Instructions for Use

Detailed instructions

This Chapter contains all the information required by users of the device for a safe, correct and accurate measurement. It includes a detailed and complete description of all the functions of the device, safety instructions and all the information required to understand operation of the device.

5.1 FIRST TIME USE

5.1.1 BASIC FUNCTIONALITIES

MESI mTABLET ABI package consists out of four MESI TUBELESS CUFF UNIT diagnostic devices and 4 tubeless cuffs. Before first use, the MESI TUBELESS CUFF UNITS need to be paired with MESI mTABLET UNIT. Follow the instructions carefully.

5.1.2 AC/DC POWER SUPPLY AND BATTERY

The MESI TUBELESS CUFF UNIT uses two power ...sources: mains electricity (which uses a AC/DC power supply for charging) and battery power (which is used while performing measurements).

Connect the AC/DC power supply to a wall socket with a mains voltage of 100-240V at 50-60Hz and to the connector at the back of the device.

5.1.3 ACTIVATION

When setting up the MESI TUBELESS CUFF UNIT for the first time it needs to be activated. The device will not respond until it is placed on the MESI LARGE CHARING PLATE and a multifunctional button illuminates. It is recommended that before first use the MESI TUBELESS CUFF UNIT is fully charged

NOTE: The battery inside a completely new device is most likely not completely empty and can provide enough power to start the device up. Nonetheless, please recharge the batteries before first use.

NOTE: When the battery needs to be replaced, the MESI mTABLET UNIT will display a battery warning. For more information see Chapter 8 ERRORS.

5.1.4 FIRST USE BATTERY STATUS

The MESI TUBELESS CUFF UNIT comes with an internal battery. To check the battery status, press multifunctional button on top of each MESI TUBELESS CUFF UNIT. The button will respond by lighting up in green or red depending on the battery state. Otherwise, see the chapter 6.1 CHARGING THE BATTERY for more information on battery charging

5.1.5 PAIRING

Before any measurements can be performed the MESI TUBELESS CUFF UNIT has to be paired with the MESI mTABLET UNIT. Take the MESI mTABLET UNIT, open user profile (for more information about user accounts see MESI mTABLET instruction manual, chapter MANAGING USERS) and observe the following instructions.

Step 1

Go to User profile > Settings > Modules > +Add module

MESI mTABLET ABI - Pairing - Step 1

Step 2

Press and hold the button on the top of the MESI TUBELESS CUFF UNIT until the multifunctional button light changes to blue.

MESI mTABLET ABI - Pairing - Step 2

Step 3

When the MESI mTABLET UNIT establishes a connection with MESI TUBELESS CUFF UNIT, the light on top of the module will change to green. Confirm the pairing process by pressing the button on top of the module again.

MESI mTABLET ABI - Pairing - Step 3

NOTE: While operating only with one MESI mTABLET UNIT, performing this operation is required only once. In case of more MESI mTABLET UNITS this process will have to be repeated on each MESI mTABLET UNIT.

Step 4

The final screen indicates successful connection between the MESI mTABLET UNIT and the MESI TUBELESS CUFF UNIT. It is possible to access all technical information about the connected modules in User profile >Settings > Modules > Connected modules

MESI mTABLET ABI - Pairing - Step 4

5.1.6 ATTACHING THE CUFFS

Before first use, cuffs should be disconnected from the MESI TUBELESS CUFF UNIT. The conical cuff can be orientated any way to the MESI TUBELESS CUFF UNIT. To connect the cuff, follow the next steps:

Step 1

Hold MESI TUBELESS CUFF UNIT firmly in your hands.

MESI mTABLET ABI - Attaching the cuffs - Step 1

Step 2

Attach cuff to the MESI TUBELESS CUFF UNIT.

MESI mTABLET ABI - Attaching the cuffs - Step 2

5.1.7 DETACHING THE CUFFS

During transportation, each conical cuff should be disconnected from the MESI TUBELESS CUFF UNIT. To detach the cuff, follow the next steps:

Step 1

Hold MESI TUBELESS CUFF UNIT firmly in your hands.

