تقنيات الاجهزة الطبية PDF

Introduction of
Medical Equipment
Prepared By:
Dr.Sherif El Gharry
Cairo University
Second Year
2018-2019
Acknowledgments
This two-year curriculum was developed through a participatory and collaborative approach between
the Academic faculty staff affiliated to Egyptian Universities as Alexandria University, Ain Shams
University, Cairo University , Mansoura University, Al-Azhar University, Tanta University, Beni Souef
University , Port Said University, Suez Canal University and MTI University and the Ministry of Health
and Population(General Directorate of Technical Health Education (THE). The design of this course
draws on rich discussions through workshops. The outcome of the workshop was course specification
with Indented learning outcomes and the course contents, which served as a guide to the initial
design.
We would like to thank Prof.Sabah Al- Sharkawi the General Coordinator of General Directorate of
Technical Health Education, Dr. Azza Dosoky the Head of Central Administration of HR
Development, Dr. Seada Farghly the General Director of THE and all share persons working at
General Administration of the THE for their time and critical feedback during the development of
this course.
Special thanks to the Minister of Health and Population Dr. Hala Zayed and Former Minister of
Health Dr. Ahmed Emad Edin Rady for their decision to recognize and professionalize health
education by issuing a decree to develop and strengthen the technical health education curriculum
for pre-service training within the technical health institutes.
‫توصيف مقرر دراسى‬
‫ بيانات المقرر‬-1
: ‫المستوى‬/ ‫الفرقة‬ ‫ مقدمة في تقنيات األجهزة الطبية‬:‫اسم المقرر‬ : ‫الرمز الكودى‬
- ‫ عملى‬4 ‫ نظرى‬2 : ‫عدد الوحدات الدراسية‬ : ‫التخصص‬
:‫ هدف المقرر‬-2
A variety of electrical and electronic equipment are used in
hospitals for various diagnostic and therapeutic purposes;
including operation theater and also used for anesthesia and
surgical purposes. Modern medicine is emerging in new trend in
equipment technology. The success of the procedures and safety of
patient depends largely on the reliability, precision sensitivity and
trouble free performance of that equipment. So this course can fill
this lacunae providing trained manpower in almost all branches
of modern medicine like Cardiology, Neurology, Physical
Medicine, Medical imaging, etc.. They can get vertical mobility in
all these disciplines in medical field.
Students for Technical Health Institutes: ‫ المستهدف من تدريس المقرر‬-3
Having successfully completed this module, students will be able to: ‫ المعلومات‬.‫ا‬
: ‫والمفاهيم‬
 Recognize principles and concepts of medical devices
technologies.
 Convey the understanding of complex relationships between
sections of specialized equipment through written, verbal,
and/or demonstrative methods.
 Improve technical service to the medical imaging equipment
registrant.
 Recognize theoretical and practical basics for enabling
students operate and understand medical instrumentation.
 Define basic medical terminology and physical parameters
needed on handling medical instrumentation.
Having successfully completed this module, students will be able to:

‫ المهارات‬-‫ب‬
 Describe and explain key healthcare technologies for
: ‫الذهنية‬
diagnosis, monitoring, therapy and as prostheses and for the
discovery of new knowledge in medicine and biology.
 Describe the different components of the hospital environment
and medical instrumentation used with respect to patient
treatment.
 Understand the capabilities and limitations of transducer
devices used to transform the patient’s vital signs into usable
signals as inputs into Biomedical Instrumentation.
Having successfully completed this module, students will be able to:

‫ المهارات المهنية‬-‫ج‬
 Analyze and demonstrate a solid understanding of electronics; :‫الخاصة بالمقرر‬
by interpreting electronic schematics and diagrams; research,
organize and interpret information from various technical
sources; identifying components; electronic test equipment
used by technician in industry.
 Convey the understanding of complex relationships between
sections of specialized equipment through written, verbal,
and/or demonstrative methods..
 Inspect the integrity of the hardware for all devices.
 Evaluate and determine that all biomedical equipment is in
proper working condition, ensuring a safe, reliable health care
environment.
 Design electrocardiographs. Physiological pressure and other
cardiovascular measurements and devices.
 Learn the measures for protection of patients and devices.
 Analyze different factors on which medical equipment

depends on. ‫ المهارات‬-‫د‬
 Apply a systematic approach to solve problems. : ‫العامة‬
 Analyze, evaluate, and apply relevant information from a
variety of sources
 Able to use techniques, skills, and modern engineering tools
necessary for engineering practice.
 Work effectively within a team
 Develop assertive skills
 Participate in ongoing educational activities related to
professional issues.
Section 1: Introduction
Introduce medical equipment technology :‫ محتوى المقرر‬-4
Types and classes of medical equipment
Section 2: Diagnostic Devices

ECG (Electrocardiograph) Machines
Sphygmomanometers (Blood Pressure. sets)
Stethoscopes
Pulse Oximeters
Endoscopes
Section 3: Therapeutic Devices

Anaesthetic Machines
Oxygen Cylinders and Flowmeters
Nebulizers
Electrosurgical Units (ESU) and Cautery Machines
Section 4: Life support and General Devices

Incubators (Infant)
Defibrillator
Infusion and syringe pumps
Autoclaves and Sterilizers
Suction Machines (Aspirators)
Operating Theatre and Delivery(Tables (
Section 5: Imaging Modalities

Ultrasound Machines
X-Ray Machines
‫ أساايب التعليم والتعلم‬-5
 Lectures
 Multimedia material (Datashow, instructional videos,
webinars…)
 Discussions and group work
 Problems solving
 On-site training in the radiology department in hospitals.
‫ أساليب التعليم والتعلم للطالب‬-6

 Individual guidance ‫ذوى القدرات المحدودة‬
 Individual feedback
: ‫ تقويم الطالب‬-7
 Assignments ‫ األساليب المستخدمة‬-‫أ‬
 Quizzes
 Midterm
 Final exam
 Assignments (weekly) ‫ التوقيت‬-‫ب‬
 Quizzes (occasionally)
 Midterm (week 8)
 Final exam (at the end of the semester)
 Assignments ( 5 marks) ‫ توزيع الدرجات‬-‫ج‬
 Quizzes and Midterm (15 marks)
 Clinical (40 marks)
 Final exam ( 09 marks)
: ‫ قائمة الكتب الدراسية والمراجع‬-8
‫ مذكرات‬-‫أ‬
“Introduction to Biomedical Equipment Technology for Technical ‫ كتب ملزمة‬-‫ب‬

Health Institutes”
 " Introduction to Biomedical Equipment Technology” 4th ‫ كتب مقترحة‬-‫ج‬

Edition by Joseph J. Carr (Author), John M. Brown
(Author), ISBN-10: 0130104922
 Webster John G and Clark John W, Medical
Instrumentation: Application and Design, 3rd Edition, John
Wiley, 1998. (R856.M489 1998)
‫ الخ‬...... ‫ دوريات علمية أو نشرات‬-‫د‬

 IEEE Transactions on Biomedical Engineering
 Biomedical Engineering: Applications, Basis and
Communications
Course Description
A variety of electrical and electronic equipment are used in hospitals for various diagnostic and therapeutic
purposes; including Operation Theater and also used for anesthesia and surgical purposes. Modern medicine is
emerging in new trend in equipment technology. The success of the procedures and safety of patient depends
largely on the reliability, precision sensitivity and trouble free performance of that equipment. So this course
can fill this lacunae providing trained manpower in almost all branches of modern medicine like Cardiology,
Neurology, Physical Medicine, Medical imaging, etc. They can get vertical mobility in all these disciplines in
medical field.
Core Knowledge
By the end of this course, students should be able to:
• Recognize principles and concepts of medical devices technologies.

• Convey the understanding of complex relationships between sections of specialized equipment
through written, verbal, and/or demonstrative methods.
• Improve technical service to the medical imaging equipment registrant.
• Recognize theoretical and practical basics for enabling students operate and understand medical
instrumentation.
• Define basic medical terminology and physical parameters needed on handling medical
instrumentation.
Introduction of Medical
Equipment
Core Skills
By the end of this course, students should be able to:
 Analyze and demonstrate a solid understanding of electronics; by interpreting electronic

schematics and diagrams; research, organize and interpret information from various technical
sources; identifying components; electronic test equipment used by technician in industry.
 Convey the understanding of complex relationships between sections of specialized equipment
through written, verbal, and/or demonstrative methods.
 Inspect the integrity of the hardware for all devices.
 Evaluate and determine that all biomedical equipment is in proper working condition, ensuring a
safe, reliable health care environment.
 Design electrocardiographs. Physiological pressure and other cardiovascular measurements and
devices.
 Learn the measures for protection of patients and devices.
8
Equipment
Course Overview
Methods of Teaching/Training with

Number of Total Hours per Topic
Assignments
Field Work
Interactive
Research
ID Topics
Lecture
Class
Lab
Introduction
1 1 0 0 0
Diagnostic Devices
2 5 4 2 4
Therapeutic Devices
3 6 5 2 4
Life Support Devices

5 4 2 4
4
Supplementary Devices 1
3 0 4
5 Imaging Modalities 6
4 2 4
TOTAL HOURS (72) 24 20 8 20
9
Equipment
Contents
Section 1: Introduction
1-Introduce Medical Equipment Technology ........................................................... 13
2-Types and Classes of Medical Equipment ........................................................... 13
2.1-Clinical Equipment ........................................................................................... 13
2.2- Laboratory Equipment .................................................................................... 14
2.3- Research Equipment ....................................................................................... 15
2.4–Others ............................................................................................................... 15
Section 2: Diagnostic Devices

1-ECG (Electrocardiograph) Machines ..................................................................... 17
1.1- Definition .................................................................................................... 18
1.2- Health Problem Addressed ...................................................................... 18
1.3- Physiological Background ....................................................................... 18
1.4- Device Description .................................................................................... 18
1.5- Electrical Circuit ........................................................................................ 19
1.6- Measuring the ECG .................................................................................. 21
1.7- Operating Steps ......................................................................................... 22
1.8- ECG Machine Types .................................................................................. 22
1.9- ECG Artifacts ............................................................................................. 22
1.10- Safety Features .......................................................................................... 24
1.11- References ................................................................................................. 24
2- Sphygmomanometer .............................................................................................. 25
2.1-Definition .......................................................................................................... 26
2.2-Description ....................................................................................................... 26
2.3-Types ................................................................................................................ 26
2.4-Operation.......................................................................................................... 27
2.5-Parts.................................................................................................................. 28
2.6-Care and Maintenance ................................................................................... 29
2.7-Precautions ...................................................................................................... 29
2.8-Refrences ......................................................................................................... 30
10
Equipment
3-Stethoscopes ........................................................................................................... 31
3.1-Definition ......................................................................................................... 32
3.2-Operation......................................................................................................... 32
3.3-Types ............................................................................................................... 38
3.4-Parts of a Stethoscope .................................................................................. 39
3.5-Cleaning/Disinfection ..................................................................................... 40
3.6- Additional Precautions ................................................................................. 40
3.7-Stethoscope Covers ....................................................................................... 40
3.8-Refrences ........................................................................................................ 40
4- Pulse Oximetry ....................................................................................................... 41
4.1-Definition ......................................................................................................... 42
4.2-Principles ........................................................................................................ 42
4.3-Procedure steps ............................................................................................. 46
4.4-Benefits ........................................................................................................... 46
4.5-Limitations ...................................................................................................... 47
4.6-Refrences ........................................................................................................ 47
5 - Endoscopy ............................................................................................................. 48
5.1-Introduction to Endoscopy System .............................................................. 49
5.2-Major Components the Endoscopy System ................................................ 49
5.3-The Flexible Endoscope ................................................................................ 50
5.4-The Rigid Endoscope ..................................................................................... 52
5.5-Capsule Endoscopy ....................................................................................... 54
5.6-Components of Capsule Endoscopy............................................................ 54
5.7-References ...................................................................................................... 55
Section 3: Therapeutic Devices

