.
Fetal Heart Rate Monitoring: Dual Fetal Heart Rate
Monitoring
 A right arrow () and a vertical dashed line print to draw attention to the start
of the shifted trend.
Refer to “Fetal Heart Rate Offset Example,” on page 5-12 for an example of a
shifted trend.
De-Activating the Fetal Heart Rate Offset Feature

After the FHR patterns have been assessed, set the secondary FHR trend back to the
normal (unshifted) position.1
1. Ensure the recorder is on.
NOTE: If the auto-revert (10-min) 2. Press and hold the Mark [Offset] button for 3 seconds. (Or use the US/US2 Setup
setting is selected on the password- screen.)
protected Install Options screen, the
shifted heart rate trace automatically  The trend returns to the unshifted position.
reverts to normal after 10 minutes.  A left arrow () and a vertical dashed line print to draw attention to the
change.
1
Setting the FHR trend to the normal (unshifted) mode does not disable the
HR Offset function; it deactivates it. To disable the mode, refer to the 250cx
Series Service Manual.
58103 58104
FHR bpm US2+20 US2+20 FHR 240bpm
210
180
150
120
90
60
US US2 FMD HBC TOCO 3CM/MIN US US2 FMD HBC TOCO 3CM/MIN
100 100
12 12 30
10 75 10 75
88
50 50
6 6
4 4
25 25
2 2
Fetal Heart Rate Offset Example

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6 Uterine Activity
Monitoring
Uterine Activity Monitoring:
For your notes

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Tocotransducer (External Method)
NOTE: Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual”
for patient application information.
Methodology
A tocotransducer applied to the maternal abdomen records relative changes in
abdominal tension caused by uterine contractions. The mode (TOCO) and value are
shown in the UA area of the display. During normal operation, the UA value displays
from 0–100 in mmHg mode and 0.0 - 13.3 in kPa mode. Uterine activity is
continuously plotted on the bottom (or right) grid of the strip chart paper as a plain
black line.
IMPORTANT:
FOR TRIMLINE TOCOTRANSDUCERS ONLY—You must wait
at least 10 seconds from the time you power the monitor on or
connect a tocotransducer before pressing the UA Reference
button.
Establishing a Baseline
Monitoring uterine activity using a tocotransducer provides relative pressure
measurements—compared to a baseline or UA reference. The quality of
measurements depends on the following:
 position of the tocotransducer;
 belt tension;
 size of the patient; and
 established baseline.
All 250cx Series Monitors provide a UA Reference button that sets the baseline.
When a baseline is established, all pressure measurements are relative to that
baseline. The baseline can be set manually by two different methods or
automatically, when necessary. Whenever the baseline is set, the bottom line of the
bottom strip chart grid is annotated with UA REF.
Initial Referencing
The initial reference occurs automatically. After you plug in a transducer, verify that
the display reads less than 30 mmHg (4 kPa). Make a note of the reading.
The purpose of establishing a baseline at this point is necessary for consistency

when applying and tightening the belt. You will have to set the baseline again, after
tightening the belt.
Uterine Activity Monitoring: Tocotransducer (External
Method)
Accounting for Belt Tension

When adjusting the belt on the patient, regardless of transducer type, it is important
to ensure a comfortable fit; also, ensure that the transducer is held securely in place.
GE Medical Systems Information Technologies recommends adjusting the belt
tension so that, between contractions, the UA display shows approximately
25 mmHg (3.3 kPa) above the initial baseline.
After the belt is adjusted, it is important to establish a new baseline to prevent belt
tension to be counted as uterine pressure; also, pressure readings could tend to go
off the scale if belt pressure is not taken into account. Again, the UA Reference
button should only be pressed between contractions.
More About Referencing

Out of Range Condition
After you press the UA Reference button, if there is insufficient range to provide at
least 100 mmHg (13.3 kPa) above the reference level (probably because the belt is
too tight), the UA display area flashes the message CHECK TOCO. If this happens,
remove the tocotransducer from the patient; re-reference with no pressure applied
to the button; reapply the transducer adjusting the belt to approximately 25 mmHg
(3.3 kPa) above the baseline; then re-reference one more time. If you still receive
the CHECK TOCO message, try a different tocotransducer or contact your GE
Service Representative.
Manually Setting the Baseline at the Default Value

Briefly pressing the UA Reference button sets the baseline at the default setting—the
default is configured on the password-protected Install Options service screen. The
monitor is shipped from the factory with either a default setting of 10 in mmHg
mode or 1.3 in kPa mode. Qualified personnel can access the password-protected
Install Options service screen to set the baseline default to 5, 10, 15, 20, or 25 relative
units in mmHg mode or 0.7, 1.3, 2.0, 2.7, or 3.3 in kPa mode. Refer to the
“250/250cx Series Monitor Service Manual” for more information.
Manually Overriding the Baseline Default Value

Pressing and holding the UA Reference button for more than 2 seconds causes the UA
reference level and display to override the default setting and cycle through all
available selections: 5, 10, 15, 20, or 25 relative units in mmHg mode or 0.7, 1.3, 2.0,
2.7, or in 3.3 kPa mode, starting at the default setting—until the button is released.
Once the button is released, the UA trace and UA value take on this new value as a
baseline for reference.
Briefly pressing the UA Reference button reverts back to using the default setting
configured via the password-protected Install Options service screen.
Automatic Baseline “Zeroing”

If pressure falls below 0 mmHg (0 kPa) (probably because the belt has
loosened), automatic UA referencing occurs and a new baseline reference is set

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Uterine Activity Monitoring: Internal Method - Intrauterine Pressure
(IUP) at 0 relative units.

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Internal Method - Intrauterine Pressure (IUP)
NOTE: To secure a strain gauge post for IUP monitoring, refer to the strain gauge
manufacturer’s instructions.
Methodology
An intrauterine pressure catheter (IUPC) inserted transcervically into the uterine
cavity measures intrauterine pressure. You can monitor using either a fluid-filled
catheter or a transducer-tipped catheter. The mode (IUP) and value are shown in the
UA area of the display. The UA value displays from 0–100 in mmHg mode and
0.0 - 13.3 in kPa mode during normal operation. Uterine activity is continuously
plotted on the bottom (or right) grid of the strip chart paper as a plain black line.
Pressure exceeding 100 mmHg (13.3 kPa) is printed as a straight line at 100 mmHg
(13.3 kPa).
Why You Must Zero the System

When you zero the system, you are referencing the pressure to 0 mmHg (0 kPa)
while the system is open to air to ensure an absolute pressure measurement. Refer to
the “Maternal/Fetal Monitoring, Clinical Applications Manual” for more
information.
 If you disconnect the patient from the monitor all zeroing information is lost.
If you re-connect the patient to the monitor you must re-zero—regardless of
whether you connect to the same monitor or a different monitor.
 If the mother’s position has changed, the baseline may have been altered. If
this is the case, re-zero.
 If the message CHECK IUP flashes in the UA display area, there is insufficient
compensation to provide 100 mmHg (13.3 kPa) above the reference level.
Re- zeroing should correct the problem.
 If a negative value is displayed (pressure less than 0 mmHg (0 kPa), the
baseline should be re-zeroed. (When a negative value occurs for more than 20
seconds, the message BASELINE PRESSURE OFFSCALE is on the bottom grid
on the strip chart paper.)
Uterine Activity Monitoring: Internal Method - Intrauterine Pressure
(IUP)

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7 Maternal Heart/Pulse
Rate Monitoring
Maternal Heart/Pulse Rate Monitoring:
For your notes

2036946-001
MHR/P Source
The MHR/P can be determined by the MECG, MSpO2, and NIBP sections of the
monitor. However, the data from only one parameter is:
 referred to as the MHR/P source
 displayed in the MHR/P area;
 used to evaluate an MHR/P alarm condition; and
 used to generate the MHR/P trace on the strip chart paper.1
The source is:
 selected via the MHR/P Setup screen

 may be manually selected or automatically selected by the monitor according
to the following priority order:
 MECG (values updated continuously)
 MSpO2 (values updated continuously)
 NIBP (NIBP is available only as an Auto selection; the Manual selection is
disabled. Values updated only when NIBP determinations are taken)
IMPORTANT:
MSpO2 AS AN MHR/P SOURCE—If MSpO2 is selected as the
MHR/P source, an MHR/P alarm only occurs if the pulse rate
value derived from the MSpO2 sensor violates an MHR/P alarm
limit. The MHR/P values derived from the MECG and NIBP
sections of the monitor are ignored. The heart rate tone varies in
pitch to reflect changes in the maternal oxygen saturation
reading. The pitch rises as the saturation values increase, and
lowers as the saturation values decrease. The pulse rate trend is a
grey line annotated by MSpO2P .
1
If NIBP is selected as the MHR/P source, there is no trending of the data since these are static
measurements.
Maternal Heart/Pulse Rate Monitoring: MHR/P Setup
Screen
MHR/P Setup Screen

Select the mode title softkey—MECG or Pulse—to access the MHR/P Setup screen.
(Refer to the following figure.)
NOTES
 The figure below provides an example of MECG selected as the MHR/P
source, as indicated by the MECG mode title. When either MSpO2 or
NIBP are selected as the MHR/P source, the mode title changes to Pulse.
 The Lead source and Pacer fields apply to MECG only.
Auto FECG US TOCO

MECG
MSpO2
165 172 MHR/P Setup
30
On
Off
MECG
89
Source: Auto MECG
0 HR/PR Trace: Off Lead: II I, II, III
1 Pacer: Off
On
2 Volume: 5 Off
3
4
5 1
Alarms High Low 35-120
6 2
MHR/P: 120 50 bpm
7 3
8 4 Alarm Volume 5
9 5
6 Exit
7 100-250
8
9
MHR/P Setup Screen
Source
This field selects the MHR/P source. When Auto is selected, the monitor checks for
parameter availability and use in the following order: MECG, MSpO2, then NIBP.
If a source is not available, the next available source is automatically selected.
IMPORTANT
WAVEFORM—The MHR/P Source field is independent of the
waveform selected on the normal operating screen. For example,
you can select MECG as the MHR/P source yet display the
MSpO2 plethysmograph waveform. Or, you can select MSpO2 as
the source and display MECG as the waveform.

2036946-001
HR/PR Trace
This field enables or disables the printing of the MHR/P trace on the strip chart
paper.
 On: The MHR/P trend is printed in grey annotated with MECG or MSpO2
P —whichever parameter is selected in the MHR/P Source field. MHR/P
data from NIBP is not trended since blood pressure determinations are static
measurements.
 Off: The MHR/P trend is not printed.
Volume
This field sets the volume of the “beep” sounded with each detected valid heartbeat
—for MECG and MSpO2 only.
Alarms
These fields adjust the high and low alarm limits for MHR/P— in increments of 5
bpm. The selectable values are shown in the MHR/P Setup screen. The factory
defaults are listed in Appendix A, “Factory Defaults”.
Alarm Volume
This field controls alarm volume for all maternal alarms.
MECG Lead
This field selects the ECG lead configuration. The lead can also be selected from the
MECG Lead Softkey on the normal operating screen.
 Lead I refers to the potential between the left arm and the right arm.
 Lead II refers to the potential between the right arm and left leg.
 Lead III refers to the potential between the left arm and the left leg.
The following figure illustrates which electrodes reference the ECG lead obtained.
BLACK (LA) BLACK (LA)

WHITE (RA) YELLOW (L)
RED (R) YELLOW (L)
WHITE (RA)
RED (R)
RED (LL)
RED (LL)
GREEN (F)
GREEN (F)
NOTE: AHA label is bolded; IEC label is italicized.

MECG Lead Selection Guide
MECG Pacer
This field enables/disables pacemaker pulse rejection circuitry.
 Off: Use this setting for a patient without a pacemaker. All ECG events are
monitored; all complexes, including pacer spikes may be displayed1 and may
be included in the heart rate calculation.
 On: Use this setting for a patient who has a pacemaker. The monitor rejects the
pacer spike from the heart rate calculation and replaces the actual pacer spike1
with a pacer event mark; in addition the letter P is displayed prior to the
waveform speed. Following is an example of an MECG waveform with the
MECG pacer On.
P 25 mm/s
II Auto
MECG 09:21:41 Frozen 09:22:06

The bracket situated to the left of the ECG waveform denotes 1 mv. If the ECG
waveform size is set to Auto, the bracket will auto-adjust to maximize the QRS
display, depending on signal amplitude.
MECG Waveform with Pacer Enabled
1
If the MECG waveform is enabled for display
Maternal Heart/Pulse Rate Monitoring: Maternal ECG
Monitoring
Maternal ECG Monitoring

Theory and Methodology
The maternal heart rate (MHR) is measured via electrodes placed on the maternal
chest. When MECG is employed, the maternal heart rate is computed on a beat-to-
beat basis using the R-to-R time interval on the maternal QRS complex. When
MECG is selected as the MHR/P source, the MHR is displayed on the front panel
display in beats per minutes (bpm), denoted by MECG. The heartbeat indicator
flashes for each detected heartbeat. The rear panel speaker emits an audible tone
for each detected heartbeat. The maternal heart rate trend, when enabled, is
continuously plotted in the top (or left) grid of the strip chart paper. The MHR
trace is a grey line annotated by MECG . The beat-to-beat MHR signal is used for
trending on the strip chart paper and for output to external devices such as a central
station system. The averaged MHR values are used for display and for alarm
detection.
Pacemaker Safety Information

The following safety information applies to patients with pacemakers.
WARNINGS
ACCESSORIES—Use only electrodes, lead wires, and cables
recommended by GE Medical Systems Information Technologies.
Failure to use recommended accessories may result in inaccurate
readings, damage to equipment, or loss of defibrillator protection.
FALSE ALARMS—False low heart rate alarms or false asystole

may result with certain pacemakers because of electrical
overshoot.
FALSE COUNTING—Be aware that a pacer spike could be

falsely counted as a QRS complex during asystole.
INTERFERENCE—Interference caused by electrosurgical or

diathermy instruments will affect the proper operation of the
MECG section of 250cx Series Monitors.
PACEMAKER SPIKE—Do not diagnostically interpret the

pacemaker spike size and shape; the spike may be attenuated by
the module in order to be displayed or printed.
PATIENT OBSERVATION—Keep pacemaker patients under

close observation.

2036946-001
CAUTION•
FDA POSTMARKET SAFETY ALERT—the United States FDA
Center for Devices and Radiological Health issued a safety
bulletin October 14, 1998. This bulletin states “that minute
ventilation rate-adaptive implantable pacemakers can occasionally
interact with certain cardiac monitoring and diagnostic equipment,
causing the pacemakers to pace at their maximum programmed
rate.” The FDA further recommends precautions to take into
consideration for patients with these types of pacemakers. These
precautions include disabling the rate responsive mode and
enabling an alternate pace mode. For more information contact:
Office of Surveillance and Biometrics, CDRH, FDA
1350 Piccard Drive, Mail Stop HFZ-510
Rockville, MD 20850
USA
MECG Waveform
When MECG monitoring is employed, the MECG waveform can be displayed and
printed—independent of the MHR/P source. Refer to Chapter 14, “Waveforms”.
8 Maternal Non-Invasive
Blood Pressure
Monitoring

2036946-001
Maternal Non-Invasive Blood Pressure Monitoring:
For your notes

Blood Pressure Safety Precautions
NOTES
 This safety information applies to the non-invasive blood pressure
(NIBP) of the monitor.
 A patient’s vital signs may vary dramatically during the use of
cardiovascular agents such as those that raise or lower blood pressure
or those that increase or decrease heart rate.
CAUTIONS
Accuracy of NIBP measurement depends on using a cuff of the
proper size. It is essential to measure the circumference of the
limb and choose the proper cuff size.
ACCURACY—As with any non-invasive oscillometric blood

pressure monitor, there are clinical conditions which can affect the
accuracy of the measurements obtained. For example, do not use
the monitor’s NIBP feature on a patient experiencing convulsions
or who is attached to a heart/lung machine. In addition, disregard
or stop automatic blood pressure determinations that coincide with
maternal contractions. Finally, be aware that the accuracy of
measurements can be affected if readings coincide with maternal
uterine contractions. Refer to “Smart BP Feature” on page 8-13.
CALIBRATION—Do not operate the monitor unless it has been

properly calibrated. Inaccurate blood pressure readings may
result. Refer to Chapter 15, “Maintenance” for details.
DISPLAY INTERVAL—The time period, in minutes, that a blood

pressure reading remains displayed before being automatically
erased, is selectable via the password-protected Install Options
Screen 2. The option can also be set to continuously display the
reading until replaced by a new reading. The display of “old”
pressure values may cause confusion. If a patient’s condition
changes during the time interval between determinations, the
monitor will not detect the change or indicate an alarm condition.
Blood pressure and pulse can fluctuate greatly between
measurements; the monitor does not alert the user (through audio
or visual means) to changes in NIBP or NIBP-derived pulse rate
occurring between measurement cycles.
EXTERNAL PRESSURE—Do not apply external pressure

against the cuff while monitoring. Doing so may cause inaccurate
blood pressure values.

2036946-001
Maternal Non-Invasive Blood Pressure Monitoring:
Warnings
CAUTIONS
PULSE RATE COMPARISONS—The pulse rate measured by
the monitor’s NIBP circuitry may differ from the heart rate
measured by the monitor’s MECG circuitry or another maternal
ECG monitor because the monitor’s blood pressure module
measures peripheral pulses, not electrical signals or contractions
of the heart. Occasionally, the electrical signals at the heart do
not produce a peripheral pulse. Similarly, if a patient’s beat-to-
beat pulse amplitude varies significantly, blood pressure and
pulse rate readings can be erratic and an alternate measuring
method should be used for confirmation.
Warnings
WARNINGS
The NIBP parameter will not measure blood pressure effectively
on patients who are experiencing seizures or tremors. Arrhythmias
will increase the time required by the NIBP parameter to
determine a blood pressure and may extend the time beyond the
capabilities of the parameter.
Use care when placing the cuff on an extremity used to monitor
other patient parameters.
The monitor is intended only for use in the non-invasive

monitoring of maternal blood pressure (NIBP). This monitor is
not intended for use in neonatal or pediatric blood pressure
monitoring.
Devices that exert pressure on tissue have been associated with

purpura, skin avulsion, compartmental syndrome, ischemia, and/
or neuropathy. To minimize these potential problems, especially
when monitoring at frequent intervals or over extended periods of
time, make sure the cuff is applied appropriately and examine the
cuff site and the limb distal to the cuff regularly for signs of
impeded blood flow.
NIBP Determination
A patient’s vital signs may vary dramatically during the use of cardiovascular
agents such as those that raise or lower blood pressure or those that increase or
decrease heart rate.
Because treatment protocol based on the patient’s blood pressure may rely on
specific values and differing measurement methods, clinicians should note a
possible variance from values obtained with this unit in planning patient care
management. The GE monitor values are based on the oscillometric method of
noninvasive blood pressure measurement and correspond to comparisons with intra-
aortic values within ANSI/ AAMI Standards for accuracy. Most automatic non-
invasive blood pressure monitoring uses the oscillometric method of measurement.
To understand how this method works, it is compared to the auscultatory method.
Auscultatory – With the auscultatory method, the clinician listens to the blood flow
and determines the systolic and diastolic pressures. The mean pressure is then
calculated with reference to these pressures (as long as the arterial pressure curve is
normal).
Oscillometric – The oscillometric method measures cuff pressure oscillations.

Oscillations are small changes in cuff pressure caused by artery motion against the
cuff. During a determination, the monitor stores oscillations along with cuff
pressures. At the end of a determination, these stored data are used to determine
systolic, mean and diastolic pressures.
Due to the difference in these methods, one cannot be used to check the accuracy of
the other.
SuperSTAT NIBP Determination

The oscillometric method of determining SuperSTAT NIBP is accomplished by a
sensitive transducer which measures cuff pressure and minute pressure oscillations
within the cuff. The first determination initially pumps up to an initial target cuff
pressure of about 135 mmHg (18.0 kPa) or to the user-selected initial target
pressure. To allow for rapid setting of cuff pressure, the monitor will momentarily
inflate to a higher pressure, then immediately deflate to the target pressure.
After inflating the cuff, the monitor begins to deflate, the oscillations versus cuff
pressure are measured, and finally, systolic, mean, and diastolic pressure are
determined, and the screen is updated. In any subsequent determination, as few as
four pressure steps may be necessary to complete the process. When employing
fewer pressure steps, the system uses the stored information from the previous blood
pressure determination to decide the best pressure steps to take. The monitor
measures the consistency of pulse size to tell if the oscillations taken at a step are
good and if more steps are needed.
If the current blood pressure reading is similar to the previous reading, the monitor
may use some information from the previous blood pressure in the current
determination. The monitor constantly evaluates data during a measurement and
tries to perform a blood pressure determination in the shortest possible time
providing greater comfort to the patient.

2036946-001
Maternal Non-Invasive Blood Pressure Monitoring: SuperSTAT NIBP
Determination
Accelerated Determination
The monitor will try to make an accelerated determination of blood pressure if it
has been 16 minutes or less since the last determination and the current blood
pressure is similar to the previous reading.
Systolic Search
If systolic pressure is not found, the NIBP parameter can search at cuff pressures
higher than the initial target pressure. The parameter will inflate the cuff above the
initial target pressure to get data in the systolic region. The maximum pressure
allowed in systolic search is limited by the normal range for cuff pressures. In any
operating mode, if a patient's systolic pressure exceeds the inflation pressure, the
parameter will begin normal deflation sequence, detect the absence of a systolic
value, stop deflation, reinflate to a higher (than initial) inflation pressure, and
resume the normal deflation sequence.
WARNING
Arrhythmias will increase the time required by the NIBP
parameter to determine a blood pressure.
NIBP Setup Screen
Select the NIBP softkey to access the NIBP Setup screen.
Manual Auto 1 min

FECG US TOCO
kPa mode
High
9.3-32.0
Low
6.7-20.0
165 172 NIBP Setup
30 100-250,
Auto 3 min
Auto 4 min
Auto 5 min
Auto 10 min
5 mmHg increments
Auto 15 min
9.3-17.3 4.0-16.0
NIBP 11:41
Mode: Manual Target: 135
Auto 20 min
Auto 30 min
130/ 85
9.3-20.0 4.0-16.0
NIBP Done Vol:5 0 Auto 40 min
100-250 35-120 1 Auto 45 min
1 2 Auto 60 min
mmHg mode MAP (107) 2 3 Auto 90 min
High Low 03:15
Alarms High Low 3 4 Auto 120 min
4 5
70-240 50-150 Systolic: 160 90 mmHg
5 6
70-130 30-120 Diastolic: 90 50 mmHg 6 7
70-150 30-120
MAP: 140 50 mmHg 7 8
MHR/P: 120 50 bpm 8 9
100-250 35-120 9
Alarm Volume:5
Exit
Maternal NIBP Setup Screen
Mode
This field alternates between the manual and automatic monitoring modes for
maternal blood pressure. For auto mode, this field also sets the interval time, in
minutes, between automatic blood pressure determinations. This interval time is
measured from beginning to beginning of determinations. (The monitor is factory-
set with the optional 1-minute interval time enabled. For information on disabling
the 1-minute interval, refer to the “250/250cx Series Monitor Service Manual”.)
NOTE: As soon as the auto mode is selected on the setup screen, the countdown
timer begins to decrement. The first automatic determination begins after
expiration of one complete interval time period.
Target
This option lets you choose the initial pressure for cuff inflation. If the NIBP is
taken while previous determination is still displayed, and within 16 minutes of the
previous determination, the initial target pressures for subsequent determinations
are based upon the systolic values of previous determination. The default initial
target pressure is 135 mmHg (18.0 kPa). Adjust the pressure between 100 to 250
mmHg (13.3 to 33.3 kPa) in increments of 5 mmHg (0.7 kPa).
NOTE: Selecting a target pressure will clear old NIBP values in the vital signs
area and cancel any determination in progress.