Step 2

Push the sliding lock in the direction indicated on it and detach the conical cuff.

MESI mTABLET ABI - Detaching the cuffs

5.2 PATIENT SELECTION

Before performing a measurement, patient needs to be selected or added to your working groups a patient list.

5.2.1 SELECTING A PATIENT

Step 1

Select the patient tab button.

MESI mTABLET ABI - Selecting a patient - Step 1

Step 2

Use the search bar (1) or scroll (2) to the patient who is having their ABI measured.

MESI mTABLET ABI - Selecting a patient - Step 2

Step 3

Select the patient.

MESI mTABLET ABI - Selecting a patient - Step 3

5.2.2 ADDING A PATIENT

Step 1

On your home screen, press the + button in the Patient tab.

MESI mTABLET ABI - Adding a patient - Step 1

Step 2

Fill out required fields (Name, Surname, Date of Birth and Gender) and any additional information regarding the patient.

MESI mTABLET ABI - Adding a patient - Step 2

Step 3

Save the patient by pressing the ✔️ button.

MESI mTABLET ABI - Adding a patient - Step 3

5.3 PERFORMING AN ABI MEASUREMENT

The patient must be in a supine position, remain still and remain quiet.

NOTE: It is recommended that the patient lies still for at least 5 minutes before starting the measurement process.

NOTE: The person carrying out the measurement should always remain by the patient’s side and closely monitor the measurement process.

5.3.1 CUFF PLACEMENT

The MESI automated wireless ABI system includes 4 cuffs for arms/legs. The ABI measurement can be made using with 4 or 3 cuffs. When using 4 cuffs the MESI mTABLET ABI system uses the SmartArm™ algorithm to identify the arm with the higher systolic blood pressure, which will be used in the calculation of ABI.

When using only 3 cuffs the user needs to identify the arm with the higher systolic blood pressure manually or perform the ABI measurement with both arms to obtain an accurate result.

NOTE: Measurement of the Ankle-Brachial Pressure Index can be affected by the placement of the cuffs, the position of the patient and their physical condition. The functioning of the device can also be affected by high temperature, humidity and altitudes. 

MESI mTABLET ABI - Cuff placementMESI mTABLET ABI - Cuff placement - Option 1MESI mTABLET ABI - Cuff placement - Option 1 (b)

ARM CUFF

Place the appropriate cuff on left/right arm and position the cuff 1-2 cm above the elbow joint. Make sure that the arrowshaped artery marking is in line with the brachial artery.

MESI mTABLET ABI - Cuff placement - Arm cuff

Place the cuff so that there is two fingers’ width of room between the limb and the cuff. Check that you have chosen the correct size using the SIZE marking and the OK area of the cuff.

MESI mTABLET ABI - Cuff placement - Arm cuff (2)

ANKLE CUFF

Place the appropriate cuff on left/right leg and position the cuff 2-3 cm above the ankle. Make sure that the arrow-shaped MEDIAL ANKLE marking points towards the inner side of the ankle.

MESI mTABLET ABI - Cuff placement - Ankle cuff

Place the cuff so that there is two fingers’ width of room between the limb and the cuff. Check that you have chosen the correct size using the SIZE marking and the OK area on the cuff.

NOTE: For other cuffs observe Instructions for use of the cuff available in the MESI TUBELESS CUFF MODULE package or contact your local distributor for more information.

5.3.2 PERFORMING AN ABI MEASUREMENT

Step 1

On the MESI mTABLET UNIT select an existing patient or add a new one. For additional information see chapter 5.2 PATIENT SELECTION.

MESI mTABLET ABI - Performing an ABI measurement - Step 1

Step 2

After selecting a patient, select the ABI application in application menu.

MESI mTABLET ABI - Performing an ABI measurement - Step 2

Step 3

Select the type of measurement – 4 cuffs or 3 cuffs (when selecting 3 cuffs you need to select the appropriate arm for calculating ABI – left/right). Press OK.