1-Anaesthetic Machines ............................................................................................. 57
1.1-Introduction.................................................................................................... 58
1.2-Functions of Anesthesia Machine ............................................................... 54
1.3-Basic Design of a Continuous Anesthesia Machine .................................. 58
1.4-the high Pressure System ............................................................................ 59
1.4-Hanger Yoke Assembly ................................................................................ 59
1.6-Pin Index Safety System ............................................................................... 60
1.7-Bourdon's Pressure Gauge .......................................................................... 60
1.8-Yoke Block ..................................................................................................... 61
1.9-Pressure Regulators ..................................................................................... 61
1.10-Basic Physics ............................................................................................. 61
1.11- Master and Slave Regulator ..................................................................... 61
1.12-The Intermediate Pressure System .......................................................... 61
1.13-O2 Flash ....................................................................................................... 61
11
Equipment
1.14-The Flow Meter Assembly .......................................................................... 62

1.15-Scale ............................................................................................................. 63
1.16-Physical Principles of Flowmeters ............................................................ 63
1.17-Sequence of Flowmeter .............................................................................. 63
1.18-Low Pressure System ................................................................................. 65
1.19-Refrences ..................................................................................................... 65
2 - Oxygen Cylinders and Flowmeters .................................................................... 66
2.1-Oxygen Therapy ............................................................................................ 67
2.2-Medical Uses ................................................................................................... 67
2.3-Storage and Sources .................................................................................... 68
2.4-Delivery ........................................................................................................... 69
2.5-Parts of the Oxygen Delivery System .......................................................... 70
2.6-Clean Oxygen Equipment .............................................................................. 71
2.7-Check an Oxygen System Daily .................................................................... 71
2.8-Maintaining and Cleaning Equipment .......................................................... 72
2.9-Advantages ..................................................................................................... 72
2.10-References ................................................................................................... 72
3-Nebulizers ............................................................................................................... 73
3.1-Introduction ................................................................................................... 74
3.2-Operation......................................................................................................... 74
3.3-Types of Nebulizers ...................................................................................... 75
3.4- Clean and Store a Nebulizer ......................................................................... 77
3.5-precautions ..................................................................................................... 78
3.6-Advantages .................................................................................................... 78
3.7-Disadvantages ............................................................................................... 78
3.8-References ..................................................................................................... 78
4-Electrosurgical Units (ESU) and Cautery Machines ........................................... 79
4.1- Introduction ................................................................................................... 80
4.2- Electrosurgery ............................................................................................. 81
4.2.1-Principle ............................................................................................... 81
4.2.2-Components of Electrosurgery Device ............................................. 82
4.2.3-Types of ESU ....................................................................................... 83
4.2.4-Safety Considerations ....................................................................... 86
4.2.5-Insulation Failure ................................................................................. 87
4.3-Electrocautery ............................................................................................... 88
4.3.1-Difintion .............................................................................................. 88
4.3.2-Types ................................................................................................... 88
4.3.3-Basic Physics Terminology ............................................................... 89
4.3.4-Electrocautery Modes ........................................................................ 90
4.4-References ..................................................................................................... 90
12
Equipment
Section 4: Life Support and General Devices

1-Infant Incubator ...................................................................................................... 92
1.1- Definition ....................................................................................................... 93
1.2-Parameters ..................................................................................................... 93
1.3-Axillary Temperature in the Newborn .......................................................... 94
1.4-Thermoregulation ........................................................................................... 94
1.5-Infant Warming Devices ................................................................................. 96
1.6-Parts of an Incubator .................................................................................... 97
1.7-Hardware Parts .............................................................................................. 98
1.8-Modes of Temperature Control .................................................................... 99
1.9-Alarms & Remedies ....................................................................................... 99
1.10-Noise ............................................................................................................. 100
1.11-Avoiding Noise ............................................................................................ 100
1.12-Cleaning ....................................................................................................... 100
1.13-Maintenance ................................................................................................. 100
1.14-Refrences ...................................................................................................... 101
2-Defibrillator ............................................................................................................. 102
2.1- Definition ....................................................................................................... 103
2.2-Principle .......................................................................................................... 103
2.3-Schematic Diagram of a Defibrillator .......................................................... 104
2.4-Components of a Defibrillator ...................................................................... 105
2.5- Operating Principle ...................................................................................... 106
2.6-Defibrillator Electrodes .................................................................................. 107
2.7-Types of Electrodes ....................................................................................... 108
2.8-Paddle Placement .......................................................................................... 108
2.9-Important Factors .......................................................................................... 109
2.10-Types ............................................................................................................ 110
2.11-Synchronization Time ................................................................................. 112
2.12-Defibrillator Maintenance ........................................................................... 112
2.13-Refrences ..................................................................................................... 112
3-Infusion and Syringe Pumps ................................................................................. 113

3.1-Introduction ................................................................................................... 114
3.2-Types of Pump ................................................................................................ 114
3.3-Infusion Pumps .............................................................................................. 114
1-Volumetric Pumps ................................................................................... 114
2-Syringe Pumps ....................................................................................... 117
3.4- Options and Alarms ...................................................................................... 118
3.5-Refreces ......................................................................................................... 120
4 -Autoclaves and Sterilizers .................................................................................... 121
4.1- Autoclave Sterilization ................................................................................. 122
4.2- Autoclave Sterilizers .................................................................................... 122
4.3- Autoclave Uses & Advantages .................................................................... 122
4.4- Autoclave Disadvantages ............................................................................ 122
13
Equipment
4.5- Autoclaves Working Principle ...................................................................... 123

4.6- Autoclave Design Diagram & Parts ............................................................ 123
4.7-Autoclave Working – Operation .................................................................... 124
4.8-Autoclave Cycles ............................................................................................ 124
4.9-Autoclave Validation ...................................................................................... 126
4.10-Refrences ...................................................................................................... 126
5- Suction Machines (Aspirators) ............................................................................ 127
5.1- Definition ....................................................................................................... 128
5.2-Suction Machines/Aspirators Uses ............................................................. 128
5.3-Products for Suction Therapy ...................................................................... 128
5.4-Power .............................................................................................................. 129
5.5-Technology .................................................................................................... 129
5.6-Portability ....................................................................................................... 129
5.7-Maintenance Time and Costs ....................................................................... 129
5.8-Cleaning and Art Replacement .................................................................... 130
5.9-Refrences ........................................................................................................ 130
6-Operating Theatre and Delivery ............................................................................. 131
6. 1-Definition ........................................................................................................ 132
6. 2-Properties and Requirements Made Of an Operating Table ..................... 132
6. 3-Comparison: Operating Table System and Mobile Operating Table ........ 133
6. 4-Operating Table Positions ............................................................................ 133
6. 5-Advantages of an Operating Table System ................................................ 133
6.6-Accessories .................................................................................................. 134
6.7-Positions ......................................................................................................... 135
6.8-Refrences ........................................................................................................ 135
Section 5: Imaging Modalities

1-Ultrasound Machines .............................................................................................. 137
1.1- Definition ........................................................................................................ 138
1.2-Parts................................................................................................................. 138
1.3-Different Types of Ultrasound ....................................................................... 140
1.4-Imaging ............................................................................................................ 141
1.5- wave ............................................................................................................... 142
1.6-Major Uses of Ultrasound .............................................................................. 144
1.7-Dangers of Ultrasound ................................................................................... 145
1.8-An Ultrasound Examination .......................................................................... 145
1.9-Modes .............................................................................................................. 145
1.10-Attributes....................................................................................................... 147
1.11-Refrences ...................................................................................................... 148
14
Equipment
2-X-ray machine .......................................................................................................... 149

2.1- Definition ........................................................................................................ 150
2.2-Uses ................................................................................................................. 150
2.3-X-rays Discretion ............................................................................................ 150
2.4-Preparation...................................................................................................... 151
2.5-Components of X-Ray Machine .................................................................... 152
2.6-Circuit Diagram ............................................................................................... 155
2.7-Risks ................................................................................................................ 155
2.8-Results............................................................................................................. 155
2.9-Refrences ........................................................................................................ 156
15
Equipment
Section 1
Introduction
1-Introduce medical
2-Equipment technology
16
Equipment
Section 1
1-Introduce Medical Equipment technology
Assistive technologies became central to medicine during the 20th century. Advances in science, engineering
and manufacturing were applied to medical problems. Technologies such as hearing aids, artificial limbs and
mobility aids became more sophisticated. Ventilators, pacemakers and other machines were developed to
support, enhance or replace the body’s organs.
The computer revolution in medicine: using computers was one of the most important technological changes in
20th-century medicine. They became central to medical care from the 1950s. Computerized machines in
hospitals monitored patients continuously. They also enabled insurers and state-run health services to track
patient records on a massive scale. Imaging techniques such as MRI or PET were possible because faster
computers could reconstruct images of the body. More diagnostic tests were developed because automated
laboratory machines performed tests quicker and more accurately.
So we must know some definitions:
Health technology: The application of organized knowledge and skills in the form of devices, medicines,
vaccines, procedures and systems developed to solve a health problem and improve quality of life. It is used
interchangeably with health-care technology.
Medical device: An article, instrument, apparatus or machine that is used in the prevention, diagnosis or
treatment of illness or disease, or for detecting, measuring, restoring, correcting or modifying the structure or
function of the body for some health purpose. Typically, the purpose of a medical device is not achieved by
pharmacological, immunological or metabolic means.
Medical equipment: Medical devices requiring calibration, maintenance, repair, user training, and
decommissioning activities usually managed by clinical engineers. Medical equipment is used for the specific
purposes of diagnosis and treatment of disease or rehabilitation following disease or injury; it can be used
either alone or in combination with any accessory, consumable, or other piece of medical equipment. Medical
equipment excludes implantable, disposable or single-use medical devices.
2-Medical Equipment Classification