2036946-001
Maternal Non-Invasive Blood Pressure Monitoring: NIBP Monitoring
NIBP Done Volume

This field sets the volume of the sound emitted at the completion of each blood
pressure determination. As you adjust the volume, a sample tone sounds.
Alarms
These fields adjust the high and low alarm limits for maternal systolic, diastolic,
and mean arterial pressures, as well as for MHR/P—in increments of 5 mmHg (0.7
kPa) or 5 bpm. The selectable values are listed in “Maternal NIBP Setup Screen,”
on
page 8-7. The factory default settings are listed in Appendix A, “Factory Defaults”.
Alarm Volume
NIBP
Monitoring
Checklist
1. The NIBP hose is securely inserted into the NIBP connector on the monitor.
2. A cuff appropriate for the limb size has been selected.
3. Cuff is properly placed on patient and connected to the NIBP hose.
4. Tubes between the cuff and the monitor are not kinked or blocked.
Patient Preparation
Cuff selection and application are important. Inappropriate selection or improper
application of the cuff will result in erroneous measurements.
WARNING
The system is designed for use only with dual-hose cuffs and
tubing.
Do not place the cuff on a limb being used for A-V fistulas,
intravenous infusion or on any area where circulation is
compromised or has the potential to be compromised.
1. Connect the air hose to the NIBP port on the front of the monitor. Make sure
that the hose is not kinked or compressed.
2. Choose the appropriate blood pressure measurement site. Because normative
values are generally based on this site and as a matter of convenience, the
upper arm is preferred. When upper arm size or shape or the patient’s clinical
condition or other factors prohibit use of the upper arm, the clinician must plan
patient care accordingly, taking into account the patient’s cardiovascular status
and the effect of an alternative site on blood pressure values, proper cuff size
and comfort.
Warning: Do not place the cuff on a limb being used for intravenous
infusion or any area where circulation is compromised or has the potential
to be compromised.
3. If patient is standing, sitting, or inclined ensure that cuffed limb is supported
to maintain cuff at level of patient’s heart. If cuff is not at heart level, the
difference in systolic and diastolic values due to hydrostatic effect must be
considered. Add 1.80 mmHg (0.24 kPa) to values for every inch (2.54 cm)
above heart level. Subtract 1.80 mmHg (0.24 kPa) from values for every inch
(2.54 cm) below heart level.
4. Choose appropriate cuff size. Measure patient’s limb and choose appropriately
sized cuff according to size marked on cuff or cuff packaging. When cuff sizes
overlap for a specified limb circumference, choose the larger size cuff.
Precaution: Accuracy depends on use of proper size cuff.
5. Inspect cuff for damage. Replace cuff when aging, tearing or weak closure
is apparent. Do not inflate cuff when unwrapped.
Precaution: Do not use cuff if structural integrity is suspect.
6. Connect the cuff to the air hose.
Warning: It is mandatory that the appropriate hose and cuff combination
be used.
7. Inspect patient’s limb prior to application.
Precaution: Do not apply cuff to areas where skin is not intact or tissue is
injured.
8. Palpate artery and place cuff so that patient’s artery is aligned with cuff arrow
marked “artery.”
9. Squeeze all air from cuff and confirm that connection is secure and
unoccluded and that tubing is not kinked.
10. Wrap cuff snugly around the patient’s limb. Cuff index line must fall within
range markings. Ensure that hook and loop closures are properly engaged so
that pressure is evenly distributed throughout cuff. If upper arm is used, place
cuff as far proximally as possible.
11. Proper cuff wrapping should be snug, but should still allow space for a finger
between patient and cuff. Cuff should not be so tight as to prevent venous
return between determinations.
Warning: Using a cuff that is too tight will cause venous congestion and
discoloration of the limb, but using a cuff that is too loose may result in no
readings and/or inaccurate readings.
Blood Pressure Methodology

During a determination, the instantaneous cuff pressure is indicated by a numeric
value displayed beside the title Cuff. This information is displayed in place of the
mean arterial pressure. When a determination is successful, the monitor emits two
short tones (high/low) and displays the three pressure readings (and the maternal
pulse, if NIBP is enabled as the MHR/P source.) Refer to Chapter 7, “Maternal
Heart/Pulse Rate Monitoring”, for information.
Regardless of the mode, auto or manual, the values remain displayed according to
the time period specified in the display timer field.

2036946-001
The systolic and diastolic pressures are each indicated with two or three digits and
separated by a slash (/). The mean arterial pressure is indicated with two or three
digits and enclosed in parentheses. All pressure values are displayed in mmHg or
kPa.
Systolic, diastolic, MAP, and pulse rate values are printed on the strip chart paper
annotated by an outlined diamond ( )which marks the time of the reading.
Hydrostatic Effect
If patient is standing, sitting, or inclined ensure that cuffed limb is supported to
maintain cuff at level of patient’s heart. If cuff is not at heart level, the difference in
systolic and diastolic values due to hydrostatic effect must be considered. Add 1.80
mmHg (0.24 kPa) to values for every inch (2.54 cm) above heart level. Subtract
1.80 mmHg (0.24 kPa) from values for every inch (2.54 cm) below heart level.
Manual Mode
In manual mode, press the NIBP Start/Stop button to begin a single determination. The
cuff will inflate to the target pressure. If this initial inflation pressure is insufficient,
the unit retries with a higher inflation pressure (+40 mmHg; +5.3 kPa). The
instantaneous cuff pressure is displayed in place of the mean arterial pressure area
and is indicated by the title Cuff.
If you have the 256 Monitor–which does not have the NIBP parameter installed–
and press the NIBP Start/Stop button, the message NOT INSTALLED appears under the
NIBP label on the monitor’s screen.
Automatic Mode
In auto mode an indefinite series of determinations are made at defined time
intervals. Upon activation, a clock icon ( ) displays in the NIBP area indicating
the time remaining until the next scheduled automatic determination.
NOTE: The first automatic determination begins after the expiration of one
complete interval time period.
Since the first automatic blood pressure reading will not occur until after a complete
interval time, you may wish to take an initial manual reading by pressing the NIBP
Start/Stop push button. Automatic determinations inflate to the target pressure if no
previous values are displayed. If previous values are displayed the cuff inflation
target pressure is based on the previous values. If this initial inflation pressure is
insufficient, the unit retries with a higher inflation pressure. The instantaneous cuff
pressure is displayed in place of the mean arterial pressure area and is indicated by
the title Cuff.
WARNING
The NIBP parameter should be set to determine blood pressures
only as frequently as is clinically indicated to ensure adequate
patient monitoring.
Taking a Manual Reading Between Auto Determinations
If the NIBP Start/Stop button is pressed during the interval time between automatic
readings, a new determination is initiated.
IMPORTANT:
The countdown timer is not reset whenever a manual blood
pressure reading is initiated; the next scheduled automatic
determination will take place as planned.
Venous Return in Auto Mode

When in auto mode, the monitor always waits at least 30 seconds from the end of
one blood pressure determination to the beginning of the next. This provides a
minimum time that pressure around the patient’s limb is relieved, to allow for
venous return.
At all settings except 1 minute, if a determination ends with less than 30 seconds
remaining until the next one, that next determination will be cancelled.
NOTE: The 250cx Series Monitor is factory-set with the optional 1-minute
interval time enabled. For information on disabling the 1-minute
interval, refer to the 250/250cx Series Service Manual.
Example 1. The auto mode is selected with a time interval of 2 minutes. A
determination begins at 12:00:00. Due to excessive patient movement, the
determination ends at 12:01:35. This leaves only 25 seconds until the next
automatic reading scheduled at 12:02:00. The 12:02:00 determination is
cancelled and the following reading will resume at 12:04:00.
The optional 1-minute interval is an exception. When 1 minute is selected, if a

determination ends with less than 30 seconds until the next one, the reading will be
delayed to guarantee 30 seconds between determinations. During the delay, Wait
appears in the Auto mode timer.
Example 2. The auto mode is selected with a time interval of 1 minute. An

automatic determination begins at 11:59:00 with the next reading therefore
scheduled for 12:00:00. The 11:59:00 determination ends at 11:59:35. This
leaves only 25 seconds until the next scheduled automatic reading. Instead of
being cancelled, the next reading is reset to start in 30 seconds at 12:00:05. The
additional 5 seconds displays as Wait.
Adjusting the Interval Time Between Automatic Determinations

You can adjust the interval time in-between determinations by going back into the
maternal NIBP Setup screen. Regardless of whether you are increasing or decreasing
the interval time, the countdown timer resets to the new value. The next automatic
reading will occur after the expiration of the new interval.
Example 1. The interval time is set at 10 minutes and the countdown timer
shows 4 minutes until the next reading — in other words 6 minutes have
elapsed. If you change the interval time to 15 minutes, the countdown timer
will wait another 15 minutes until the next reading. Therefore a total of 21
minutes will elapse between readings.
Example 2. The interval time is set at 15 minutes and the countdown timer
shows 2 minutes until the next reading — in other words 13 minutes have
elapsed. If you change the interval time to 10 minutes, the countdown timer
will wait another 10 minutes until the next reading. Therefore a total of 23
minutes will elapse between readings.
NIBP Interval Button

Shortcut
You can set the interval time from the NIBP Setup screen or from the normal
operating screen using a front panel button shortcut:
1. While the normal operating screen is displayed, press and hold the NIBP
Start/ Stop button on the front panel.
2. After holding for approximately 2 seconds, the interval field display in place
of the countdown timer. Refer to “NIBP Interval Time Shortcut,” on page 8-
12.
3. Continuous pressure on the NIBP Start/Stop button cycles through the available
intervals: 1, 2, 3, 4, 5, 10, 15, 20, 30, 40, 45, 60, 90, and 120 minutes, and Off. Off
appears as a blank in the interval field display.
NOTES
 Since the intervals are displayed in the countdown timer area, they appear
as follows: 1:00, 2:00, 3:00,... 60:00, etc.
 The monitor is factory-set with the optional 1-minute interval time
enabled. For information on disabling the 1-minute interval, refer to the
“250/250cx Series Monitor Service Manual”.
4. When the desired interval is displayed, release the NIBP Start/Stop button.
5. The timer reappears and begins to count down from the new value.
NIBP Interval Time replaces the

countdown timer, while NIBP Start/Stop
button is held.
US FMD US2 HBC TOCO
165 172 30
NIBP 15:00 MECG MSpO2
130/ 85
MAP (107) 87 98%
03:15
25 mm/s
II 2x
MECG 03:22:45
NIBP Interval Time Shortcut

Maternal Non-Invasive Blood Pressure Monitoring: Smart BP Feature
Terminating a Determination in Progress

A determination—manual or automatic—can be cancelled by pressing the NIBP Start/
Stop button.
 The selected mode (Manual or Auto) remains in effect.
 The next scheduled automatic determination takes place as planned.
Smart BP Feature
The 250cx Series monitor has the patented Smart BP feature that prevents an
automatic blood pressure determination from occurring during a uterine contraction.
This feature:
 reduces the chances for erroneous vital signs readings; and
 reduces patient discomfort during labor.
Enabling/Disabling Smart BP
The Smart BP feature is enabled/disabled via the password-protected Install Options
service screen. Refer to the “250/250cx Series Monitor Service Manual” for more
information.
Methodology
The Smart BP feature is functional with both TOCO and IUP monitoring when:
 the automatic blood pressure mode is selected; and
 the interval time is set to 5 minutes or greater.
NOTE: Blood pressure readings cannot be postponed indefinitely. The Smart BP

feature ensures that a BP reading is completed even in the presence of
frequent uterine contractions.
Uterine activity trends are continuously analyzed to recognize patterns of uterine

contractions. Once the onset of a contraction is identified:
 An active blood pressure reading automatically stops and the cuff deflates;
it will be re-started following the contraction.
 A scheduled reading is delayed until after the contraction.

2036946-001
9 Maternal Pulse Oximetry
Monitoring

2036946-001
Maternal Pulse Oximetry Monitoring:
For your notes

MSpO2 Technology
Pulse oximetry is a continuous and non-invasive method of measuring the level of
arterial oxygen saturation in blood. The measurement is usually taken by placing a
sensor on the adult patient’s fingertip. The sensor is connected to the monitor by a
patient cable. The sensor collects signal data from the patient and sends it to the
monitor.
Pulse oximetry is governed by the following principles:
1. Oxyhemoglobin (oxygenated blood) and deoxyhemoglobin (non-oxygenated

blood) differ in their absorption of red and infrared light
(spectrophotometry).
2. The amount of arterial blood in tissue changes with your
pulse (photoplethysmography).
Therefore, the amount of light absorbed by the varying quantities of arterial blood
changes as well. The 250cx Series Monitor measures the maternal oxygen saturation
(MSpO2) and pulse rate using the principles of spectrophotometry and
plethysmography.
Which Module is Installed?

GE Medical Systems Information Technologies offers you the choice of one of the
following MSpO2 options:
 Ohmeda Oximetry® Technology

 MASIMO SET® Technology
 Nellcor® Technology
You can identify which MSpO2 technology your monitor contains by referring to the
front of the monitor. The MSpO2 technology logo appears next to the lower, right-
hand side of the display (example shown below).
.
Ohmeda, Nellcor, and Masimo Set Labels

2036946-001
Maternal Pulse Oximetry Monitoring: MSpO2
Technology
Theory of Operation
Ohmeda TruSignal™ Oximetry
TruSignal™ Enhanced SpO2

Ohmeda’s TruSignal Enhanced SpO2 offers fine performance, especially during
challenging conditions of clinical patient motion and low perfusion. With ultra-low-
noise technology, TruSignal selects the appropriate clinically-developed algorithm
to correct weak signals and generate reliable saturation readings. The waveform
update rate is 48 Hz. SpO2 and pulse rate are continuously calculated using a 12-
second weighted moving average controlled by priority in the TruSignal algorithms.
Signal processing
Ohmeda pulse oximetry uses a two-wavelength pulsatile system—red and infrared
light—to distinguish between oxyhemoglobin (O2Hb) and reduced hemoglobin
(HHb). The light is emitted from the oximeter sensor, which contains a light source
and a photodetector.
 The light source consists of red and infrared light-emitting diodes (LEDs).
 The photodetector is an electronic device that produces an
electrical current proportional to incident light intensity.
The two light wavelengths generated by the LEDs are transmitted through the
tissue at the sensor site and are modulated by arterial blood pulsation. The
photodetector in the sensor converts the light intensity information into an
electronic signal that is processed by the monitor.
Masimo SET®
Signal Processing
The Masimo MS-11 technology uses a two-wavelength pulsatile system to
distinguish between oxygenated and deoxygenated blood. Signal data is obtained
by passing red (rd) (663 nm wavelength) and infrared (ir) (880 nm wavelength)
light through a capillary bed (e.g., a fingertip, a hand, a foot) and measuring
changes in light absorption during the pulsatile cycle. The Masimo sensor has red
and infrared light-emitting diodes (LEDs) that pass light through the site to a
photodiode (photodetector). The photodetector receives the light, converts it into
an electronic signal and sends it, via a patient cable, to the MSpO2 parameter for
calculation of the patient’s functional oxygen saturation and pulse rate.
The MASIMO SET® MS-11 pulse oximeter is based on three principles:
1. Oxyhemoglobin and deoxyhemoglobin differ in their absorption of red

and infrared light (spectrophotometry).
2. The volume of arterial blood in tissue and the light absorbed by the
blood changes during the pulse (plethysmography).
3. Arterio-venous shunting is highly variable and that fluctuating
absorbance by venous blood is a major component of noise during
the pulse.
Traditional pulse oximetry assumes that all pulsations in the light absorbance
signal are caused by oscillations in the arterial blood volume. This assumes that the
blood flow in the region of the sensor passes entirely through the capillary bed
rather than through any arterio-venous shunts.
Masimo’s principle of operation is that arterio-venous shunting is highly variable and

that fluctuating absorbance by venous blood is a major component of noise during
the pulse. The Masimo product decomposes red and infrared pulsatile absorbance
into an arterial signal plus a noise component and then calculates the ratio of the
arterial signals minus the noise.
The practitioner can adjust high and low alarm limits to a desired value, if required,
and then monitor the waveform, pulse rate and Sp02 value on the display. If an
alarm limit is reached, the information on the display helps to assess the condition
of the patient and aids in determining if any intervention is required.
Nellcor OxiMax®
Due to a change in Nellcor technology, the SpO2 parameter in the Corometrics
250cx Monitor is migrating from Nellcor 506 technology to Nellcor NELL-3
technology. To determine which Nellcor technology your monitor contains, refer to
the Service Lock screen.
To display the Service Lock:
1. Select the Setup softkey to display the General screen.

2. Select the Service softkey from the General Setup screen.
3. The Service Lock screen appears.
Service Lock
Enter Access Code
0000
MSpO2 NELLCOR NELL-3 V1.9.0.1 NIBP Pri1.25 Sec.1.1 12/9/03

KeyPd 1.1
CPU VX.XX
DSP XX.XX
Exit
Nellcor uses pulse oximetry to measure functional oxygen saturation in the blood.
Pulse oximetry works by applying an OxiMax® sensor to a pulsating arteriolar
vascular bed, such as a finger or toe.
The OxiMax sensor contains a dual light source and a photodetector. Bone, tissue,
pigmentation, and venous vessels normally absorb a constant amount of light over
time. The arteriolar bed normally pulsates and absorbs variable amounts of light
during the pulsations. The ratio of light absorbed is translated into a measurement of
functional oxygen saturation (SpO2).
Because a measurement of SpO2 is dependent upon light from the OxiMax sensor,
excessive ambient light can interfere with this measurement.
Select an appropriate OxiMax sensor, apply it as directed, and observe all warnings
and cautions presented in the directions for use accompanying the OxiMax sensor.
Clean and remove any substances such as nail polish from the application site.
Periodically check to ensure that the OxiMax sensor remains properly positioned on
the patient.
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 OxiMax sensor. To prevent
interference from ambient light, ensure that the OxiMax sensor is properly applied,
and cover the OxiMax sensor site with opaque material.
WARNING
Failure to cover the OxiMax sensor site with opaque material in
high ambient light conditions may result in inaccurate
measurements.
The Nellcor Technology determines SpO2 by passing red and infrared light into an
arteriolar bed and measuring changes in light absorption during the pulsatile cycle.
Red and infrared low-voltage light-emitting diodes (LED) in the oximetry OxiMax
sensor serve as light sources; a photo diode serves as the photodetector.
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 pulse oximeter
bases its SpO2 measurements on the difference between maximum and minimum
absorption (measurements at systole and diastole). By doing so, it focuses on light
absorption by pulsatile arterial blood, eliminating the effects of nonpulsatile
absorbers such as tissue, bone, and venous blood.
Automatic Calibration
Because light absorption by hemoglobin is wavelength dependent and because the
mean wavelength of LEDs varies, an oximeter must know the mean wavelength
of the OxiMax sensor's red LED to accurately measure SpO2.
During monitoring, the software selects coefficients that are appropriate for the
wavelength of that individual OxiMax 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 OxiMax sensor's LEDs is adjusted automatically.
SatSeconds™
False or nuisance alarms are a common concern in pulse oximetry monitoring. They
are often triggered by minor brief desaturation events that are clinically
insignificant. SatSeconds is a proprietary Nellcor alarm management technique that
helps reduce false and nuisance alarms without risking patient safety.
With traditional alarm management, upper and lower alarm limits are set for
monitoring oxygen saturation. During monitoring, as soon as an alarm limit is
violated by as little as one percentage point, an audible alarm immediately sounds.
When the SpO2 level fluctuates near an alarm limit, the alarm sounds each time the
limit is violated.
Such frequent alarms can be distracting. With the SatSeconds technique, upper and
lower alarm limits are set in the same way as with traditional alarm management.
The clinician also sets a SatSeconds limit that allows the monitoring of SpO2 below
the selected low alarm limit and SpO2 above the selected high alarm limit for a
period of time before an audible alarm sounds.
The SatSeconds limit controls the time that the SpO2 level may fall outside the
alarm before an audible alarm sounds.
The method of calculation is as follows:
The number of percentage points that the SpO2 falls outside of the alarm limit is
multiplied 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 a lower 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
2X 2= 4
4X 3= 12
6X 6= 36
Total SatSeconds = 11 52
SatSeconds Calculation
After approximately 10.9 seconds the SatSeconds alarm would sound, because 50
SatSeconds (the assumed SatSeconds limit in this example) had been exceeded.
90
88
SpO2
86
84
0 1 2 3 4 5 6 7 8 9 10 1 1
SECONDS
Alarm Response with SatSeconds
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 pulse oximeter 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 “Safety Net”

The SatSeconds “Safety Net” is for patients with saturation levels having frequent
excursions below the limit, but not staying below the limit long enough for the
SatSeconds time setting to be reached.
Using SatSeconds
The SatSeconds option is located in the Service Mode.To activate SatSeconds, your
biomed sets the SatSeconds limit (Off, 10, 25, 50, or 100) that suits the clinical
environment and patient condition. To deactivate SatSeconds, your biomed sets the
SatSeconds limit to Off. When it is set to Off, the alarm sounds immediately without
any delay.
The SatSeconds factory default setting is set at 10 SatSeconds. To change this

setting refer to your biomed or 250/250cx Series Service Manual.
IMPORTANT: If you set SatSeconds to Off, the monitor behavior will

change. Any brief desaturation event will cause the monitor to alarm.
Maternal Pulse Oximetry Monitoring: MSpO2 Setup
Screen
MSpO2 Setup Screen

Select the MSpO2 softkey to access the MSpO2 Setup screen. (See figure below.)
FECG US TOCO
165 172 MSpO2 Setup

30
Response Time: Fast MSpO2
Print Interval:
% O2 Trace:
5 min
Off
97%
Alarm High Low

s 100 95 %
MSpO2 120 50 bpm
:
MHR/P: Alarm Volume: 5
Exit
Nellcor MSpO2 Setup Screen
NOTES
 A Masimo MSpO2 Setup Screen differs slightly from the Nellcor Setup
Screen. The Response Time field is absent, and it is replaced by a
Sensitivity field followed by an Averaging Time field.
 An Ohmeda MSpO2 Setup Screen also differs from the above example as the
Response Time field is absent.
Response Time (Nellcor 506 Technology Only)

Before you begin, confirm which Nellcor Technology your monitor contains. Refer
to “Nellcor OxiMax®” on page 9-5 for instructions. Choose a response time mode
in order to compensate for different levels of patient activity.
 Normal: Useful when patient is unavoidably active, least affected by patient
motion.
 Fast: Factory default setting. Useful in most clinical situations for relatively
inactive patients.
Response Time (Nellcor NELL-3 Technology Only)

Before you begin, confirm which Nellcor Technology your monitor contains. Refer
to “Nellcor OxiMax®” on page 9-5 for instructions. If your monitor contains NELL-
3, Fast is the only available setting.
Sensitivity (Masimo Technology Only)

This menu option appears only when using Masimo Technology and sensor.
 Normal: Use the Normal Sensitivity setting for normal patient monitoring purposes.
 Maximum: Use the Maximum Sensitivity setting for improved low perfusion
performance and for faster tracking of rapid MSpO2 saturation changes.

2036946-001
Averaging Time (Masimo Technology Only)
This menu option only appears when using Masimo Technology and sensor.
Choose a response time in order to compensate for different levels of patient
activity: 2, 4, 8, 10, 12, 14, or 16 seconds.
For the 2 and 4 second averaging settings: The actual averaging times may range
from 2 to 4 and 4 to 6 seconds, respectively.
 10, 12, 14, or 16 seconds: These averaging settings are least affected by
patient movement.
 8 seconds: This averaging selection is recommended in cases where the
patient is relatively inactive.
 2 or 4 seconds: These averaging selections are most affected by patient movement.
Print Interval
This setting determines the time interval for printing the MSpO2 values on the strip
chart paper.
%O2 Trace
This setting enables or disables the printing of the MSpO2 trend on the bottom grid
of the strip chart paper.
 On: The MSpO2 trend prints in grey and is annotated with MSpO2.
 Off: The MSpO2 trend is not printed.
Alarms
These fields adjust the high and low alarm limits for MSpO2, as well as for MHR/
P—in increments of 1% or 5 bpm. The selectable values are listed in Chapter 10,
“Alarms.” Refer to Appendix A, “Factory Defaults” for additional information.
Alarm Volume
Refer to “Factory Defaults” on page A-1 for information on factory defaults and
setting options.
MSpO2 Methodology
The maternal oxygen saturation is indicated by up to three digits representing the
percentage of oxygen saturation. The pulse amplitude indicator is a vertical bar that
visually indicates each pulse.
When MSpO2 monitoring is employed, the MSpO2 pulsatile (plethysmograph)

waveform can be displayed and printed. Refer to Chapter 14, “Waveforms” for more
information.
Maternal Pulse Oximetry Monitoring: Module and Probe
Compatibility
MSpO2 Pulse Beat Audio

If MSpO2 is selected as the MHR/P source, each pulse beat is indicated with a
“beep”: the pitch of the beep will vary according to the saturation value; the pitch
rises as the saturation value increases; the pitch lowers as the saturation value
decreases. If MECG is selected as the MHR/P source, the MECG audio plink is used
instead; it will not vary in pitch. NIBP cannot be chosen as the MHR/P source.
(Refer to Chapter 7, “Maternal Heart/Pulse Rate Monitoring” for more information.)
The MSpO2 Waveform

When MSpO2 monitoring is employed, the MSpO2 pulsatile (plethysmograph)
waveform can be displayed and printed. Refer to Chapter 14, “Waveforms” for more
information.
When enabled, the MSpO2 trend prints in the bottom grid as a grey trace annotated
by MSpO2 . Values are printed on the annotation area preceded by an
outlined diamond which marks the time of the reading.
Module and Probe Compatibility

Ohmeda, Masimo, and Nellcor pulse oximetry parameters are calibrated to display
functional saturation. Other manufacturer’s pulse oximetry monitors may be
calibrated to display fractional saturation.
 250cx Series Monitors with Masimo Technology are compatible only
with Masimo LNOP and LNCS sensors. For additional information, refer
to Directions for Use supplied with sensor.
 250cx Series Monitors with Ohmeda Technology are compatible only with
Ohmeda OxiTip+ sensors. For additional information, refer to Directions
for Use supplied with sensor.
 250cx Series Monitors with Nellcor Technology are compatible
only with Nellcor OxiMax sensors. For additional information,
refer to Directions for Use supplied with sensor.
IMPORTANT: Use only Masimo LNOP oximetry sensors with the Masimo
Technology, Ohmeda sensors with the Ohmeda Technology, and Nellcor
sensors with the Nellcor Technology. Other sensors may result in unpredictable
performance.
The MSpO2 cable should plug into the monitor’s MSpO2 connector easily and
securely. Do not use excessive force to connect the cable. If the MSpO2 cable does
not easily fit into the MSpO2 connector on the monitor, it is likely that you are using
an incorrect cable.
IMPORTANT: It is possible to connect the wrong MSpO2 cable and/or

sensor to the monitor. If this happens, the MSpO2 parameter will not work
(Ohmeda and Masimo) or will cause an error (Nellcor error: SENSOR). Be sure
to check the type of MSpO2 technology your monitor contains (the label next to
the lower, right-hand side of the display) and use the corresponding cables and
sensors for that technology.

