Life Scope VS (BSM-3500 and BSM-3700 series) bedside monitors from NIHON KOHDEN

Category: Product Review, multi parameter patient monitor, Smart Cable System Product Life Cycle, MULTI connectors, Telemetry

 

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In this record we reviewed and shared the NIHON KOHDEN Life Scope VS (Venus) series bedside monitors and related. The Life Scope VS series consists of BSM-3521, BSM-3552, BSM-3562, BSM-3572, BSM-3733, BSM-3753, BSM-3763 and BSM-3773.

 

Launched in early 2011, the configured LIFE SCOPE VS (BSM-3500 and BSM-3700) series patient monitors targets mid-acuity sites with the configured BSM-3500 series using a 12.1 inch touchscreen display while the configured BSM-3700 series uses a 15-inch touchscreen display. (The BSM-3500 series was belatedly launched in the USA market in 2016).

 

Configured Life Scope VS (BSM-3000) series models

 

There are four models for the 12.1-inch configured BSM-3500 series, namely

a. Life Scope BSM-3532 bedside monitor

b. Life Scope BSM-3552 bedside monitor

c. Life Scope BSM-3562 bedside monitor

d. Life Scope BSM-3572 bedside monitor

The difference among the monitors is the SpO2 algorithm; the latest international version is refrained from use in the USA market for undisclosed reasons.

 

Another four models are for the 15-inch configured BSM-3700 series, namely

a. Life Scope BSM-3753 bedside monitor

b. Life Scope BSM-3755 bedside monitor

c. Life Scope BSM-3763 bedside monitor

d. Life Scope BSM-3773 bedside monitor

 

The prominent feature of the Life Scope VS series monitors is the utilization of yellow shared-use MULTI sockets. The 12.1 inch models make use of TWO yellow shared-use MULTI sockets while the 15 inch models make use of THREE. Note the MULTI sockets do not accept ordinary cables but only cables embedded with codes defined by NIHON KOHDEN.

The yellow MULTI sockets are part of a legacy circuit known as a Multi-parameter Unit and sacrifices must be made to make use of them, but this is not revealed to the market and easily lead customers into having an unrealistic expectation of what the yellow MULTI sockets can actually deliver.

There is a constraint to increasing the number of MULTI sockets since each additional MULTI socket also adds an IBP amplifier hardware, this means the number of sockets for sharing is not enough for use.

The patient monitoring hardware in the Life Scope BSM-3500 series (12-inch) bedside monitors are separated into two blocks:

(BLOCK A) The hardware using dedicated connector sockets and ordinary cables:

- ECG

- SpO2

- NIBP

(PART B) The hardware sharing the two adapting MULTI sockets in a separate Multi-parameter Unit using Smart Cables for connections:

- 2 channels of IBP  (2 MULTI sockets = 2-ch IBP)

- 2 channels of TEMP  (1 MULTI socket = 2-ch TEMP)

- Cardiac Output

 

a. The mainstream CO2, BIS, APCO, NMT comes in the form of a self-contained serial kit set, utilizing the MULTI socket only as a serial port. What is a MULTI-parameter Unit in the monitor will be soon explained.

b. Other parameter options are using external device interface, not the MULTI sockets.

Similarly, there are two blocks of patient monitoring hardware in the Life Scope BSM-3700 series (15-inch) bedside monitors:

(Part A) The hardware using dedicated connector sockets and ordinary cables:

- ECG

- SpO2

- NIBP

(b) The hardware sharing the three adapting MULTI sockets in a separate Multi-parameter Unit using coded measurement cables (known as Smart Cables) for connections:

- 3 channels of IBP (3 MULTI sockets = 3-ch IBP)

- 2 channels of TEMP (1 MULTI socket = 2-ch TEMP)

- Cardiac Output

As seen, the difference between the BSM-3500 series and the BSM-3700 series is the addition of one MULTI socket, and of course it means an additional IBP amplifier. However, the use of a Multi-parameter Unit in the monitors are no longer justified.