2.1- Clinical Equipment:
Diagnostics Equipment: Any type of equipment whose main purpose is to help doctors detect and
diagnose diseases for example: ECG, EMG, EEG, Ultrasound machines, X-ray machines, CT
Scanners, MRI machines, Endoscopes
FIGURE 1.1 FIGURE 1.2 FIGURE 1. 3

MRI Ultrasound ECG
Section 1 17
Equipment
Therapeutic Equipment:
Any equipment used after surgeries and other medical treatments to help patients recover and improve their
health.
For example: Medical Lasers, Catheters, Endoscopes, Radiotherapy machines, Ocular Equipment, Dental
Equipment
FIGURE1. 4 FIGURE1. 5
LASER DIATHERMY
Surgical Instruments:
Any instrument can be used in surgeries for example:
Cutting instruments, Grasping or holding instruments, implants
FIGURE 1.6 FIGURE 1.7

CUTING TOOLS IMPLANTS
Life support Equipment:

Any equipment that is used to maintain a patient’s organs functioning when said organs have failed
For example: Hemodialysis, Ventilators, Incubators, Heart Lung Machine
FIGURE1. 8 FIGURE 1.9 FIGURE 1.10

HEMODIALYSIS VENTILATOR INCUPATOR
2.2 - Laboratory Equipment:

Any equipment that is used in laboratories for example:
* sample separation, centrifugation etc. *electrophoresis, capillary
*pH / ISE meters *particle / cell counters
*spectrophotometers *flow cytometry
*microscopy *HPLC (chromatography)
Section 1 18
Equipment
*clinical chemistry * hematology
*immunology *scintillation systems
*genetic analysis
2.3 - Research Equipment:

Any equipment that is used for research for example:
*Any previous Device *Imagining
*Microscopes
2.4 –Others:
1 - Prosthetic Devices – Implants
FIGURE 1.11 FIGURE 1.12 FIGURE 1.13

Prosthetic Devices – Implants Artificial heart STENS
2 - POC (Point of Care) Devices

3 - Disposable Medical Devices
FIGURE 1.14
Suction catheter
FIGURE 1.15
I.V. cannulae
Blood glucose meter
4 - Devices for Self-testing “home devices”
FIGURE 1.16
Blood glucose meter
Section 1 19
Equipment
Section 2
Diagnostic Devices
ECG (Electrocardiograph) Machines
Sphygmomanometers (Blood Pressure. sets)
Stethoscopes
Pulse Oximeters
Endoscopes
20
Equipment
Section 2
Diagnostic Devices
1-ECG (Electrocardiograph) Machines
FIGURE 2.1
Electrocardiograph
Section 2 21
Equipment
1.1- Definition:
Electrocardiography is the process of recording the electrical activity of the heart over a period of time using
electrodes placed on the skin. These electrodes detect the tiny electrical changes on the skin that arise from
the heart muscle's electro-physiologic pattern of depolarizing during each heartbeat. It is a very commonly
performed cardiology test.
1.2- Health Problem Addressed:
ECG is used to:
 Diagnose and assist in treating some types of heart disease and arrhythmias.
 Determine a patient’s response to drug therapy.
 Reveal trends or changes in heart function.
1.3- Physiological Background:

 Each electrical signal begins in a group of cells called the sinus node or senatorial (SA) node.
 The SA node is located in the right atrium (AY-tree-um), which is the upper right chamber of the heart.
 In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to
100 times a minute.
 From the SA node, the signal travels through the right and left atria. This causes the atria to contract,
which helps move blood into the heart's lower chambers, the ventricles.
 The electrical signal moving through the atria is recorded as the P wave on the ECG.
 The electrical signal passes between the atria and ventricles through a group of cells called the
atrioventricular (AV) node.
 The electrical signal then leaves the AV
node and travels along a pathway called
the bundle of His.
 The signal spreads quickly across your
heart's ventricles, causing them to
contract and pump blood to your lungs
and the rest of your body. This process
is recorded as the QRS waves on the
ECG.
 The ventricles then recover their normal
electrical state (shown as the T wave on
the ECG). The muscle stops contracting
to allow the heart to refill with blood.
FIGURE 2.2 Physiological Steps Of Heart

1.4- Device Description:
1.4.1-The ECG Unit
 ECG voltages measured across the body are on the order of
hundreds of micro volts up to 1 mill volt. ECG unit consists of
a low noise circuit (filters) and instrumentation amplifiers.
 Early ECG units were constructed with analog electronics
and the signal could drive a motor to print the signal on
paper. FIGURE 2.3 The ECG unit
 Today, ECG unit uses analog-to-digital converters to convert
to a digital signal that can then be manipulated with digital electronics
(computers). FIGURE 2. 3
ECG Unit
22
Section 2
Equipment
1.4.2-Electrodes:
 An electrode is a conductive pad in contact with the body that makes an electrical circuit with the ECG.
 The most common electrode used for an ECG machine is the silver and silver chloride electrode
because it is stable when exposed to biological tissue.
FIGURE 2. 4
Electrodes
1.4.3-Cables
FIGURE 2.5
cables
Section 2
1.5- Electrical Circuit:
FIGURE 2. 6
Electrical Circuit
Section 2 23
Equipment
1.6- Measuring the ECG:
FIGURE 2. 7
Measuring the ECG
 Electrocardiographs record small voltages of about one mill volt (mV) that appear on the skin as a
result of cardiac activity.
 In a conventional 12-lead ECG, 10 electrodes are placed on the patient's limbs and on the surface of
the chest.
 The overall magnitude of the heart's electrical potential is then measured from 12 different angles
("leads") and is recorded over a period of time (usually 10 seconds).
 In this way, the overall magnitude and direction of the heart's electrical depolarization is captured at
each moment throughout the cardiac cycle.
FIGURE 2. 8
Measuring the ECG
Section 2 24
Equipment
1.6.1-The Electrode Placements:
FIGURE 2. 9
Measuring the
ECG
FIGURE 2. 10
Measuring the ECG
 The leads used in an ECG machine can be divided into two types, bipolar and unipolar.
 The bipolar leads record voltage difference between two electrodes, but unipolar leads record the
voltage difference between a reference electrode and the body surface to which they are attached.
 Leads are broken down into three sets:
 Limb leads
 augmented limb leads
 Primordial Leads
 The 12-lead ECG has a total of three limb leads and three augmented limb leads and six primordial
leads that lie on the perpendicular.
Section 2 25
Equipment
1.7- Operating Steps:

 After the electrodes are attached to the patient, ask the patient to relax and breathe normally and to lie
still and not to talk when you record the ECG.
 The user selects automatic or manual lead switching, signal sensitivity, frequency response range, and
chart speed.
 In some units, the operator can choose the lead groupings, their sequence, and the recording duration
for each group.
 Press the RECORD button. Observe the tracing quality. The machine will record all 12 leads
automatically, recording three consecutive leads simultaneously.
 Some machines have a display screen so that you can preview waveforms before the machine records
them on paper.
 If any part of the waveform height extends beyond the paper when you record the ECG, adjust the
normal standardization to half standardization.
FIGURE 2.11
ECG
1.8- ECG Machine Types:

 The 12-lead ECG is the standard ECG machine used for medical diagnostic testing.
 A 5-lead ECG machine uses 5 electrodes, 4 of which are placed on each of the limbs and 1 on the
chest. It is usually used for continuous monitoring, like during a major surgical procedure or while a
patient is being transported in an ambulance.
 A 3-lead ECG machine uses 4 electrodes placed on each of the limbs, which is enough to produce
adequate data on heart rhythm monitoring.
 Portable handheld ECG monitors are the smallest ECG machines in the market today. In spite of their
portable and handheld size, they can display and record heart rate like their larger counterparts.
 Wireless ECGs are similar to a standard ECG machine, but without the wires. The electrodes used
have wireless units that transmit data to the computer or telemetry station. A wireless ECG provides
more functionality and comfort for patients, who wouldn’t have to worry about wires attached to their
bodies.
1.9- ECG Artifacts:
1- Reversed leads / Misplaced electrodes:
 Electrode/lead placement is very important. If one were to accidentally confuse the red and white lead
cables. When this happens, you are essentially viewing the rhythm in a completely different lead.
Section 2 26
Equipment
FIGURE 2.12
Reversed leads
2-AC interference:
 When an ECG machine is poorly grounded or not equipped to filter out this interference, you can get a
thick looking ECG line.
FIGURE 2.13
AC interference
3-Muscle Tremor / Noise:

 When your skeletal muscles undergo tremors, the ECG is bombarded with seemingly random activity.
FIGURE 2.14
Muscle tremor
4-Wandering Baseline:
 In wandering baseline, the isoelectric line changes position. One possible cause is the cables moving
during the reading. Patient movement, dirty lead wires/electrodes and loose electrodes.
FIGURE 2.15
Wandering baseline
Section 2 27
Equipment
1.10- Safety Features:
 Safety features that include voltage protection for the patient and operator. Since the machines are
powered by mains power, it is conceivable that either person could be subjected to voltage capable of
causing death. Additionally, the heart is sensitive to the AC frequencies typically used for mains power
(50 or 60 Hz).
 Defibrillation protection. Any ECG used in healthcare may be attached to a person who requires
defibrillation and the electrocardiograph needs to protect itself from this source of energy.
 Electrostatic discharge is similar to defibrillation discharge and requires voltage protection up to 18,000
volts.
 Additionally, circuitry called the right leg driver can be used to reduce common-mode interference
(typically the 50/60 Hz mains power).
1.11- References:
http://www.theheartcheck.com/documents/ECG%20Interpretation%20Made%20Incredibly%20Easy!%20(5th%20edit
ion).pdf
https://www.emedicinehealth.com/electrocardiogram_ecg/article_em.htm
Section 2 28
Equipment
2- Sphygmomanometer
Figure 2.16 :Sphygmomanometer
Figure 2. 17: Sphygmomanometer
29
Section 2
Equipment
2.1-Definition:
The sphygmomanometer is designed to monitor blood pressure by measuring the force of the blood in the
heart where the pressure is greatest. This occurs during the contraction of the ventricles, when blood is
pumped from the heart to the rest of the body (systolic pressure). The minimal force is also measured. This
occurs during the period when the heart is relaxed between beats and pressure is lowest (diastolic pressure).
A sphygmomanometer is used to establish a baseline at a healthcare encounter and on admission to a
hospital. Checking blood pressure is also performed to monitor the effectiveness of medication and other
methods to control hypertension, and as a diagnostic aid to detect various diseases and abnormalities.
2.2-Description:
A sphygmomanometer consists of a hand bulb pump, a unit that displays the blood pressure reading, and an
inflatable cuff that is usually wrapped around a person's upper arm. Care should be taken to ensure that the
cuff size is appropriate for the person whose blood pressure is being taken. This improves the accuracy of the
reading. Children and adults with smaller or larger than average-sized arms require special sized cuffs
appropriate for their needs. A stethoscope is also used in conjunction with the sphygmomanometer to hear the
blood pressure sounds. Some devices have the stethoscope already built in.
A sphygmomanometer can be used or encountered in a variety of settings:
 home
 hospital
 primary care clinic or professional office
 ambulance
 dental office
 pharmacy and other retail establishment
Figure 2.18 :sphygmomanometer measure