2036946-001
Modules and Sensors
The Masimo, Ohmeda, and Nellcor parameters are used to measure the amount of
oxygenated hemoglobin and pulse rate non-invasively. The absorption of selected
wavelengths of light is measured with sensors. Although these parameters process
the MSpO2 measurements differently, the function and appearance of MSpO2 on
your monitor is the same.
No Implied License
Possession or purchase of this device does not convey any express or implied
license to use the device with unauthorized replacement parts which would, alone,
or in combination with this device, fall within the scope of one or more of the
patents relating to this device.
Sensors
Before use, carefully read the manufacturer’s sensor directions for use.
CAUTIONS
TISSUE DAMAGE—Tissue damage can be caused by incorrect
application or use of a MSpO2 sensor, for example by wrapping
the sensor too tightly. Inspect the sensor site as directed in the
sensor’s directions for use to ensure skin integrity and correct
positioning and adhesion of the sensor.
 Do not use damaged sensors.

 Do not use a sensor with exposed optical components.
Do not re-sterilize single-patient use sensors. For reusable sensors,
refer to the manufacturer’s instructions for cleaning and sterilization.
Do not immerse the patient cable in water, solvents, or cleaning
solutions (the patient cable connectors are not waterproof).
Do not re-sterilize the patient cable by irradiation, steam, or
ethylene oxide.
10 Alarms

2036946-001
Alarms:
For your notes

Introduction
This chapter provides a summary of alarms for all modalities in the 250cx Series
monitor. The monitor provides patient alarms (alarm limit threshold violations) for:
 FHR1
 FHR2
 NIBP (systolic, diastolic, and mean arterial pressures)
 MHR/P (for the selected source)
 MSpO2
In addition, the monitor provides signal quality alarms.
NOTE: The audio portion of an alarm takes priority to override the song player if
activated.
Alarm Setup
Master Alarm Setup Screen
The figure below is a sample Master Alarm Setup screen. Although each of the fields
on this screen can be accessed under the individual parameter setup screens, the
Master Alarm Setup screen provides an overall summary of the maternal alarm setup
information
.
FECG US TOCO
165 172 30
Master Alarm Setup
Alarms High Low

Systolic: 160 90 mmH
g
Diastolic: 90 50 mmH
g
MAP: 140 50 mmH
g
MHR/P: 120 50 bpm
MSpO2: 100 95 %
Alarm Volume: 5
Exit
Master Maternal Alarm Setup

Screen
Alarms
These fields adjust the high and low alarm limits for NIBP, MHR/P, and MSpO 2.
The available ranges are shown the “Technical Specifications” section. The factory
default setting are listed in Appendix A, “Factory Defaults”.
2036946-001
Alarms: Alarm
Setup
The alarm limits for each modality are configured by a respective setup screen.
Refer to Chapter 4, “Setup Procedures”. A Master Alarm Setup screen provides a
summary of most alarm limit settings with the exception of the FHR1 and FHR2
limit settings which are set independently.
NOTE: For each modality, the available ranges of high and low alarm limits
overlap; however, the monitor prevents the selection of overlapping alarm
limits.
Alarm Volume
The alarm volume can be set on any individual setup screen or on the Master Alarm
Setup screen. This settings is used for all alarms.
CAUTION
ALARM SETUP—Prior to monitoring each patient, it is
recommended that you check the alarm limits to ensure they are
appropriate for the patient.
Alarm Silence
The figure below is a sample of the ALARM SILENCE message on-screen. Press the
Alarm Silence button to silence an individual maternal audio alarm or paper load
error. However, for MECG and MSpO2 monitoring and during a paper-load error
condition, an alarm will be reissued if the alarm state continues after a specified
amount of time. Once alarm silence is activated, an ALARM SILENCE message box
appears on-screen with a timer that counts down the remaining time to re-alarm.
US INOP HBC IUP
120 ALARM SILENCE 2:00

95
NIBP Pulse MSpO2
- - -/- - -
MAP (---)
10:12
25 mm/s
II 1 x
MECG 10:34:01
Alarm Silence Message On-Screen

Alarm Setting Indicators
An alarm setting indicator displays for FHR1, FHR2, NIBP, MHR/P, and MSpO2.
The following table provides a summary of the two possible states for this indicator
NOTE: The FHR alarms may be completely disabled from the password-protected
Install Options service screen. When disabled, the alarm setting indicator is
not displayed.
.
Alarm Setting Indicators
Mode
All of the following are true: At least one of the following is true:
 The FHR audio alarm is on.  The FHR audio alarm is off.
FHR  Each of the FHR high/low limits is set to a value.  The FHR high limit is off.
 The FHR low limit is off.
 The NIBP audio alarm is on.  Maternal alarms cannot be turned off.
NIBP
 Each of the NIBP high/low limits is set to a
value.
 The MHR/P audio alarm is on.  Maternal alarms cannot be turned off.
MHR/P
 Each of the MHR/P high/low limits is set to a
value.
 The MSpO2 audio alarm is on.  Maternal alarms cannot be turned off.
MSpO2
 Each of the MSpO2 high/low limits is set to a
value.
Maternal Alarm Occurring During Setup

Alarm Behavior
If the visual indication of a maternal alarm is inhibited by a setup screen, only an
audio alarm (if enabled) is issued. As soon as you exit the setup screen, the
visual alarm indication displays.
 Example: If the NIBP Setup screen is displayed, the primary labor parameters
continue to be displayed as well as the maternal NIBP area of the screen. Under
an alarm condition that affects NIBP, both a visual and audible alarm is issued.
Under an alarm condition that affects MSpO2 or MECG, only an audio alarm
(if enabled) is issued while the NIBP Setup screen remains displayed. Once the
setup screen is exited, the visual alarm indication for MSpO2 or MECG
displays.

2036946-001
Alarms: Fetal Heart Rate
Alarms

FHR Patient Alarms
A fetal heart rate patient alarm occurs when any fetal heart rate falls outside of the
pre-defined alarm limits—greater than the high limit setting or less than the low
limit setting.
The FHR alarm function can be completely disabled from the password-protected
Install Options service screen. For this change to take effect, you must cycle power.
Refer to the “250/250cx Series Monitor Service Manual” for more information.
NOTE: The re-alarm time does not apply to FHR alarms—only MECG and
MSpO2 alarms. FHR values are not configurable.
Active Patient Alarm

A patient alarm is indicated both visually and audibly. The visual indication is
provided by flashing the affected FHR numeric. The audio alarm consists of
alternating high/low tones.
Resolved Patient Alarm

Resolved FHR alarms function differently than other alarms with a 250cx Series
Monitor:
 Resolved, Unsilenced FHR Patient Alarm: You must acknowledge an FHR
patient alarm—even if the condition has already been resolved. The visual and
audible indications remain present until you press the Alarm Silence button.
This ensures that a clinician is aware that an alarm occurred. You may hear
this type of alarm described as latching.
 Resolved, Silenced FHR Patient Alarm: If you have already silenced an
FHR patient alarm, the visual indications disappear automatically.
By comparison, the visual and audible indications for a maternal patient alarm
automatically disappear as soon as the condition is resolved—whether or not you
have acknowledged the alarm.
FHR Signal Quality Alarms

A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an
acceptable FHR signal.

A signal quality alarm is indicated both visually and audibly. The visual indication
is provided by flashing the FHR numeric (if available) or flashing dashes “– – –” in
place of the FHR numeric. The audio alarm consists of alternating high/low tones.
Resolved signal quality alarms function like most other 250cx Series alarms. As
soon as an alarm condition is resolved, both the visual and audible indications
automatically disappear.
Silencing an FHR Audio Alarm

Press the Alarm Silence button to cancel the audio; however, the visual indication
remains until the condition is resolved.
Maternal Alarms
Maternal Patient Alarms
A maternal patient alarm occurs when a parameter value falls outside of the pre-
defined alarm limits—greater than the high limit setting or less than the low limit
setting.
 For MHR/P, the value used for analysis comes from the selected MHR/P source.
For Ohmeda and Masimo MSpO2, the value must be out of range for 8 seconds. For
Nellcor MSpO2, the range depends upon the SatSeconds setting. Refer to
SatSeconds in the “Maternal Pulse Oximetry Monitoring” Section for more
information.
Active Patient Alarm
A patient alarm is indicated both visually and audibly. The visual indication is
provided by flashing the associated numeric. The audio alarm consists of alternating
high/low tones.
For MSpO2, the MSpO2 value and accompanying pulse rate are printed on the strip
chart paper.
Resolved Patient Alarm

The visual and audible indications automatically disappear as soon as the condition
is resolved.
Signal Quality Alarms

If the monitor is unable to detect an acceptable signal, a signal quality alarm is
provided.

2036946-001
Alarms: Maternal
Alarms

The following signal quality alarms are indicated both visually and audibly. The
audio alarm consists of alternating high/low tones. The visual indication varies
according to the alarm:
 Asystole: Dashes “– – –” display in place of the MHR/P numeric.
 MECG Leads Off: Dashes “– – –” display in place of the MHR/P numeric.
The following message displays in the MHR/P area: MECG LEADS OFF.
During this type of alarm, the MHR/P source automatically switches to the
next available parameter (MSpO2 then NIBP). As soon as the alarm condition
is resolved and the MECG signal is detected, and the monitor resumes using
MECG as the MHR/P source.
 NIBP System Problem: When there is a malfunction with the NIBP
parameter, cuff, or air hoses, the monitor will be unable to make a
determination. During this type of alarm, one of the following messages
displays in the NIBP area: CHECK CUFF, OVERPRESSURE, COMM, MOTION,
WEAK SIGNAL, or REPAIR. Refer to Chapter 16, “Troubleshooting”, for more
information on these messages.
 MSpO2 System Problem: When there is a malfunction with the monitor’s
built-in MSpO2 parameter, one of the following messages displays in the
MSpO2 area: COMM, REPAIR or SENSOR (Nellcor only). Refer to Chapter 16,
“Troubleshooting”, for more information.
 MSpO2 Disconnect: An MSpO2 disconnect alarm occurs if: the MSpO2
intermediate cable is disconnected from the monitor, the sensor assembly is
disconnected from the intermediate cable, or the sensor or cable have a broken
wire. Dashes “– – –” display in place of the MSpO2 numeric.

Resolved signal quality alarms behave like most other 250cx Series alarms. As soon
as an alarm condition is resolved, the visual and audible indications automatically
disappear.
Silencing a Maternal Audio Alarm

Press the Alarm Silence button to cancel the audio; however, the visual indication
remains until the condition is resolved.
For MECG and MSpO2, you can only temporarily silence the audio portion of the
alarm. If the alarm condition remains, after expiration of the re-alarm time
configured on the Master Alarm Setup screen, the audio alarm is re-issued.
Alarms Summary
Summary of 250cx Series Alarms
Type Condition Display Message Audible Notification
FHR An alarm setting (audio or —
high/low limit) is turned off. displays to the left of
the FHR mode title.
Alarm Defaults
Audio: on
Volume: 5
Limits: High = 160 bpm, Low =
120 bpm
FHR limit (high or low) actively FHR numeric flashes. Alternating high/low tones (if
being violated. audio enabled).
or
Unsilenced, resolved FHR limit
violation (the limit was violated
but the FHR has since returned
to the normal range before
clinical acknowledgement).
For continuous limit violations: a

high alarm activates after 5
minutes; a low alarm activates
after 30 seconds.
About Latching Alarms: The FHR

limit alarms are latching alarms
which means that a clinician
must acknowledge the alarm
using the monitor’s Alarm
Silence button in order to clear
the alarm.
Inadequate FHR signal quality. Flashing dashes “– – –” in place Alternating high/low tones (if
of FHR numeric. audio enabled).
NIBP Systolic, diastolic, or MAP NIBP numeric (systolic, Alternating high/low tones
pressure value (high or low) diastolic, or MAP) flashes. (if audio enabled).
actively being violated.
Malfunction with NIBP circuitry, CHECK CUFF, COMM, MOTION, Alternating high/low tones
cuff, or air hoses. WEAK SIGNAL, or REPAIR (if audio enabled).
message displays in NIBP
area.

2036946-001
Alarms: Alarms
Summary
Summary of 250cx Series Alarms

Type Condition Display Message Audible Notification
MHR/Paa MHR/P limit (high or low) MHR/P numeric flashes. Alternating high/low tones
actively being violated. (if audio enabled).
The tachycardia response time is <

8 seconds.
Asystole. Flashing dashes “– – –” in place Alternating high/low tones

of MHR/P numeric. (if audio enabled).
MECG leads off. Flashing dashes “– – –” in place Alternating high/low tones

of MHR/P numeric and MECG (if audio enabled).
LEADS OFF message displays
underneath.
MSpO2b MSPO2 limit (high or low) MSpO2 numeric flashes. Alternating high/low tones
actively being violated. Issued MSpO2 value and pulse rate (if audio enabled).
after about 8 seconds. print on the strip chart.
Malfunction with MSpO2 circuitry. COMM or REPAIR message Alternating high/low tones
displays in MSpO2 area. (if audio enabled).
MSpO2 intermediate cable Dashes “– – –” in place of Alternating high/low tones

disconnected from monitor, MSpO2 numeric. (if audio enabled).
sensor assembly disconnected
from intermediate cable, or
sensor or cable has a broken
wire.
a
There is an MECG re-alarm.
b
There is an MSpO2 re-alarm.
11 Recorder Modes

2036946-001
Recorder Modes:
For your notes

Modes
The 250cx Series Monitor has three recorder modes: off, on, and maternal-only.
Factory default is ON.
Off Mode
When the recorder is off, the yellow Record indicator is off and nothing is
automatically printed on the strip chart paper.
Even with the recorder turned off, it is possible to manually print the displayed
waveform or the maternal vital signs history. Selecting the Print or PrintAll softkey
places the recorder into a special high-speed printing mode. After the information is
printed, the recorder turns off again. Refer to Chapter 12, “Maternal Vital Signs
History” and Chapter 14, “Waveforms”, for more information.
On Mode
When the recorder is on, the yellow Record indicator continuously illuminates and
the recorder runs at the selected speed of 1, 2, or 3 cm/min.
Maternal-Only Mode
What is the Maternal-Only Mode?
The maternal-only printing mode sets the recorder to a standby mode—turning the
recorder on and off as needed to print information, such as:
 maternal non-invasive blood pressure;
 maternal pulse oximetry; and
 notes from a Model 2116B Clinical-Notes/Data-Entry System.
When the recorder is in the maternal-only mode, the yellow Record indicator flashes
approximately every 5 seconds.
Printing Style
Information printed using the maternal-only mode prints vertically across the page.
Figure on page 11-4 provides an example of a maternal-only mode printout.

2036946-001
Recorder Modes: Changing Recorder
Modes
02377 12:4 6 MS P O 297 % P 72

12:4 5 NIBP 11 3/64 M88 P 7
12:4 1 MS O 98 % P 74
P2
12:3 6 MS P O 297 % P 73
12:3 1 MS P
O 299 % P 74
bpm
12 :30 N I BP 11 5 / 62 M 88 P 7
18 F E B 96
12:2 8
FHR
Maternal-Only Mode Printout
A summary of the printed information follows:

 A blank line is printed after each message to improve readability.
 Each message can be a maximum of 40 characters in length.
 The time precedes each message.
 An outlined diamond marker ( ) indicates the data is provided by one of the
monitor’s built-in parameters.
 A filled diamond marker ( ) indicates the data is provided by an external
device interfaced to the monitor.
 The date is printed when the maternal-only mode is first activated, when
the date/time is changed, and at midnight.
Changing Recorder Modes

Use the Record button to select between on, maternal-only mode, and off. Turn the
recorder on for continuous trending; set the recorder to maternal-only mode when
you are interested in the maternal vital signs, except MECG heart rate.
CAUTION
DATA STORAGE—Stored maternal vital signs history data is
erased when you turn the monitor off. Therefore, for intermittent
monitoring, it is recommended that you leave the monitor on, but
turn the recorder off. Refer to Chapter 12, “Maternal Vital Signs
History” for more information.
Changing Recorder Modes

From To Button
Off On Briefly press once; or press and hold 3 seconds.
Off Maternal-Only Briefly press twice.
On Maternal-Only Briefly press once.
On Off Press and hold 3 seconds.1
Maternal-Only On Briefly press once.
Maternal-Only Off Press and hold 3 seconds.1
1
A confirmation tone sounds to indicate the recorder has been turned off.
Recorder Mode Audiovisual Indicator Status

Recorder Mode Record Indicator Audio Indicator
On continuously illuminated
Maternal-Only lights three short flashes Off
every 5 seconds
Off Off
Functionality with a QS System

Users of a Quantitative Sentinel (QS) System (Software Version 4.0.3.0 or earlier)
should be aware of the following items when using the monitor’s maternal-only
mode:
Paper Versus Electronic Strip Charts

As described earlier, the monitor’s maternal-only mode acts as a “paper saver”
turning the strip chart recorder on and off as needed. However, the QS System
overrides the maternal-only mode by storing the entire patient record. In other
words, the electronic strip chart is retained as if the monitor’s recorder were left on

2036946-001
Recorder Modes: Trends
continuously with all data lines printing in the annotation area; this may result in
many blank pages in-between maternal vital signs data. In addition, the FHR mode
will list INOP. Contact your Service Representative for clarification on your QS
System’s wiring.

The QS System is designed to alarm when there is no fetal heart rate signal so it is
recommended that you unplug the ultrasound and/or FECG transducers from the
monitor, when not in use, to eliminate false alarms.
Trends
Multiple Trends
Multiple trends can be simultaneously printed on the strip chart paper. The Table
below provides a summary of the different trend types; Figure on page 11-7
provides an example of a strip chart with five traces printed simultaneously.
Up to three heart/pulse rate trends can be printed in the top (or left) channel of the
strip chart paper: two FHR trends as well as the MHR/P trend. The primary FHR
trend is printed in plain black. The secondary FHR trend is printed in bold black.
The MHR/P trend is printed in grey.
The UA, External FSpO2, and MSpO2 trends are printed in the bottom (or right)
grid of the strip chart paper. The UA trend is printed in plain black. The External
FSpO2 trend is printed as a black beaded line. The MSpO2 trend is printed in grey.
The FHR and UA trends are printed continuously. The MHR/P, External FSpO2,
and MSpO2 trends must all be enabled via the respective setup screen.
Summary of Strip Chart Trends

Grid Source Type Trace Description Parameter Trend Source
Top Fetal Plain Black FHR1 US or FECG
Bold Black FHR2 US or US2
Maternal Grey MHR/P MECG or MSpO2P
Bottom External Fetal Plain Black FSpO2 External FSpO2
Maternal Plain Black UA TOCO or IUP

Grey MSpO2 MSpO2
Five Trends Printing Simultaneously
SpO2 Scale
Two scale options are available for printing the MSpO 2 trends. The scale is printed
on the paper along with the trend. This option is located in the password-protected
Install Options screen.
 Auto: The trend plots on an expanded scale of 60–100% or 50–100%,
depending on the paper.2
 0–100%: This option configures the MSpO2 trend to always plot at a fixed
scale of 0–100%.
Annotations
Several standard annotations are printed by the monitor to help analyze the strip
chart data and complete the patient record. Most annotations print in the area
between the top and bottom grids of the strip chart paper; however, some
annotations print in either grid. All annotations are listed and explained in the
“Summary of Annotations” Table.
2
The MSpO2 trend is plotted over a range of 60-100% on paper with a HR scale ranging from 30-240
bpm. The MSpO2 trend is plotted over a range of 50-100% on paper with a HR scale ranging from 50-

2036946-001
210 bpm.

2036946-001
Recorder Modes: Annotations
Standard Annotations
The most common of the annotations which print on the bottom line are:
 date
 time
 active modes
 heart rate coincidence enable status
 fetal heart rate alarm enable status
 recorder speed
 telemetry status
Blood Pressure Annotations

A blood pressure reading can print on any of the first three annotation lines—
depending on which printing line is available. A diamond marks the time of the
reading.
 : An unfilled diamond indicates the reading was received from the monitor’s
built-in blood pressure parameter. The vital signs print below the diamond.
See Figure on page 11-8.
 : An unfilled diamond with a slash indicates a blood pressure reading was
cancelled/delayed. The marks the time the reading was originally
scheduled. The annotation NIBP (D) prints below the marker. See Figure on
page 11-8.
 : A filled diamond indicates the reading was received from an external
blood pressure monitor connected to the 250cx Series Monitor. The vital signs
print below the diamond. (Contact your Service Representative for
connectivity information.)
If the top three printing lines are busy printing other data, the diamond prints at the
time of the reading; however, the vital signs data prints as soon as a line becomes
available.
NIBP Vital Signs Data Annotation from Built-In Module

Maternal Pulse Oximetry Annotations
A maternal pulse oximetry reading prints according to the interval time set on the
MSpO2 Setup screen (for built-in parameter) or the General Setup screen (for external
device). For the built-in parameter, a reading also prints for each alarm generated.
The reading can print on any of the first three annotation lines—depending on
which printing line is available. A diamond marks the time of the reading.
 : An unfilled diamond indicates the reading was received from the
monitor’s built-in maternal pulse oximetry parameter. The vital signs print
below the diamond.
 : A filled diamond indicates the reading was received from an external
maternal pulse oximeter connected to the 250cx Series Monitor. The vital
signs print below the diamond. (Contact your Service Representative for
connectivity information.)
If the top three printing lines are busy printing other data, the diamond prints at the
time of the reading; however, the vital signs data prints as soon as a line becomes
available.
The pulse rate value determined by MSpO2 always prints along with MSpO2.
Annotations from a Central Information System

The 250cx Series Monitor has three built-in RS-232C ports which can be used to
connect to a central information system which supports Hewlett Packard’s Digital
Series Protocol. Contact your Service Representative for more information.
The 250cx Series Monitor can also be configured via a communications service
screen to print annotations received from a central information system. A computer
marker prints on the bottom two lines of the heart rate grid marking the time the
annotation was made from a remote location if the central station has the capability
to send that command. See Figure on page 11-10.
Multiple
Annotations
Sometimes annotations occur within seconds of each other. Consider the following
example shown in Figure on page 11-10:
 an automatic NIBP reading occurs at 16:51:30
 three annotations are received from a central information system; the entries
are made between 16:51:40 and 16:52:00
 a manual NIBP reading occurs at 16:52:10
Recorder Modes: Summary of
Annotations
Multiple Annotations Example
Summary of Annotations
Summary of Annotations
Annotation Explanation
Time and Date Time and date are both printed on the bottom annotation line 20 seconds
(Example: 10:40 12 AUG 97) after the recorder is turned on and when the date changes after
midnight.
A time stamp automatically prints approximately every 10 minutes—at the

10- minute mark. For example: 10:50, 11:00, 11:10, 11:20, 11:30, etc. If the
bottom annotation line is being used to print another annotation, the
time stamp is delayed. For example: 10:50, 11:00, 11:12, 11:20, 11:30, etc. In
this example, the
11:10 date stamp was delayed until 11:12.
The time and/or date also prints whenever it is changed via the General
Setup
screen.
SET TIME/DATE If the monitor senses a clock circuit fault, when the recorder is turned
on, this message replaces the normal time/date stamp. The message
reprints every 10 minutes, at the 10-minute mark, until the clock is reset.
TEST: ARE ALL DOTS PRINTED? This annotation prints across the width of the top strip chart grid when you
press the Test button. The message reminds you to check for a continuous
unbroken line of recorder dots.
This icons prints prior to the FHR trend source annotations if the FHR alarms
are enabled. The FHR alarm option is enabled/disabled via the password-
protected Install Options service screen.
US or FECG The trend source prints on the bottom annotation line by the following
rules:
US or US2  All trend sources print 20 seconds after the recorder is turned on,
including inoperative modes.
MECG or MSpO2P  All trend sources print every 30 minutes.
 If a mode change occurs, only those trend sources belonging to the
corresponding group print. If any top grid trend source changes, all top
UA
grid active trend sources are printed. If the UA mode changes, the active
UA trend source is printed. A mode change is defined as: switching
External FSpO2 connectors; connecting to a front panel receptacle; disconnecting
from a front panel receptacle; or enabling/disabling a trend on a setup
menu.
2036946-001
Summary of Annotations (Continued)
CARDIO INOP This annotation prints in place of any trend source if the respective
connector
(FECG/MECG, US, or US2) is unused.
UA INOP This annotation prints in place of the trend source if the UA receptacle is
unused.
MSpO2 INOP This annotation prints if the trend is enabled and the Maternal SpO2
receptacle is unused.
Chart Speed The chart speed prints on the bottom annotation line 20 seconds after you
(Example: 3 turn on the monitor.
cm/min)
UA REF This message prints on the bottom line of the bottom strip chart paper grid
during active uterine activity monitoring whenever:
 you press the UA Reference button; or
 whenever automatic re-zeroing occurs during tocotransducer monitoring.
BASELINE PRESSURE OFFSCALE This annotation prints on the bottom line of the bottom strip chart paper
grid during IUPC monitoring when the pressure falls below 0 mmHg for more
than 20 seconds.
Maternal NIBP vital signs data. For example: Maternal NIBP vital signs data prints for each manual and
automatic determination.
NIBP 103/ 71 M 83 P 72 (mmHg mode)  identifies the 250cx Series as the source.
NIBP 13.7/9.5 M 11.1 P 72 (kPa mode)  identifies an external device as the source.
or
The diamond prints on the bottom two lines of the bottom grid of the
NIBP 103/ 71 M 83 P 72 (mmHg mode) strip chart paper and marks the time of the reading. The vital signs data
NIBP 13.7/9.5 M 11.1 P 72 (kPa mode) prints in one of the top three lines of the annotation area as soon as a
printing line is available. The printed pulse rate value is derived from the
blood pressure parameter and is independent of the MHR/P source
selected on the MHR/P Setup screen.
Indicates an NIBP determination was cancelled or delayed due to
NIBP (D) the occurrence of a uterine contraction.
MSpO2 vital signs data. For example: MSpO2 vital signs data is printed at selected intervals according to the
MSpO2 Setup screen (built-in parameter) or the General Setup screen
(external device). In addition, for the built-in parameter only, vital signs
data is printed when a MSpO2 alarm occurs; however, only one alarm-
MSpO2 97% P 66
related print occurs within a 5- minute period.
or
 identifies the 250cx Series as the source.