The legacy Multi-parameter Unit was originally devised only to solve a product issue

 

In the 1990s, when developing the first digital modular monitor, the development team encountered a problem of insufficient front panel space for connector sockets on the first digital multi-parameter module being made. A few sockets were specially adjusted for time-sharing use by a group of five types internal analog hardware to overcome the space limitation; to differentiate them, they were colored yellow and known as MULTI sockets.

 

At the time NIHON KOHDEN was responding to an important emerging trend of using a high-density digital multi-parameter module as basic building block for modular monitors

 

 

In analog modular monitors, only single parameter modules were produced by NIHON KOHDEN. When designing the first digital modular monitor, the company discovered the critical care market had already moved to using a digital multi-parameter module with higher density of electronic components as a basic building block for modular monitors.

 

Apart from the higher electronic density, the difference between a single parameter module and a multi-parameter module is the presence of a CPU processor in the latter; the output of a multi-parameter module is thus processed digital data. This new development of distributed processing made it possible for patient data to be stored and moved with the module. Digital modules can also be connected directly to a (proprietary) digital data-exchange network as a node.

 

NIHON KOHDEN wanted to follow the trend by offering the first digital multi-parameter module, and the first digital multi-parameter module made by the company was named the Saturn module.

Responding to new trend in the 1990s using a multi-parameter module with higher electronic density as a basic building block for modular monitor

Even occupying a 3-slot width of the module rack, the Saturn multi-parameter module (August 1998) was not big enough to hold all necessary connector sockets

 

Nihon Kohden intended a module rack integrated physically with the main unit to form a limited footprint just big enough to stack the display monitor on top of it (see below illustration). The physical size of the Saturn module was therefore constrained; in addition, the multi-parameter module must work in combination with other parameter modules like recorder, sidestream CO2, BIS, EEG, Flow/ PAW, SvO2 in the module rack.

The Saturn module was intended to be physically small in size

  

The elegant but expensive solution from NIHON KOHDEN for the physical size limitation of the Saturn module was to modify two of the connector sockets for sharing use

 

Two sockets were modified for time-sharing use because there was not enough free space on the Saturn module for more sockets

The method selected by NIHON KOHDEN was to make use of coded measurement cable cited as "Smart Cables" to share two connector sockets. The patient monitoring hardware were separated into two blocks in the Saturn module:

(BLOCK A) The hardware using dedicated sockets and ordinary cables:

- ECG

- SpO2

- NIBP

(BLOCK B) The hardware sharing the two adapting MULTI sockets in the Multi-parameter Unit using only Smart Cables for connections:

- 2 channels of IBP (2 MULTI sockets = 2-ch IBP)

- 4 channels of Temperature (2 MULTI sockets = 4-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

The adapting MULTI sockets were additionally allowed to be diverted to act as a costly digital serial ports so that mainstream CO2 digital serial kit sets can also use it; this being an easy task since no internal analog hardware is being involved.

The mainstream CO2 comes in the form of a self-contained serial kit set, utilizing the MULTI socket only as a serial port.

Remember this is for purpose of minimizing connector sockets on the Saturn multi-parameter module, as it does not make sense outside this context. In the next section, we will explain what is a Multi-parameter Unit in the Saturn module.

The label for the yellow MULTI socket indicated the five specific hardware plus mainstream CO2 using it as a serial port.

 

The label for the yellow MULTI sockets on the Saturn module

 

Time-sharing means only one type of the internal hardware sharing the connector sockets has exclusive use of it at any point of time

 

There are cheaper and more practical alternatives to solving the problem of insufficient space on the input panel, such as commonly integrating more than one signal onto a socket and using an external splitter to resolve the signals.

 

Example of resolving integrated signals to individual P1 and P2

 

So far, time-sharing of connector sockets is only done by NIHON KOHDEN and not repeated by any other leading manufacturers of patient monitors for obvious reasons.

It is foremost important to know the overall cost is very high to share connector sockets.

 

The connector sockets that were being time-shared are known as MULTI Sockets and colored yellow. The yellow MULTI sockets must be used in conjunction with coded measurement cables known as Smart Cables, and the plug of a Smart Cable has the same color as the MULTI sockets. The Smart Cables are each marked with a digital hexadecimal code to identify the purpose of the measurement cable (i.e. what parameter is being measured).