.
2.3-Types:
Both manual and digital meters are currently employed, with different trade-offs in accuracy
versus convenience.
1-Manual:
A stethoscope is generally required for auscultation Manual meters are used by trained practitioners, and,
while it is possible to obtain a basic reading through palpation alone, this only yields the systolic pressure.
 Mercury sphygmomanometers are considered the gold standard. They show blood pressure by
affecting the height of a column of mercury, which does not require recalibration. Because of their
accuracy, they are often used in clinical trials of drugs and in clinical evaluations of high-risk patients,
including pregnant women. A wall mounted mercury sphygmomanometer is also known as a Bauman
meter.
Section 2 30
Equipment
 Aneroid sphygmomanometers (mechanical types with a

dial) are in common use; they may require calibration
checks, unlike mercury manometers. Aneroid
sphygmomanometers are considered safer than mercury
sphygmomanometers, although inexpensive ones are less
accurate. A major cause of departure from calibration is
mechanical jarring. Androids mounted on walls or stands
are not susceptible to this particular problem.
FIGURE 2.19
Aneroid sphygmomanometer
with an adult cuff
2-Digital:
Digital meters employ oscillometric measurements and
electronic calculations rather than auscultation. They
may use manual or automatic inflation, but both types
are electronic, easy to operate without training, and can
be used in noisy environments. They
measure systolic and diastolic pressures by
oscillometric detection, employing either deformable
membranes that are measured using differential
capacitance, or differential piezoresistance, and they
include a microprocessor. They accurately measure mean
blood pressure and pulse rate, while systolic and
diastolic pressures are obtained less accurately than FIGURE 2.20 : Clinical WelchAllyn Sphygmomanometer
with manual meters, and calibration is also a concern. Digital oscillometric monitors may not be
advisable for some patients, such as those suffering from arteriosclerosis, arrhythmia, preeclampsia, pulses,
and pulses, as their calculations may not correct for these conditions, and in these cases, an analog
sphygmomanometer is preferable when used by a trained person.
Digital instruments may use a cuff placed, in order of accuracy and inverse order of portability and
convenience, around the upper arm, the wrist, or a finger.
The oscillometric method of detection used gives blood pressure readings that differ from those determined by
auscultation, and vary according to many factors, such as pulse pressure, heart rate and arterial
stiffness, although some instruments are claimed also to measure arterial stiffness, and some can detect
irregular heartbeats.
2.4-Operation:
In humans, the cuff is normally placed smoothly and snugly around an upper arm, at roughly the same vertical
height as the heart while the subject is seated with the arm supported. Other sites of placement depend on
species; it may include the flipper or tail. It is essential that the correct size of cuff is selected for the patient.
Too small a cuff results in too high a pressure, while too large a cuff results in too low a pressure. For clinical
measurements it is usual to measure and record both arms in the initial consultation to determine if the
pressure is significantly higher in one arm than the other. A difference of 10 mm Hg may be a sign
of coarctation of the aorta. If the arms read differently, the higher reading arm would be used for later
readings. The cuff is inflated until the artery is completely occluded.
With a manual instrument, listening with a stethoscope to the brachial artery at the elbow, the examiner slowly
releases the pressure in the cuff. As the pressure in the cuffs falls, a "whooshing" or pounding sound is heard.
When blood flow first starts again in the artery. The pressure at which this sound began is noted and recorded
as the systolic blood pressure. The cuff pressure is further released until the sound can no longer be heard.
Section 2 31
Equipment
This is recorded as the diastolic blood pressure. In noisy environments where auscultation is impossible (such
as the scenes often encountered in emergency medicine), systolic blood pressure alone may be read by
releasing the pressure until a radial pulse is palpated (felt). In veterinary medicine, auscultation is rarely of use,
and palpation or visualization of pulse distal to the sphygmomanometer is used to detect systolic pressure.
FIGURE 2.21
Medical student taking blood pressure at the brachial
artery
2.5-Parts:
Some of the different parts of a Sphygmomanometer, like ADC Generic Aneroid Sphygmomanometer, include:
1-Bladder - An inflatable bag that occludes the artery when compressed.
2-Cuff - It is designed to hold the bladder around limb.
3-Valve - A deflation valve is present with the sphygmomanometer to allow for controlled deflation for
measurement.
4-Bulb - For accurate measurement, a blub is needed to pump air into the cuff.
5-Manometer
FIGURE 2.22
ADC Generic Aneroid Sphygmomanometer FIGURE 2.23:
Bladder
Section 2 32
2
Equipment
FIGURE 2.24: FIGURE 2.25 : Manometer

Cuff
FIGURE 2.26:
Valve
2.6-Care and Maintenance:

1-STORAGE:
Pocket Gauge: After measurement, fully exhaust cuff then wrap cuff around gauge and bulb and store in
zippered carrying case.
NOTE: This product will maintain the safety and performance characteristics specified at temperatures
ranging from 50°F to 104°F (10°C to 40°C) at a relative humidity level of 15% to 85%. This device can be
safely stored at temperatures ranging from -4°F (-20°C) to 131°F (55°C) with a relative humidity of 90%.
Manometer: Your pocket aneroid gauge requires minimal care and maintenance.
The manometer may be cleaned with a soft cloth, but should not be dismantled under any circumstances.
Gauge accuracy can be checked visually; simply be certain the needle rests within the printed oval when the
unit is fully deflated.
FIGURE 2.27 storage
Should the indicator needle of the manometer rest outside of this calibration mark, then the manometer must
be re-calibrated to within ±3 mmHg when compared to a reference device that has been certified to national or
international measurement standards. A manometer, whose indicator needle is resting outside of this mark, is
NOT acceptable for use. In the event that the gauge is ever in need of calibration, simply return for service.
Damaged or broken parts will be replaced as needed at a minimal charge. Refer to the warranty for specific
details of warranty coverage. The manufacturer recommends a calibration check every 2 years
33
Section 2
Equipment
2-Cuff Cleaning and Disinfecting:

NOTE: Use one or more of the following methods and allow to air dry:
 Wipe with mild detergent and water solution (1:9 solution). Rinse.
 Wipe with Enroll per manufacturer’s instructions. Rinse.
 Wipe with .5% bleach and water solution. Rinse.
 Wipe with 70% isopropyl alcohol.
 Launder with mild detergent in warm water, normal wash cycle. Remove bladder first. Cuff is
compatible with 5 wash cycles.
3-Disposal:
When your sphygmomanometer has reached its end of life, please be sure to dispose of it in accordance with
all regional and national environmental regulations. Devices that have become contaminated should be
disposed of in accordance with all local ordinances and regulations.
2.7-Precautions:
 Aneroid and digital manometers may require periodic calibration.
 Use a larger cuff on obese or heavily muscled subjects.
 Use a smaller cuff for pediatric patients.
 For pediatric patients a lower blood pressure may indicate the presence of hypertension.
 Don't place the cuff over clothing.
 Flex and support the subject's arm.
 In some patients the Korotkoff sounds disappear as the systolic pressure is bled down. After an
interval, the Korotkoff sounds reappear. This interval is referred to as the "auscultator gap." This
pathophysiologic occurrence can lead to a marked under-estimation of systolic pressure if the cuff
pressure is not elevated enough. It is for this reason that the rapid inflation of the blood pressure cuff to
180mmHg was recommended above. The "auscultator gap" is felt to be associated with carotid
atherosclerosis and a decrease in arterial compliance in patients with increased blood pressure.
2.8-Refrences:
https://www.suntechmed.com/downloads/Documents/10StepstoBP.pdf
https://pdfs.semanticscholar.org/1cec/8b761be1990ecc5e7a168fefa535d857ae4c.pdf
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/403448/Bloo
d_pressure_measurement_devices.pdf
Section 2 34
Equipment
3-Stethoscopes
FIGURE 2.28
Modern stethoscope
Section 2 35
Equipment
3.1-Definition:
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal
or human body. It typically has a small disc-shaped resonator that is placed against the chest, and two tubes
connected to earpieces. It is often used to listen to lung and heart sounds. It is also used to listen
to intestines and blood flow in arteries and veins. In combination with a sphygmomanometer, it is commonly
used for measurements of blood pressure. Less commonly, "mechanic's stethoscopes", equipped with rod
shaped chest pieces, are used to listen to internal sounds made by machines (for example, sounds and
vibrations emitted by worn ball bearings), such as diagnosing a malfunctioning automobile engine by listening
to the sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum chambers for
leaks, and for various other small-scale acoustic monitoring tasks. A stethoscope that
intensifies auscultator sounds is called phonendoscope.
3.2-Operation:
Method 1
Choosing and Adjusting a Stethoscope
1-Get a high quality stethoscope.

A high quality stethoscope is important. The better the quality of your stethoscope, the easier it will be
for you to listen to your patient’s body.
FIGURE 2.29
High Quality Stethoscope
2-Adjust your stethoscope’s earpieces.

It is important to make sure that the earpieces are facing forward and that they fit well. Otherwise, you
might not be able to hear anything with your
stethoscope.
FIGURE 2.30
Adjust your stethoscope’s earpieces
36
Section 2
Equipment
3-Check the earpiece tension on your stethoscope.

In other words, make sure that the earpieces are close to your head
but not too close. If your earpieces are too tight or too loose, readjust
them.
FIGURE 2.31
Check the earpiece tension on your stethoscope
4-Choose an appropriate chest piece for your stethoscope.

There are many different types of chest pieces available for
stethoscopes. Choose one that is appropriate for your
needs. Chest pieces come in different sizes for adults and
children.
FIGURE 2.32
Choose an appropriate chest piece
Method 2
Preparing to Use a Stethoscope
1-Select a quiet place to use your stethoscope.
Use your stethoscope in a quiet place. Find a quiet area to ensure that the body sounds you want to hear will
not be overpowered by background noises.
FIGURE 2.33
quiet place
37
Section 2
Equipment
2-Position your patient.
FIGURE 2.34
Position your patient
3-Decide whether to use the diaphragm or bell.

The diaphragm, or flat side of the drum, is better for hearing medium- or high-pitched sounds. The bell, or
round side of the drum, is better for hearing low-pitched sounds. If you want a stethoscope with really high
sound quality, you might want to consider an electronic stethoscope. An electronic stethoscope provides
amplification so that it is easier to hear heart and lung sounds. Using an electronic stethoscope may make it
easier to hear your patient’s heart and lungs, but keep in mind that they are expensive.
FIGURE 2.35
diaphragm or bell
4-Have your patient put on a hospital gown or lifts up clothing to expose skin.
FIGURE 2.36
put on a hospital gown or lift up clothing to expose skin
Section 2 38
Equipment
Method 3
Listening to the Heart
1-Hold the diaphragm over the patient’s heart.
Position the diaphragm on the left upper part of the

chest where the 4th to 6th ribs meet, almost directly
under the breast. Hold the stethoscope between your
pointer and middle fingers and apply enough gentle
pressure so that you don’t hear your fingers rubbing
together.
FIGURE 2.37
Hold the diaphragm over the patient’s heart
2-Listen to the heart for a full minute.