MSpO2 98% P 70
 identifies an external device as the source.
The diamond prints on the bottom two lines of the bottom grid of the
strip chart paper and marks the time of the reading. The vital signs data
prints in one of the top three lines of the annotation area as soon as a
printing line is available. The printed pulse rate value is derived from the
pulse oximetry parameter/monitor and is independent of the MHR/P source
selected on the maternal MHR/P Setup screen.
Remote annotation from a central information This annotation represents notes received from a remote central information
system. For example: system. The computer icon prints in the bottom two lines of the top
grid. The icon marks the time of the annotation and also indicates that
the information comes from a remote computer such as a QS/Perinatal
System. The notes print on any lines except the first, (The first line is
reserved from NIBP vital signs data.)
EPIDURAL GIVEN.
AROM.
POS CHG LEFT SIDE.
HBC This annotation prints on the first annotation line following the active heart
rate mode(s) indicating heartbeat coincidence is enabled. This feature is
enabled/ disabled via the password-protected Install Options service
screen. The annotation represents only that the feature is enabled; it does
not indicate that heartbeat coincidence has been detected.
This annotation prints in the top two lines of the upper grid indicating that
the monitor detects heartbeat coincidence.
This annotation prints in the top two lines of the upper grid indicating
the cessation of heartbeat coincidence.
This annotation prints on the bottom two lines of the upper grid indicating
that active telemetry signals are being received. The annotation re-prints
every 30 minutes along with the modes.
that telemetry signals are no longer being received.
This annotation can only be seen when dual heart rate monitoring is in
or progress.
 
| |
| | The offset annotation or prints at the top of the upper
| | grid indicating that the secondary fetal heart rate trend is shifted +20 bpm.
| | The right/ left arrows ( )and vertical dashed lines bracketing the
  heart rate grid indicate the start/end of the fetal heart rate offset mode,
respectively.
an event. Generate the mark by one of the following:
 Briefly press the monitor’s Mark [Offset] button.
 Press the FM Remote Marker button. (The Remote Marker is an
accessory that can be connected to the 250cx Series Monitor. The
monitor can be configured to use this arrow annotation or the one
shown in the next row of this table. Refer to the “250/250cx Series
Monitor Service Manual”.)
Recorder Modes: Adjustable Recorder Font
Size

that the mother perceives fetal movement. The arrow prints each time
the mother presses the FM Remote Marker button.
Note: A horizontal bar prints as a tail on the arrow for as long as the
button is held down.
(The Remote Marker is an accessory that can be connected to the 250cx
Series Monitor. The monitor can be configured to use this annotation or the
one shown in the previous row of this table. Refer to the “250/250cx
Series Monitor Service Manual”.)
that the Corometrics Model 146 Fetal Acoustic Stimulator is being used.
The music symbol prints each time a clinician presses the button on the
stimulator.
Freestyle annotations. For example: Entries typed using a Corometrics Model 2116B Data-Entry/Clinical Notes
Keyboard print in the annotation area. (The Model 2116B is an optional
PT. NAME: JANET STEVENS device that can be connected to the 250cx Series Monitor.)
PT. ID#: 6535148
PT. AGE: 18 DR. CARTER
Adjustable Recorder Font Size

The 250cx Series Monitor offers a choice of font sizes to print annotations. (Refer to
Table , “Summary of Annotations,” on page 11-10.) A larger font size fosters
readability; a smaller font size increases printing speed.
Set the font size on the password-protected Install Options service screen. Refer to the
“250/250cx Series Monitor Service Manual” for more information.
CAUTION
FONT SIZE—If the medium or large font size is selected, there is
the possibility that messages may be truncated during periods of
multiple annotations.

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Summary of Font Settings
Printing Description
Font Setting
30–240 bpm Scale Paper 50–210 bpm Scale Paper
Small  Eight annotation lines are available.  Four annotation lines are available.
 Time/date, modes, and annotations all print  Time/date, modes, and annotations all print
using the small font size. using the small font size.
 See Figure on page 11-14.
Medium  Four annotation lines are available.  Two annotation lines are available.
 Time/date and annotations print using the  Time/date and annotations print using the
medium font size. medium font size.
 Modes print using the small font size.  Modes print using the small font size.
Large  Three annotation lines are available.
 Annotation print using the large font size.
 Time/date print using the medium font size.
 Modes print using the small font size.
Multiple Font Sizes
Chart Style Vital Signs Printing

The monitor provides an option for chart-style printing of blood pressure and
MSpO2 values on standard clock quarter, half, and whole hour marks.
Enabling/Disabling Chart-Style Printing

The chart-style feature is enabled/disabled from the password-protected Install
Options service screen. Refer to the “Maternal/Fetal Monitoring, Clinical
Applications Manual” for more information.
Recorder Modes: Chart Style Vital Signs
Printing
Examples of Printing Styles

Chart-Style Printing Examples
When chart-style printing is enabled:
 The 15-minute interval prints on the quarter hour (e.g., 9:00, 9:15, 9:30, 9:45, etc.).
 The 30-minute interval prints on the half hour (e.g., 9:00, 9:30, 10:00, 10:30, etc.).
 The 60-minute interval prints on the hour (e.g., 9:00, 10:00, 11:00, 12:00, etc.).
The following are examples of chart-style printing:

 NIBP Example 1: The automatic blood pressure mode is activated at 9:03,
with the interval time set to 15 minutes. Whereas the first real-time reading
would occur at 9:18, the first chart-style reading is taken at 9:15. Subsequent
readings are taken and printed at 9:30, 9:45, 10:00, 10:15, etc.
 NIBP Example 2: The automatic blood pressure mode is activated at 9:17,
with the interval time set to 30 minutes. Whereas the first real-time reading
would occur at 9:47, the first chart-style reading is taken at 9:30. Subsequent
readings are taken and printed at 10:00, 10:30, 11:00, 11:30, etc.
 MSpO2 Example 1: The MSpO2 print interval time is set to 30 minutes and the
sensor is connected at 9:24 a.m. Whereas the first real-time printing would
occur at 9:54, the first chart-style printing is done at 9:30. Subsequent values
are printed at 10:00, 10:30, 11:00, 11:30, etc.
 MSpO2 Example 2: The MSpO2 print interval time is set to 60 minutes and the
sensor is connected at 9:42 a.m. Whereas the first real-time printing would
occur at 10:42, the first chart-style printing is done at 10:00. Subsequent
values are printed at 11:00, 12:00, 1:00, 2:00, etc.
Real-Time Printing Example

When chart-style printing is disabled, standard real-time printing occurs.
 NIBP Example: The automatic blood pressure mode is activated at 9:03, with
the interval time set to 15 minutes. The first reading occurs at 9:18.
Subsequent readings are taken at 9:33, 9:48, 10:03, etc.
 MSpO2 Example: The print interval is set to 15 minutes and the first
acceptable pulse signal is detected at 9:05 a.m. The first printing occurs at
9:05. Subsequent MSpO2 values are printed at 9:20, 9:35. 9:50, 10:05, etc.
Chart-Style 7-Minute Exception for NIBP

If you take a manual blood pressure reading within 7 minutes of a chart-style
interval (15, 30, or 60 minutes) and then activate automatic blood pressure readings
using a chart-style interval, the first automatic reading will be skipped.
This rule only applies to the first reading when chart-style vital signs printing is
enabled on the password-protected Install Options service screen.
 Example: You take a manual blood pressure reading at 7:10. At 7:13 you then
activate automatic blood pressure readings using a 15-minute time interval.
The 7:15 chart-style reading is skipped since a manual reading occurred 5-
minutes earlier. The first automatic reading is taken at 7:30. Since the rule
applies only to the first reading, if you take another manual reading at 7:40, the
7:45 automatic reading occurs as scheduled.

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Strip Chart Paper
Instructions for loading the strip chart paper are provided in Chapter 4, “Setup
Procedures”. Two kinds of strip chart paper are available from GE.
 Z-Fold Chart Paper with Pre-Printed 30–240 bpm Heart Rate Scale (Refer
to Figure on Page 11-17.)
 Z-Fold Chart Paper with Pre-Printed 50–210 bpm Heart Rate Scale (Refer
to Figure on Page 11-18.)
In the United States of America, the most common grid is the 30-240 bpm scale
with the recorder speed set at 3 cm/min. As shown in Figure on Page 11-17, a dark
line is printed every 3 cm, which represents 1 minute in time at a speed of 3
cm/min.
In other countries, the most common grid may be the 50–210 bpm scale with the
recorder speed set at 1 cm/min. As shown in Figure on Page 11-18, every other
vertical line measures 1 cm, or 1 minute in time at a speed of 1 cm/min.
Regardless of the heart rate scale, the uterine activity scale is pre-printed from 0–
100 mmHg (0.0–13.3 kPa); this same scale is used for relative units. When SpO2
and monitoring is in progress, the scale is printed on the paper by the recorder. The
Figures on pages 12-3 and 12-4 also call out the top grid, bottom grid, and the
annotation area for each style paper.
Recorder Modes: Strip Chart
Paper
Top Grid
Pre-printed HR Scale
Primary Annotation Area
Pre-printed UA Scale
Bottom Grid
Strip Chart Paper with 30–240 bpm Heart Rate Scale

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Top Grid
Pre-printed HR Scale
Primary Annotation Area
Pre-printed UA Scale
Bottom Grid
Strip Chart Paper with a 50–210 bpm Heart Rate Scale
PAPER-LOW, PAPER-OUT, and PAPER-LOADING

Error Conditions
The 250cx Series Monitor alerts you when paper is running low or when the
recorder is completely out of paper. To protect against paper jams, the recorder also
contains a paper-loading sensor which notifies you if the paper has been incorrectly
loaded. Refer to “Loading Strip Chart Recorder Paper” on page 4-3, and follow the
instructions on loading paper into a 250cx Series Monitor.
Recorder Modes: Paper-Low, Paper-Out, and Paper-LoadING Error Conditions
The alarms are summarized by the following Table . The volume of the alarm tone
for all three conditions is configured on the password-protected Install Options
Screen 1 screen.
Recorder Error Conditions

Paper Error Recorder Alarm Silence
Record Indicator Status Audio Status
Condition Behavior Button Behavior
PAPER LOW Flashes on and off once every Continues to Two short tones every 30 Cancels the alarm.
Low/Out second. print until paper seconds. 1
runs out.
PAPER OUT Off Automatically Three short tones every Cancels the alarm.
Out Only stops printing. 30 seconds. 1
PAPER Flashes on and off once every Does not print. Three short tones every 3 Temporarily silences alarm.
INCORRECTLY second. The message PAPER seconds. The alarm is re-issued if
LOADED INCORRECTLY LOADED, RELOAD the condition continues
WITH BLACK SQUARES DOWN after the re-alarm time
displays in the waveform area of specified on the Install
the display. Options Screen 2.
1
The paper chime audio is enabled on the password-protected Install Options Screen 1.

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12 Maternal Vital
Signs History

2036946-001
Maternal Vital Signs History:
For your notes

What is the Maternal Vital Signs History Screen?
This feature displays/prints maternal vital signs data in a spreadsheet format—called
Vital Signs History. An example of the maternal Vital Signs Screen is shown on
page 12-4. A printout example is shown on page 12-6.
CAUTION
DATA STORAGE—Stored data for history is immediately lost
when the monitor is turned off.
This ensures that stored data for one patient is not inadvertently
transferred to a new patient. It should be noted that the maternal
Vital Signs History feature is most beneficial when a patient is
being continuously monitored. If a patient is being monitored
intermittently, all history data is erased each time the monitor is
turned off.
If a significant amount of history data has been collected and the

monitor must be turned off, you may wish to print the data prior
to powering off the monitor in order to retain a hard copy for
your files.
The monitor stores up to 8 hours of data on a first-in, first-out basis —available for
review and printing at any time. After 8 hours of data storage, the oldest data
begins to be replaced by new data.
NOTE: The monitor stores blood pressure and maternal pulse oximetry events
from the monitor’s built-in parameters. The monitor only stores external
device data from the TAT-5000 external temperature probe. See monitor
service manual for proper communications settings to interface TAT-5000.
The monitor stores the following maternal vital signs data:

 Each manual and automatic blood pressure event is stored. A blood pressure
event includes the systolic pressure, diastolic pressure, mean arterial pressure,
and maternal pulse rate derived from the blood pressure cuff.
 An event snapshot of MSpO2 is taken every minute. An MSpO2 event includes
the MSpO2 and the maternal pulse rate derived from the sensor.
 An event snaphot of the MHR is taken every minute. An MHR event is the
MHR value derived from the MECG electrodes.
 Manual temperature events initiated from the external TAT-5000 temperature

probe.

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Maternal Vital Signs History: Using the Maternal Vital Signs History
Screen
US US2 TOCO
154 135 Vital Signs History

17
Date: 24-Mar 24-Mar 24-Mar 24-Mar 24-Mar
Time: 12:00 12:10 12:20 12:30 12:40
NIBP
SYS 120 122 122 125 124
DIA 85 87 90 95 90
MAP 94 95 94 105 98
P 74 76 75 81 77
MSpO2 100 98
%02 98 99 99 81 78
P 76 77 75
81 78
MECG 75 74 75
HX Interval: 10 min
Print PrintAll View Exit
NOTE: NIBP values appear in kPa when in kPa mode.
Maternal Vital Signs History Screen
Using the Maternal Vital Signs History Screen

Displaying the Screen
1. Select the VSHX softkey to display the Vital Signs History screen.
2. Select the VIEW softkey to scroll through the data. Scroll right roll towards
the oldest data; scroll left towards the most recent data
3. Press the Trim Knob control to de-activate the VIEW softkey.
4. Select the Exit softkey to return to the main screen.
Selecting the HX Interval

The maternal Vital Signs History screen can be configured to display different
columns of data by adjusting the HX Interval field. The interval choices are: Event (to
display all events) and 1, 5, 10, 15, 30, and 60 minutes. (The factory default setting
is Event.)
The history interval has no effect on the data being stored. You can change the
interval setting at any time and all data for the most recent 8 hours is available for
display.
When the screen is called up for display, the previous minute in time is listed at the
far right of the screen; the preceding values to be displayed are counted backwards
from the previous minute in time, based on the intervals you have selected.
 Example: The HX Interval is set at 5 minutes and the maternal Vital Signs History
screen is displayed when the current time is 13:57. When the screen is
displayed there will be five columns of data for the following times:
13:36 13:41 13:46 13:51 13:56

If the screen remains displayed for 1 minute the columns of data change to:
13:37 13:42 13:47 13:52 13:57
Printing the Maternal Vital Signs History Screen

NOTE: Once the print function is You can select all or a portion of the maternal vital signs history for printing on the
activated, you may exit the history strip chart paper. The information is printed in the upper portion of the top (or left)
screen; it need not remain displayed grid of the strip chart paper at a high speed mode. If the recorder is on, all other
during printing. trending is interrupted while the maternal vital signs history is printed. If the
recorder is in the maternal-only mode, the recorder interrupts any printing of data to
print the vital signs history; any pre-empted data is printed at the end. If the recorder
is off, it will turn on to print the vital signs history, then turn off again.
Printing the Entire Vital Signs History

Select the PrintAll softkey to print the entire vital signs history. An audible tone
provides confirmation.
Printing a Page of the Vital Signs History

Use the View softkey to display a page; then select the Print softkey to print the
selected page. An audible tone provides confirmation.
Stopping the Printing of Maternal Vital Signs History

Printing automatically stops if:
 you open the recorder door;
 strip chart paper runs out;
 you press the Test button;
 you change the recorder mode.
CAUTION
Do not turn monitor off during printing or your data will be lost.

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Vital Signs History Print Example
13 Heartbeat Coincidence

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Heartbeat Coincidence:
For your notes

Heartbeat Coincidence Theory
The heartbeat coincidence feature alerts you when there is the possibility that you
may be monitoring a duplicate signal. Heartbeat coincidence is indicated when any
two heartbeats have a consistent phase relationship for equal to or greater than 60%
of the detected beats for about 60 seconds; the cessation of coincidence is indicated
when the phase relationship is inconsistent for greater than 40% of the detected
beats for about 7 seconds.
Heartbeat coincidence detection is most useful when monitoring twins but can also
detect when an elevated maternal heart rate is mistaken for a fetal heart rate.
NOTE: The maternal heart rate derived from blood pressure readings is not used to
detect heartbeat coincidence since blood pressure is a static measurement.
The following table summarizes the combinations of heart rate sources that are
continuously compared for the possibility of coincidence.
Heartbeat Coincidence Comparisons
Mode FECG US US2 MECG MSpO2
FECG    
US    
US2    
MECG   
MSpO2   
Using the Heartbeat Coincidence Feature

Enabling/Disabling Heartbeat Coincidence Detection
This feature is enabled from the password-protected Install Options service mode
screen. Refer to the “250/250cx Series Monitor Service Manual” for detailed
information about enabling/disabling this feature.
Display Indicator
When heartbeat coincidence detection is enabled, the acronym HBC appears to the
right of the FHR2 mode title. (See “Heartbeat Coincidence Example” below.) If the
monitor detects two heartbeats that appear to be coinciding, this may indicate that
the two channels are picking up the same signal. When this coincidence occurs, the
heart rate numerics for both heart rates display in inverse video, as shown below.
(Inverse video is a dark background with white numerics.) As soon as coincidence
is resolved, the numerics return to standard video. (Standard video is a white
background with dark numerics.)

2036946-001
Heartbeat Coincidence: Using the Heartbeat Coincidence
Feature
NOTE: Although an unlikely scenario, if three channels are picking up the same
signal, the heart rate numerics for all three heart rates display in inverse
video.
If you disconnect a transducer while coincidence is detected, any value displayed in

inverse video returns to standard video.
US US2 HBC TOCO
163 163 30
Pulse
77
Off
12:32:27
Alarms Setup VSHX
Heartbeat Coincidence Example

Strip Chart Annotation
When heartbeat coincidence detection is enabled, the annotation HBC prints in the
center margin of the strip chart paper following the active FHR modes. (Refer to
“Simulated Heartbeat Coincidence Detection Trace,” on page 13-5.)
As soon as heartbeat coincidence is detected, two overlaid hearts print in the

upper portion of the top grid of the strip chart paper; the hearts print every 4.5 cm
for as long a coincidence is detected. Once coincidence is resolved, two side-by-
side hearts print once.
If you disconnect a transducer while coincidence is detected, the overlaid hearts

stop printing. In addition, the mode status line prints on the strip chart paper—
without the HBC annotation—indicating the deactivated mode.
Coincidence detected.
Coincidence resolved.
Simulated trends.
Coincidence enabled. This annotation prints every 30 minutes along with the modes.
Simulated Heartbeat Coincidence Detection Trace

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14 Waveforms

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Waveforms:
For your notes

Waveform Area
The waveform area displays approximately 4 seconds of waveform data from one of
the following: FECG, MECG, or MSpO2. The waveform chosen for display is
independent of any of the numerics shown on the display.
For example: MSpO2 can be chosen as the maternal pulse rate source (numerics)
while the MECG waveform is selected for display in the waveform area.
CAUTION
WAVEFORM INTERPRETATION—Waveforms generated by
the 250cx Series Monitor are not intended for true diagnostic
interpretation.
Selecting the Waveform

Use the Waveform softkey on the normal operating screen to select FECG, MECG,
MSpO2, or Off. (Refer to Figure on page 14-4.)
Waveform Speed
All waveforms are displayed at a rate of 25mm/sec. This speed is not adjustable.
The speed is displayed at the top right of the waveform.
ECG Size
The size is printed in the upper right above the waveform. This label is also a
softkey which can be used to change the setting. Select from the following: 0.25x (4
mV/cm), 0.5x (2.0 mV/cm), 1x (1.0 mV/cm), 2x (0.5 mV/cm), 4x (0.25 mV/cm), or Auto.
MECG Lead Select

The selected lead is displayed in the upper right above the waveform. This label is
also a softkey which can be used to change the setting. Select from the following: I,
II, or III.
NOTE: The MECG lead can also be changed from the MHR/P Setup screen.
MECG Pacer Label

When the MECG Pacer option is enabled (On), the letter P is displayed prior to the
waveform speed. See Figure on page 7-6.

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Waveforms: Waveform Area
Moving Gap
For all waveforms, a moving gap (a blank gap separating the line in a waveform)
scrolls along the screen. The gap can be thought of as a pen drawing the waveform
on the screen and erasing old data along the way. The most recent data is displayed
to the left of the bar; the oldest data is displayed to the right of the bar.
US US2 HBC TOCO
165 172 30
MECG
NIBP
89 MSpO2
02:15
130/ 85
This softkey selects
MAP (107)
97% the lead for MECG
only: I, II, or III.
03:15
25 mm/s II Auto
Scale
represents 1 mv
MECG09:21:41 Frozen 09:22:06
This softkey selects the waveform for Moving gap This softkey selects the size for FECG or
display: FECG, MECG, MSpO2, or Off. MECG: 0.25X, 0.5X, 1X, 2X, 4X, or Auto.
Waveform Area on the Display
Freezing Waveforms
The waveform displayed in the waveform area can be “frozen” on the display for
review; the most recent data is displayed on the screen for analysis. The message
Frozen (for any waveform), along with the time of activation, is displayed at the
lower left of the waveform. (All numerics continue to be updated and the real-time
clock continues to be displayed.)
Select the Freeze softkey to freeze a waveform; select it again to return to real-time
display.
Printing a Waveform Snapshot
Select the Print softkey to print a 6-second snapshot of the displayed waveform—
regardless of whether the waveform real-time or frozen. The following figure
provides a sample MECG waveform snapshot on strip chart paper.
The waveform is printed on the lower portion of the top (or left) grid. A vertical tick
mark is printed at the start, 3-second mark, and end (or 6-second mark), for
reference. If the waveform is frozen, 6 seconds of historical data are printed ending
with the time the waveform was frozen on the display. If the waveform is displayed
in real-time, 6 seconds of historical data are printed ending with the time the Print
softkey was activated.
Example MECG Waveform Snapshot
Recorder On
If the recorder is on, the waveform overlaps the MHR/P trace (if enabled), with no
interruption to other trending. The recorder speed remains at the selected rate of 1, 2,
or 3 cm/min.

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Waveforms: Printing a Waveform
Snapshot
Recorder in Maternal-Only Mode

If the recorder is running in maternal-only mode, the waveform does not interrupt
the printing of data and prints at a high-speed mode of 12 cm/min. When finished,
the recorder returns to the maternal-only mode.
Recorder Off
If the recorder is off, the waveform print using a high-speed mode of 12 cm/min
after which the recorder turns off again.
NOTE: You cannot switch between different types of waveforms without

cancelling any printing that is in progress.
NOTE: The monitor must collect 6 seconds of new data following completion of a
print function before it can print again.
Stopping a Print Command

The following actions interrupt waveform printing:
 changing the recorder mode
 pressing the Test button
 opening the recorder door
 running out of paper
 turning off the monitor
CAUTION
DATA STORAGE—Stored data for the maternal Vital Signs History
screen is immediately lost when the monitor is turned off. This
ensures that stored data for one patient is not inadvertently
transferred to a new patient. Refer to Chapter 12, “Maternal Vital
Signs History” for more information.
15 Maintenance

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Maintenance:
For your notes

Cleaning
General care and cleaning are required for the 250cx Series Monitor and its
accessories. If an accessory is not listed, consult the manufacturer’s instructions.
CAUTION
Unplug the monitor from the AC power source and detach all
accessories from the monitor. Do not immerse accessories in any
liquid. Do not use abrasive cloth or cleaners on monitor or
accessories.
Monitor Exterior
1. The exterior surfaces of the equipment may be cleaned with a dampened, lint-
free cloth. Use one of the following approved solutions:
 Commercial diluted bleach solution
 Mild soap (diluted)
 Commercial diluted ammonia solution
NOTE: Always dilute cleaning solutions per manufacturers’
recommendations.
2. Wipe off cleaning solutions with a clean dry cloth.
3. Do not use a cleaning substance containing wax.
4. Do not pour or spray water or any cleaning solution on the equipment or
permit fluids to run behind switches, into the connectors, into the recorder, or
into any ventilation openings in the equipment.
5. Do not use the following cleaning agents:
 Abrasive cleaners or solvents of any kind
 Acetone
 Ketone
 Alcohol-based cleaning agents or
 Betadine
CAUTION
Failure to follow these rules may melt, distort, or dull the finish of
the case, blur lettering on the labels, or cause equipment failures.
Cleaning products known to cause the types of problems
mentioned above include, but are not limited to Sani-Cloth
Wipes*, Sani-Wipes*, and Ascepti Wipes*. These should be
avoided. Products containing active ingredients and solutions
similar to these products should also be avoided.