 

Overview

 

The digital code is stored in an EEPROM chip mounted on a small flexible PC board electrically wired to the pins of the cable plug. The hexadecimal code in the EEPROM is inserted at the factory and not allowed to change after production. It is actually not difficult to make the Smart Cables but they are being priced highly by the manufacturer; only the common IBP cable can be sourced from China suppliers at a reasonable price.

 

A code stored in the plug of the measurement cable gives switching instruction to an engaged MULTI socket

 

The code in the plug makes known what parameter a measurement cable is meant for and it is the instruction to the engaged MULTI socket to link internally to any of the five types of embedded parameter hardware, namely:

 

Temperature, Invasive Blood Pressure, Thermo-dilution Cardiac Output, Thermistor Respiration and FiO2

 

Thus, a coded "Smart Cable" makes it possible for exclusive use of an engaged yellow MULTI socket via internal switching among five types of specific hardware.

The MULTI sockets are therefore adapter sockets with the ability to take switching instructions from the digital codes stored in measurement cables known as "Smart Cables"

 

Principle of Operation

 

The Multi-parameter Unit (MPU) in the Saturn module

 

In addition to the coded "Smart Cables", costly mechanism must be in place internally to select the correct active hardware corresponding to the specific code of the measurement cable being used.

The hardware sharing the two MULTI sockets are internal components of the Multi-parameter Unit, together with the necessary mechanism needed to support the time-sharing. For example, when a measurement cable with a "Cardiac Output" code is plugged into a MULTI socket, the internal Cardiac Output hardware will have exclusive use of the engaged MULTI socket. If a hexadecimal code is not detected (such as a damaged Smart Cable plug), the MPU would not do anything and none of the internal hardware would be linked.

 

Sharing of connector sockets is made possible by coded measurement cables and an internal Multi-parameter Unit

 

The MULTI PARAMETER UNIT is an official term found in the service manual

 

Extension is badly needed for the MULTI-PARAMETER UNIT in the Saturn module

 

There are not enough connection sockets on the Saturn module, more sockets are needed. This is only solved by having one or more satellite boxes containing two usable MULTI sockets each, placed next to the Saturn module. The image gives an impression of scalability when skipping the details, but the necessary hardware are already embedded in the Saturn module except for additional IBP amplifiers which must be tied to the number of available MULTI sockets.

What you are seeing is making use of space external to the Saturn module to add back the missing connector sockets

The deficiency of connector sockets is solved only by providing additional MULTI connector sockets placed on external boxes

Since the Multi-parameter Unit of the Saturn module had only two yellow MULTI sockets, it is impossible to perform more than two channels of IBP monitoring; this means IBP hardware must always correspond to the number of MULTI sockets available. For this reason, each MULTI socket comes with their own one-channel IBP hardware.

Temperature hardware is not an issue since each MULTI socket can take two channels of Temperature measurements

The extension Smart module is therefore a 2-channel IBP box using two yellow shared-use MULTI sockets that can also access the Multi-parameter unit to make use of the Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware already embedded in the Saturn module.

The necessary hardware are already in the Saturn module except for additional IBP amplifiers tied to number of available MULTI sockets

So, there is clearly an unexpressed MULTI sockets hardware rule that is being kept under wraps by the manufacturer:

"Each functional yellow MULTI socket comes with one IBP amplifier hardware"

This of course, turns into a limitation when the MULTI sockets are being used out of context.

The Saturn module, together with two satellite boxes adding 4 channels of IBP to the Saturn module is shown below. The four MULTI sockets on the satellite boxes can also access the MPU of the Saturn module. Together, six IBP channels and six shared-use MULTI sockets are available to the users.