Ask the patient to relax and breathe normally. You should hear the normal sounds of the human heart, which
sound like “lub-dub.” These sounds are also called systolic and diastolic. Systolic is the “lub” sound and
diastolic is the “dub” sound.
 The “lub,” or systolic, sound happens when the mitral and tricuspid valves of the heart close.
 The “dub,” or diastolic, sound happens when the aortic and pulmonic valves close.
FIGURE 2.38
Listen to the heart for a full
minute
3-Count the number of heartbeats you hear in a minute.

The normal resting heart rate for adults and children over
10 years old is between 60-100 beats per minute. For
well-trained athletes, the normal resting heart rate may
only be between 40-60 beats per minute.
 There are several different ranges of resting heart
rates to consider for patients under 10 years old.
Those ranges include:
Section 2 39
Equipment
 Newborns up to one month old: 70-190 beats per minute

 Infants 1 - 11 months old: 80 - 160 beats per minute
 Children 1 - 2 years old: 80 - 130 beats per minute
FIGURE 2.39
Count the number of heartbeats
4-Listen for abnormal heart sounds.

As you count the heartbeats, you should also listen for any abnormal sounds. Anything that does not sound
like lub-dub may be considered abnormal. If you hear anything abnormal, your patient may need further
evaluation by a doctor.
 If you hear a whooshing sound or a sound that is more like “lub...shhh...dub,” your patient might have a
heart murmur. A heart murmur is blood rushing quickly
through the valves. Many people have what are called
“innocent” heart murmurs. But some heart murmurs do
point to issues with heart valves, so you should advise
your patient to see a doctor if you detect a heart murmur.
 If you hear a third heart sound that is like a low frequency
vibration, your patient might have a ventricular defect. This
third heart sound is referred to as S3 or a ventricular
gallop. Advise the patient to see a doctor if you hear a third
heart sound.
 Try listening to samples of normal and abnormal heart sounds to help you determine if what you are
hearing is normal. FIGURE 2.40
Listen for abnormal heart sounds
Method 4
Section 2
Listening to the Lungs
40
Equipment
1-Ask your patient to sit straight up and breathe normally.

As you listen, you can ask the patient to take a deep breath if you cannot hear breath sounds or if they are too
quiet to determine if there are any abnormalities.
FIGURE 2.41
Ask your patient to sit
straight up and breathe
normally
2-Use the diaphragm of your stethoscope to listen to

your patient’s lungs.
Listen to the patient’s lungs in the upper and lower lobes, and on
the front and back of the patient.
FIGURE 2.42
Use the diaphragm of your stethoscope
to listen
3- Listen for normal breath sounds.

Normal breath sounds are clear, like listening to someone blowing air into a cup. Listen to a sample of healthy
lungs and then compare the sounds to what you hear in your patient’s lungs.
FIGURE 2.43
Listen for normal breath
sounds
Section 2
4-Listen for abnormal breath sounds.
41
Equipment
Abnormal breath sounds include wheezing, strider, rhonchi, and rales. If you do not hear any breath sounds,
the patient may have air or fluid around the lungs, thickness around the chest wall, or airflow that is slowed
down or over inflation to the lungs.
FIGURE 2.44
Listen for abnormal breath sounds
3.3-Types:
3.3.1-Acoustic:
Acoustic stethoscopes are familiar to most people, and
operate on the transmission of sound from the chest piece,
via air-filled hollow tubes, to the listener's ears. The chest
piece usually consists of two sides that can be placed
against the patient for sensing sound: a diaphragm (plastic
disc) or bell (hollow cup). If the diaphragm is placed on the
patient, body sounds vibrate the diaphragm, creating
acoustic pressure waves which travel up the tubing to the
listener's ears. If the bell is placed on the patient, the FIGURE 2.45
Acoustic stethoscope, with the bell upwards
Vibrations of the skin directly produce acoustic pressure
waves traveling up to the listener's ears.
3.3.2-Electronic:
An electronic stethoscope (or stethophone) overcomes the low sound levels by electronically amplifying body
sounds. However, amplification of stethoscope contact artifacts, and component cutoffs (frequency response
thresholds of electronic stethoscope microphones, pre-amps, amps, and speakers) limit electronically amplified
stethoscopes' overall utility by amplifying mid-range sounds, while simultaneously attenuating high- and low-
frequency range sounds. Currently, a number of companies offer electronic stethoscopes. Electronic
stethoscopes require conversion of acoustic sound waves to electrical signals which can then be amplified and
processed for optimal listening. Unlike acoustic stethoscopes, which are all based on the same physics,
transducers in electronic stethoscopes vary widely. The simplest and least effective method of sound detection
is achieved by placing a microphone in the chest piece. This method suffers from ambient noise interference
and has fallen out of favor. Another method, used in Welch-Allyn's Meditron stethoscope, comprises placement
of a piezoelectric crystal at the head of a metal shaft, the bottom of the shaft making contact with a diaphragm.
.
3.3.3-Recording:
Some electronic stethoscopes feature direct audio output that can be used with an external recording device,
such as a laptop or MP3 recorder. The same connection can be used to listen to the previously
recorded auscultation through the stethoscope headphones, allowing for more detailed study for general
research as well as evaluation and consultation regarding a particular patient's condition and telemedicine, or
remote diagnosis.
There are some Smartphone apps that can use the phone as a stethoscope. At least one uses the phone's
own microphone to amplify sound, produce visualization, and e-mail the results. These apps may be used for
training purposes or as novelties, but have not yet gained acceptance for professional medical use.
The first stethoscope that could work with a Smartphone application was introduced in 2015.
Section 2
42
Equipment
3.3.4-Fetal:
A fetal stethoscope or fetoscope is an acoustic stethoscope shaped like a listening trumpet. It is placed against
the abdomen of a pregnant woman to listen to the heart sounds of the fetus. The fetal stethoscope is also
known as a Pindar horn after French obstetrician
3.3.5-Doppler:
A Doppler stethoscope is an electronic device that measures the Doppler effect of ultrasound waves reflected
from organs within the body. Motion is detected by the change in frequency, due to the Doppler effect, of the
reflected waves. Hence the Doppler stethoscope is particularly suited to deal with moving objects such as a
beating heart. It was recently demonstrated that continuous Doppler enables the auscultation of valvular
movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in
adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while
classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior
in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic
auscultation are different, it has been suggested that both methods could complement each other. A military
noise-immune Doppler based stethoscope has recently been developed for auscultation of patients in loud
sound environments (up to 110 dB).
3.3.6-3D-printed:
A 3D-printed stethoscope is an open-source medical device meant for auscultation and manufactured via
means of printing. The 3D stethoscope was developed by Dr. Tarek Loubani and a team of medical and
technology specialists. The 3D-stethoscope was developed as part of the Glia project, and its design is open
source from the outset.
3.4-Parts of a Stethoscope:

tubing tubing
Section 2 43
Equipment
FIGURE 2.49: Chestpiece
3.5-Cleaning/Disinfection:
According to the Public Health Agency of Canada (PHAC, 1999) and Capital Health policy, devices such as
stethoscopes should undergo cleaning and disinfection between each use. This is accomplished through the
use of an approved hospital-grade disinfectant wipe (such as a Virox wipe) or by wiping the stethoscope with a
piece of gauze moistened with 70% alcohol. Pre-moistened alcohol swabs are not sufficient due to their small
size. Stethoscopes should be wiped from clean to dirty, typically from earpieces to bell/diaphragm.
3.6- Additional Precautions:

When patients are placed on Additional Precautions, a stethoscope should be dedicated for use with this
patient only (dedicated equipment). If clinicians opt to use their own stethoscopes in the care of patients on
Additional Precautions, they must assume full responsibility for the proper cleaning and disinfection of the
stethoscope after use and before leaving that patient’s environment.
3.7-Stethoscope Covers:
Many clinicians have made attempts to personalize their stethoscopes through the application of fabric
stethoscope covers or “cozies”. Fabric stethoscope covers will become contaminated during patient care
activities and may act as a fomite for infection (Milam et al., 2001). The application of a fabric stethoscope
cover prevents the necessary cleaning and disinfection and therefore should not be used in any Capital Health
facility.
3.8-Refrences:
https://www.drtompetty.org/wp-content/uploads/2011/12/PettyStethoscope.pdf
http://www.bibnum.education.fr/sites/default/files/laennec-analysis-en.pdf
44
Equipment
4- Pulse oximetry Section 2
FIGURE 2.50
Pulse oximetry
45
Section 2
Equipment
4.1-Definition:
Is a noninvasive method for monitoring a person's oxygen saturation (SO2). Though its reading of
SpO2 (peripheral oxygen saturation) is not always identical to the more desirable reading of SaO2 (arterial
oxygen saturation) from arterial blood gas analysis, the two are correlated well enough that the safe,
convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation
in clinical use.
In its most common (trans-missive) application mode, a sensor device is placed on a thin part of the patient's
body, usually a fingertip or earlobe, or in the case of an infant, across a foot. The device passes two
wavelengths of light through the body part to a photo detector. It measures the changing absorbance at each
of the wavelengths, allowing it to determine the absorbance due to the pulsing arterial blood alone,
excluding venous blood, skin, bone, muscle, fat, and (in most cases) nail polish.
Less commonly, reflectance pulse oximetry is used as an alternative to trans-missive pulse oximetry described
above. This method does not require a thin section of the person's body and is therefore well suited to a
universal application such as the feet, forehead, and chest, but it also has some limitations. Vasodilatation and
pooling of venous blood in the head due to compromised venous return to the heart can cause a combination
of arterial and venous pulsations in the forehead region and lead to spurious SpO2 results. Such conditions
occur while undergoing anesthesia with end tracheal intubation and mechanical ventilation or in patients in
the Trendelenburg position.
•Pulse oximetry tells you: •Pulse oximetry cannot tell you:

–SpO2 –O2 content of the blood
–Pulse rate –Amount of O2 dissolved in blood
–Respiratory rate or tidal volume (ventilation)
–Cardiac output or blood pressure.
4.2-Principles:
1- Pulse oximetry is based on two physical
Principles:
 The presence of a pulsatile signal generated by arterial blood.
 Absorption for red and infrared lights
2- Some light is absorbed by:
 –Arterial blood
 –Venous blood
 –Tissues FIGURE 2.51
principles
Light that passes through the tissues is detected by a photo detector.