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Maintenance: Cleaning
Display
To clean the display screen, use a soft, clean cloth dampened with a glass cleaner.
Do not spray the glass cleaner directly onto the display. Do not use alcohol or
hospital disinfectants like Cidex* or Betadine.
Tocotransducer and Ultrasound Transducer
CAUTIONS
ABRASION—Do not use abrasive cloth, sharp objects, or
abrasive cleaners.
ALCOHOL—Do not use Alcohol in cleaning solutions. DISCONNECTION
—Detach the transducers from the monitor.
NOTE: Only Nautilus transducers are immersible.
1. Dampen a cloth or paper towel with one of the following products; then wring
out until only slightly wet:
 Sodium Hypochlorite 5.25% (Bleach) diluted 10:1
 Cidex*
 Sporicidin*
 Soap and water
2. Rub soiled area until clean, taking care not to excessively wet
the tocotransducer diaphragm seal. Rub around the seal.
3. Dry with a soft, dry cloth.
Leg Plates and MECG Cables
CAUTIONS
ABRASION—Do not use abrasive cloth, sharp objects, or
abrasive cleaners.
ALCOHOL—Do not use Alcohol in cleaning solutions.
DISCONNECTION—Detach the cables/legplate from the

monitor.
IMMERSION—Do not immerse cables or hold under running

water.
1. Dampen a cloth or paper towel with one of the following products; then wring
out until only slightly wet:
 Sodium Hypochlorite 5.25% (Bleach) diluted 10:1
 Cidex*
*Trademarked
 Sporicidin* Soap and water
2. Rub soiled area until clean.
3. Dry with a soft, dry cloth.
Maternal NIBP Cuffs and Hoses

General
The cuff must be thoroughly cleaned with the specified detergent before reuse.
The additional use of household bleach as described below provides at least
intermediate-level disinfection.
 Apply cuff hose plugs before cleaning.

 The following cleansing procedure was repeated 20 times on DURA-
CUF® Blood Pressure Cuffs and once on SOFT-CUF® Blood Pressure
Cuffs without affecting the performance of the cuff.
 While this procedure is adequate for cleaning/disinfection, it may not
remove all stains.
 Do not immerse hoses.
 Do not immerse cuffs without prior application of cuff hose caps.
Materials
 Enzymatic detergent such as ENZOL* enzymatic detergent (US)
or Cidezyme* enzymatic detergent (UK)
 Distilled water
 10% solution of household bleach (5.25% sodium hypochlorite) in
distilled water
 Soft cloths and soft-bristled brushes
 Spray bottles
Procedure
1. Prepare the enzymatic detergent according to the manufacturer’s
instructions and the 10% bleach solution, in separate spray bottles.
2. Spray the detergent liberally on device. If the material is dried on, allow the
cuff to sit for 1 minute. For soil on the soft part of the closure or the cuff itself,
wipe the material off with a soft cloth. For persistent contamination on the soft
part of the closure, use a soft-bristled brush to loosen particles. Rinse with
copious amounts of distilled water. Repeat until no visible contamination
remains. For soil on the hook part of the closure, use a soft-bristled brush to
remove the material, and rinse with copious amounts of distilled water. Repeat
until no visible contamination remains.
3. Spray the 10% bleach solution on the affected area until the area is saturated.
Allow the cuff to sit for 5 minutes.
4. Wipe away any excess solution and rinse the cuff again with distilled
water. Allow 2 hours for drying.
*Trademarked
Maintenance: Maternal SpO2
Calibration
The user has the responsibility to validate any deviations from the recommended
method of cleaning and disinfection.
For additional information on infection control procedures, contact GE Medical

Systems Information Technologies Technical Support.
SpO2 Sensors
Adhesive sensors are sterile and for single use only. Reusable sensors should be
cleaned before reuse with a 70% alcohol solution. If low-level disinfection is
required, use a 1:10 bleach solution. Do not use undiluted bleach (5% - 5.25%
sodium chlorite) or any cleaning solution other than those recommended here
because permanent damage to the sensor could occur. Do not sterilize the sensor by
irradiation, steam, or ethylene oxide. If disposable sensors or their packaging are
damaged, they must be disposed of as advised in this appendix.
To clean or disinfect the sensor:
1. Saturate a clean, dry gauze pad with the cleaning solution. Wipe all surfaces of
the sensor and cable with this gauze pad.
2. Saturate another clean, dry gauze pad with sterile or distilled water. Wipe
all surfaces of the sensor and cable with this gauze pad.
3. Dry the sensor and cable by wiping all surfaces with a clean, dry gauze pad.
Maternal SpO2 Calibration

The 250cx Series Monitor automatically calibrates the pulse oximetry parameter
upon power up, whenever a new sensor is attached, and at periodic intervals during
use. The intensity of the sensor’s LEDs are also automatically adjusted to
compensate for differences in tissue density.
NIBP Maintenance
A leak test of the NIBP parameter should be performed at least once a year or when
there is doubt about the validity of the pressure readings.
CAUTION
Refer calibration and leak testing to qualified service personnel.
Full calibration details are available in the Corometrics 250cx
Series Monitor Service Manual, available from GE Medical
Systems Information Technologies.

2036946-001
Disposal of Product Waste
As you use the 250cx Series monitor, you will accumulate solid wastes that require
proper disposal or recycling. These include patient applied parts and packaging
material.
Patient Applied Parts

Certain patient applied parts, such as those with adhesive (disposable SpO 2 sensors),
are intended for single use and should be disposed of properly as medical waste in
accordance with regional body controlled guideline.
Other patient applied parts, such as blood pressure cuffs, should be cleaned
according to instructions. Inspect reusable applied parts for wear, replace as
necessary, and dispose of used product as medical waste in accordance with
regional body controlled guideline.
Packaging Material
Retain original packaging materials for future use in storing or shipping the monitor
and accessories. This recommendation includes corrugated shippers and inserts.
Whenever possible recycle the packaging of accessories and patient applied parts.
Monitor
At the end of its service life, the product described in this manual, as well as its
accessories, must be disposed of in compliance with the guidelines regulating the
disposal of such products. If you have questions concerning disposal of the product,
please contact GE Medical Systems Information Technologies or its representatives.
Maintenance: Disposal of Product
Waste

2036946-001
16 Troubleshooting
This section of the manual provides a troubleshooting guide for the most basic
250cx Series Monitor operational problems. If the response to a specific question is
not found, contact Technical Support.
Inside the United States: 1-800-558-7044
Outside the United States: Contact your local representative

Troubleshooting:
For your notes

2036946-001
General Troubleshooting
General Troubleshooting
Problem Probable Cause Possible Solution
No monitoring functions and green  Monitor is not connected to an AC  Connect the power cord to an AC
Power indicator does not illuminate line receptacle. line receptacle.
when Power switch is placed in the  The AC power cord is defective.  Replace the power cord.
On (I) position.  The AC outlet is defective.  Use a different outlet.
 The power cord is not connected to  Connect the power cord to the
the monitor. monitor.
 Blown fuses.
 Power selector software has the  Call Biomedical Engineering
wrong setting. Department.
 Recorder does not function and  Recorder is off, out of paper, or paper  Press Record button; or install/re-install
the Record indicator is off. is incorrectly loaded. paper (see 4-3), then press Record
button.
 Recorder does not function and  Recorder is in maternal-only mode.  Press Record button to turn on.
the Record indicator flickers three
short flashes every 5 seconds.
 Recorder functions however, Record  Paper supply is low.  Install paper (see 4-3).
indicator flashes on and off every
second.
 Recorder does not function; the  Paper loaded backwards.  Re-install paper (see 4-3).
Record indicator is off; the
message PAPER INCORRECTLY
LOADED, RELOAD WITH BLACK
SQUARES DOWN is shown in
maternal waveform area.  Service required.  Call Biomedical Engineering
 Recorder does not function and Department.
the Record indicator is on.
Incorrect time and date.  Time incorrectly set.  Access the General Setup screen
and reset the time and date (see
“Setup Section”).
 Clock circuit or battery fault.  Call Biomedical Engineering
Department.
Battery Low Icon appears  Data Corruption  Cycle power. Access setup screens
and reset last-used settings
 Battery needs service.  Call GE Service to report
No heartbeat or pulse sounds.  Volume set too low.  Press the Volume buttons or
access the respective setup
screen(s) (FECG, US, or US2) to
 Transducer not connected or is loose. increase the volume.
 Ensure that each transducer is
securely attached to monitor and
applied to the patient.
Troubleshooting: Ultrasound
Troubleshooting
Ultrasound Troubleshooting
Ultrasound Troubleshooting
Ultrasound not functioning properly.  Transducer not properly connected  Ensure that transducer is
to monitor. securely attached to monitor.
 Transducer placement.  Wait before moving transducer;
FHR often returns. Reposition
 Too little gel applied to transducer. transducer.
 Defective transducer.  Apply more gel.
 Active fetus or mother. Fetal arrhythmia  Replace transducer.
or hiccups. Extreme maternal obesity.  Use alternate technique.
 No signal.
 Service required.  Auscultate FHR.
 Call Biomedical Engineering
Department.
 Check maternal pulse to
ensure monitoring of FHR.
Static noise on ultrasound.  Active fetus.  Reposition transducer.
 Environmental noise.  Keep sheets and gown off
transducer. Do not hold transducer
 Maternal movement. with hand.
 Defective transducer.  Use alternate monitoring mode.
 Replace transducer.
Rate on FHR area of display and FHR Monitor is set for 30 bpm/cm vertical Call Biomedical Engineering Department.
trend on strip chart paper do not scale and 20 bpm/cm vertical scale strip
correlate. chart recorder paper is being used (or vice
versa).

2036946-001
FECG Troubleshooting
FECG Troubleshooting
Internal FECG erratic or not  Cable not properly connected to monitor.  Ensure cable is securely attached to
recording properly. the monitor.
 Attachment pad or legplate not  Secure attachment pad or legplate
securely attached to patient. to patient.
 Electrode wire not secure  Inspect legplate connection.
in legplate post.
 Paste is dried or incorrect paste is  Check ECG paste; re-apply,
being used. if necessary.
 Electrode not properly attached.  Replace electrode.
 No FECG signal.  Auscultate FHR.
 Defective electrode.  Replace electrode.
 Defective attachment pad.  Replace attachment pad.
 Service required.  Call Biomedical Engineering
Department.
Rate in FHR area of the display and Monitor is set for 30 bpm/cm vertical Call Biomedical Engineering Department.
the FHR trend on the strip chart paper scale and 20 bpm/cm vertical scale
do not correlate. strip chart recorder paper is being
used (or vice versa).
External Uterine Activity Troubleshooting

External UA Troubleshooting
Tocotransducer not recording contractions.  Transducer not properly connected  Ensure that transducer is
to monitor. securely attached to monitor.
 Transducer not properly placed.  Reposition transducer.
 Transducer not secured to patient.  Secure or re-apply transducer to patient.
 Defective transducer/cable assembly.  Replace transducer/cable assembly.
 No maternal contractions.  Wait.
 UA Reference range exceeded.  Loosen belts or remove transducer
from patient. Press UA Reference
button while no pressure is applied
to transducer button. Re-apply
transducer. Do not overtighten belt.
Press UA Reference button again
between contractions. (See “Out of
Range Condition” on page 6-4 for further
information.)
Troubleshooting: Internal UA
Troubleshooting
External UA Troubleshooting
Flashing “+” sign. mmHg > 100 (13.3 kPa) Press the UA Reference button between
contractions.
CHECK TOCO message is shown in  UA Reference button pressed  You must wait 10 seconds
UA area of the display area when before UA circuits stabilized. following powering on the
the UA Reference button is pressed. monitor and/or connecting to the
 UA Reference range exceeded due UA connector.
to over-tightening belt.  Loosen belts or remove transducer
from patient. Press UA Reference
button while no pressure is applied
to transducer button. Re-apply
transducer. Do not overtighten belt.
Press UA Reference button again
between contractions. (See “Out of
 Transducer defective. Range Condition” on page 6-4 for further
 Service required. information.)
 Replace transducer.
 Call Biomedical Engineering
Department.
Internal UA Troubleshooting
Internal UA Troubleshooting
Internal pressure not measuring correctly.  Cable not properly connected to monitor.  Ensure cable is securely attached
to monitor.
 Catheter has fallen out of place.  Replace catheter.
 Catheter zeroed.  Calibrate catheter.
Department.
CHECK IUP message displayed in UA  Blockage or kinked catheter.  Flush catheter. Re-zero.
area of the display. Replace catheter if necessary.
 Fetus pressing directly on catheter.  Reposition by twisting catheter.
 Defective catheter.  Replace catheter.
Department.

2036946-001
MECG Troubleshooting
MECG Troubleshooting
MECG erratic or not functioning  Cable not properly connected to monitor.  Ensure cable is securely attached
properly. to monitor.
 Re-apply electrodes.
 Electrodes not properly placed.
 Check clip attachments.
 Clips not attached to electrodes
 Check electrodes and change
properly.
if necessary.
 Electrode gel dried.
 Replace cable.
 Defective MECG cable.  Change lead selection on MHR/P
 Selected lead Setup
providing inadequate screen.
signal.  Call Biomedical Engineering
 Service required. Department.
Dashes (– – –) shown in MHR/P area Monitor unable to make a Ensure patient is not asystolic.
of display. determination due to insufficient Ensure electrodes are firmly secured
signal. to patient.
Blood Pressure Troubleshooting

High reading. Measurement taken during  Annotate chart, then take a
uterine contraction. manual reading in-between
contractions.
 If possible, cancel reading
during contraction.
 Enable the monitor’s Smart BP
feature.
CHECK CUFF message displayed in  Improper cuff position.  Reposition cuff.
NIBP  Loose cuff.  Tighten cuff.
area of display.  Air pressure error.  Contact Biomedical Engineering
Department.
 Maternal movement.  Restrict patient limb movement.
 Hose not properly connected to  Ensure that hose is firmly attached
monitor. to monitor.
 Ensure an adult cuff is connected.
 Neonatal cuff connected.
OVERPRESSURE message displayed in  Cuff pressure has exceeded the  Restrict patient limb movement. If this
NIBP area of display. overpressure limit of 315 ± 15 is not the case, contact Biomedical
mmHg (42.0 ± 2.0 kPa). Engineering Department to perform
pneumatic test.
 Kinked hose.  Check the external cuff for kinks.
 Blocked hose.
Troubleshooting: Maternal Pulse Oximetry Troubleshooting

COMM ERROR message displayed in Communication error between the built- Call Biomedical Engineering Department.
NIBP area of display. in NIBP parameter and the remainder
of the monitor circuitry.
MOTION message displayed in NIBP  Excessive maternal movement.  Talk to patient about the importance
area of display.  Maximum reading determination time of minimizing limb movement.
exceeded.  Reposition cuff.
 Check patient for arrhythmia. Move
cuff to another limb.
REPAIR message display in NIBP area of System error or self-test failure. Contact Biomedical Engineering
display. Department.
WEAK SIGNAL? message Monitor unable to make a Assess patient situation.
determination due to insufficient
signal.
Maternal Pulse Oximetry Troubleshooting

Maternal Pulse Oximetry Troubleshooting
Dashes (– – –) shown in MSpO2  Monitor unable to make a  Check patient. The patient may be
display area. determination due to insufficient experiencing shock, hypotension, severe
signal. vasoconstriction, severe anemia,
hypothermia, arterial occlusion
proximal to the sensor, or cardiac
arrest.
 Ensure that the intermediate cable
is firmly attached to the monitor and to
the sensor assembly.
 Improperly applied sensor.  Ensure sensor is not too tight.
Move sensor to another location.
 Excessive maternal movement.  Restrict patient limb movement. Restrain
limb if necessary.
 Excessive ambient light.  Cover sensor with opaque material.
 Damaged sensor  Replace sensor.
REPAIR message shown in MSpO2 area of System error or self-test failure. Contact Biomedical Engineering
display. Department.
SENSOR message shown in MSpO2 area Wrong MSpO2 cable and/or sensor Check the type of MSpO2 technology
of display. (Nellcor only) connected to the monitor. your monitor contains (the label next to
the lower, right-hand side of the
display) and use the corresponding
cables and sensors for that technology.

2036946-001
17 Technical Specifications
This section contains a detailed list of the technical specifications for the 250cx
Series Monitor.
Technical Specifications:
For your notes

2036946-001
General Monitor
General Monitor Technical Specifications
Category Technical Specifications
Power Requirements
Nominal Line Voltage: 100VAC 120 VAC 220 VAC 230 VAC 240 VAC
Line Frequency: 50/60 Hz 50/60 Hz 50/60 Hz 50/60 Hz 50/60 Hz
Power Consumption (maximum): 100 W 100 W 0.4 A 0.4 A 0.4 A
Chassis Leakage: <300 µA
Physical Characteristics
Height: 6.7 in (17.0 cm)
Width: 16.7 in (42.4 cm)
Depth: 17.5 in (44.4 cm)
Weight: 22.0 lbs (10.9 kg) approx.
Environmental Conditions Operating Storage

Monitor:
Ambient Temperature: 50°F to 104°F (10°C to 40°C) 14°F to 131°F (–10°C to 55°C)
Relative Humidity: 10% to 95%, non-condensing 0% to 95%, non-condensing
Atmospheric Pressure: 700–1060 mbar (525–795 mmHg) 700–1060 mbar (525–795 mmHg)
Strip Chart Paper1:
Ambient Temperature: 50°F to 104°F (10°C to 40°C) < 80°F (< 26.5°C)
Relative Humidity: 30% to 70%, non-condensing 45% to 65%, non-condensing
Atmospheric Pressure: 700–1060 mbar (525–795 mmHg) 700–1060 mbar (525–795 mmHg)
Certification
ANSI/AAMI EC13-1992: Complies with all areas except those listed below:
3.1.2.1e: Heart Rate Meter Accuracy and Response to Irregular Rhythm (not
tested) 3.2.6.1: Range of QRS wave amplitude and duration
3.2.7: Range and accuracy of heart rate meter (4.2.7 f: input rate of 300
bpm.) 3.2.8.1: Lower Alarm Limit (The lowest alarm limit on the 250cx Series
is 35 bpm.) 3.2.9.7a: Output Display a) Channel Width
3.2.9.8c: Impulse Response
3.2.9.12: Pacemaker Pulse Display
UL-2601.1: capability Classified to UL-2601.1
Medical electrical equipment classified by Underwriter’s Laboratories, Inc., with
respect to fire, shock, and mechanical hazards in accordance with UL-2601.1.
CUL: Classified with respect to electric shock, fire, mechanical, and other specified
hazards only, in accordance with CAN/CSA C22.2 No. 601.1
1
Paper operating environmental conditions are for a period of less than one month. Paper storage environmental conditions are for extended storage.
Technical Specifications: Operating Modes
Operating Modes
Operating Mode Specifications
CAUTION
The monitor may produce incorrect results if
operated outside the minimum specified parameter
specifications in this table.
FECG Mode
Technique: Peak detecting, beat-to-beat cardiotachometer
Heart Rate Counting Range: 30–240 bpm
Heart Rate Resolution: ± 1 bpm
Artifact Elimination: Selectable, ± 25 bpm artifact rejection
Countable Input Signal Range: 15 µV to 2 mV peak-to-peak
Offset Voltage Tolerance (Differential): ± 300 mVdc maximum
Maximum Common Mode Voltage: 20 V peak-to-peak
Preamplifier Bandwidth: 1–90 Hz
Common Mode Rejection:
Balanced: > 120 dB at mains frequency, with patient cable
Unbalanced 5kΩ RA or > 110 dB at mains frequency
LA: Input Equivalent Noise: < 10 µV peak-to-peak
Input Impedance:
Differential: > 10 MΩ
Common Mode: > 20 MΩ
Mains Frequency Rejection: > 40 dB
Leakage Current: < 60 µA at 254 VAC, electrically isolated
Isolation, Mains-to-Patient: > 4 kVAC
Ultrasound Mode
Technique: Pulsed Doppler with autocorrelation processing
Transducer Type: 9-crystal
Pulse Repetition Frequency:
Single Ultrasound Mode: 4 kHz
Dual Ultrasound Mode: 2 kHz
Pulse Duration: 92 µs
Transmitter Frequency: 1.151 MHz
Spatial-Peak Temporal Average Intensity: Ispta < 10 mW/cm2
Spatial-Average Temporal Average Intensity:
Isata< 5 mW/cm2
Focal 20 dB Beam Area:
16.6 cm2, at a range = 7 cm
Peak Instantaneous Intensity: 1.8
Peak-Negative Acoustic Pressure:
mW/cm2 p
Heart Rate Counting Range: < 10.0 kPa
Leakage Current: 50–210
bpm
< 10 µA at 120–240 VAC, isolated by transducer
Uterine Activity Mode Strain Gauge Tocotransducer
Range:1 0–100 mmHg (0–13.3 kPa) 0–100 mmHg (0–13.3 kPa)
Resolution: 1 mmHg (0.13 kPa) 1 mmHg (0.13 kPa)
Bandwidth: dc to 0.5 Hz dc to 0.5 Hz
Excitation Voltage: +4.0 Vdc
Zero Set Temperature < 0.1 mmHg/°C (0.013 kPa/°C), excluding transducer
Drift: Leakage Current: < 60 µA at 254 VAC, electrically isolated

2036946-001
Technical Specifications: Operating Modes
1
The ranges shown here are typical ranges seen in a clinical setting.

2036946-001
Operating Mode Specifications (Continued)
MECG Mode
Technique: Peak detecting, beat-to-beat cardiotachometer
Maternal ECG Electrode Type: Medtronic 1700-003 or equivalent
Leads Available: I, II, and III
Heart Rate Counting Range: 30–240 bpm
Heart Rate Resolution: ± 1 bpm
Heart Rate Update Rate: > 1 update per second
Countable Input Signal 0.5 mV to 5 mV peak-to-peak
Range: Baseline Drift: < 0.5 mV RTI
Tall T-wave Rejection: 0.8 x QRS amplitude
Heart Rate Meter Response
Time: 80–120 bpm Step < 2 seconds
Increase: 80–40 bpm Step < 3 seconds
Decrease: < 10 seconds (high alarm limit at 100 bpm)
Alarm Time for Tachycardia 80–200 ± 300 mVdc maximum
bpm: Offset Voltage Tolerance 20 V peak-to-peak
(Differential): Maximum Common 0.6 to 40 Hz
Mode Voltage: Preamplifier
Bandwidth: > 80 dB at mains frequency, with patient cable
Common Mode Rejection: > 50 dB at mains frequency
Balanced: < 30 µV peak-to-peak
Unbalanced 5K RA or LA: > 2.5 MΩ
Input Equivalent Noise: Input > 10 MΩ
Impedance: Differential: > 40 dB
Common Mode: < 60 µA at 254 VAC, with cable, electrically isolated
Mains Frequency Rejection: > 4 kVAC
Leakage Current: dc current < 0.1 µA
Isolation, Mains-to-Patient:
Leads Off Detection: Alternating 1.5-second chimes
Alarms: Flashing heart rate numeric or message
Audio: User-selectable high and low maternal heart
Visual: rate Leads off
Limits: < 8 seconds
Technical:
Tachycardia Response Time:
Pacemaker Detection/Rejection:
Input Voltage Range: ± 2.5 mV to ± 700mV
Input Pulse Width: 0.1 to 2 ms
Pulse Rise/Fall Time: < 10% of pulse width; not greater than
Overshoot/Undershoot: 100 µs 2 mV
CAUTION
Excessive overshoot time of pacemaker pulse may cause false QRS
detection.
Maternal Blood Pressure Mode (DINAMAP® SuperSTAT)

Technique: Oscillometric. Microprocessor software eliminates most ambient
noise and motion artifact.
Blood Pressure Range:
Systolic 30–290 mmHg (4.0–38.7 kPa)
Diastolic Visual 10–220 mmHg (1.3–29.3 kPa)
Mean Arterial Pressure (MAP) 20–260 mmHg (2.7–34.7 kPa)
Pulse Rate Range: 30–200 bpm