MESI mTABLET ABI - Performing an ABI measurement - Step 3

Step 4

Amputation option – if a patient has an amputated limb or is not compliant for ABI measurement due to severe and/or painful wounds, the ABI can be measured only on patient’s existing limbs. Before the measurement the user can disable the selected cuff, by clicking on the button and selecting the limb that is not compliant for measurement.

MESI mTABLET ABI - Performing an ABI measurement - Step 4

NOTE: If the MESI TUBELESS CUFF UNIT has low battery or connectivity issues, a warning will be displayed on the instructions screen. In case of errors please consult Chapters 8 ERRORS and 9 TROUBLESHOOTING.

Step 5

Apply the cuffs to the appropriate locations (arm/legs) according to Chapter 5.3.1 Cuff placement and follow the onscreen instructions. The patient should be in a supine position, remain still and remain quiet. Press the START button to begin the measurement.

MESI mTABLET ABI - Performing an ABI measurement - Step 5

Step 6

During the measurement the pressure waveforms show oscillation of pressure for each limb while the pressure next to the oscillation displays the current pressure in the corresponding cuff.

Progress bar: The progress bar shows the timeline of the ABI measurement. When the bar comes to an end the measurement of all blood pressures concludes and all the cuffs deflate. The results screen follows.

Cuff pressure (mmHg)

STOP button – for cancelling the measurement

MESI mTABLET ABI - Performing an ABI measurement - Step 6

5.4 REVIEWING AN ABI MEASUREMENT

MESI mTABLET ABI - Reviewing an abi measurement - Step 1MESI mTABLET ABI - Reviewing an abi measurement - Step 2MESI mTABLET ABI - Reviewing an abi measurement - Step 3

5.4.1 MESI MTABLET RESULTS SCREEN

When the measurement process is completed, results will be displayed on the screen. This consists of seven different areas: navigation area, ABI values, SYS/MAP/DIA blood pressure values and SmartArm™ selection, Oscilation graphs and Pulse waveforms, patient’s measurements history, comments on the result and another navigation area.

NOTE: If the results of the Ankle-Brachial Pressure Index measurement are very unusual, repeat the measurement three times.

5.4.1.1 Navigation area

All the buttons and information placed in the navigation area are there to help you get around the application. You can toggle between previous results of this patient. If you are not satisfied with the result for any reason, you can quickly discard it or, in the case of uncertainty, you can consult with a specialist by entering their e-mail addresses or by pressing the printer icon which will provide you with a printout of a selected measurement. The navigation menu also contains the names of both the doctor performing the recording and the patient.

5.4.1.2 Measurement information

Parameters from the measurement (Right/Left Ankle-Brachial Index) This section shows the left and right Ankle-Brachial index results along with the systolic and diastolic blood pressures of the arm that was used for the calculation.

Pressing the “Show more” button will display more detailed information regarding the systolic and diastolic blood pressure measurement (mmHg) on the arm/s and leg/s and the pulse rate (depending on which option of the measurement did the user select 3-cuff or 4-cuff measurement).

5.4.1.3 Oscillation graphs and Pulse waveforms

In this section, the entire ABI measurement pulse waveform (oscillation graph) or a detailed view (pulse waveform) can be examined. For more information regarding the reading, the oscillation or pulse waveform graph see chapter 5.5 INTERPRETATION OF AN ABI RESULT.

5.4.1.4 Patient measurement history

History holds an overview of measurements measurements taken by the same doctor on the same patient. It shows the trend of the patient’s results for left and right ABI on a specific date.

A comment can be added to every measurement. It will be stored and always available together with recoding report.

5.5 INTERPRETATION OF AN ABI RESULT

5.5.1 DETECTION OF SEVERE PAD AND INCOMPRESSIBLE ARTERIES

When the result “Abnormally weak pulse” is displayed, there is a high probability of severe Peripheral Arterial Disease (PAD) or incompressible arteries (Medial Calcinosis).