3- Oxygenated hemoglobin absorbs more infrared light and allows more red lights to pass
through.
FIGURE 2.52
Oxygenated hemoglobin absorbs
more infrared light and allows more
red lights
46
Section 2
Equipment
4- Deoxygenated (or reduced) hemoglobin absorbs more red light and allows more infrared light to
pass through
5- Red light is in the (660 nm) wavelength light band. Infrared light is in the 900-940nm wavelength
light
FIGURE 2.53
Deoxygenated (or reduced) hemoglobin absorbs FIGURE 2.54
more red light and allows more infrared light Oxygenated hemoglobin absorbs more
infrared light and allows more red lights
4.2.1-Oximetry Probe Placement

 Finger
 Earlobe
 Heel (neonates)
Section 2
FIGURE 2.55
Probe Placement
4.2.2-Block diagram
FIGURE 2.56
Block Diagram
47
Section 2
Equipment
1-Sensor
- Divided into 2 components:
Transmitter (Leds): Receiver:
It is impossible to use the normal led so we use a  The photo detector is a silicon photodiode
special-purpose Led because: that produces current linearly proportional
 Red Leds are now being manufactured with to the intensity of light striking it.
internal lensing systems to give high intensity  During passage through the tissues, some
outputs so that the peak power available light is absorbed by blood and soft tissues
from them can be increased without depending on the concentration of
increasing the average power hemoglobin.
 We using two light emitting diodes (LED's),  The amount of light absorption at each light
one in the visible red spectrum (660nm) and frequency depends on the degree of
the other in the infrared spectrum (940nm). oxygenation of hemoglobin within the
 The beams of light pass through the tissues tissues.
to a photo detector.
-Types of Sensors
Transmittance Reflectance
 It measures the amount of light  •It measures the amount of light
Passes through the tissue as in a reflected back to the probe
finger probe
FIGURE 2.58
FIGURE 2.57 Reflectance
Transmittance
Section 2 48
Equipment
Both types use the same technology differing only in positioning

Of the probes and calibration
Advantages Disadvantages
 The transmittance sensor is greater as the  The major disadvantages of the transmittance
amount of the light passing through thin probes are that the sensor application is
tissue is greater than the amount of light limited to peripheral parts but reflectance
reflected. probe can be placed on virtually in any place
on the body
 The transmittance sensor is greater as the
light passing through the tissue is
concentrated in particular area, the intensity
of detected light is larger for transmittance
probes
2-Amplifier
The transmitted light detected by the photodiode is amplified and converted to a voltage using an op−amp
configured as a current−to−voltage converter.
3-Microcontroller
Since the light is pulsed, we need to use a sample−and−hold circuit to reconstitute the waveforms at each of
the two wavelengths.
Then these data pass to the microcontroller and use a look up table between R ratio and blood oxygen
saturation.
4-Display
After enter to microcontroller then we display it in a 7 segments or LCD
FIGURE 2.59
Display
Section 2 49
Equipment
4.3-Procedure Steps
Pulse oximetry may be used in both inpatient and outpatient settings. In some cases, your doctor may
recommend that you have a pulse oximeter for home use.
The pulse oximetry process is as follows:
 Most commonly, a clip-like device will be placed on your finger, earlobe, or toe. You may feel a small
amount of pressure, but there is no pain or pinching. In some cases, a small probe may be placed on
your finger or forehead with a sticky adhesive. You may be asked to remove your fingernail polish if it’s
being attached to a finger.
 You’ll keep the probe on for as long as needed to monitor your pulse and oxygen saturation. When
monitoring physical activity capabilities, this will be during the extent of the exercise and during the
recovery period. During surgery, the probe will be attached beforehand and removed once you’re awake
and no longer under supervision. Sometimes, it will only be used to take a single reading very quickly.
 Once the test is over, the clip or probe will be removed.
4.4-Benefits
 Pulse oximeters are useful for people who have conditions that affect oxygen saturation. For example, a
sleep specialist might recommend a pulse oximeter to monitor the nighttime oxygen saturation level of
someone with suspected sleep apnea or severe snoring.
 Pulse oximetry can also provide feedback about the effectiveness of breathing interventions, such as
oxygen therapy and ventilators.
 Some doctors use pulse oximetry to assess the safety of physical activity in people with cardiovascular
or respiratory problems, or may recommend that a person wears a pulse oximeter while exercising. A
doctor may also use pulse oximetry as part of a stress test.
 Some hospitals also use pulse oximeters for particularly vulnerable patients. For instance, infants in
neonatal intensive care units may wear pulse oximeters, which can alert staff of a drop in oxygen
saturation.
 Some benefits of pulse oximetry include:
 monitoring oxygen saturation over time
 alerting to dangerously low oxygen levels, particularly in newborns
 offering peace of mind to people with chronic respiratory or cardiovascular conditions
 assessing the need for supplemental oxygen
 monitoring oxygen saturation levels in people under anesthesia
50
Equipment
4.5-Limitations
Some factors can reduce the accuracy of a pulse oximeter reading, including:
 changes in the pulse

 carbon monoxide poisoning, which may not produce an alert in a pulse oximeter
 bilirubin levels
 lipids in blood plasma
 interference from external light or color, including nail polish
 having cold hands or poor circulation
 People who use pulse oximeters to monitor oxygen saturation should not rely on the oximeter as a
substitute for subjective experience.
People experiencing difficulty breathing, shortness of breath, dizziness, or other signs of possible
oxygen deprivation should seek medical attention.
4.6-Refrances:
http://www.who.int/patientsafety/safesurgery/pulse_oximetry/who_ps_pulse_oxymetry_training
_manual_en.pdf
http://www.diva-portal.se/smash/get/diva2:1117776/FULLTEXT01.pdf
Section 2 51
Equipment
5-Endoscopy
FIGURE 2.60
Endoscopy
52
Section 2
Equipment
5.1-Introduction to Endoscopy System

 The endoscopy system is a minimally invasive diagnostic medical procedure.
 The examination of internal body cavities using a specialized
medical instrument called an endoscope.
 It gives visual evidence of the problem (e.g. cancer, ulceration or
inflammation)
 It can be used to collect a sample of tissue or remove
problematic tissue
 It Is also used to take photograph of the hollow internal organs
 It is performed under
– Conscious sedation
– Total Anesthesia
 Physicians use endoscopy to

– diagnose, monitor, and surgically treat various medical
problems
 A surgeon introduces the endoscope in to the body either FIGURE 2.61
through a body opening, Endoscopy
– Such as the mouth or the anus, or through a Small incision in the skin.
FIGURE 2.62
the endoscopein to the body
either through a body opening,
 Risks of Endoscopy
– Sedation
– Damage to dentition
– Aspiration
– Perforation or hemorrhage after endoscopic dilatation
– Perforation, infection, and an aspiration after percutaneous endoscopic gastrostomy insertion
– Pancreatitis, cholangitis, perforation or bleeding after ERCP
5.2-Major Components of the Endoscopy System

 The endoscope is slender, flexible or rigid tube
 Equipped with lenses and alight source.
 CCDs are used to feed a video to the monitor
Section 2 53
Equipment
 Through the accessory channels of the endoscope water and air is supplied to wash and dry the
surgical site.
 Also has a channel through which surgeons can manipulate tiny instruments, such as forceps,
surgical scissors, and suction devices.
 A variety of instruments can be fitted to the endoscope for different purposes.

endoscope endoscope
5.3-The Flexible Endoscope
5.4.1 - Parts of the Endoscope:

1. Control Section
2. Insertion Section
3. Connector Section
FIGURE 2.65
Parts of the endoscope
Section 2 54
Equipment
5.4.2- There Are Two Types:

1 – Fiber optic instruments
2 – Video-endoscopes
1-Fiber optic instruments

 Based on optical viewing bundles
 2–3mmindiameter
 It contains 200–400 fine glass fibers, each close to 10 μ min diameter.
 Each individual glass fiber is coated with glass of a lower optical density to prevent leakage of
light from within the fiber
 The space between the fibers causes a dark ‘packing fraction’
– That is why, fine mesh frequently apparent in the fiber optic image
 Advantages
– Fiber optic bundles are extremely flexible, and an image can be transmitted even when tied in a
knot.
– Small diameter
– Direct view (monitor not necessary)
 Limitations
– The image quality of a fiber optic bundle, though excellent, can never equal that of a rigid lens
system or a video-endoscope
– Limited number of “pixels”
FIGURE 2.66
2-Video-endoscopes
 A CCD chip and supporting electronics mounted at the tip
 To and fro wiring replacing the optical bundle
 Advantages
– Improved image quality
– View through a monitor
– Removing any need to hold the instrument close to the
endoscopes’ eye has hygienic advantages (avoidance of
splash contamination)
– Improved instrument design and handling techniques
 Limitations
– No direct viewing FIGURE 2.67: Video-endoscopes
– Cannot be made<5mm
Section 2 55
Equipment
5.4-The Rigid Endoscope:
 A lens system transmitting the image to the viewer

– Typically, are lay lens system
– Rod lenses provide for better image quality and light efficiency
FIGURE 2.68
Rigid Endoscope
 Surgical or Rigid Endoscopy:

– Arthroscopy
– Urethrocytoscopy
– Laparoscopy (Laparoscopic Surgery)
FIGURE 2.69 FIGURE 2.70:

Arthroscopy Arthroscopy
Section 2 56
Equipment
 Laparoscopy is minimal access surgery that accomplishes surgical therapeutic goals with
minimal somatic and psychological trauma.
 A rigid endoscope is introduced through a sleeve into the peritoneal cavity.
 The abdomen inflated with carbon dioxide
 Further sleeves or ports are inserted to enable instrument access and their use for dissection.
 Benefits of Laparoscopic Surgery:
– Smaller incision
– Improved cosmetics
– Reduced possibility of infection
– Reduced post op pain
– Reduced blood loss
– Return home quicker
– Return to work quicker

Improved cosmetics Smaller incision
 Limitations of Laparoscopic Surgery

– Reliance on remote vision and operating
– Loss of tactile feedback
– Dependence on hand–eye coordination
– Difficulty with homeostasis
– Extraction of large specimens
– Reliance on new techniques
Section 2 57
Equipment
5.5-Capsule Endoscopy:
 Capsule endoscopy was first used in humans in 1999.
 How does it work?
– Capsule is swallowed by the patient like a conventional pill.
– It takes images as it is propelled forward by peristalsis.
– A wireless recorder, worn on a belt, receives the images transmitted by the pill.
– A computer work station processes the data and produces continuous still images.
FIGURE 2.75
Capsule FIGURE 2.76
Endoscopy Capsule
Endoscopy
5.6-Components of capsule Endoscopy:

1. Optical Dome
– This shape results in easy orientation of the capsule axis along the small in testing and so helps
propel the capsule forward easily.
– It contains the Light Receiving Window
2. Lens Holder
– The Lens Holder is that part of the capsule which accommodates the lens.
– The lens is tightly fixed to the holder so that it does not get dislocated any time.
3. Lens
4. Illuminating LED’s
– Four LED’s (Light Emitting Diodes) are present.
– These plural lighting devices are arranged in donut shape
5. CMOS Image Sensor

