Category: High-end NIHON
KOHDEN CardioLife
TEC-8300 series biphasic defibrillators, Acti-Biphasic waveform.
| There are five types of CardioLife TEC-8300K series defibrillators |
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It is incomprehensible why many items could not
be offered as optional, that they must instead be assembled in the factory before
delivery when other manufacturers can do it in the field.
There are actually five models of CardioLife TEC-8300K series defibrillators!
1. CardioLife TEC-8321K defibrillator
2. CardioLife TEC-8322K defibrillator
3. CardioLife TEC-8332K defibrillator
4. CardioLife TEC-8342K defibrillator
5. CardioLife TEC-8352K defibrillator
| The many models means inefficiency for distributors and dealers trying to sell any of the defibrillators |
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It is high inventory cost against the competition.
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| Why is there a need for so many models? |
The rigid models implies the lack of designing skills and a burden to users; it is impossible to upgrade a model in the field and a customer must buy a new model if such a need arises.
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| Which of the five models should you keep stock when your competitors only need to keep one? |
| High-end models with a built-in high-acuity patient monitor |
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Launched in August 2011, the high-acuity Monitor in the defibrillator is expected to have networking capability comparable to any high-acuity patient monitor in the hospital, with the ability to connect to a Central Nurse Station, the ability to upload to a ECG Data management server
for 12-lead ECG reports of the monitored patient etc. This is typically realized through Ethernet LAN networking capability on the patient monitor.
| The defibrillators cannot do networking |
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We were puzzled to find each of the TEC-8300 series defibrillators does not even have an Ethernet LAN output.
This clearly meant it does not connect to a monitoring Central Nurse Station
or send 12-lead ECG Reports to a ECG Data Management Server while still in the hospital, so how are they going to do it from outside of the hospital? This is important missing specification and we wondered how this product could meet the needs of the export markets?
It is clear again this can only be accepted in the domestic market in Japan, which is protectively-insulated from international high-tech competition, and where the bargaining power of buyers is poor.
| High-acuity monitors need networking |
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Below image shows a competing Philips HeartStart MRx with a Central Nurse Station; the HeartStart MRx was launched almost eight years before the CardioLife TEC-8300 series defibrillators.
The HeartStart MRx can be monitored as a bedside monitor on the ICU Central Nurse Station while inside the hospital, as well as when outside of the hospital. Similarly, the 12-lead ECG reports can also be uploaded to the ECG Data Management Server from the defibrillator when it is inside or outside of the hospital.
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| A competing Philips HeartStart MRx could be linked to IntelliVue Information Center (Central Station) like any bedside monitor inside the hospital |
When an advanced defibrillator is outside in the field, it is expected to continue the network link (using the internet)
with the hospital, similar to the way real-time stock/ Forex prices are communicated. Such network link allows remote real-time monitoring by hospital physicians to make preliminary diagnosis and care decisions while patient is en route to hospital; this important capability will save valuable time if the patient needs immediate surgery or transfer to another hospital with more appropriate Specialists and facilities.
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| Remote real-time monitoring en route to hospitals is expected as standard for the TEC-8300 series defibrillators |
| Do you notice 12-lead ECG reports are sent back to the hospital in a technically crude way? |
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The 12-lead ECG reports files of a CardioLife TEC-8300K defibrillator are similar to that from any CardioLife defibrillators, except the files in the CardioLife TEC-8300K defibrillators can be sent out from the defibrillator using wireless Bluetooth technology.
The problem is how to send the 12-lead ECG reports files using Bluetooth, so that the hospital end can retrieve and view the files before arrival of the patients?
To send 12-lead ECG Reports back to the hospital, a CardioLife TEC-8300K series defibrillator must
first transfer them via Bluetooth to a mobile phone. The transferred 12-lead ECG report electronic file is then manually sent out as an email attachment. It is unbelievable.
To receive the email attachments over the hospital side, you need to set up a dedicated email server for the sole purpose of receiving these 12-lead ECG reports as email attachments. The manufacturer provides the QP-832VK TECLink software for installation in PC or laptop to access the dedicated email server for the email retrieval.
The attached 12-lead ECG report files can then be viewed using a proprietary viewer software from the manufacturer. The flow is as shown below.
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| A highly simplistic way of sending electronic 12-lead ECG report files back to the hospital |
One purchasing evaluation committee in Singapore (who had rejected the product as a joke), suggested product improvement of
just equipping the defibrillators with simple built-in fax capability which will make it easy for a hospital to receive the 12-lead ECG reports using a fax machine.
| Beware the Careless and Dangerous use of Estimated CO2 values as True values |
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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 weakness, Nihon Kohden monitors have never been able to offer benefits of integrated sidestream CO2 measurement.
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| The inability to integrate the sidestream CO2 unit into the patient monitor main unit |
The
adoption of semi-quantitative mainstream CO2 measurement was to reduce
cost and its simplicity also help in miniaturization of the transducers.
The first solution offered by Nihon Kohden was the 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 (P907) has very small sensors because semi-quantitative measurement is adopted, the method is
not commonly seen and many are not aware of the risks of obtained CO2
readings from the semi-quantitative CO2 kit sets, and to make matter
worse, the semi-quantitative measurements are also being made used of to
display a flawed continuous CO2 waveform.
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| Nihon Kohden cap-ONE P907 (TG-920P) mainstream CO2 sensor kit |
| How do users remove a relatively big disposable adapter from the two tiny transducers after use? |
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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.
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| 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. This means the transducers are unlikely to last.
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| Users just doing the inevitable |
Shown below is another TG-900P etCO2 kit set (order code P903) that makes semi-quantitative CO2 measurements on a traditional mainstream CO2 sensor. The TG-901T3 kit set (order code P906)
is the same thing but using a non-coded connection plug. The medical
devices from same manufacturer that make use of semi-quantitative CO2
kit sets for patient CO2 measurements and waveform include:
- Life Scope patient monitors
- Vismo patient monitors
- Cap-STAT OLG-2800
- CardioLife defibrillators
- Neurofax EEG machines etc.
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| Nihon Kohden semi-quantitative CO2 kit sets with traditional mainstream transducer |
| The manufacturer is not aware semi-quantitative CO2 measurements are only estimates and sell it as alternative to quantitative type |
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