Stimpod 450X+ Nerve Stimulator and TOF Monitor

The Stimpod 450X+ is a quantitative neuromuscular transmission (NMT) monitoring device that combines a nerve stimulator with a Train-of-Four (TOF) and other stimulation modes monitor. It supports both acceleromyography (AMG) and electromyography (EMG) sensor modalities, enabling precise assessment of neuromuscular blockade and recovery. It is intended for intra-operative and peri-operative monitoring of neuromuscular blocking agents (NMBAs) and is not intended for pain therapy.

1. It offers dual-sensor capability, meaning you can use either AMG or EMG depending on clinical context (for example, AMG when the ulnar nerve is easily accessible, EMG when arms/limbs are tucked or in robotic cases).
2. It supports multiple stimulation modes: TOF, Double Burst (DB), Post-Tetanic Count (PTC), Tetanus (TET), and Twitch (1/2/5 Hz).
3. AMG mode uses a tri-axial accelerometer (3-D vector), offering faster setup and no calibration or baseline required.
4. By providing real-time quantitative feedback, it helps reduce residual neuromuscular blockade (RNMB), optimize the use of reversal agents, support safer extubation, improve patient safety, and potentially lower post-operative complications.
5. Cost-effective: AMG uses a reusable sensor lead cable and standard ECG electrodes rather than expensive proprietary electrode arrays.
6. The Stimpod dual-sensor AMG and EMG capability allow the anesthesia provider a choice of what is the best monitoring method to use based on the patient and the procedure.

1. AMG (Acceleromyography): Measures limb movement response (via accelerometer). Xavant’s tri-axial accelerometer design eliminates the calibration required by older 1-D accelerometers. It is cost-efficient (reusable sensor, standard electrodes) and works well in accessible limbs (thumb, toe, etc.).
2. EMG (Electromyography): Measures the electrical activity of the muscle directly. Ideal when movement detection is limited or limbs are inaccessible (e.g., tucked arms, robotic surgery). The Stimpod 450X+ Nerve Stimulator uses patented flexible EMG electrodes for these challenging setups.
3. When to choose which? If limb movement is unrestricted and cost-efficiency is key, AMG is typically preferred. If patient positioning restricts movement or accelerometry may be compromised, use EMG. The device allows selection of either by changing the cable/sensor setup, giving flexibility to the anesthesia provider based on the patient and the surgery type.

The Stimpod 450X+ Nerve Stimulator supports:

1. Train-of-Four (TOF): Common baseline monitoring mode for neuromuscular blockade and recovery.
2. Double Burst (DB): More sensitive detection of early neuromuscular block compared to TOF.
3. Post-Tetanic Count (PTC): Used when deep neuromuscular blockade is present and TOF responses are absent.
4. Twitch (1Hz, 2Hz, 5Hz): Utility for peripheral nerve mapping/locating or for simpler monitoring.
5. Tetanus (TET): High-frequency stimulation to assess nerve/muscle, primarily for advanced users.

This broad mode support ensures the Stimpod can adapt to different surgical procedures, the depth of blockade, and recovery phases.

The Stimpod 450X+ Nerve Stimulator supports data connectivity and downloads for case documentation, allowing integration into hospital electronic medical records (EMR) and anesthesia information systems. For example, the “X-Link” feature enables plug-and-play transfer of case data for documentation, audit, and quality-improvement initiatives. From a workflow perspective, its intuitive user interface, quick setup (no calibration required in AMG setups), and full color touchscreen display support anesthesia teams moving between ORs, PACU, and ICU.

Evidence shows that subjective neuromuscular monitoring (visual or tactile assessment) often misses residual blockade (RNMB), which can lead to increased post-operative complications, delayed extubation, airway events, and extended PACU stay. International guidelines (such as those from the American Society of Anesthesiologists – ASA) now recommend quantitative monitoring for neuromuscular blockade management. By offering accurate, real-time monitoring and documentation, the Stimpod 450X+ supports best practices for patient safety and institutional risk reduction.

1. The device kit includes the main stimulator unit, a rechargeable battery, and cables (depending on configuration: AMG cable or EMG monitoring cable), as listed on the Bell Medical product page.
2. For AMG mode: reusable sensor/cable plus standard ECG electrodes (or dedicated NMT sensor for higher-current applications). This helps reduce ongoing consumable costs.
3. For EMG mode: dedicated single-use or replaceable ripple-design EMG electrodes (depending on hospital preference), which represent a consumable cost.
4. Additional accessories include mounting brackets or IV pole mounts, cable sets for nerve mapping/locating, and power/charging accessories. Additional costs include data cables or network integration modules for EMR connectivity. 
5. A separate battery charging station able to recharge two rechargeable batteries is available as an accessory. 
6. The dual-sensor Stimpod design enables cost-optimization by selecting AMG where appropriate and EMG only when necessary.

Yes. The Stimpod 450X+ Nerve Stimulator is a versatile “full-case” device suitable for OR, ICU, and PACU settings. The handheld/mountable format, long battery life, quick setup, and dual-sensor mode make it ideal for monitoring neuromuscular function not only during surgery but also during recovery and extubation phases. This flexibility supports the hospital’s standardization of neuromuscular monitoring across multiple care areas.

1. Although the unit is designed for intuitive use (touchscreen, simple mode selection, auto-sensor detection), it is still a medical device requiring knowledge of neuromuscular physiology, blockade reversal agents, and safe monitoring practices.
2. Training should include electrode placement (AMG vs EMG), device setup and confirmation (e.g., checking impedance, electrode integrity), recognizing waveforms and trend graphs, interpreting TOF/DB/PTC results, and integrating output into case documentation.
3. The manufacturer (Xavant) and many distributors offer training materials, videos, and quick-start guides.
4. For hospitals adopting this device across multiple ORs or shifting from subjective monitoring, it may be beneficial to implement standard operating procedures (SOPs) for neuromuscular monitoring, recovery criteria (e.g., TOF ratio ≥ 0.9), and audit/review of monitoring compliance.

According to the manufacturer’s Instructions for Use, the device carries a 24-month warranty against manufacturing defects (for the main unit when used according to operating instructions). Cable sets and accessories may have shorter warranties (e.g., 6 months for cables) in some jurisdictions. Service and maintenance must be performed by the manufacturer or authorized personnel to maintain compliance and patient safety. It’s advisable to check with Bell Medical for specific warranty terms and VOLUME-based service programs (e.g., multi-unit site discounts and training bundles).

By purchasing through Bell Medical, you benefit from a partner who specializes in anesthesia supplies and perioperative equipment for over 50 years. The product page highlights the Stimpod 450X+ Nerve Stimulator device as “the only handheld neuromuscular blockade monitoring system available with both AMG and EMG,” enabling cost control and standardization across the hospital. Bell Medical also handles demonstration requests and supports implementation for anesthesia teams, helping optimize adoption and ROI.