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What This Guide Helps With
This guide helps troubleshoot an IPI LOW ALARM on a Medtronic Capnostream 20p capnography monitor. The alarm indicates that the Integrated Pulmonary Index is below the lower alarm limit and may represent a change in patient status. This should be treated as a patient safety alarm first, with equipment and accessory checks performed only after the patient has been evaluated.
Step-by-Step Troubleshooting
Ensure Patient Safety First
- Treat IPI LOW ALARM as a patient condition until proven otherwise.
- Do not silence, ignore, or troubleshoot the monitor before clinical staff assess the patient.
- Have nursing, respiratory therapy, or the provider evaluate the patient’s respiratory status, airway, oxygenation, ventilation, level of consciousness, and overall condition.
- If monitoring is unreliable, move the patient to a backup monitor or backup monitoring method before continuing troubleshooting.
Verify the Reported Alarm
- Confirm the displayed alarm is exactly IPI LOW ALARM.
- Ask staff when the alarm occurred and whether it was continuous or intermittent.
- Note whether it occurred during patient movement, sleep, sedation, transport, after medication, or after sensor or cannula repositioning.
Review Other Monitored Parameters
- Check EtCO2, respiration rate, SpO2, pulse rate, waveform quality, and trend data.
- Look for values that support the low IPI alarm, such as abnormal EtCO2, abnormal respiratory rate, low SpO2, or poor ventilation trends.
- If the IPI alarm does not match the other parameters, continue checking for signal, sensor, or accessory issues.
Confirm Alarm Limits and Patient Setup
- Verify the IPI lower alarm limit is appropriate for the patient population and care area.
- Confirm the monitor is configured correctly for the patient and clinical use case.
- Do not change alarm limits unless directed by clinical staff and facility policy.
Check the CO2 Sampling Setup
- Inspect the nasal cannula, oral/nasal sampling line, airway adapter, or FilterLine connection.
- Look for kinks, loose connections, moisture, blockage, disconnection, or incorrect placement.
- Correct placement or replace the sampling line if the waveform is poor, unstable, or missing.
Check the SpO2 Sensor and Patient Connection
- Inspect SpO2 sensor placement, sensor size, cable connection, and patient movement.
- Check for low perfusion, cold extremity, nail polish, poor contact, or sensor damage.
- Reposition or replace the sensor if SpO2 or pulse rate readings are unstable or not believable.
Check Cables, Accessories, and Connections
- Confirm the CO2 sampling line, SpO2 sensor, SpO2 extension cable, and monitor ports are fully seated.
- Inspect accessories for damage, contamination, loose fit, or intermittent connection.
- Swap suspect accessories with known-good parts when available.
Assess for Motion or Environmental Causes
- Look for patient movement, transport vibration, cable tension, cannula displacement, or poor sensor contact.
- Secure cables and sampling lines so they do not pull during care.
- Observe whether the alarm clears after motion, placement, or accessory problems are corrected.
If the Problem Persists
If the IPI LOW ALARM continues after the patient has been evaluated, alarm settings are confirmed, and known-good CO2 and SpO2 accessories have been used, external causes have been ruled out.
Remove the monitor from service. Label it Out of Service and send it for repair or bench evaluation. Persistent IPI alarms with unreliable parameter readings may indicate a device, module, connector, or signal-processing issue.
Clinical Use Tip
Never troubleshoot this alarm on an active patient until clinical staff have assessed the patient and confirmed it is safe to continue. If the monitor or accessories cannot provide reliable readings, move the patient to a backup monitor first.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Capnostream 20p reported IPI LOW ALARM during patient monitoring. Staff reported low IPI indication and requested evaluation of monitor and accessories."
Cause
What was observed during troubleshooting.
Example:
"Patient status alarm required clinical evaluation. CO2 sampling line and SpO2 sensor were checked for placement, connection, damage, and signal quality. Alarm condition was supported by monitored parameters / caused by unstable accessory signal / could not be duplicated after accessory correction."
Resolution
What action was taken.
Example:
"Patient care team evaluated patient. Verified alarm behavior, reviewed EtCO2, respiration rate, SpO2, pulse rate, and IPI trend. Checked sampling line, SpO2 sensor, cables, and alarm settings. Corrected accessory issue and returned monitor to service, or removed monitor from service for bench evaluation if alarm persisted."
Helpful Details to Include (If Known)
- Alarm behavior
- Accessories swapped
- Power behavior
- Environmental factors
- Indicator lights
- Final device status
Final Thought
An IPI LOW ALARM should be handled as a patient safety event first and an equipment issue second. Clinical Engineering should confirm the alarm, check simple external causes, verify accessory performance, and escalate only after patient condition and common causes have been addressed.
That is successful troubleshooting.