The sockets on the satellite boxes make up for those missing connector sockets on the Saturn module

 

A yellow shared-use MULTI socket is a high-cost serial port when it does not select any hardware

 

MULTI socket poorly utilized as a costly serial port

The initial arrangement was only for mainstream CO2 serial kit sets, but later extended enthusiastically to BIS kit set, 2nd-SpO2 kit set, APCO kit set, NMT kit set etc., whose motivation is highly questionable given this greatly increases the interface cost compared to a plain serial port.

The use of Smart Cables for serial communications, however, gives the false illusion of a mighty MULTI socket when the capabilities are in reality coming from the system software. The truth is NIHON KOHDEN no longer needs the Smart Cables and MULTI sockets.

 

Make no mistake, the serial kit sets are self-contained and whether a particular kit set is supported depends on the system software, not on the type of connector sockets being used.

To reiterate, there is no difference if you connect digital serial data to the monitor using Smart Cables or ordinary serial cables

 

This is how you connect the BIS processor kit to a yellow MULTI socket

 

NIHON KOHDEN failed to justify use of the Multi-parameter Unit and Smart Cables when out of context

Preceding Life Scope VS bedside monitor was the Life Scope BSM-2300K series monitors, let's see how the sole yellow MULTI socket was actually being used in this series.

 

The portable 8.4-inch Life Scope i (BSM-2301K)

 

To insist the use of Smart Cables, the Life Scope BSM-2301K monitor has a MULTI-parameter Unit with only one yellow MULTI socket for three types of measurements, namely:

 

a. Invasive Blood Pressure

b. Thermistor Respiration

c. Digital self-contained mainstream CO2 serial kit sets.

 

The MULTI socket does not mean flexibility because you can only do one of the above parameter at any one time. Using three dedicated sockets is a far superior proposal; why suffer pain of two missing sockets to gain use of one flexible socket?

 

Life Scope-i does not have enough connector sockets

 

The use of a MULTI socket is self-contradictory from the start. We have to ask why is the monitor avoiding the use of MULTI socket to access the Temperature hardware if sharing a socket is preferred capability? This is a slap on the face for proposing use of Smart Cables on a bedside monitor!

The two blocks of patient monitoring hardware in the Life Scope BSM-2301 bedside monitor are:

(BLOCK A) The hardware using dedicated sockets and ordinary cables:

- 1-ch TEMP

- ECG

- SpO2

- NIBP

(PART B) The hardware sharing the single yellow MULTI socket in the Multi-parameter Unit using only Smart Cables:

- 1-ch IBP (1 MULTI socket = 1-ch IBP)

- Thermistor Respiration

The mainstream CO2 comes in the form of a self-contained serial kit set, utilizing the MULTI socket only as a serial port

The reality is the shortage of two connector sockets, and the flood of complaints from users insisting the single MULTI connector socket on the BSM-2301K was not enough. The manufacturer was pressured to respond with an updated model (BSM-2303K) with an isolated MULTI socket added. The isolation was done so as not to disturb existing Multi-parameter Unit with an additional MULTI socket. It means the additional MULTI socket is not a functional MULTI socket.

The isolated MULTI socket is solely for IBP monitoring, effectively relieving the MULTI socket of existing MPU to only measure either Thermistor Respiration or act as serial port for the mainstream CO2 kit set. The solution was only partial, and it reduced two missing sockets to one missing socket; a total solution would have been just using dedicated sockets as there is no need for socket sharing.

There was no actual demand for additional IBP channel, but the BSM-2303 bedside monitor was camouflaged as an upgraded monitor with 2 channels of IBP.

Under pressure, an additional isolated MULTI socket acting solely as an IBP amplifier had to be introduced

The value captured by users from using the Multi-parameter Unit and Smart Cables is negative

 

How is NIHON KOHDEN making use of the Multi-parameter Unit can be seen from below illustration. Users of the left monitor (BSM-3500 series with 2 channels of IBP) requires five connection sockets to connect freely for unconstrained use but only two MULTI sockets are provided for time-sharing use! Similarly, users of the right monitor (BSM-3700 series with 3 channels of IBP) requires six connection sockets for necessary unconstrained use but the manufacturer insists three time-shared MULTI sockets are enough for use. How does such deliberate insistence for shortage of connector sockets benefit the users?