NOTE: The majority of the “Abnormally weak pulse” results describe the patients with an ABPI around or lower than 0,5.

NOTE: In case of Medial Calcinosis, the arteries cannot be compressed due to stiff arterial walls. The measurement of blood pressure with cuffs is not possible, and therefore the ABPI cannot be reliable. The patient should be referred for a Toe Brachial Index measurement.

5.5.2 PULSE WAVEFORM

The MESI mTABLET ABI uses the PADsense™ pattern recognitional algorithm to automatically interpret the acquired pulse waveform and calculate the ABI with the result. However, to help an operator to better understand a performed ABI measurement, this pulse waveform is available on the applications results screen.

Combining both the ABI result and pulse waveform represents the best practice in evaluating the presence and severity of Peripheral Arterial Disease (PAD).

Normal pulse waveform will display:

(1) a rapid rise in the upstroke during systole,

(2) a very sharp peak,

(3) a gradual downstroke,

(4) a presence of dicrotic notch.

MESI mTABLET ABI - Pulse waveform - Image 01

An absence of the dicrotic notch, a smaller amplitude, decreased slope and rounding of the systolic peak are the initial signs of a possible abnormality - the measured ABI value is lower than the one with normal pulse waveform.

MESI mTABLET ABI - Pulse waveform - Image 02

A flattened PVR waveform or a PVR without the typical shape is an indicator of severe PAD. The absence of the pulsations caused by occlusions in the artery makes it impossible to calculate the ankle pressures. Instead of ABI value, the device will display a “PAD” result, indicating severe disease. The result is confirmed with non-typical, f lattened PVR waveform, similarly to the picture below.

MESI mTABLET ABI - Pulse waveform - Image 03

5.5.3 OSCILATION GRAPH

As with the pulse waveform the MESI mTABLET ABI displays on result page also oscillation graphs which provide the operator with a pulse waveform analysis through the whole ABI measurement.

Below are a couple of examples of different oscillation graphs:

Normal oscilation graph

MESI mTABLET ABI - Normal oscilation graph

Severe PAD oscilation graph

MESI mTABLET ABI - Severe PAD oscilation graph

Incompressible arteriesoscilation graph

MESI mTABLET ABI - Incompressible arteriesoscilation graph

5.6 MULTIFUNCTIONAL BUTTON

5.6.1 LED INDICATORS

Even though most of the MESI TUBELESS CUFF UNIT control is performed through the MESI mTABLET UNIT interface there is still a multifunctional button on top of the device. Next to basic colour light notification functionalities of this button there is also a possibility to perform some additional operations. These operations are based on the current status of the MESI TUBELESS CUFF UNIT.

MESI mTABLET ABI - LED indicators
5.6.1.1 Standby

Green: Battery capacity is more than 25%.

Red: Unit battery is less than 25%, please recharge the unit as soon as possible.

5.6.1.2 Charging

Green: Battery is fully charged.

Orange: Unit is charging.

5.6.1.3 Pairing

Blue: Unit is waiting for confirmation from the mTABLET.

5.6.2 BUTTON FUNCTIONS

5.6.2.1 Standby
Button functions - Standby
Column AColumn B
Status checkQuickly pressing the on button in standby mode will perform a basic status check of the MESI TUBELESS CUFF UNIT – green, more than 25% battery charge, while red means less than 25% charge is left, and the module should be charged.
Pairing modeHolding the button for 4 seconds will put the module into pairing mode where it can be connected to the MESI mTABLET UNIT (for more information look at Chapter 5.1.5 Pairing).
Resetting the ABI unitTo perform a reset of the MESI TUBELESS CUFF UNIT press and hold the LED button for 10 seconds until it changes colour to red. Unit will be ready to use in a few seconds.
5.6.2.2 Measurement mode
Button functions - Measurement mode
Column AColumn B
Stop measuringPressing the top button on the MESI TUBELESS CUFF UNIT while performing the ABI measurement will stop the measurement.

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