Blood Pressure Accuracy: ± 5 mmHg (0.7 kPa) with a standard deviation no greater than 8
mmHg (1.1 kPa)
Pulse Rate Accuracy: ± 2 bpm or ± 2% (whichever is greater)
Cuff Inflation: Initial inflation to 135 mmHg (18.0 kPa). Subsequent inflation
approximately 30 mmHg (4.0 kPa) greater than the previous
systolic pressure.
Inflation Pressure Range: 100-250 mmHg in increments of 5 (13.3 ± 33.3 kPa in steps of
Cuff Deflation: 0.7) Automatic
Safety Features: Automatic cuff deflation if: cuff pressure exceeds the overpressure
limit of 315 mmHg ± 15 mmHg (42.0 ± 2.0 kPa); or maximum
reading determination time is exceeded (not to exceed AAMI /ANSI
SP10-1992 limit of 180 s); or safety timer detects microprocessor
failure. Auto mode minimum 30-second delay from the end of one
determination to the beginning of another to allow for venous
return.
Display/Record:
Alarms: Systolic, diastolic, and mean pressure; pulse rate
Audio
Visual Alternating 1.5-second chimes
Limits Flashing pressure numeric or
message
Technical User-selectable high and low systolic, diastolic, and mean
pressures; User-selectable high and low pulse rate
Cuff errors, connection errors, insufficient signal, excessive inflation
or determination times, overpressure, hose errors, excessive
motion, communication problem, or self-test failure.
Compliance:
The 250cx Series blood pressure parameter complies with the
American National Standard for Electronic or Automated
Sphygmomanometers [AAMI/ANSI SP10-1992]. The GE monitor
values are based on the oscillometric method of noninvasive
blood pressure measurement and correspond to comparisons with intra-
aortic values within ANSI/AAMI Standards for accuracy.
This device is covered under one or more of the following US Patents: 6,423,010; 6,358,213; 5,704,362; 5,680,870; 5,579,776; 5,518,000; 5,170,795; 5,052,397;
4,754,761; 4,638,810 and international equivalents. USA patents pending.
Maternal Pulse Oximetry Mode (Masimo)
Technique: Spectrophotometry and plethysmography.
Sensor Accuracy1:
Sensor Model LNOP® DC-I, LNOP-Adt, LNCS PC-I, and LNCS-Adt
Weight Range > 30 kg
Saturation No Motion ± 2%
Accuracy Motion ± 3%
Pulse Rate No Motion ± 3 bpm
Accuracy Motion ± 5 bpm
Low Perfusion Saturation ± 2%
Accuracy Pulse Rate ± 3 bpm
Measurement Range:
Saturation Range (SpO2%) 1%-100%
Pulse Rate (bpm) 25-240 beats/min
Perfusion 0.02%-20%
Accuracy and Motion Tolerance:
Saturation (SpO2%)
During no motion conditions - Adults 2 70%-100% ± 2 digits
During motion conditions - Adults3 70%-100% ± 3 digits
Low Perfusion 70%-100% ± 2 digits
0%-69% unspecified
Wavelengths:
Red 663 nm, nominal
Infrared 880 nm, nominal
Maximum Optical Output Power:
Radiant Power at 50 mA pulsed 0.13 mW, minimum
0.79 mW, maximum
Pulse Rate (bpm)
During no motion conditions - Adults 25 to 240 bpm ± 3 digits
During motion conditions - Adults 25 to 240 bpm ± 5 digits
Resolution:
Saturation (SpO2%) 1%
Pulse Rate (bpm) 1
Low Perfusion Performance4:
>0.02% Pulse Amplitude and % Transmission > Saturation (SpO2%) ± 2 digits
5% Pulse Rate ± 3 digits
Alarms:
Visual Flashing SpO2 numerics or message
Audio Alternating 1.5-second chimes
Interfering Substances Carboxyhemoglobin may erroneously increase readings. The level

of increase is approximately equal to the amount of
carboxyhemoglobin present. Dyes, or any substance containing
dyes, that change usual arterial pigmentation may cause
erroneous readings.
Maternal Pulse Oximetry Mode (Masimo continued)
1
Accuracy specified when used with Masimo SET pulse oximetry modules using PC or LNC series patient cables. Numbers represent ± 1 standard deviation.Plus or
minus one standard deviation represents 68% of the population.SpO2 accuracy from 70% to 100%.Pulse Rate accuracy from 25 to 240 bpm.
2
The Masimo SET® SpO2 parameter with LNOP-Adt sensors has been validated for no motion accuracy in human blood studies on healthy adult volunteers in
induced hypoxia studies in the range of 70-100% SpO2 against a laboratory co-oximeter and ECG monitor. This variation equals plus or minus one standard
deviation. Plus or minus one standard deviation encompasses 68% of the population.
3
The Masimo SET SpO2 parameter with LNOP-Adt sensors has been validated for motion accuracy in human blood studies on healthy adult volunteers in induced
hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz at an amplitude of 1 to 2 cm and a non repetitive motion before 1 to 5 Hz at an
amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70-100% SpO2 against a laboratory co-oximeter and ECG monitor. This variation equals plus or
minus one standard deviation. Plus or minus one standard deviation encompasses 68% of the population. Masimo SET technology with LNOP and LNCS
sensors have been validated with
human blood studies on healthy adult volunteers with induced hypoxia studies. The volunteer population composed of both men and women spanned a range of
skin pigmentations from light to dark and ranged in age from 22 to 40 years old.
4
The Masimo SET SpO2 parameter has been validated for low perfusion accuracy in bench top testing against a Biotek Index 2 simulator and Masimo’s simulator
with signal strengths of greater than 0.02% and a % transmission of greater than 5% for saturations ranging from 70 to 100%. This variation equals plus or minus,
one standard deviation. Plus or minus one standard deviation encompasses 68% of the population.
NOTE: Because pulse oximeter equipment measurements are statistically distributed, only about two-thirds of pulse oximeter equipment measurements can be
expected to fall within ± Arms of the value measured by a CO-Oximeter.
NOTE: Use of a functional SpO2 simulator to assess the accuracy of the Corometrics 250cx SpO2 parameter has not been demonstrated.
This device is covered under one or more of the following US Patents:5,482,036;5,490,505;5,632,272;5,685,299; 5,758,644; 5,769,785; 6,002,952; 6,036,642;
6,067,462; 6,206,830; 6,157,850 and international equivalents. USA and international patents pending.
Maternal Pulse Oximetry Mode (Ohmeda)
Technique: Spectrophotometry and plethysmography
Sensor Type1: OxiTip+ OXY-AP and OxiTip+ OXY-F
Pulse Rate Accuracy: 30-250 bpm; ± 2 digits or ± 2%, whichever is greater (no
motion) 30-250 bpm; ± 5 digits or ± 5%, whichever is greater
(with motion) 30-250 bpm; ± 3 digits or ± 3%, whichever is
greater (during low perfusion)
Saturation Range: 0-100%
Pulse Rate Range: 30-250 bpm
Saturation Accuracy:2 Accuracy, Arms (root mean square of paired values;
previously represented by ± 1 standard deviation)
70-100% ± 2 digits (without motion)
70-100% ± 3 digits (during clinical motion)1
70-100% ± 2 digits (during clinical low
perfusion) Below 70% unspecified
Wavelengths:
Red 650-670 nm
Infrared 930-950 nm
Maximum Optical Output 10.5 mW
Power: Alarms: (audio and
visual) Alternating 1.5-second chimes
Audio Flashing SpO2 numeric or
Visual message
Limits User-selectable high and low SpO2, and high and low pulse
Technical
rate Sensor errors, connection errors, insufficient signal, excessive
motion, communication problem, internal calibration error, or self-
test failure.
1
Applicability: OxyTip+ Adult/Pediatric. Accuracy of Oxy-F sensors has not been validated under clinical motion conditions. Ohmeda sensor accuracy tests were
done with 13 healthy adult subjects. The volunteer population was composed of 3 females and 10 males. The ages ranged from 19 to 35 years old. The weights
ranged from 120 to 185 lb with a mean weight of 158 lb. The skin tones were as follows: 2 African-American and Jamaican subjects with dark pigmentation, 1
Asian subject with light yellow pigmentation, 1 Hispanic subject and 1 Mexican subject with medium pigmentation, and 8 Caucasian subjects with light to medium
pigmentation. OxyTip+ OXY- AP sensor has been validated under motion condition. Three types of motion artifacts were evaluated: mechanically induced tapping
at 3 Hz, random frequency clinical rubbing motion with hand in prone position, and random frequency clinical rubbing motion with hand in supine position.
2
OxyTip+ sensors are validated during low perfusion conditions. Low perfusion was achieved by having the room chilled to 60-68º F, keeping the left side of the
subject warm and the right side cooled to a perfusion index level <= 0.1. Saturation readings were compared against a reference system that was compared to
arterial blood draws.
This device is covered under one or more of the following US Patents: 5,503,148, 5,766,127, 5,934,277, 6,381,479, 6,385,471, 6,397,092, 6,408,198,
6,415,166,
6,434,408, 6,505,060, 6,505,133, 6,510,329, 6,650,918, 6,707,257, 6,714,803.
Maternal Pulse Oximetry Mode (Nellcor)
Technique: Spectrophotometry and plethysmography.
Sensor Type and Accuracy1: SpO2 Range:
OxiMax® Sensor 70%–100%:
Models MAX-A2, ± 2 digits
DS-100A ± 3 digits
Saturation Range: 1–100%
Pulse Rate Range: 30–250 bpm
Accuracy:
Saturation (SpO2%)
Adults2 70%-100% ± 2 digits
Low Perfusion3 70%-100% ± 2 digits
0%-69% unspecified
Pulse Rate (bpm)
Adults 20 to 250 bpm ± 3 digits
Wavelengths:
Red 660 nm, nominal
Infrared 890 nm, nominal
Maximum Optical Output < 15 mW
Power: Response Time: Fast
Alarms (audible and Alternating 1.5-second chimes
visual): Audio Flashing SpO2 numeric or
Visual message
Limits User-selectable high and low SpO2; User-selectable high and
low pulse rate
Technical Sensor errors, connection errors, insufficient signal,
communication problem, internal calibration error, or self-test
failure.
1
Accuracy specifications are based on controlled hypoxia studies with healthy, non-smoking adult volunteers over the specified saturation SpO2 range. Pulse
oximeter SpO2 readings were compared to SaO2 values of drawn blood samples measured by hemoximetry. All accuracies are expressed as ± “X” digits. This
variation equals ± one standard deviation (± 1 SD), which encompasses 68%of the population.Oxygen saturation accuracy can be affected by certain environmental
and patient physiological conditions, as discussed in the operator’s manual for the monitor. Use Nellcor sensors only with 250cx Series Monitors containing Nellcor
oximetry. Consult individual manufacturers for accuracy specifications and compatibility information of particular instruments and Nellcor sensor models. The
volunteer population was composed of healthy men and women recruited from the local population. The ages ranged from 18 to 50 years old, with variations
of skin pigmentations.
2
Adult specifications are shown for OxiMax®MAX-A and MAX-N sensors with the N-600. Saturation accuracy will vary by sensor type.
3
Applicability: OxiMax® MAX-A, MAX-AL, MAX-P, MAX-I, and MAX-N sensors.
4
Information of wavelength range can be especially useful to clinicians performing photodynamic therapy.
This device is covered under one or more of the following Patents: US Patent No. 4,802,486; 4,869,254; 4,928,692; 4,934,372; 4,960,126; 5,078,136; 5,485,847;
5,743,263;
5,865,736; 6,035,223; 6,298,252; 6,463,310; 6,591,123; 6,675,031; 6,708,049; 6,801,797; Re. 35,122; and foreign equivalents.
Maternal Vital Signs History
Storage/Recall: 8 hours, maximum
Technical Specifications: Strip Chart Recorder
Strip Chart Recorder

Strip Chart Recorder Technical Specifications
Heart Rate Scale Domestic International
Chart Width: 7 cm 8 cm
Scaling: 30 bpm/cm 20 bpm/cm
Range: 30–240 bpm 50–210 bpm
Resolution: 1 bpm 1 bpm
Uterine Activity Scale Strain Gauge Tocotransducer
Scaling: 25 mmHg (3.3 kPa)/cm 25 mmHg (3.3 kPa)/cm
Range: 0–100 mmHg (0–13.3 kPa) 0–100 mmHg (0–13.3 kPa)
Resolution: 1 mmHg (0.13 kPa) 1 mmHg (0.13 kPa)
Maternal Pulse Oximetry MSpO2 Scale Domestic International

Scaling: 12.5%/cm or 25%/cm 12.5%/cm or 25%/cm
Range: 60–100% or 0–100% 50–100% or 0–100%
Resolution: 1% 1%
Recorder Drive
Speeds: 1, 2, and 3 cm/min
Speed Accuracy: ± 1%
NOTE: Specifications are subject to change without notice.

2036946-001
18 Supplies & Accessories
This section provides an overall listing of supplies and accessories for use with
250cx Series Monitors. To order any of the supplies and accessories listed in this
manual:
Inside the United States: Call 1-800-558-7044
Outside the United States: Contact your local representative

2036946-001
Supplies & Accessories:
For your notes

General Add-Ons Ordering Information
General Supplies
Item Catalog Number (REF)
Remote Event Marker 3919BAO
Model 2116B Clinical-Notes/Data-Entry System 2116BAX
Model 146 Fetal Acoustic Stimulator 0146AAY
Exergen TemporalScannerTM TAT-5000 Assembly 2036641-001
Paper Supplies Ordering Information

Paper Supplies
Z-Fold Chart Paper Pack, 30–240 bpm Heart Rate Scale (40/carton) 4305CAO
Z-Fold Chart Paper Pack, 50–210 bpm Heart Rate Scale (40/carton) 4305DAO
Ultrasound Ordering Information

Ultrasound Supplies
Loop-Style Ultrasound Transducer (Nautilus), 8-foot Cord 5700LAX
Button-Style Ultrasound Transducer (Nautilus), 8-foot Cord 5700HAX
Ultrasound Coupling Gel Bottle, 250 ml (12/carton) 2434AAO

Reusable Belt for Loop-Style Transducer, Mesh Style (10/carton) 4425AAO
Reusable Belt for Loop-Style Transducer, Velcro Style (10/carton) 4425CAO
Reusable Belt for Button-Style Transducer, Blue (10/carton) 2015827-001
Reusable Belt for Button-Style Transducer, 1 pink and 1 blue/pack (100 packs/case) 2015919-001
Semi-Reusable Belt for Loop-Style Transducer, Velcro Style (1pink and 1 blue/pack; 50 packs/carton) 4425FAO
Single-Patient Use Belt for Loop-Style Transducer, Foam Style with Velcro Closure 8024AAO

2036946-001
Supplies & Accessories: FECG Ordering Information
FECG Ordering Information

FECG Supplies
Qwik Connect Plus Spiral Electrode (50/carton) 7000AAO
Leg Plate for Qwik Connect Plus Spiral Electrode, 8-foot Cord (round connector) 1590AAO
Leg Plate for Qwik Connect Plus Spiral Electrode, 8-foot Cord (rectangular connector) 1591AAO
Attachment Pads for Qwik Connect Plus Spiral Electrode Legplate (50/carton) 2464AAO
Tocotransducer Ordering Information

Tocotransducer Supplies
Loop-Style Tocotransducer (Nautilus), 8-foot Cord 2264LAX
Button-Style Tocotransducer (Nautilus), 8-foot Cord 2264HAX
Reusable Belt for Loop-Style Transducer, Mesh Style (10/carton) 4425AAO
Reusable Belt for Loop-Style Transducer, Velcro Style (10/carton) 4425CAO
Reusable Belt for Button-Style Transducer, Blue (10/carton) 2015827-001

Reusable Belt for Button-Style Transducer, 1 pink and 1 blue/pack: (100 2015919-001
packs/case)
Semi-Reusable Belt for Loop-Style Transducer, Velcro Style 4425FAO
(2/pack; 50 packs/carton)
Single-Patient Use Belt for Loop-Style Transducer, Foam Style with Velcro 8024AAO
Closure
IUPC Ordering Information

IUPC Supplies and Accessories
Saflex IUPC with Amnio Infusion/Sampling Capabilities (10/carton) 2076BAO
Saflex Intermediate Cable 1336AAO

MECG Ordering Information
Defibrillator protection requires the use of GE Medical Systems Information
Technologies recommended cables.
MECG Supplies and Accessories

FECG/MECG Y Adapter Cable 1442AAO
® 1442BAO
FECG Socket Adapter, accepts 1590AAO QuikConnect Plus Leg Plates
MECG Cable for use with detachable leadwires (requires 1442AAO), USA/AHA 1553AAO
MECG Cable for use with detachable leadwires (requires 1442AAO), Intl./IEC 1553BAO
Multi-Link Snap Leadwires, Set of 3, Grouped Detachable, 31 inches 411203-001
Multi-Link Snap Leadwires, Set of 5, Individually Detachable, 31 inches 411200-001
Multi-Link Grabber Leadwires, Set of 3, Grouped Detachable, 31 inches 412682-001
Multi-Link Grabber Leadwires, Set of 5, Individually Detachable, 31 inches 414556-001

Leadwire Adapter, 3-Lead Multi-Link to 3-Lead DIN 414371-001
Electrodes, Round, Foam, Pouches of 30, Case of 300 9431-004
NIBP Ordering Information

NIBP Supplies and Accessories
Air Hose for Dual-Tube, Threaded-Luer Cuff, 12-foot Hose 9461-217
Reusable Single-Tube, Male-Luer Cuff, Small Adult, 18–26 cm Range 5531CAO
Reusable Dual-Tube, Threaded-Luer Cuff, Small Adult E27795
Reusable Single-Tube, Male-Luer Cuff, Adult, 25-35 cm Range 5522CAO

Reusable Single-Tube, Male-Luer Cuff, Large Adult, 33-47 cm Range 5523CAO
Reusable Dual-Tube, Threaded-Luer Cuff, Adult, 25-35 cm Range 5522AAO

Reusable Dual-Tube, Threaded-Luer Cuff, Large Adult, 34-47 cm Range 5523AAO
Reusable Dual-Tube, Threaded-Luer Cuff, Adult Thigh, 46-66 cm Range 5524AAO
Single-Patient Use, Dual-Tube, Locking-Luer Cuff, Small Adult, 18-26 cm Range (10/carton) 900373-003
Single-Patient Use, Dual-Tube, Locking-Luer Cuff, Adult, 25-35 cm Range (10/carton) 900373-002

2036946-001
Supplies & Accessories: MSpO2 Ordering Information
NIBP Supplies and Accessories

Single-Patient Use, Dual-Tube, Locking-Luer Cuff, Large Adult, 33-47 cm Range (10/carton) 900373-001
NIBP Cuff Hose Adapter 414876-001
MSpO2 Ordering Information
MSpO2 Supplies and Accessories

Ohmeda OxyTip+ Adult Adhesive Sensor (10/box) OXY-AP-10
Ohmeda OxyTip+ Adult Adhesive Sensor (25/box) OXY-AP-25
Ohmeda OxyTip+ Interconnect Finger Sensor OXY-F-UN
Intermediate Cable for Nellcor Sensors 2025350-001

Intermediate Cable for Masimo LNOP Sensors 2017002-003
Intermediate Cable for Ohmeda Sensors OXY-ES3

Nellcor Durasensor Adult Reusable Finger Probe 407705-006
Masimo Sensor LNOP Adult Reusable Finger Probe E9008JC/2002800-001
Masimo Sensor LNCS Adult Adhesive (20/box) 2027253-001
Masimo Sensor LNCS Adult Reusable Finger Probe 2027258-001

Intermediate Cable for Masimo LNCS Sensors 2027263-001
Peripheral Device Ordering Information

Peripheral Device Supplies and Accessories
Interface Cable to Nellcor Model N-200/M-400 1557BAO
Pulse Oximetry Monitor, 6-foot
Interface Cable to Nellcor Model N-200/N-400 1557AAO

Pulse Oximetry Monitor, 1-foot
RS-232C Interface Cable to Quantitative Sentinel/Perinatal System 1558AAO

A Factory Defaults
Factory Defaults are found in the table that follows. Factory defaults settings are
dependent upon the model purchased.
Revision C 250cx Series Maternal/Fetal Monitor A-1

2036946-001
Factory Defaults:
For your notes

Table of Defaults
Summary of Factory Defaults
Setup
Field Description Factory Default Default Options Hospital Preference
Screen
FECG or FHR Volume 5 0-9
US/US2
FHR Alarm Limits High Low 200-140, Off
160 120 bpm 60-140, Off
Audio Alarms On On, Off
Volume 5 1-9
NIBP Initial Target Pressure 135 mmHg 100-250 mmHg (13.3-33.3
(18.0 kPa) kPa) in increments of 5
mmHg (0.7 kPa)
Mode Manual Manual, 1, 2, 3, 4, 5, 10,
15,
20, 30, 40, 45, 60, 90, 120
min
NIBP Done Vol 5 0-9
Alarm (mmHg mode) High Low High Low
Systolic 160 90 mmHg 70-240 50-150
Diastolic 90 50 mmHg 70-130 30-120
MAP 140 50 mmHg 70-150 30-120
MHR/P 120 50 bpm 100-250 35-120
Alarm (kPa mode) High Low High Low
Systolic 21.3 12.0 kPa 9.3-32.0 6.7-20.0
Diastolic 12.0 6.7 kPa 9.3-17.3 4.0-16.0
MAP 18.7 6.7 kPa 9.3-20.0 4.0-16.
MHR/P 120 50 bpm 100-250 35-120
Volume 5 1-9
Revision C 250cx Series Maternal/Fetal Monitor A-3

2036946-001
Factory Defaults: Table of
Defaults

Setup
Screen
MSpO2 Response Time Fast Normal, Fast
(Nellcor 506)
Response Time Fast Fast
(Nellcor NELL-3)
Averaging Time (Masimo) 8 seconds 2, 4, 8, 10, 12, 14,
16 seconds
Sensitivity (Masimo) Normal Normal, Maximum
Print Interval 5 minutes Off, 2, 5, 10, 15, 30,
60 minutes
%O2 Trace Off On, Off
Alarms High Low High Low

MSpO2 100 95% 85-100 80-99
MHR/P 120 50 bpm 100-250 35-120
Volume 5 1-9
MHR/P Source Auto Auto, MECG, MSpO2, NIBP
MHR/P Trace Off On, Off

Volume 0 0-9
Alarms High Low High Low
120 50 bpm 100-250 35-120
Alarm Volume 5 1-9
MECG Lead II I, II, III
Pacer Off On, Off
Normal (Waveform Display) MECG FECG, MECG, MSpO2,
Operation Off
(MECG Waveform Size) 1X (1 mV/cm) 0.25X, 0.5X, 1X, 2X, 4X,
Auto
Setup
Screen
Master Alarm Limits (mmHg) High Low High Low
Alarm Systolic 160 90mmHg 70-240 50-150
Setup Diastolic 90 50 mmHg 70-130 30-120
MAP 140 50 mmHg 70-150 30-120
MHR/P 120 50 bpm 100-25 35-120
MSpO2 100 95% 85-100 80-99
Alarm (kPa mode) High Low High Low
Systolic 21.3 12.0 kPa 9.3-32.0 6.7-20.0
Diastolic 12.0 6.7 kPa 9.3-17.3 4.0-16.0
MAP 18.7 6.7 kPa 9.3-20.0 4.0-16.
MHR/P 120 50 bpm 100-250 35-120
Volume 5 1-9
General Play Song Off Off, Happy Birthday,
Setup Brahms’ Lullaby, Rock-a-
Bye-Baby, All
Song Volume 5 0-9
Temp Done Volume 5 0-9
Brightness 9 0-9 (nine = brightest)
Paper Speed United States: 3 cm/min 1-3 cm/min
International: 1 cm/min
Date Set to current local date. Set to current local date.
Time Set to current local Set to current local time.
time. Must manually
change to EST/EDT.
MSpO2 Print Interval 5 min Off, 2, 5, 10, 15, 30, 60
(External Monitor) min
FSpO2 Print Interval 5 min Off, 2, 5, 10, 15, 30, 60

(External Monitor) min
FSpO2 Trace Off Off, On
Vital Signs HX Interval Event 1, 5, 10, 15, 30, 60, Event

History
Setup
Screen
Install Language Set according to shipping Set according to shipping
Options destination destination
Screen 1
(Service) Line Frequency United States: 60 Hz 50 Hz, 60 Hz
International: 50 Hz
Scaling United States: 30–240 bpm United States: 30–240
bpm
International: 50–210 bpm International: 50–210 bpm
Recorder Font Size Medium Small, Medium, Large
FECG Artifact Elimination Off On, Off
Paper Chime Out Only Off, Low/out, Out only
Paper Chime Volume 5 1-9
HBC (Heartbeat On On, Off
Coincidence Enable)
HR Offset 10 min Off, On, 10 min
(Applies to US or US2—
whichever is FHR2)
FM (Fetal Movement) On On, Off
Remote Marker
SpO2 Scale 0–100% Auto, 0-100%
(Does not change)
A-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001
Factory Defaults: Table of
Defaults

Setup
Screen
Install Fetal Alert/Alarm Off Off, Alarms, Alerts
Options
Screen 2 Alert Suspend Off Off, On
(Service) Re-Alarm 120 sec 120 - 300 seconds in
(MECG and SpO2 only) 5-second intervals
VS (Vital Signs) Print Real Time Real Time, Chart Style

Interval
Default TOCO Reference 10 in mmHg mode or 1.3 in 5, 10, 15, 20, or 25 relative
kPa modes units in mmHg mode or
0.7,
1.3, 2.0, 2.7, or in 3.3 kPa
mode
Smart BP On On, Off
NIBP 1-min Interval On On, Off
NIBP Display On On, 1, 2, 3, 5, 10, 15,
30 min
Pressure Units mmHg mmHg, kPa
China: kPa
SatSeconds (Nellcor) 10 Off, 10, 25, 50, 100
Default Settings Factory Factory, Hospital
A-8 250cx Series Maternal/Fetal Monitor Revision C
2036946-001
B Fetal Movement
Detection
Each monitor in the 250cx Series can be upgraded to include fetal movement
detection. This feature is designed to detect gross fetal body movements and body
movements with associated limb movement.
Fetal Movement Detection:
For your notes
B-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001
Introduction
Availability
Fetal movement detection is an option which can be installed in your 250cx Series
Monitor to function with the US channel. Contact your Sales Representative for
information.
Methodology
Fetal movement detection (FMD) is designed to detect gross fetal body movements
and body movements with associated limb movement. Corometrics defines gross
fetal body movement as the “extension, flexion, or rolling over of the fetal trunk
about the longitudinal axis of the body and associated limb movements.”
Movements of the extremities alone may not be detected. Eye movements will not
be detected.
CAUTION
FALSE DETECTION—The following may be automatically
detected as fetal movement: transducer movement and maternal
movement such as coughing, laughing, repositioning, mother
poking her abdomen, in addition to emesis, fetal hiccups, or twins.
During fetal sleep, or in the event of a fetal demise, some of these
detected movements may be confused with fetal movement.
Using Fetal Movement Detection While Monitoring

Enabling/Disabling Fetal Movement Detection
The fetal movement detection is available for the US connector only. FMD is not
available for the US2 connector. To enable/disable fetal movement detection, set the
FM Detect field on the US Setup screen to On. (Refer to Figure below.)
This field is only displayed: for the US connector; and if the option is installed in
your monitor and if a transducer is plugged into the US connector. Rotating the
Trim Knob control alternates between On and Off. (The factory default setting is
Off.)
Fetal Movement Detection: Using Fetal Movement Detection While
Monitoring
Display Indicator
When fetal movement detection is enabled, and a transducer is plugged in, the
annotation FMD appears in-between the FHR1 and FHR2 mode titles. (Refer to
Figure below.)
US FMD TOCO
165 30
US Setup
FM Detect: On
Volume: 5
Volume: 5
Exit
US Setup Screen
Strip Chart Annotation

When fetal movement detection is enabled, the mode annotation FMD prints
following the FHR modes. The annotation provides an indication that the feature
is enabled—it does not indicate detection.
When fetal movement is detected, a solid line is automatically marked on the

bottom of the upper grid for the duration of the detected movement. (Refer to
Figure, “Simulated Fetal Movement Detection Trace,” on page B-5.)
Using the FM Remote Marker to Complement the Patient Record

The FM Remote Marker is an accessory that can be used to complement the patient
record.
1. Connect the Corometrics FM Remote Marker to the Remote Marker

connector on the rear panel of the 250cx Series Monitor.
2. Instruct the mother to press the FM Remote Marker button whenever she feels
fetal movement. Ask her to hold down the button for the duration of the
perceived fetal movement. The annotation, or , with a horizontal bar,

prints on the strip chart for as long as the button is held down. (Refer to
Figure, “Simulated Fetal Movement Detection Trace,” on page B-5.)