 

The two monitors are enduring pains of insufficient connector sockets to gain use of two or three flexible sockets

 

Manufacturers make their profits by providing product benefits to users but the yellow MULTI sockets have no benefit. The first vehement complaint from users is the yellow MULTI sockets on the monitor are not enough, yet this was done intentionally.

What benefit can it offer users when necessary connector sockets go missing?

NIHON KOHDEN Multi-parameter Unit (using only Smart Cables for connections) is configured

 

The yellow MULTI socket by itself does not automatically mean all the five types of mentioned parameters are available for measurements; it still depends on whether any of the five types of active hardware are actually being placed inside the Multi-parameter Unit. The amount of configured hardware inside each Multi-parameter Unit is always different; so is the system support for serial kits. If a model is not equipped with FiO2 hardware internally, no amount of yellow MULTI sockets can provide this measurement capability.

It is the built-in hardware that determine the parameter capability; and in the case of serial kit sets, the system software. This of course, is the same description as a configured patient monitor

 

 

Actual internal hardware and system support for serial kits varies for each multi-parameter unit

This means Life Scope VS bedside monitors making use of the Multi-parameter Unit are still configured monitors. The manufacturer has no reason to use the Multi-parameter Unit; it is not flexibility, but dabbling with distortions and limitations.

Additional struggle to use serial kit sets to improve credibility of Multi-parameter Unit and Smart Cables

  

To improve credibility, more self-contained serial kit sets are insisted to pass through a yellow MULTI socket as mandatory path instead of just using a direct digital serial interface.

Making for a higher deficiency of connector sockets

The net effect of the move increases the cost of the serial interface, and the unnecessary jump in demand for more yellow MULTI sockets.

Forceful diversion of signal path to pass through the MULTI sockets

There is no technical need for the serial kit sets to use the yellow time-shared MULTI sockets

 

 

The digital serial data does not need to pass through a MULTI socket

 

 

The serial kit sets are independent self-contained packages with electronic boxes, drawing only power from the MULTI sockets. A small connector socket is all it needs for handling such digital serial data.

 

Only a small connector socket is needed for handling a one-bit digital data

 

Placing the serial interface in perspective, most patient monitoring parameters cannot be made into serial kits; it is the exception rather than the rule. Thus, although serial kit sets could be used by configured monitors for capability expansion but it is limited in scope and does not upgrade a configured monitor to be modular.

This is what happened when complaints from users about connector socket shortages becomes overwhelming; users just want their sockets back!!!

 

Electrically, the manufacturer can restore the input units or monitors with insufficient connector sockets back to normalcy using a satellite socket box filled with yellow MULTI sockets, making up for the missing sockets.

Life Scope VS bedside monitors were launched without options of expansion units; however, it had become necessary when complaints about socket shortages became overwhelming. The solution offered by the manufacturer speaks volume about the urgency to restore normalcy; the customers are desperate to have their sockets back!

 

Socket boxes from Life Scope TR are tendered as solution when complaints from users became overwhelming!

As seen, the expansion units from Life Scope TR are offered to overcome the man-made problem; the makeshift solution makes the bedside monitor look awkward, resembling a product prototype.

The expansion units are either a 2x IBP box (with 2 MULTI sockets) or a 4x IBP box (with four MULTI sockets). This is not scalability, but putting back the missing sockets; if users only need the missing sockets but not the additional IBP hardware, should they pay for the sockets?

 

There is no customer value created by sharing cheap connector sockets

 

Elaborate time-sharing are applied to things that are expensive (high in demand, an asset), and not worth the efforts for things that are cheap (high in supply, a commodity) like a connector socket or a switch! It only makes sense to see productive efforts being made to time-share a CPU, a car, a hotel room, a yacht, an airplane but not a calculator, a pencil or a pair of scissors. The legitimate resources for a patient monitor to time-share are obviously the analog amplifier hardware and not the connector sockets or switches; this way there would not have any idling costly hardware leading to inefficient use of valuable resources!

