Re: Collecting reaserch data

["MIKE SMITH" <msmith_01@email.msn.com>]

Jerry,
Thanks again for the information.  I will disagree with you on some of these
points.

"The clinician can use the electronic manometer (displayed on the NIBP
screen of the Propaq) to auscultate the blood pressure systolic and
diastolic sounds while the
monitor is making it normal measurement.  Your results should agree
with the monitor
within the specified accuracy band for NIBP measurements."

We have done this and still had huge swings.  A measurement in the same arm
with in a minute should most likely be close.  In a separate arm you could
expect the #'s to be different due many problems.

Mike Smith


----- Original Message -----
From: Jerry Zion <jerryz@protocol.com>
To: <flightmed@flightweb.com>
Sent: Monday, May 21, 2001 06:50 PM
Subject: Re: Collecting reaserch data


> When comparing Propaq NIBP measurements against a manual reading there
> are several items that will be expected to vary:
>
> 1.  Were measurements taken on the same limb at 2 different times?
> The literature shows that readings taken at different times even using
> the same
> limb will vary in pressure.  The literature also shows that when making
> this type
> of comparison, but using different technologies (automated
> oscillometric monitor vs
> aneroid gauge and stethoscope) the differences between the technologies
> may add to
> the variance between the resulting readings.  Oscillometry detects and
> measures the
> MEAN pressure in the cuff, then calculates the Systolic and Diastolic
> readings.
> When you auscultate the cuff blood pressure, you estimate the Systolic
> and Diastolic
> pressures based on the Karotkoff sounds, and then you calculate the
> MEAN pressure.
> It also makes a difference whether one uses the 1st or 5th Karotkoff
> sound to make
> the blood pressure estimate.  While I have used the term "estimate"
> here, let me
> be clear that such an estimate is usually very accurate.  The
> literature supports
> all of this.
>
> 2. Were measurements taken on different limbs (right and left arms,
> right and left legs)?
> The literature shows that readings taken on different limbs vary.  The
> same comment
> applies here regarding different technologies.
>
> So how can a user in the field feel satisfied that the Propaq is
> calibrated and providing
> appropriately accurate readings?
> Propaq oscillometric NIBP was compared against invasive blood pressure
> readings
> in a variety of use settings and patient age groups in order to obtain
> market
> clearance by the FDA.  The design and manufacturing process continue to
> be
> audited to ensure that we have not "lost the formula".
>
> The Propaq Service Manual provides instructions for a Biomedical
> Technician or
> Engineer to verify the static calibration of the NIBP measurement
> system.  This
> procedure can be performed whenever users feel the monitor is not
> providing
> accurate measurements, and has not displayed an equipment alert message
> or other
> error code indicating that Propaq needs service.
>
> Welch Allyn Protocol always
> verifies calibration after any repair to the Propaq, especially those
> having to
> do with NIBP.  Biomedical Departments performing repairs should follow
> this
> practice.
>
> The clinician can use the electronic manometer (displayed on the NIBP
> screen of the Propaq) to auscultate the blood pressure systolic and
> diastolic sounds while the
> monitor is making it normal measurement.  Your results should agree
> with the monitor
> within the specified accuracy band for NIBP measurements.
>
> To ensure accurate readings when faced with motion artifact, use a
> Propaq Encore or Propaq CS monitor with Smartcuf NIBP.  This specialized
> algorithm makes use of the ECG waveform to
> identify the pressure wave in the cuff most closely associated with the
> contraction of the heart that produced it.  That way the motion artifact
> can be ignored.  Except when arrhythmia is also present, this algorithm
> is producing some exciting results in everyday Air Medical Transport
> use.  Please feel free to contact Becky Fee, CFRN LifeFlight Network,
> Portland, OR or Renee Holleran, RN PhD of Cincinnati AirCare.  Both have
> experience with usind it.
>
> Jerry Zion, CBET, MS
> Welch Allyn Protocol, Inc.
>
> MIKE SMITH wrote:
> >
> > Jerry,
> >
> > All I'm looking for is whether your monitor is calibrated against some
sort
> > of control.  One of our Propac's worked as normal however, compared to a
> > manual pressure it measured any where from 30 - 60 mmHg off.  Is that
> > calibrated?  Could that cause a problem with a patient?  What if you
were
> > using vasoactive drugs?
> >
> > So, all I'm interested in is ... does your machine get calibrated?
> >
> > Thanks,
> > Mike Smith
> > ----- Original Message -----
> > From: Jerry Zion <jerryz@protocol.com>
> > To: <flightmed@flightweb.com>
> > Sent: Monday, May 21, 2001 02:16 PM
> > Subject: Re: Colecting reaserch data
> >
> > > To the question, "how often has your NIBP monitor been calibrated",
> > > would it not be important to know how often the manufacturer of your
> > > NIBP monitor says it should be calibrated?  Consider the Propaq.  The
> > > equipment alert tells you when service (including calibration) is
> > > required.  It calibrates itself everytime the monitor is turned on.
If
> > > it cannot calibrate, it then tells you (via an equipment alert or
error
> > > message) that it's time for a repair.  Other devices (monitors and
> > > manometers) don't do this, and therefore have a required periodic
> > > re-calibration specified by the manufacturer.
> > >
> > > Jerry Zion, CBET, MS
> > > Welch Allyn Protocol, Inc.
> > >
> > > MIKE SMITH wrote:
> > > >
> > > > Hello,
> > > >
> > > > I am collecting data for a research project. If you could answer
these
> > > > questions and e-mail them back directly to me as not to clog the
list
> > with
> > > > this thread.
> > > >
> > > > Thanks, Michael D. Smith
> > > > msmith@grandviewheights.org
> > > >
> > > > Survey
> > > >
> > > > Name of Department/Service:
> > > >
> > > > City/State:
> > > >
> > > > ALS BLS:
> > > >
> > > > Do you use pulse SpO2?
> > > >
> > > > Do you use NiBP?
> > > >
> > > > Do you use hands off Defib?
> > > >
> > > > Do you have a policy or protocol regarding use of NiBP?
> > > >
> > > > Do you use manual BP measurement with NiBP?
> > > >
> > > > Do you use NiBP as your sole source of blood pressure measurement?
> > > >
> > > > How often has your NiBP monitor been calibrated?
> > > >
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