HearTwave II Training Program

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HearTwave II Training Program
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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Patient PreparationYoull Need These Materials

• 7 Micro V sensors
• 7 Standard Electrodes
• 3M One Step Skin Prep
• Razor
• Gauze

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Patient PreparationPrep Electrode Locations

• Shave to remove all hair from the site.
• Gently wipe the skin with a gauze pad if the skin
  is very oily or moist or has lotion. DO NOT USE
  ALCOHOL.
• GENTLY abrade with 3M Skin Prep. Make sure to
  abrade an area of skin at least as big as the
  electrode or sensor.

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Patient PreparationAbrade Electrode Locations

• PrecautionONLY MINIMUM ABRASION IS NEEDED.A
  good preparation removes only the surface layer
  of dead skin cells. Excessive abrasion of the
  skin can increase the risk of contact
  dermatitis.Never apply electrodes or Alternans
  Sensors to broken skin.
• Apply the electrode or sensor immediately after
  prepping each site. Make sure to place the
  electrode or sensor exactly over the area of the
  skin that you just prepped. Apply the sensor with
  the tab pointing down.
• Rub the electrode or sensor to ensure even
  contact.
• After all electrodes and sensors are placed,
  connect the lead wires. Insert the tab of the
  sensor into the lead wire until the black line is
  just visible.
• Make sure that the lead wires are not caught
  under the belt and are not pulled tight

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Patient PreparationElectrode Placement Flat Man

• Attach Micro-V and standard leads in the
  positions indicated below.

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Patient PreparationConnecting Patient Cable
Leads and Patient Module

• Connect all electrode leads taking care to avoid
  tangled leads. Use lead separators as necessary.
• Attach patient leads cable to the patient module.
• Attach to patient by securing the belt around the
  patients waist.

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Performing a Test Main Screen

• Enter Physician, Technician and Protocol
  information using simple arrow keys and touchpad
  for navigation
• Select a manual protocol of choice MTWA Exer,
  MTWA Pace, MTWA Pharm
• With the cursor in the Patient field, press
  Enter to open the Patient Information dialog

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Performing a Test Lead Check

• By pressing Perform Test on Heartwave II Main
  Screen you will enter the Lead Check Screen.
• State of the art standard diagnostic 1-mm grid
  for onscreen interpretation of ECG waveforms.
• Observe waveforms for low noise and make sure no
  leads are OFF (indicated in red below lead
  name)
• Note the Lead Noise display. This provides
  real time baseline noise measurements which could
  possibly interfere with MTWA results.
• The user can proactively reduce noise during
  testing thereby increasing likelihood of
  determinate results
• Recommended noise thresholds for rest and
  exercise phases are indicated by horizontal lines
  on the Lead Noise display. Attempt to keep noise
  below these levels.
• Note It takes about 30 seconds for the lead
  noise bars to be calculated and displayed.

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Performing a Test Lead Check

• If all leads are properly connected, with good
  electrode-to-skin contact, the screen displays
  All Leads OK with a Start button in the lower
  left corner
• If skin prep was not sufficient, then leads on
  flat man will be color coded in yellow or red to
  indicate poor impedance. The screen displays
  Examine Red/Yellow Leads and you must
  re-perform a lead check. As with HearTwave I,
  overrides are discouraged
• You are now ready to begin the rest phase of
  testing by pressing START

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Performing a Test Rest Phase(Pre-Exercise)

• Use the dedicated BP/Event function key for
  documentation of vital patient data
• Print a resting 12 lead ECG report for the
  patients record as a baseline measurement
• Allow 45 minutes to conduct a complete MTWA test
  (ensures sufficient time for patient prep,
  re-prep if required, exercise testing and
  re-testing if required)
• All MTWA protocols can be manually controlled to
  achieve a smooth gradual increase in heart rate
  profile for target ranges. As always, adjustment
  of grade is recommended over speed to minimize
  noise.

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Performing a Test Rest Phase(Pre-Exercise)

• For MTWA exercise tests, allow the patient to get
  comfortable on the treadmill (without starting
  the belt). Check and adjust any lead cables that
  may be pulling
• While the patient is moving, observe that the
  Lead Noise bars are below the EXER level. If
  noise levels are too high, try to identify the
  source (usually inadequate patient prep)
• Collect at least one minute of rest data
• Note dedicated custom command keys on keyboard
  for frequently used functions
• After informing and instructing the patient about
  the test, select the green Start Treadmill key
  on the keyboard
• Use the red Stop Treadmill key to stop the
  treadmill
• Press the Start Exercise key to initiate the
  exercise phase of the test

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Performing a Test Exercise Phase

• Note there are two pie graphs on the HearTwave II
  screen
• First Pie (bottom)
• 2.5 minutes between 100-110 BPM
• Second Pie (top)
• 1.5 minutes between 110-120 BPM
• In an ideal test, the first pie is filled to
  100, and then the second pie fills to 100,
  followed by recovery back to the resting heart
  rate. If for some reason pies cannot be filled to
  100, it is very important to fill it to at least
  the 60 marker. A test is likely to be
  indeterminate if either pie is less than 60
  filled
• HR Control Messages are displayed to assist with
  MTWA protocol
• Note As a minimum requirement, at least three
  minutes of data must be collected to initiate
  alternans processing and complete a test

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Performing a Test Exercise Phase

• New feature Real-time 3-lead ECG monitoring
• 8 seconds of diagnostic waveform display in
  industry standard leads (II, V2, V5)
• Need to focus on only one screen for MTWA testing
  and patient monitoring
• Simple customizable screen setup

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Performing a Test Recovery Phase

• After satisfying HR profile requirements, proceed
  back to recovery allowing the patients heart
  rate to return to 90 bpm (or the resting level if
  higher)
• Make sure at least one minute of recovery data is
  collected
• Ability to continue monitoring patient status
  using on-screen 3-Lead ECG display
• When ready, press the End/Print button and
  select an End Test Reason

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Ending a Test Monitoring Phase

• Once an end reason is selected, data processing
  will begin and you will enter Monitoring phase
• During processing, do not remove leads from
  patient until report results are displayed. If a
  result is indeterminate, repeat test after
  addressing reason for indeterminacy (see
  Indeterminacy Reference Card)

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Printing a Test Results Displayed

• Once processing is complete, the alternans
  classification results will be displayed in the
  upper right corner of the screen
• Initial interpretation is generated by the
  automated report classifier (Interpreted by
  Computer)
• Ability to repeat test directly from this screen
  without re-entering patient data

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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New Feature Editing a Report

• If desired, user can edit the classifier results
  by pressing Reprint and Edit Results button
• Option of changing any of the alternans results
  parameters and inserting their own comments
• Edited results will be saved with user name and
  date
• Report editor is also available through review
  reports screen

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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Review Reports Screen and Review Mode

• Ability to print alternans reports
• Ability to edit alternans results
• Ability to print stress reports
• Ability to review entire test through review mode

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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HearTwave II MTWA Training Program

• Patient Preparation
• Performing a Test
• Main Screen
• Lead Check
• Rest Phase (Pre-Exercise)
• Exercise Phase
• Recovery Phase
• Ending a Test (Monitoring Phase)
• Printing a Test (Results Displayed)
• Editing a Report
• Review Reports Screen and Review Mode
• Data Management
• System Setup

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HearTwave II MTWA Training Program

• System Setup allows the ability to fully
  customize common system parameters such as
• Protocols Custom Text Final Reports Screen
  setup

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