 

Time-sharing of a car (an asset) creates value for the customers but time-sharing of a cheap connector socket does not

 

The next picture shows another manufacturer time-sharing one channel bio-amplifier hardware between IBP and Temperature measurements, and there was no sharing of connector socket; this is exactly the opposite of what NIHON KOHDEN is doing. The said manufacturer merely ensures physically it is not possible to make use of both the PRESS and the TEMP socket at the same time.

 

Only share the expensive hardware, not the cheap sockets

 

WATCH OUT the dangerous use of semi-quantitative estimation data for uncertain measurements and concurrently displaying a flawed CO2 waveform

 

Nihon Kohden lacks sidestream CO2 sampling expertise and buys OEM units to offer them as expensive standalone. The AG-400 CO2 unit as shown, for example, is technology from Oridion Medical. For monitoring such as post-surgery recovery, integration of the sidestream CO2 into the monitor is a mandatory requirement because an external unit requires additional power socket besides necessitating the use of a trolley.

 

For some unknown reason, Nihon Kohden monitors could not offer integrated sidestream CO2 unit.

 

The inability to integrate the sidestream CO2 unit into the patient monitor main unit

Nihon Kohden solution was to offer miniaturized mainstream cap-ONE TG-920P CO2 sensor kit (order code P907) that can be used on non-intubated patients.

 

The cap-ONE TG-920P CO2 sensor kit (order code P907) has very small sensors because semi-quantitative measurement is adopted, the method is not commonly seen and many are not alerted to the risk of using data from semi-quantitative etCO2 kit sets for critical measurements and true CO2 waveform display.

 

Nihon Kohden cap-ONE P907 (TG-920P) mainstream CO2 sensor kit

 

How to remove a relatively big disposable adapter from the two tiny transducers after use?

 

When the sensors become smaller, it also means the disposable adapter becomes relatively much bigger as seen in this below picture. When trying to remove the disposable adapter from the transducers, it is difficult to separate the two because of the latching mechanism. A small size transducer means anything that latches onto it must be even smaller.

It is not easy to separate the disposable adapter from the Cap-ONE transducers after use

 

When removing disposable adapter from the mini sensors, users tend to just pull from the cables and this action quickly weakens the joint holding the sensors and cables. The action will cause stress to the two joints and quickly degenerate the performance of the transducers.

 

Users just doing the inevitable

 

Shown below is another TG-900P etCO2 kit set (order code P903) that makes semi-quantitative CO2 measurements; the TG-901T3 kit set (order code P906) is the same thing using a different connection plug. The medical devices from same manufacturer that uses semi-quantitative etCO2 kit sets for patient CO2 waveform monitoring have Life Scope patient monitors, Vismo patient monitors, Cap-STAT OLG-2800, CardioLife defibrillators and Neurofax EEG machines etc.

 

Nihon Kohden semi-quantitative etCO2 kit sets

 

A highly relevant question: Can users accept estimated measurements for patient monitoring?

    

To save costs, the semi-quantitative kit sets do not make measurement during the inspiration phase, the measurement duty cycle is as shown. This means semi-quantitative CO2 measurements are not made continuously.

Semi-quantitative means there is a duty cycle, and measurement is not continuous

 

Semi-quantitative measurement is also of low-accuracy type, performed using one IR detector instead of the usual two to save cost. This is reflected in the measurement tolerance.

 

Contrasting, quantitative measurement delivers high accuracy for critical care. To ensure the necessary high accuracy, quantitative measurement employed two IR detectors for simultaneous CO2 measurements at different wavelength for results comparison. CO2 measurements are also being made continuously.

 

Quantitative measurement employs two detectors to make continuous measurement at different wave-lengths to compare readings for high accuracy

 

NIHON KOHDEN specification for TG-901T CO2 sensor kit shows even the specified low accuracy of CO2 measurement using semi-quantitative method no longer holds true once CO2 is present during the inspiration phase.

This is because actual CO2 value will be more.

As seen from the duty cycle, there is no measurement being made during the inspiration phase; how do the users know specified measurement accuracy is valid?