2036946-001
The annotation resulting from the FM Remote Marker can be configured as one of
the following:
 : commonly used to record a general event; or
 : commonly used as an indication that the mother has perceived

fetal movement. (This is the factory default setting.)
Simulated Fetal Movement Detection Trace

2036946-001
C Spectra Alerts
Each monitor in the 250cx Series can be upgraded to include Spectra Alerts.
Contact your Sales Representative for more information. This feature analyzes
heart rate and uterine activity data to detect certain abnormal trends and alert the
clinician. A Nurse Call Light Interface is also provided as part of the Spectra Alerts
upgrade.
Spectra Alerts:
For your notes
C-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001
Important Safety Information
IMPORTANT
INSTRUCTIONS FOR USE—It is mandatory that you read this
chapter prior to operating a 250cx Series Monitor with the Spectra
Alerts feature enabled. Keep this manual available for future
reference and for the orientation of new personnel.
The Spectra Alerts option is designed to assist the perinatal staff in assessing the
status of a patient at the bedside by recognizing normal and abnormal FHR and UA
pattern features. The system does not replace observation and evaluation of the
mother and fetus at regular intervals, by a qualified care provider, who will make
diagnoses and decide on treatments or interventions. The user should determine the
status of the patient at regular intervals (see “Standards for Obstetric-Gynecologic
Services”, 7th edition, Washington, D.C., ACOG, 1989) by visual assessment of the
fetal monitor tracing at the bedside and evaluation of maternal vital signs and
progress in labor. The absence of an alert does not indicate fetal or maternal well-
being.
The alert message and priority level are only a means to direct the staff’s attention
to the patient, since more than one parameter may be contributing to the alert
condition. Visual assessment of the strip chart, combined with knowledge of
patient history and risk factors are necessary to manage the situation appropriately.
The alert system will not detect every possible abnormality and cannot detect
abnormalities that have not been clinically recognized and described in the
literature. Frequent assessment of the fetal monitor tracing is necessary to ensure
recognition of unusual, undefined, or suspicious patterns.
The care provider should only make the “diagnosis” of abnormal fetal heart rate
patterns by personal assessment of the fetal monitor tracing from the bedside fetal
monitor, not the alert message. The monitor requires data of a consistently good
quality to recognize abnormalities. Artifact will limit its ability to recognize
abnormalities. Increased variability, long and frequent accelerations, baseline
changes, half-counting or double-counting, and poor or absent uterine activity are
examples of factors which may limit detection capabilities.
Spectra Alerts: Using the Spectra Alert
Option
Using the Spectra Alert Option

Enabling/Disabling Spectra Alerts
CAUTION
CIS—The Spectra Alerts option provides bedside alerts only. If
you connect the 250cx Series Monitor to a Quantitative Sentinel
or Spectra 400 Alert and Surveillance Central System you must
disable the Spectra Alerts feature in the monitor.
The Spectra Alerts option, when installed, is enabled/disabled from the Fetal Alert/
Alarm field on the password-protected Install Options service screen. FHR alarms and
Spectra Alerts cannot be enabled at the same time. You may select one or the other;
or you can disable them both. To effect a change to the Fetal Alarms setting, you
must turn the monitor off, then back on again.
When the Alerts option is enabled, a solid bell icon displays next to the FHR
mode title(s) and prints on the strip chart paper prior to the active FHR mode
annotation(s). Refer to the Figure, “Spectra Alert Enabled Annotation,” on page C-
5 and the Figure, “Example of a Level One Decelerations Alert,” on page C-6. This
icon indicates that the feature is enabled only; it does not indicate the presence of
an alert condition.
Methodology
The Spectra Alerts feature is designed to assist the perinatal staff in assessing the
status of monitored patients by recognizing normal and abnormal pattern features.
Medically researched pattern recognition techniques are utilized to detect when
the pre-set limits1 have been exceeded. When abnormal features are recognized by
the system, these features are displayed on an Alert Parameters area on the FECG,
US, or US2 Setup screen—whichever is affected. When the abnormal feature(s)
meet the preset criteria for an alert, the monitor provides an audible and visual
indication of that alert. When an alert condition is detected, the system categorizes
the alert into one of three levels—with level three being the most severe. Refer to
the “Possible Alert Conditions” Table.
1
Limits are not user-selectable.

2036946-001
Spectra Alert Enabled Annotation
Possible Alert Conditions

Level One Alert Level Two Alert Level Three Alert
* ** ***
 decreased variability  tachycardia (>180 bpm)  bradycardia (<90 bpm)
 flat variability  bradycardia (90–99 bpm)  prolonged deceleration (<80 bpm)
 bradycardia (100–119 bpm)  late decelerations  late, variable, or mixed
 tachycardia (161–180 bpm)  severe variable or decelerations with decreased
 mild/moderate variable decelerations sporadic decelerations variability and tachycardia or
 mild/moderate sporadic decelerations  tachycardia with flat variability bradycardia
 mild variable decelerations with  mild sporadic decelerations  severe late or variable
decreased variability or mild tachycardia with decreased variability decelerations with tachycardia or
or mild bradycardia  moderate variable decelerations with bradycardia or decreased
 tachycardia (161–180 bpm) tachycardia or bradycardia or variability
with decreased variability decreased variability  moderate bradycardia and flat variability
 undefined decelerations  mixed decelerations  any deceleration (except mild variables)
 mild bradycardia and  mild bradycardia and flat variability and flat variability
decreased variability  mild late or mixed decelerations with  late or severe variables with
 prolonged deceleration (>120 bpm) decreased variability or mild tetanic uterine contraction
 increased variability tachycardia
 uterine hypertonus  mild variables and flat variability
 tetanic uterine contraction (>60 sec)  mild variables and mild tachycardia and
 signal quality decreased variability
 prolonged deceleration
(80–119 bpm)
Spectra Alerts: Alert Indications
Alert Indications
Active Alerts
When the system detects an alert condition, visual and audible indications are
provided. (There is no printed indication of the alert.) The alert level, indicated by
asterisks, flashes and displays in inverse video between the FHR1 and FHR2 areas;
in addition, the associated FHR numerics flash. The audio indication is a pattern of
beeps representing the alert level:
Level 1: Beep Beep Beep ...
Level 2: BeepBeep BeepBeep BeepBeep ...
Level 3: BeepBeepBeep BeepBeepBeep BeepBeepBeep ...
“Beep” represents audio tone sets and “ ” is the pause between sets.
The following figure provides an example of an active alert—level one

decelerations.
Alert enabled icon.
For an active alert, the FHR numerics

flash, indicating which FHR is
associated with the alert. For a silenced FECG * US TOCO
147 138
alert, the
numerics continue to flash until the
condition is resolved.
12
3 UC/10
For an active, unsilenced alert, the
alert level flashes and displays in NIBP MECG MSpO2
87
inverse video. After the alert is
silenced, the alert level stops flashing
and displays in normal video until the
98%
alert is reset or the condition is resolved.
25 mm/s
II 2x
MECG 15:52:58
Example of a Level One Decelerations Alert
Silencing Alerts
Press the Alarm Silence button to cancel the audio. The alert level stops flashing and
displays in normal video; however, the associated FHR numerics continue to flash.
For an active, silenced alert, the visual indications remain present until the condition
is resolved or the alert is reset. (Refer to “Resetting Alerts” on page C-12.)

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Resolved Alerts
Resolved alerts function similar to the FHR alarms, yet differently from the maternal
alarms.
 Resolved, Unsilenced Alert: You must acknowledge an alert—even if the
condition has already been resolved. The visual and audible indication remain
present until you press the Alarm Silence button. This ensures that a clinician is
aware that an alert occurred. You may hear this type of alert described as
latching.
 Resolved, Silenced, Alert: If you have already silenced an alert, the
visual indications disappear automatically.
Alert Suspension Feature

When a care provider is at the patient’s bedside, it may be desirable to suspend the
audio component of alerts. When you suspend alerts, the audio indication is
inhibited as well as the nurse call interface; the visual indications remain active and
data continues to be assessed.
Enabling/Disabling the Alert Suspension Feature

The alert suspension feature must be enabled/disabled on the password-protected
Install Options service screen. Refer to the 250cx Series Service Manual for more
information.
The alert suspension feature has two settings:

 Off (disabled): users cannot activate the function.
 On (enabled): users can manually activate/de-activate the function.
Suspending Audio Alerts (and the Nurse Call Interface)

To suspend alerts, press and hold the Alarm Silence button for approximately 3
seconds; you will hear two beeps as feedback.
While suspended:
 alerts are only indicated visually on the monitor’s display screen;
 an alert suspension icon displays next to the FHR mode title(s);
 an alert suspension icon prints on the strip chart paper along with the
active FHR mode annotations(s); and
 alert output to a nurse call system is inhibited.
Refer to the figures on this page.
Restoring Audio Alerts (and the Nurse Call Interface)

To restore full alert functionality, press and hold the Alarm Silence button for
approximately 3 seconds; you will hear two beeps as feedback.
Once restored, the alert enable icon : displays next to the FHR mode title(s); and
prints on the strip chart paper along with the active FHR mode annotation(s).
Spectra Alerts: Alert Indications
FECG * US TOCO
Alert suspended
147 138 12
3 UC/10
icon. NIBP MECG
87 MSpO2
98%
25 mm/s II 2x
MECG 15:52:58
Spectra Alert Suspended Icon
Alert restored.
Alert suspended.
Spectra Alert Suspend/Restore Annotations

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Alert Parameters Summary
The FHR setup screens (FECG or US/US2) include an Alert Parameters summary
presenting an overview of the alert analysis results for FHR and UA. Fields shown
in inverse video are contributing factors to an alert. Some fields contain a second
column to provide qualifying information. The Table, “Summary of Alert
Parameters”, provides a list of possible results which can appear in the Alert
Parameters summary.
NOTEParameters displayed in inverse video are contributing to an active alert.

Items displayed in normal video may indicate an alert is pending.
Summary of Alert Parameters

Alert Analysis Result Possibilities
Parameter Label
Column 1 Column 2
Alert Level
Baseline HR (bpm) High
Range Low
(For example: 145–150) Brady
Tachy
FHR Variability Unknown
Average
Increased
Decreased
Flat
Increased
Decreased
Flat
Decelerations Absent
Present
Present
Artifact/Arrhythmia Present
UA Baseline Pressure pressure in relative units or mmHg Hypertonus
(kPa when selected) Hypertonus
UC in 10 min Tachysyst
# of UCs
Tachysyst
Spectra Alerts: Alert Parameters
Summary

Alert Analysis Result Possibilities
Parameter Label
Column 1 Column 2
Duration of Last UC Tetanic
# of seconds
Tetanic
Signal Quality Good

Moderate
Poor
Unknown
The next Figure provides an example of an alert with two columns of information.
Inverse video indicates the feature

is contributing to an alert.
Some fields are

informational.
Some fields indicate a

prealert condition.
Alert Parameters Example with Two Columns of Alert Information
The following figure shows an example of alert parameters for a level one
decelerations alert for FECG.

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Items listed in inverse video are
contributing factors to the alert.
Other items may indicate an alert
is pending.
Alert Parameters Example—FECG is the FHR associated with the alert
The next Figure shows an example of alert parameters for the US Setup screen when
the FHR is not associated with any alert.
The alert level is blank indicating

there is no active alert for this FHR.
The alert parameter information is
available, even if there is no alert
associated with this FHR.
Alert Parameters Example—US is not associated with any alert

Spectra Alerts: Resetting Alerts
Resetting Alerts
If you do not agree with an alert (see “False Pattern Recognition” and “Mode
Switching”), you can clear the data being used via the Alert field on the associated
setup screen (FECG or US/US2).
NOTEFHR data is collected over time for analysis. Resetting an alert clears all
data from the monitor’s memory for both FHR1 and FHR2.
To reset an alert:
1. Access the setup screen associated with the alert—indicated by the

flashing FHR numerics. Select the mode title softkey (FECG or US/US2).
2. Highlight the Alert field. Whenever you display the setup screen, this field is
set to On.
3. Change the Alert field setting to Reset. (If you change the field to Reset by
mistake and wish to change it back, simply set it to On again.)
4. Once an alert is reset: audio and visual indications are removed; and the
alert parameters information clears.
NOTEIt is possible that the Spectra Alerts feature may generate the same alert
again.
False Pattern Recognition

The system may recognize accelerations as baseline.
Mode Switching
During dual FHR monitoring, the system may “confuse” the FHRs following mode
switches after delivery of the presenting twin.
To guard against mode changes prior to delivery of the presenting twin: Use US for
the presenting twin and US2 for the second twin. When switching to FECG for the
presenting twin, disconnect the US connector which is no longer in use.
If an alert is generated following delivery of the presenting twin, evaluate the

tracing to determine if there are any clinical factors contributing to the alert. If you
feel the alert was generated in error, change the Alert field on the associated setup
screen to Reset. Consider the following:
 If you continue monitoring the second twin with US2, and you disconnect the
FECG transducer which is no longer in use: the US2 fetal heart rate now
moves to the primary display; and the FHR trend, which was bold, now prints
using a normal print density.
 If you later switch to internal monitoring for the second twin and you
disconnect the US2 transducer which is no longer in use: the fetal heart rate
for the second twin displays as FECG in the primary heart rate area; and the
FHR trend continues to print using a normal print density.

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Trend Screen
Select the Trend softkey from the FHR Setup screen to display the FHR/UA trend
screen. (For dual fetal heart rate monitoring, you can access it from either
mode’s setup screen.) The Trend screen displays:
 the alert level and message, if present;
 the most recent 10 minutes of FHR and UA trend data—reflecting the paper
scale and chart speed settings; and
 the current time.
The following Figure shows a sample Trend screen with dual FHR monitoring
in progress and a level one decelerations alert.
FECG * US TOCO
30 210 1
Alert level and message.
*
210
Decelerations?
The Trend screen displays the most recent 10 160

minutes of FHR and uterine activity data.
120
For dual heart rate monitoring, the same trend
screen displays regardless of which FHR 50
setup screen (FECG or US/US2) you use to 100
access the Trend screen. 50
0
The current time. 10:56:41
Exit
Trend Screen Example
Uterine Contraction Frequency

The Spectra Alerts option includes a uterine contraction (UC) frequency display.
When enabled, the UA screen:
 provides the setup field for the UA display;
 provides a uterine contraction audio indicator; and
 provides a UC frequency histogram which graphs the contractions per 10
minutes over the most recent 100 minutes.
Spectra Alerts: Uterine Contraction
Frequency
Enabling/Disabling UC Frequency Display

A UA Setup screen is automatically activated when the Spectra Alerts option is
installed and enabled. To enable/disable the UC Display option:
1. Access the UA setup screen by selecting the UA mode title (TOCO or IUP).
2. Set the UA Display field to the desired setting: UA or UA/UCF. Refer to the
Figure, “UC Frequency Histogram,” on page C-15.
UC Frequency in UA Display Area

When enabled (On), the UC frequency, per 10 minutes, displays in the UA Display
area; the UA value displays in a smaller size in order to accommodate the additional
information. (See figure below.)
US US2 TOCO
UC Frequency
165 172 30
3 UC/10
option enabled. MECG
NIBP02:15
130/ 85 89 MSpO2
MAP (107)
97%
25 mm/s II 2x
03:15
MECG 03:22:45
UC Frequency Option Enabled

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UC Frequency Histogram
If the Spectra Alerts option is enabled, the UA Setup screen displays a UC
Frequency Histogram as shown in the next Figure. Each bar in the graph represents
the number of contractions in a 10-minute segment. The graph displays up to 10
bars (or 100 minutes).
FECG US TOCO
148 153
>= 10
UC in 10 min
59
3 UC/10
9
8
7
6
5
4
3
2
1
0
09:44 10:24 11:14
UA UA Display: UA/UCF UC Chime: OFF On Off

UA/UCF Exit
UC Frequency Histogram
The following two messages may display above the UC Frequency Histogram:
RECORDING UA? and UA BASELINE SET? For more information, refer to Table on
pages C-17 through C-21.
Enabling/Disabling UC Chime
If the Spectra Alerts option is enabled, the UA Setup screen contains a UC Chime
field. When enabled: a low-frequency chime sounds at the onset of a contraction; a
high-frequency chime sounds at the conclusion. This audio contraction indicator is
useful to caregivers as well as patients. Caregivers are made aware of contractions
during internal exams or while making adjustments to internal sensors/transducers
without having to watch the monitor. An anesthetized mother can use the indicator
as a “push signal” if she is unable to feel contractions.
To enable/disable the UC Chime:
1. Access the UA setup screen by selecting the UA mode title (TOCO or IUP).
2. Set the UC Chime field to the desired setting: On or Off. Refer to the Figure,
“UC Frequency Histogram”.
Spectra Alerts: Nurse Call
Interface
Nurse Call Interface

The Spectra Alerts option includes a Nurse Call Interface rear panel connector, as
shown in the Figure below. This connector attaches to a standard Nurse Call
System. The connector’s maximum output is 50 Vdc at 100 mA; the maximum on
resistance is 0.5 Ω. When connected to a Nurse Call System, the monitor will
activate the system each time a Spectra Alert is issued. This interface simulates
pressing the button on a bedside Nurse Call System allowing nurses to respond to
patient needs quickly and efficiently. Refer to the 250cx Series Service Manual for
more information.
NOTEIf the Spectra Alerts are suspended (see “Alert Suspension Feature” on
page C-7), the Nurse Call output is inhibited during the suspension time.
J103 ! J102 !
P
J101 ! J104 !
Nurse Call
Interface
250cx Series Rear Panel Communications Connectors

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Alert Parameters

ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN
Parameter Column 1 Column 2 Message Criteria
*
* ** + message? Alert has not been silenced.
** ***
Alert Level ***
*
** - message Alert has been silenced.
***
High Alert pending: FHR > 160 bpm for
5 minutes.
Tachy
BASELINE? Alert has not been silenced. Reflects
the detection of baseline FHR > 160 bpm
for 10 minutes.
Tachy
BASELINE? Alert silenced.
Low Alert pending. FHR < 120 bpm for
Baseline HR Average rate over 5 minutes.
(bpm) past 10 minutes.
Brady BASELINE? Alert has not been silenced. Reflects
the detection of baseline FHR < 120 bpm
for a pre-determined period of time.
The alert occurs in 2–10 minutes,
depending on how low the rate goes.
Brady BASELINE? Alert silenced.
Alert is deleted when baseline FHR is

within the “normal” range for 10
minutes.

Unknown (external)
Baseline variability is determined to be 5–
Average (internal)
15 beats peak-to-peak.
Increased Alert pending. Approximately 5 minutes of
baseline variability which is > 15 beats
peak- to-peak.
Increased VARIABILITY? Alert is issued if baseline variability

remains increased for approximately 10
minutes and there are no other FHR
alerts detected.
Increased VARIABILITY?
Alert silenced.
Decreased Alert pending. Reflects the detection of
baseline variability which is < 4–5
FHR Variability
beats peak-to-peak for approximately 10
minutes.
Decreased VARIABILITY?
Alert will be issued 20–40 minutes after
decreased variability is detected. The
“time- to-alert” depends on whether or
not any other alert parameters are
outside the normal range.
Decreased VARIABILITY?
Alert silenced.
Flat Alert pending. Absent variability detected
for approximately 4 minutes.
Flat VARIABILITY? Alert will be issued approximately 6–10

minutes after “flat” variability is
detected.
Flat VARIABILITY?
Alert silenced.
Alert is deleted if approximately 5 minutes
of “better” variability is detected.
Decelerations Absent (May miss subtle decelerations.)
Present Deceleration with or without a contraction

is detected. This indication may come and
go prior to alert condition. Once an alert
condition is detected, the word Present
remains until the alert condition is
resolved.

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Decelerations Present? DECELERATIONS? The analysis of deceleration
characteristics has recognized features of
either variable, late, mixed, or prolonged
decelerations; or decelerations without
uterine activity recorded. The baseline
FHR and variability impact the monitor’s
ability to analyze patterns, as well as
the “severity” of the pattern. The monitor
attempts to integrate the baseline features
with the deceleration features (onset,
size, duration, etc.) to determine when to
alert. The alert message is issued on the
basis of 1, 2, or 3 decelerations
depending on the size, shape, onset,
duration, etc. and related baseline rate
and variability.
Examples: An alert occurs when:
Three out of 5 contractions have mild

variable decelerations; if baseline FHR is
in normal range; and variability is
average.
Two out of 5 contractions have any
decelerations (except early) if the
variability decreased.
One severe variable deceleration that
drops to < 60 bpm for > 60 seconds.
NOTE: Alert occurs in approximately 2
minutes.
Present?
Alert silenced.
DECELERATIONS? The alert is deleted when there are 4
contractions without a deceleration; or
10 minutes without decelerations if no
uterine contractions are present.
No alert. 5% of data in last minute

Artifact/Arrhythmia Present
may be PVCs, other arrhythmias, or
artifact.

Uterine activity >40 mmHg (5.3 kPa) for
5 minutes.
# mmHg (kPa) No alert.
(TOCO)
UA BASELINE SET? appears in
Uterine Activity Display.
Hypertonus Uterine activity > 25 mmHg (3.3 kPa) for
5 minutes (7 minutes at start-up).
No alert.
UA Baseline
Pressure
UA BASELINE SET? appears in
Uterine Activity Display.
# mmHg (kPa)
(IUP)
Hypertonus UA? Uterine activity > 35 mmHg (4.7 kPa) for
5 minutes.
Alert has not been silenced.
Hypertonus? UA? Alert silenced and question resolved.
The alert is deleted after uterine activity is

< 35 mmHg (4.7 kPa) for 5 minutes
Tachysyst Six uterine contractions completed in
10 minutes, any size, internal or
external. No alert.
# of uterine
contractions Tachysyst If FHR Alert is present.
UC (Uterine The alert is deleted if there are < 6

contractions) uterine contractions in 10 minutes.
in 10 min
If # =’blank’ Start-up: No contractions detected for
10 minutes.
Continuous Monitoring: No contractions
detected for 30 minutes.
RECORDING UA? appears in Uterine

Activity Display.
Duration of Last # seconds Tetanic UA? Alert has not been silenced.
UC One uterine contraction with amplitude >
50 mmHg above baseline for 60
seconds.
Tetanic UA?
Alert silenced.
The alert is deleted after one

“normal” uterine contraction.

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Good Alert pending.
Moderate Alert has not been silenced.
Poor
Unknown (appears
when UC is the
only active SIGNAL QUALITY?
parameter) Three minutes of unsatisfactory
data (FECG).
Poor Five minutes of unsatisfactory
data (ultrasound).
SIGNAL QUALITY? Alert silenced.

Poor
The alert is deleted after 3 minutes
Signal Quality of satisfactory data.
Poor With UC Data unsatisfactory with uterine contractions

present.
Poor With UC SIGNAL QUALITY? Alert has not been silenced.
Data between uterine contractions is

acceptable; data during contractions is
either poor quality or absent. Alert
occurs after 1, 2, or 3 uterine
contractions depending on what
events preceded it.
Poor With UC SIGNAL QUALITY?
Alert silenced.
The alert is deleted following two
uterine contractions with satisfactory
data or 10 minutes of “good” data.
Message appears if there is a problem
with the monitor or the Spectra Alerts
no data REPAIR
option.
Contact Biomedical Department or
Service Representative.