  

Measurements are invalid when CO2 is present during inspiration, but CO2 is not measured during this period; can you have confidence in the measurements?

 

It should be clear each semi-quantitative CO2 measurement is only an estimation since its accuracy is rendered uncertain by the inability to confirm if CO2 is present during the inspiration phase. The specified measurement tolerance therefore has no meaning for the users!

 

The users are also not alerted on screen there is no CO2 measurement being made during the inspiration phase, and unknowingly made to take an unnecessary risk.

 

Semi-quantitative methodology means cost-effective estimations and the design cannot be used in a general way, only on a selective basis with known risks

 

 

For example, semi-quantitative methodology can be used as a simple estimation tool for obtaining the numerical value of End-tidal Carbon Dioxide level (etCO2).

 

Below picture shows the semi-quantitative method in the way it was intended for, estimating only the etCO2 numerical value for purpose of airway tube placement confirmation. It is not for continuous waveform display.

A hand-held semi-quantitative etCO2 estimation tool (with SpO2) for airway tube placement confirmation

 

 

How is it feasible to display a true continuous CO2 waveform when the semi-quantitative measurement kits do not have the ability to make continuous measurements?

 

 

NIHON KOHDEN also allows data from semi-quantitative measurements to be displayed on screen with the non-measurement period reset to zero level. The insistence to display a continuous waveform using discontinuous measurement data from semi-quantitative mainstream CO2 estimation kits is unacceptable; the manufacturer is just subjecting the monitored patients and users to dangerous misinterpretation risks.

 

A zero CO2 reading on the waveform means zero measured value. No measurement can only mean a defective sensor, not by design!

Note the etCO2 value shown is also not alerted as estimated etCO2 only.

 

A flawed CO2 waveform with non-measurement intervals reflected as zero measured CO2 value

As seen from the two true CO2 traces below, expiratory upstrokes do not always start from zero CO2 level!

 

Quantitative measurements confirming expiratory upstrokes do not always start from zero CO2 level

  

Check the latest updated table to make sure you only use quantitative method for critical measurements and true CO2 waveform display on screen.

 

Use only quantitative method for waveform display; the quantitative TG-950P (P905) shown here was already discontinued.

 

 

How about fully-quantitative type miniaturized mainstream CO2 sensor?

   

The TG-907P CO2 Sensor kit (order code P909) shown in above table is using quantitative method as declared. This sensor was designed for non-intubated adult CO2 monitoring, as well as neonatal CO2 monitoring. In short, Nihon Kohden is trying not to rely on others for sidestream CO2 sampling expertise.

 

The miniaturized CO2 sensor is easily broken by the bigger and stronger adapter

 

 

In addition to the dead space problem, they had not foreseen miniaturized mainstream CO2 sensors could be easily broken by the disposable adapters. This happened because the disposable adapters are now relatively bigger and stronger!

These are common defects of a TG-970P CO2 sensor kit (P909). The design is impractical.

 

 

Undeniable confirmation the fragile miniaturized CO2 sensor is of poor design, and easily broken

 

 

Key point is, it does not last

Users should aware the mandatory need for network isolation units when connecting Life Scope VS bedside monitors to a Central Nurse Station

 

For hardwired Ethernet networking, a Life Scope VS bedside monitor equipped with a non-isolated Ethernet LAN interface when connecting to a real-time LAN network is a danger to the patient. It is mandatory to observe patient electrical safety by using a network isolation unit to protect the patients.

NIHON KOHDEN network isolation transformer

 

When an isolated monitor with an non-isolated Ethernet port is connected to a hardwired network, it is no longer a medical device unless the above-shown network isolation transformer is introduced between the monitor and network. If the network isolation transformer is not installed, dangerous electric shocks can be delivered to a monitored patient through the wired Ethernet network. Such dangerous electric shocks are potentially lethal and no hospital should ignore this mandatory requirement.

For telemetry networking, the ZS-900P Telemetry Transmitter is optionally required. This is required specification for the Japanese domestic market due to government subsidy but unpopular outside of Japan because of cost.

Telemetry networking is not popular outside of Japan due to cost

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