2036946-001
D Frequently Asked
Questions
Frequently Asked Questions:
D-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001
FAQs
Question Answer
NOTE: When the monitor is powered off, then on again, the settings revert back to the factory default settings or can be saved if you
choose Store Current to Hospital in the password-protected Install Options screen.
How do I change the alarm limits for 1.Rotate the Trim Knob to highlight the legend for FHR1. (This legend is at the top
Fetal Heart Rate 1 left on the display, and it may read INOP, FECG, US, or US2.
2.Once you highlight the FHR1 legend, press the Trim Knob. The display
changes to show the <MODE> Setup screen, where mode is the current
legend.
3.Now rotate the Trim Knob to highlight the FHR1 High heart rate alarm limit setting.
4.Once the High heart rate alarms limit is highlighted, press the Trim Knob again.
The current setting in displayed in blinking inverse video.
5.Now rotate the Trim Knob to change the current setting. Select a value between
140 bpm and 200 bpm or Off.
6.Once you set the desired alarm value, press the Trim Knob again to confirm
your selection. The current value setting stops blinking.
7.Repeat 3 through 6 for the Low heart rate alarm setting. The valid range is 60
bpm to
140 bpm or Off.
NOTE: The software does not permit the alarm settings to overlap.
8.Now rotate the Trim Knob to select (highlight) the Exit item on the bottom menu.
9.Press the Trim Knob again to return to the main monitoring display screen.
NOTE: When the monitor is powered off, then on again, the settings revert
back to the factory default settings or can be saved if you choose Store
How do I change the alarm limits for
Current to Hospital from the password-protected Install Options screen.
Fetal Heart Rate 2?
1.Rotate the Trim Knob to highlight the legend for FHR2. (This legend is at the top
left on the display, and it may read INOP or US2.
2.Once you highlight the FHR2 legend, press the Trim Knob. The display
legend.
3.Now rotate the Trim Knob to highlight the FHR2 High heart rate alarm limit setting.
4.Once the High heart rate alarms limit is highlighted, press the Trim Knob again.
The current setting is displayed in blinking inverse video.
140 bpm and 200 bpm or Off.
6.Once you set the desired alarm value, press the Trim Knob to confirm your
selection. The current value setting stops blinking.
7.Repeat 3 through 6 for the Low heart rate alarm setting. The valid range is 60
bpm to
140 bpm or Off.
NOTE: The software does not permit the alarm settings to overlap.
NOTE: When the monitor is powered off, then on again, the settings revert
back to the factory default settings or can be saved if you choose Store
Current to Hospital from the password-protected Install Options screen.
Question Answer
How do I change the alarm limits for

Non- Invasive Blood Pressure? 1.Rotate the Trim Knob to highlight the legend for NIBP. (This legend is slightly
above center, on the left side of the display.
2.Once the NIBP legend is highlighted, press the Trim Knob. The display changes
to show the NIBP Setup screen.
3.Rotate the Trim Knob to highlight the Systolic High alarm limit setting.
4.Once the Systolic High alarms limit setting is highlighted, press the Trim Knob
again. The current setting displays in blinking inverse video.
70 mmHg and 240 mmHg (9.3 kPa and 32.0 kPa).
7.Repeat 3 through 6 for the
 Systolic Low: select a value between 50 mmHg and 150 mmHg (6.7 kPa and
20.0 kPa).
 Diastolic High: select a value between 70 mmHg and 130 mmHg (9.3 kPa and
32.0 kPa).
 Diastolic Low: select a value between 30 mmHg and 120 mmHg (4.0 kPa and
16.0 kPa).
 MAP (Mean Arterial Pressure) High: select a value between 70 mmHg and
150 mmHg (9.3 kPa and 20.0 kPa).
 MAP Low: select a value between 30 mmHg and 120 mmHg (4.0 kPa and
16.0 kPa).
 You may optionally change the MHR/P (Maternal Heart Rate/Pulse)
High: select a value between 100 bpm and 250 bpm.
Note: The MHR/P alarm settings are also available through the Pulse
legend, or the MSpO2 legend, on the main monitoring screen.
 You may optionally change the MHR/P
Low: select a value between 35 bpm and 120 bpm.
Note: The MHR/P alarm settings are also available via the Pulse legend, or the
MSpO2 legend, on the main monitoring screen.
How do I change the alarm limits
for MHR/P, Maternal Heart Rate 1.Rotate the Trim Knob to highlight the legend for MHR/P. (This legend is
Pulse? located approximately in the center of the display and may indicate MECG,
Pulse or INOP, depending on the settings that are currently enabled.)
2.Once the MHR/P legend is highlighted, press the Trim Knob. The display changes
to the MHR/P Setup screen.
3.Now rotate the Trim Knob to highlight the MHR High alarm limit setting.
4.Once the MHR High alarm limit setting is highlighted, press the Trim Knob again.
The current setting displays in blinking inverse video.
100 bpm and 250 bpm.
selection. The current value setting tops blinking.
7.Repeat 3 through 6 for the MHR Low alarm limit setting. Select a value between
35 bpm and 120 bpm.

2036946-001
Question Answer
How do I enable the MHR/P,

Maternal Heart Rate Pulse, trend 1.Rotate the Trim Knob to highlight the legend for MHR/P. (This legend is
recorder tracing? located approximately in the center of the display, and may indicate MECG,
Pulse or INOP, according on the settings that are currently enabled.
to show the MHR/P Setup screen.
3.Now rotate the Trim Knob to highlight the HR/PR: setting. (It should read Off.)
4.Once the HR/PR: setting is highlighted, press the Trim Knob again. The
current setting displays in blinking inverse video.
5.Now rotate the Trim Knob to change the current setting. Select a setting of On
(to enable MHR/P trace) or Off.
6.Once you set the desired trace setting, press the Trim Knob to confirm
your selection. The current setting stops blinking.
How do I change the source parameter 1.Rotate the Trim Knob to highlight the legend for MHR/P. This legend is
for MHR/P, Maternal Heart Rate located approximately in the center of the display, and may indicate
Pulse? MECG, Pulse or INOP according to the settings that are currently enabled.
3.Now rotate the Trim Knob to highlight the Source: setting. (It will read Auto,
MSpO2, MECG.)
4.Once the Source: setting is highlighted, press the Trim Knob again. The current
setting displays in blinking inverse video.
5.Now rotate the Trim Knob to change the current setting. Select from Auto,
MSpO2, MECG. If you select Auto, the pulse value parameter is automatically
selected according to the parameters that are currently enabled with
precedence, highest to lowest, in the following order: MECG, MSpO2.
6.Once you set the desired source parameter, press the Trim Knob to confirm your
1.Rotate the Trim Knob to highlight the legend for MSpO2. (This legend is
How do I enable the MSpO2, located above the center, on the right side of the display.)
Maternal Blood Oxygen Saturation, 2.Once the MSpO2 legend is highlighted, press the Trim Knob. The display changes
trend recorder tracing? to show the MSpO2 Setup screen.
3.Now rotate the Trim Knob to highlight the %O2 Trace: setting. (It should read
Off.)
4.Once the %O2 Trace: setting is highlighted, press the Trim Knob again. The
5.Now rotate the Trim Knob to change the current setting. Select a setting of On
(to enable MSpO2 trace) or Off.
6.Once you set the desired trace setting, press the Trim Knob to confirm
your selection. The current setting stops blinking.
Question Answer
How do I change the alarm limits

for MSpO2, Maternal Blood 1.Rotate the Trim Knob to highlight the legend for MSpO2. (This legend is
Oxygen Saturation? slightly above center, on the right side of the display.)
2.Once the MSpO2 legend is highlighted, press the Trim Knob. The display changes
to show the MSpO2 Setup screen.
3.Now rotate the Trim Knob to highlight the current High: saturation percentage
(%) alarm limit setting.
4.Once the High: saturation percentage (%) alarm limit setting is highlighted, press
the Trim Knob again. The current setting displays in blinking inverse video.
5.Now rotate the Trim Knob to change the current setting. Select from 100 to 85%.
6.Repeat 3 through 6 for the High: saturation percentage (%) alarm limit setting.
Select a value between 99% and 80%.
 You may optionally change the MHR/P (Maternal Heart Rate/Pulse) High:
select a value between 100 bpm and 250 bpm. (The MHR/P alarm
settings are also available through the Pulse legend, or the NIBP legend
on the main monitoring screen.)
 You may optionally change the MHR/P Low: select a value between 35
bpm and 120 bpm. (The MHR/P alarm settings are also available via the
Pulse legend, or the NIBP legend on the main monitoring screen.)
7.Once the desired source parameter is set, press the Trim Knob to confirm
How do I change the waveform
1.Rotate the Trim Knob to highlight the waveform selection item. (This legend
parameter being displayed?
is slightly above the bottom menu bar, to the far left of the display, and should
indicate one of the following: Off, MECG, MSpO2, or FECG.)
2.Once the waveform selection item is highlighted, press the Trim Knob again.
3.Now rotate the Trim Knob to change the setting to Off, MECG, MSpO2, or
FECG.
4.Once you set the desired source parameter, press the Trim Knob to confirm
5.The selected waveform parameter displays on the main monitoring screen.

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Question Answer
How do I change the Maternal ECG

lead waveform being displayed? Option 1
1.Rotate the Trim Knob to highlight the legend for MHR/P. (This legend is in the
approximate center of the display and reads MECG, Pulse or INOP, according
to the settings that are currently enabled.)
2.Once the MECG legend is highlighted, press the Trim Knob. The display changes
3.Now rotate the Trim Knob to highlight the Source: setting. (It will read Auto,
MSpO2, MECG or NIBP.)
4.If the Source: setting is not MECG, press the Trim Knob again. The current
setting displays in blinking inverse video.
5.Now rotate the Trim Knob to change the current setting to MECG.
6.Once you set the desired source parameter, press the Trim Knob again to save
the value. The current value setting stops blinking.
7.Now rotate the Trim Knob to select (highlight) the MECG Lead: setting. This setting
is slightly above vertical center towards the right side of the screen and indicates
Lead I, II or III.
8.Now press the Trim Knob again. The current setting displays in blinking
inverse video.
9.Now rotate the Trim Knob to change the current setting to the desired lead
selection.
10. Once you set the desired source parameter, press the Trim Knob to confirm
11. Now rotate the Trim Knob to select (highlight) the Exit item on the bottom menu.
12. Press the Trim Knob again to return to the main monitoring display screen.
Option 2
1.If the MHR/P Source setting is set to Auto, and MECG is currently enabled
(plugged in) OR MHR/P Source is set to MECG, then, from the main monitor
screen, rotate the Trim Knob to highlight the selected Lead setting for MECG.
(This setting is slightly below vertical center, on the right hand side of the
display. It will indicate I, II or III.)
2.Once the MECG Lead setting legend is highlighted, press the Trim
Knob. The current setting displays in blinking inverse video.
3.Now rotate the Trim Knob to change the current setting to MECG Lead setting I, II or
III.
4.Once you set the desired source parameter, press the Trim Knob to confirm
How do I change the waveform your selection. The current value setting stops blinking and the waveform
vertical scale on the display? should reflect the selected lead.
1.To change the waveform scale, the current selected waveform must be MECG
or FECG. The waveform scale cannot be altered when you view MSpO2
plethsysmograph waveforms which auto-scale.
2.Rotate the Trim Knob to highlight the scale factor setting for the waveform
display. (This setting is slightly below vertical center, on the right hand side
of the display, below the horizontal speed indication of 25 mm/s. The vertical
scale indicates one of the following: Auto, 0.25x, 0.5x, 1x, 2x, or 4x.
3.Once the MECG scale setting is highlighted, press the Trim Knob. The
4.Now rotate the Trim Knob to change the current setting to Auto, 0.25x, 0.5x, 1x,
2x,
or 4x.
5.Once you set the desired scale, press the Trim Knob to confirm your selection.
The current value setting stops blinking, and the waveform should reflect the
selected lead.
Question Answer
How do I disable/enable Fetal Movement

Detection? (FMD is an optional feature 1.Rotate the Trim Knob to highlight the legend for US. (This legend is top left
that is purchased separately.) on the display.)
Note: This feature applies only if ultrasound is the source.
2.Once the US legend is highlighted, press the Trim Knob. The display changes
to show the US Setup screen where US (not US2 Setup) is the current
legend.
3.Now rotate the Trim Knob to highlight the FM Detect: setting. This setting is On
or
Off.
4.Once the FM Detect: setting is highlighted, press the Trim Knob again. The
5.Now rotate the Trim Knob to change the current setting. Select a value of On
(enabled) or Off (disabled).
6.Once you set the desired value, press the Trim Knob again to save the value.
The current value setting stops blinking.
How do I enable and change the 7.Now rotate the Trim Knob to select (highlight) the Exit item on the bottom menu.
alarm volume settings for Fetal Heart 8.Press the Trim Knob again to return to the main monitoring display screen.
Rate 1?
1.Rotate the Trim Knob to highlight the legend for FHR1. (This legend is top left on
the display, and it may read INOP, FECG, US, or US2.)
2.Once the FHR1 legend is highlighted, press the Trim Knob. The display
changes to show the <MODE> Setup screen, where <MODE> is the current
legend.
3.Now rotate the Trim Knob to highlight the FHR1 Audio Alarms: setting. This is
at the bottom of the flat panel display, slightly above the menu bar, on the
left half of the screen. The setting is either On or Off. If the setting is Off, it
needs to be enabled. Proceed to (Step 4) below. If it is already On, and you
simply wish to change the Volume: setting, proceed to (Step 7) below.
4.Once the Audio Alarms: setting is highlighted, press the Trim Knob again.
5.Now rotate the Trim Knob to change the current setting to On.
7.Now rotate the Trim Knob to select (highlight) the Volume: setting which is
located immediately to the right. The setting is in the range of 1 to 9.
8.Once the Volume: setting is highlighted, press the Trim Knob again. The
current setting displays in blinking inverse video, and an audio tone, indicative
of the alarm volume, is emitted from the speaker.
9.Now rotate the Trim Knob to change the current setting, as desired. Each time
you change a setting, you will hear an audio tone, indicative of the alarm volume,
emitted from the speaker.
10. Once you set the desired alarm value, press the Trim Knob to confirm
your selection. The current value setting stops blinking. A final audio tone,
indicative of the alarm volume, is emitted from the speaker.
11. Now rotate the Trim Knob to select (highlight) the Exit item on the bottom
menu.
12. Press the Trim Knob again to return to the main monitoring display screen.

2036946-001
Question Answer
How do I enable or change alarm

volume settings for Fetal Heart Rate 1.Rotate the Trim Knob to highlight the legend for FHR2. (This legend is top left on
2? the display, and may display as INOP or US2.
legend.
3.Now rotate the Trim Knob to highlight the FHR2 Audio Alarms: setting. This is
at the bottom of the flat panel display, slightly above the menu bar, on the
left half of the screen. The setting is either On or Off. If the setting is Off, you
must enable it. Proceed to (Step 4) below. If the setting is already On, and
you simply wish to change the Volume: setting, proceed to (Step 7) below.
4.Once the Audio Alarms: setting is highlighted, press the Trim Knob again.
5.Now rotate the Trim Knob to change the current setting to On.
7.Now rotate the Trim Knob to select (highlight) the Volume: setting
located immediately to the right. The setting is in the range of 1 to
9.
of the alarm volume, will be emitted from the speaker.
9.Now rotate the Trim Knob to change the current setting as desired. With each
setting change, an audio tone, indicative of the alarm volume, will be emitted
from the speaker.
10. Once you set the desired alarm value, press the Trim Knob to confirm
your selection. The current value setting stops blinking. A final audio tone,
indicative of the alarm volume, is emitted from the speaker.
11. Now rotate the Trim Knob to select (highlight) the Exit item on the bottom
How do I enable or change alarm menu.
volume settings for Non-Invasive Blood 12. Press the Trim Knob again to return to the main monitoring display screen.
Pressure?
1.Rotate the Trim Knob to highlight the legend for NIBP. (This legend is slightly
above center, on the left side of the display.)
3.Now rotate the Trim Knob to select (highlight) the Volume: setting which is
5.Now rotate the Trim Knob to change the current setting as desired. Each time
you change a setting, an audio tone, indicative of the alarm volume, will be
emitted from the speaker.
selection. The current value setting stops blinking. A final audio tone, indicative
Question Answer

volume settings for MHR/P (Maternal 1.Rotate the Trim Knob to highlight the legend for MHR/P. (This legend is
Pulse)? located approximately in the center of the display, and may indicate MECG,
Pulse or INOP, depending on the settings that are currently enabled.
3.Now rotate the Trim Knob to select (highlight) the Alarm Volume: setting
4.Once the Alarm Volume: setting is highlighted, press the Trim Knob again. The
current setting displays in blinking inverse video, and an audio tone, indicative of
the alarm volume, is emitted from the speaker.
from the speaker.
1.Rotate the Trim Knob to highlight the legend for MSpO2. (This legend is
volume settings for Maternal Blood located slightly above center, on the right side of the display.)
Oxygen Saturation (MSpO2)? 2.Once the MSpO2 legend is highlighted, press the Trim Knob. The display changes
to
show the MSpO2 Setup screen.
3.Now rotate the Trim Knob to select (highlight) the Alarm Volume: setting
which is located immediately to the right. The setting is in the range of 1
to 9.
4.Once the Alarm Volume: setting is highlighted, press the Trim Knob again. The
current setting displays in blinking inverse video, and an audio tone, indicative of
the alarm volume, is emitted from the speaker.
from the speaker.

2036946-001
Question Answer
How do I change the volume for

FHR1 audio or heart beat tones? Option 1
1.Use the front panel Volume Up or Volume Down buttons (left) to control
volume for FHR Channel 1.
Option 2
the display, and it may read INOP, FECG, US, or US2. However, to be able to
alter the volume with this method, you must enable one FHR1 mode by inserting
a transducer into the appropriate receptacle on the front of the monitor.)
changes to show the <MODE> SETUP SCREEN, where mode is the
current legend.
3.Now rotate the Trim Knob to highlight the FHR1 Volume: setting which is
located slightly above vertical center, on the left, next to the volume bar
graph.
5.Now rotate the Trim Knob to change the current volume setting. Select a
value between 0 and 9. As the setting is changes, the bar graph changes to
reflect the current setting.
How do I change the volume for 7.Now rotate the Trim Knob to select (highlight) the Exit item on the bottom menu.
FHR2 audio or heart beat tones? 8.Press the Trim Knob again to return to the main monitoring display screen.
Option 1
1. Use the front panel Volume Up or Volume Down buttons (right) to control
volume for FHR Channel 2.
Option 2
the display, and it may read INOP or US2. However, to be able to alter the
volume using this method, you must enable one FHR2 mode by inserting a
transducer into the appropriate receptacle on the front of the monitor)
changes to show the <MODE> SETUP SCREEN, where mode represents the
current legend.
3.Now rotate the Trim Knob to highlight the FHR2 Volume: setting which is
located slightly above vertical center, on the left, next to the volume bar
graph.
value between 0 and 9. As the setting changes, the bar graph changes to
reflect the current setting.
Question Answer

MHR Pulse tones? 1.Rotate the Trim Knob to highlight the legend for MHR/P. (This legend is located
near the center of the display, and may indicate MECG, Pulse or INOP,
depending on the settings that are currently enabled.
3.In the MHR/P Setup screen, rotate the Trim Knob to highlight Volume: setting.
This setting is at the vertical center in the left half of the display, next to the
Volume: bar graph.
value between 0 and 9. As the setting changes, the bar graph changes
to reflect the current setting.
NIBP completion indication? 1.Rotate the Trim Knob to highlight the legend for NIBP. (This legend is slightly
above center, on the left side of the display.
3.In the NIBP Setup screen, rotate the Trim Knob to highlight the NIBP
Done Vol: setting. This setting is slightly above vertical center, in the right half
of the display, next to the NIBP Done Vol: bar graph.
4.Once the NIBP Done Vol: setting is highlighted, press the Trim Knob again.
value between 0 and 9. As the setting changes, the bar graph changes to
reflect the current setting. With each change, an audio tone, that reflects the
selected audio level, is heard.

2036946-001
Question Answer
How do I change the interval time for

taking Non-Invasive Blood Pressures? 1.Rotate the Trim Knob to highlight the legend for NIBP. (This legend is slightly
above center, on the left side of the display.)
3.Now rotate the Trim Knob to highlight the Mode: setting which is below
the NIBP Setup title. The current setting is one of the following: Manual,
Auto 1 min, Auto 2 min, Auto 3 min, Auto 4 min, Auto 5 min, Auto 10 min, Auto 20
min, Auto 30 min, Auto 40 min, Auto 45 min, Auto 60 min, Auto 90 min, or Auto
120 min.
4.Once the MODE: setting is highlighted, press the Trim Knob again. The
5.Now rotate the Trim Knob to change the current setting. Select a value from one
of the following: Manual, Auto 1 min, Auto 2 min, Auto 3 min, Auto 4 min, Auto 5
min, Auto 10 min, Auto 20 min, Auto 30 min, Auto 40 min, Auto 45 min, Auto 60
min, Auto 90 min, or Auto 120 min.
How do I activate and terminate Heart 8.Press the Trim Knob again to return to the main monitoring screen.
Rate Offset?
1.Press and hold the Mark [Offset] button (over the recorder) on the front panel
of the 250cx Series Monitor for 2 seconds. You will hear a short, two-tone audio
beep from the monitor when offset is activated.
2.To end the HR offset period, press and hold the Mark [Offset] button (over
the recorder) again for 2 seconds. You will hear a short, two-tone audio beep
How do I know when the monitor from the monitor when HR offset is Off.
detects Heart Beat Coincidence?
Heart Beat Coincidence (HBC) indicates that two HR channels may be monitoring
the same signal by placing both heart rates in inverse video on the front panel
display, AND by placing a symbol of two overlapping hearts on the trend
recorder.
How do I change the date? 1. Rotate the Trim Knob to highlight the Setup legend at the bottom of the display,
below the menu bar.
2.Once the Setup legend is highlighted, press the Trim Knob.
3.The display will change to the General Setup screen.
4.In the General Setup screen, rotate the Trim Knob to highlight one of the
Date: setting fields on the top right corner of the display. These fields are for
day (DD), month (MMM), and year (YYYY).
5.After the desired field is highlighted (selected), press the Trim Knob. The
6.Now rotate the Trim Knob to change the current date parameter setting.
8.Repeat Step 4 through Step 7 for any other date parameters that need to be set.
Question Answer
How do I change the time? 1. Rotate the Trim Knob to highlight the Setup legend at the bottom of the display,
below the menu bar.
2.Once the Setup legend is highlighted, press the Trim Knob.
3.The display changes to the General Setup screen.
4.In the General Setup screen, rotate the Trim Knob to highlight one of the
Time: setting fields on the top left corner of the display. These fields are for
hours (HH), minutes (MMM), and seconds (YYYY). Note that the seconds
field cannot be selected or set.
5.After the desired field is highlighted (selected), press the Trim Knob. The
6.Now rotate the Trim Knob to change the current time parameter setting.
8.Repeat Step 4 through Step 7 for any other date parameters that need to be set.
How do I enable the maternal-only

recorder mode? 1.From the On state, (The yellow LED above the recorder is illuminated.), press
the Record button once quickly. The recorder advances, printing the date and
time on the chart paper perpendicular (rather than parallel) to the direction of
paper travel. Then the recorder halts and the yellow LED flashes
intermittently to indicate MATERNAL ONLY mode is enabled.
2.From the Off state, (The yellow LED above the recorder is off), press the
Record button twice quickly. The recorder advances, printing the date and time
on the chart paper perpendicular (rather than parallel) to the direction of paper
travel. Then the recorder halts and the yellow LED flashes intermittently to
indicate MATERNAL ONLY mode is enabled.
How do I turn off the recorder completely? From the On or MATERNAL ONLY state, (The yellow LED above the recorder is
illuminated or flashing intermittently.), press Record and hold for 2 seconds,
until the monitor emits a two tone audio beep which indicates that the recorder is
off. The yellow LED is now extinguished.

2036946-001
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Information Technologies, Inc. Information Technologies GmbH Information Technologies Asia; GE (China) Co., Ltd.
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1 800 558 5120 (US only) Tel: + 49 761 45 43 - 0 Tel: + 86 21 5257 4650
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GE

Corometrics™ 250cx Series Monitor

Corometrics 250cx Series Monitor

Corometrics™ 250cx Series Monitor

Corometrics 250cx Series Monitor

GE MEDICAL SYSTEMS Information Technologies

NELLCOR®, OxiMax®, C-LOCK® and SatSeconds™ are trademarks of Nellcor Puritan

The device is manufactured in India; the CE mark is applied

The country of manufacture and appropriate Notified Body can be

The product complies with the requirements of standard EN

Components of the Certified Systems

The equipment listed below is representative of all possible

Revision C 250cx Series Maternal/Fetal Monitor CE-1

Be aware that adding accessories or components, or modifying the

Definitions of Terminology.......................................................................................... 1-4

Monitor Contraindications, Warnings, and Precautions...........................................1-5

Equipment Symbols................................................................................................... 1-10

Fetal Monitoring Indications for Use..........................................................................2-3

Maternal Monitoring Indications for Use....................................................................2-3

Series Overview............................................................................................................ 2-4

3 Controls, Indicators, and Connectors................................3-1

Revision C 250cx Series Maternal/Fetal Monitor i

Primary Labor Parameters........................................................................................... 3-8

MHR/P Area................................................................................................................. 3-11

MSpO2 Area................................................................................................................. 3-12

Rear Panel Description.............................................................................................. 3-16

Self-Test Routine.......................................................................................................... 4-7

Setup Screens.............................................................................................................. 4-7

General Setup Screen.................................................................................................. 4-9

Preparing the Monitor for Patient Use......................................................................4-11

ii 250cx Series Maternal/Fetal Monitor Revision C

FECG (Internal Method)............................................................................................... 5-4

FECG Setup Screen...................................................................................................... 5-5

Fetal Heart Rate Alarms...............................................................................................5-6

Single Fetal Heart Rate Monitoring...........................................................................5-10

Dual Fetal Heart Rate Monitoring..............................................................................5-10

6 Uterine Activity Monitoring..................................................6-1

Accounting for Belt Tension.................................................................6-4

Revision C 250cx Series Maternal/Fetal Monitor iii

Internal Method - Intrauterine Pressure (IUP)............................................................6-5

7 Maternal Heart/Pulse Rate Monitoring................................7-1

MHR/P Setup Screen.................................................................................................... 7-4

Maternal ECG Monitoring............................................................................................ 7-7

8 Maternal Non-Invasive Blood Pressure Monitoring..........8-1

NIBP Determination...................................................................................................... 8-5

SuperSTAT NIBP Determination.................................................................................8-5

NIBP Setup Screen....................................................................................................... 8-7

NIBP Monitoring........................................................................................................... 8-8

iv 250cx Series Maternal/Fetal Monitor Revision C

Smart BP Feature....................................................................................................... 8-13

9 Maternal Pulse Oximetry Monitoring..................................9-1

MSpO2 Setup Screen.................................................................................................... 9-9

MSpO2 Methodology................................................................................................... 9-10

Module and Probe Compatibility...............................................................................9-11

Alarm Setup................................................................................................................ 10-3

Revision C 250cx Series Maternal/Fetal Monitor v

Fetal Heart Rate Alarms............................................................................................. 10-6

Maternal Alarms......................................................................................................... 10-7

Alarms Summary........................................................................................................ 10-9