– CMOS (Complementary Metal Oxide Semiconductor)
Image Sensor is the most important part of the capsule.
– It is highly sensitive and produces very high quality images.
– It has 140º field of view and can detect objects as small as possible.
6. Two batteries
7. ASIC Transmitter
8. Antennae
– For transmission outside the body
FIGURE 2.77
capsule
Endoscopy parts
Section 2 58
Equipment
 Advantages
– Painless, no side effects or complications.
– Miniature size so can move easily through the digestive system.
– Accurate, precise and effective.
– Images taken are of high quality are sent almost instantaneously to the data recorder for storage.
– Made of bio-compatible material, doesn’t cause any harm to the body.
 Anatomical Limitations
– Slow Gastric/Intestinal Motility.
– Narrowing or obstruction
– Morbidly obese patient
 Technical limitations
– Poorer quality of images as compared to Fiber optic scopes
– The position of the capsule cannot be accurately controlled
– Interpretation of results are very observer dependent
– In ability to biopsy or treat any pathology seen
–
 How to overcome this limitation??
– Smaller devices
– Advanced cameras
5.7-References:
http://www.ceutica.com.au/assets/Endoscopy-handbook-32259.pdf
http://thaitage.org/source/content-file/content-file-id-19.pdf
Section 2 59
Equipment
Section 3
Therapeutic Devices
1- Anesthetic Machines
2- Oxygen Cylinders and Flowmeters
3- Nebulizers
4- Electrosurgical Units (ESU) and Cautery
Machines
Section 3 60
Equipment
Section 3
Therapeutic Devices
1-Anaesthetic Machines:
FIGURE 3.1
Anaesthetic
Machines
Section 3 61
Equipment
1.1-Introduction:
For many years, anesthesiologists did not require a machine to deliver anesthesia to the patients. After the
introduction of oxygen and nitrous oxide in the form of compressed gases in cylinders, there was a necessity
for mounting these cylinders on a metal frame. This stimulated many people to attempt to construct the
anesthesia machine. HEG Boyle in the year 1917 modified the Gwathmey's machine and this became popular
as Boyle anesthesia machine. Though a lot of changes have been made for the original Boyle machine still the
basic structure remains the same. All the subsequent changes which have been brought are mainly to improve
the safety of the patients. Knowing the details of the basic machine will make the trainee to understand the
additional improvements. It is also important for every practicing anesthesiologist to have a thorough
knowledge of the basic anesthesia machine for safe conduct of anesthesia.
The most important piece of equipment that the anesthesiologist uses is the anesthesia machine. Safe use of
anesthesia machine depends upon an interaction between the basic design of the machine with its safety
features and the knowledge and skills of the anesthesiologist. The basic function of an anesthesia machine is
to prepare a gas mixture of precisely known, but variable composition. The gas mixture can then be delivered
to a breathing system. Anesthesia machine itself has evolved from a simple pneumatic device to a complex
array of mechanical, electrical and computer – controlled components. Much of the driving force for these
changes have been to improve patient safety and user convenience
1.2-Function of Anesthesia Machine:

 The machine performs four essential functions:
 Provides O2,
 Accurately mixes anesthetic gases and vapors,
 Enables patient ventilation and
 Minimizes anesthesia related risks to patients and staff.
1.3-Basic Design of a Continuous Anesthesia

Machine:
The basic design of an anesthesia machine consists of pressurized
gases supplied by cylinders or pipelines to the anesthetic machine, which
controls the flow of gases before passing them through a vaporizer and
delivering the resulting mixture to the patient through the breathing circuit
The early Boyle's machine had five elements, which are still present in
modern machines:
1) A high pressure supply of gases,
2) pressure gauges on O2 cylinders, with pressure reducing valves,
3) flow meters
4) metal and glass vaporizer bottle for ether
5) a breathing system.
The anesthesia machine is a continuous flow machine in which all the
components are mounted on a table. Box shaped sections of welded
steel or aluminum provide a rigid metal framework mounted on wheels
with antistatic tires (Castors) and brakes. Antistatic measures improve FIGURE 3.2
flow meter performance and where flammable vapors are used, reduce Anaesthetic Machines
the risk of ignition.
Section 3 62
Equipment
The basic machine has provision for fixing two O2 cylinders and two N2O cylinders through the yoke assembly
with PISS. There is also provision for connecting the pipeline gas source of O2 and N2O (from the wall outlet
with quick couplers and yoke blocks at the machine end) instead of one of the cylinders at the yoke assembly.
A pressure gauge is mounted on to the yoke assembly to read the pressure in the cylinder. Pressure regulators
are located downstream of the yoke assembly, which reduce the high pressure in the cylinders to a low and
constant pressure of 45-60 PSIG. From the pressure regulators, there
are connections through high pressure tunings constructed of heavy duty materials to the flow meter assembly,
which is secured to the back bar of the machine by one or more bolts. The back bar supports the flow meter
assembly and the vaporizers. At the end of the back bar, there is the common gas outlet to which the breathing
circuits are connected to provide the anesthetic vapor containing O2 enriched gases to the patient.
The anesthesia machine can be conveniently divided into three parts: (a) The high pressure system, which
receives gases at cylinder pressure, reduces the pressure and makes it more constant, (b) the intermediate
pressure system, which receives gases from the regulator or hospital pipeline and delivers them to the flow
meters or O2 flush valve and (c) the low pressure system, which takes gases from the flow meters to the
machine outlet and also contains the vaporizers.
1.4-The High Pressure System:

The high pressure system consists of all parts of the machine, which receive gas at cylinder pressure. These
include the following:
1) The hanger yoke which connects a cylinder to the machine.
2) The yoke block, used to connect cylinders larger than size E or pipeline hoses to the machine through
the yoke.
3) the cylinder pressure gauge, which indicates the gas pressure in the cylinder
4) The pressure regulator, which converts a high variable gas pressure into a lower, more constant
pressure, suitable for use in the machine.
1.5-Hanger Yoke Assembly:

The hanger yoke orients the cylinder, provides gas tight seal and ensures a unidirectional gas flow. The
workstation standard requirement is that there should be at least one yoke for O2 and N2O.
If the machine is likely to be used in locations that do not have piped gases, it is advisable to have a double
yoke, especially for O2.
The hanger yoke consists of:
1) The body, which is the principle framework and supporting structure
2) the retaining screw, which tightens the cylinder in the yoke,
3) the nipple, through which gas enters the machine
4) the index pins, which prevent attaching an incorrect cylinder
5) The Bodok seal, the washer which helps to form a seal between the cylinder and the yoke a filter, to
remove particulate matter.
6) the check valve assembly which ensures a unidirectional flow of gas through the yoke
FIGURE 3.3: Yoke assembly with bodok seal and yoke plug
Section 3 63
Equipment
1.6-Pin Index Safety System:

Machines are usually equipped with one or two E type cylinders that hang on specific hanger yokes. The
medical gas pin-index safety system ensures that the correct medical gas cylinder is hung in the correct yoke.
The system consists of two pins that are fixed in the yoke, and which fit into two corresponding holes in the
cylinder valve. The two pins are in a unique configuration for each gas and should never be removed from the
hanger yoke. Specific pin configurations exist for each of the medical gases supplied in small cylinders in order
to prevent erroneous misconnections of gas supplies. A cylinder should never be force-fitted to a hanger yoke.
For O2 the pin index number is 2-5 and for N2O it is 3-5. Substitution of an E type N2O cylinder for O2 can
occur if pins in the index face are missing or broken or if several washers are used simultaneously. This fault is
deceptive because the PISS is thought fool proof. This defect can only be detected by direct inspection of the
yoke and cylinder gas identity markings each time a cylinder is replaced on the machine.
The check valve assembly prevents trans-filling of empty cylinders. Since there is always a chance of check
valves not functioning properly, yoke should not be left vacant and a yoke plug (which is a solid metal piece
with a conical depression on one side and a hollow area on the other side for retention screw and nipple of the
yoke respectively) should be fitted. Yoke plugs are usually kept chained to the machine
1.7-Bourdon’s Pressure Gauge:

Cylinder pressure is usually measured by a Bourdon's pressure gauge, which is a flexible tube which
straightens when exposed to gas pressure causing a gear mechanism to move a needle pointer. In the older
machines like in Boyle's mark-3, the front of the Bourdon's pressure gauge is covered by a heavy glass
window and the back is covered by loosely fitted tin sheet. The idea being if there is a sudden increase in the
pressure and the tube ruptures, then high pressured gases are vented from the back preventing injury to the
patient and the anesthesiologist. In machines like Boyle ‘F’, there were no pressure gauges for N2O as it was
thought that there is no use of the same as the pressure remains constant until all the liquid N2O evaporates.
In Boyle mark-3, pressure gauges were introduced for N2O also so that once the indicator starts showing
pressure less than 750 PSIG, the anesthesiologist will come to know that all the liquid N2O has evaporated
and what remains is only N2O gas. The pressure gauges are color coded, white for O2 and French blue for
N2O.
FIGURE 3.4
Internal assembly of basic anaesthesia machine when viewed from above
with covering plate removed
64
Section 3
Equipment
1.8-Yoke Block:
It is a piece of metal, shaped like a cylinder valve that is pin indexed and has a port and a conical depression
to fit into a yoke. With the introduction of diameter index safety system for pipeline inlet connections, the use of
yoke blocks has been discontinued in modern machines as they were associated with several hazards.
1.9-Pressure Regulator:
These are the devices which reduce the high pressures in the cylinders to a lower and more constant pressure
to maintain a constant flow. The reasons for their presence are:
(1) If there are no pressure regulators, then there will be a necessity for the anesthesiologist to keep re-
adjusting the flow control valves to maintain a constant flow as the cylinder pressure decreases with use,
decreasing the flow.
(2) The high pressure from the cylinders can produce damage to the flow control valves.
(3) The high pressure can also produce barotraumas to the patient's lungs.
(4) With lowered pressure supplied to the flow meters’ fine adjustments of the flow is possible.
The pressure regulators reduce the pressure of the O2 cylinders from 2200 PSIG to 45-60 PSIG and the N2O
cylinders from 750 PSIG 45-60 PSIG.
1.10-Basic Physics:
The pressure regulators work on the basic principle “force = pressure × area”. When force is kept constant with
a spring and area inside the regulator is increased using a diaphragm, then automatically pressure of the gas
decreases. By keeping the force exerted by the spring high, changes in the cylinder pressure due to use will
not affect the reduced output pressure. The output pressure is fixed by the manufacturing company and hence
these are called as ‘fixed pressure regulators’.
1.11- Master and Slave Regulator:

With early anesthesia machines (Boyle-F), if an O2 cylinder becomes exhausted or the pipeline source failed, in
the face of significant N2O flow, the patient would receive a lower fraction of O 2 or even a hypoxic gas mixture.
Especially before the advent of pulse oximetry, hypoxemia and patient injury could occur unless the machine
fault is immediately recognized by the anesthesiologist. In the subsequent anesthesia machines, since there
was no separate O2 fail safe mechanism, the N2O pressure regulator was constructed in such a way that
pressure of the O2 flow was required to release the flow of N2O. So, N2O regulator was made to act like a
‘slave’ regulator to O2 as the ‘master’ regulator. When this was introduced as a safety mechanism, it was
thought that hypoxic mixture could not be delivered to the patient as O2 in the pipeline supply or cylinder supply
gets depleted, N2O output from the N2O regulator also would stop and anesthesiologist will be alarmed as the
reservoir bag collapses. This was not a fool proof system as still hypoxic mixtures could be delivered if the
O2 is cut off at the flow meters. Hence proportion ting devices had to be introduced at the flow meter assembly
in modern machines.
1.12-The Intermediate Pressure System:

It includes the components of the machine which receive gases at reduced pressures usually 37-55 PSIG. This
in older machines includes the O2 failure alarms; flow meter assembly and O2 flush and in modern machines
also include O2 pressure fail safe systems, pipeline inlet connections, pipeline pressure gauges and ventilator
power outlets.
1.13-O2 Flush:
There is direct tubing connecting the O2 pressure regulator to the O2 flush. It gives 35-70 L/min of flow with a
pressure of 45-60 PSIG.
65
Section 3
Equipment
Its main use is during the mask ventilation with a lot of leak between the mask and the patient's face especially
in elderly patients and in patients with difficult airways and also acceptable power source for jet ventilation for
providing partial, if not total, ventilator support in most clinical situations. When it is operated, even if the
vaporizers are turned on, the patient will receive pure O2 uncontaminated with N2O and volatile agents.
Inappropriate use of the O2 flush valve has been associated with both barotraumas and intraoperative
awareness. Barotraumas can occur because the flush valve allows fresh gas to enter the breathing circuit at a
rate of approximately 1 L/s. Also if it is accidently turned on and unobserved, patient may not be adequately
anaesthetized. When the flush is activated, the flow meters may not show its activation but as it makes
sufficient noise, the same cannot be overlooked.
1.14-The Flow Meter Assembly:

The flow meter assembly controls, measures and indicates the rate of flow of gas passing through it. The flow
meter assembly consists of flow control valve and flow meter sub-assembly.
FIGURE 3.5
Flow metere assembly, back bar and pop-off valve
1.14.1-Flow Control Valves:

The flow control valve controls the rate of flow of a gas through its associated flow meter by manual adjustment
of variable orifice. Flow control valve is also called as needle valve or pin valve. The valve mainly consists of
the control knob, stem and seat. The control knob is color coded and touch coded for each gas. The control
knob is large, cylindrical in shape with wide flutes and colored white for O2 and is small, conical in shape with
narrow flutes and colored blue for N2O. The machine standard requires a distance of 25 mm between the
knobs. The flow control knobs are turned counter-clockwise to open the gas flow in the flow meter and
clockwise to close the gas flow.
The flow control knobs are connected to the stem which has a pin at its distal end. When the valve is closed,
the pin fits into a seat of metal and no gas flows. When the stem is turned counter-clockwise, then an opening
is created between the pin and the seat and gas starts flowing into the flow meter. There are stops for the
closed position and maximum opening position which prevent damage to the fine needle valve or disengage
the stem from the valve body respectively. In the newer machines proportion ting systems like link-25 or
O2 ratio monitor control will be present which will not allow the user to give O2 less than 25% of the total flow.
1.14.2-Flow Meter Sub-Assembly:

This consists of the tube through which the gas flows, the indicator or bobbin or float, a stop at the top of the
tube and the scale which indicates the flow. Flow meter tubes are known as Thorpe type and are made of
borosilicate glass Pyrex. The tubes either have a single taper or a double taper. When there are separate flow
meter tubes for low flows and high flows for the same gas then the tubes are single tapered. If there is a single
tube for the gas, then it is double tapered. The lower portion of the dual tapered flow tube has a fine taper for
measuring low flows and the upper portion has a coarse taper for reading high flows rates.
Indicator also called as rotameter or bobbin or float is present within the flow meter tube which moves up and
rotates as the gas flows into the tube.
Section 3 66
Equipment
The bobbin is made of aluminum and has an upper rim which is wider than the body. The upper rim contains
slanted flutes, which makes the bobbin rotate as the gas strikes the flutes. There is a fluorescent dot over the
bobbin making its rotation to be observed easily. The flow tubes and floats are assembled and calibrated
together for each specific gas. Therefore, if the flow tube breaks, the entire flow meter assembly including the
float should be replaced. Sometimes the float may get stuck to the side of the tube as a result of development
of static electricity, particularly in dry atmospheres. The effects of static electricity may be reduced by spraying
the outside of the tube with an antistatic agent such as carotene.
1.15-Scale:
The flow meter scale can be marked directly on the flow tube or to the right of the tube. Gradations
corresponding to equal increments in flow rate are closer together at the top of the scale because the annular
space increases more rapidly than the internal diameter from bottom to top of the tube.
The bobbin floats and rotates without touching the sides, giving an accurate indication of gas flow. Flow is read
from the top of the bobbin. Features reducing inaccuracy to within ±2% include:
1) Sight tubes for each gas are individually calibrated at 20°C and 101.3 kPa; they are non-
interchangeable.
2) Tubes have different lengths and diameters, and may have a pin-index system at each end.
3) Tubes are leak-proof because of neoprene washers (O-rings) at both ends of the flow meter block.
4) The tubes have an antistatic coating on their inner and outer surfaces. This prevents the bobbin from
sticking to the tube wall.
5) The bobbin is visible throughout the length of the tube and has vanes to improve its rotation in the gas
flow.
1.16-Physical Principles of Flowmeter:

The flow meter is of variable orifice type due to the tapering of the tube which has its lower diameter at the
bottom. When there is no flow of gas the bobbin rests at the bottom and when the flow control valve is opened
the bobbin moves up as the gas flows in. The bobbin floats freely in the tube at an equilibrium position where
the downward force on it due to gravity equals the upward force due to the gas flow. The gas flows in the
annular opening between the bobbin and the tube. The annular opening around the bobbin increases with the
height. The rate of gas flow depends on the three factors:
1) The pressure drop across the constriction is constant for all positions in the tube and is equal to the
weight of the float divided by its cross-sectional area.
2) The size of the annular opening - the larger is the size of the annular opening around the bobbin, higher
will be the flow.
3) Physical characteristics of the gas - because the annular space is tubular at low flow rates, flow is
laminar and viscosity determines the gas flow rate and hence follows the Poiseuille's law. The annular
space simulates an orifice at high flow rates, and turbulent gas flow then depends predominantly on the
density of the gas and follows the Graham's law.
Since in a variable orifice flow meter there is a mixture of turbulent and laminar flow, for calibration purposes
both density and viscosity of the gas are important. Consequently, careful calibration is required if a flow meter
is used for a different gas than that for which it was designed. When the anesthesia machines are used at high
altitudes since the density of the gases decreases, when higher flows are set in the flow meters, actual flow of
gases will be higher than the set flows, as flow is inversely proportional to the square root of density as per
Graham's law.
1.17-Sequence of Flowmeter:
The position of the flow meters of individual gases is also important. O2 flow meter should be downstream to all
other gases to prevent hypoxic mixture delivered to the patient. As shown in, there are 3 flow meter tubes.
O2 is upstream and N2O being downstream and in between is the third gas like air or CO2.
Section 3 67
Equipment
If there is a break or leak in the middle tube, then part of O2 will move out through the break in the middle tube
and the patient will be getting a hypoxic mixture containing more of N2O rather than O2. Instead, if O2 is
downstream and N2O is upstream, then even if there is a leak in the middle tube then patient will get a higher
fraction of inspired O2 which may produce lighter planes of anesthesia, but not hypoxemia. Without changing
the position of the tubes as in, still O2 can be made downstream of all gases by placing a wedge inside the
manifold.

Arrangement of flow meter tubes A leak in the middle tube with oxygen flowing
with oxygen upstream out resulting in delivery of hypoxic mixture

(a) Arrangement of flow meters with nitrous (b) A wedge in the manifold creating
oxide (N2O) upstream, leak in the middle oxygen to be downstream
tube resulting in N2O flowing out but oxygen
flow intact.
Section 3 68
Equipment
1.18-Low Pressure System:

The low pressure system is the part of the machine downstream of the flow meters in which the pressure is
slightly above the atmosphere. The components in this system are:
1) Vaporizers mounted on the back bar
2) back pressure safety devices
3) The common gas outlet.
The back bar may terminate in a valve (circuit selector) which turned in one direction permits the use of a semi-
closed breathing attachment and in the other passes the gases to a circle absorber. This unit is sometimes
combined with a “Trilene Interlock” which prevents the trichloroethylene vaporizer being turned on when closed
circuit is in use. Also when trilene vaporizer is turned on, one cannot change over to the closed circuit.
1.19-Refrences:
http://www.denhatparts.com/images/documents/anaesthetic-machine.pdf
https://www.sharn.com/images/art/Professional-Anesthesia-Handbook.pdf
Section 3 69
Equipment
2-Oxygen Cylinders and Flowmeters

Oxygen Cylinders Oxygen Cylinders and Flowmeters
Section 3 70
Equipment
2.1-Oxygen therapy:
Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as a medical treatment. This can
include for low blood oxygen, carbon monoxide toxicity, cluster headaches, and to maintain enough oxygen
while inhaled anesthetics are given. Long term oxygen is often useful in people with chronically low oxygen
such as from severe COPD or fibrosis. Oxygen can be given in a number of ways including nasal canola , face
mask, and inside a hyperbaric chamber.
Oxygen is required for normal cell metabolism .Excessively high concentrations can cause oxygen
toxicity such as lung damage or result in respiratory failure in those who are predisposed. Higher oxygen
concentrations also increase the risk of fires, particularly while smoking, and without humidification can also
dry out the nose .The target oxygen saturation recommended depends on the condition being treated. In most
conditions a saturation of 94–96% is recommended, while in those at risk of carbon dioxide
retention saturations of 88–92% are preferred, and in those with carbon monoxide toxicity or cardiac
arrest they should be as high as possible .Air is typically 21% oxygen by volume while oxygen therapy
increases this by some amount up to 100%.
The use of oxygen in medicine became common around 1917.It is on the World Health Organization's List of
Essential Medicines, the most effective and safe medicines needed in a health system. The cost of home
oxygen is about 150 USD a month in Brazil and 400 USD a month in the United States. Home oxygen can be
provided either by oxygen tanks or an oxygen concentrator. Oxygen is believed to be the most common
treatment given in hospitals in the developed world.
FIGURE 3.12
A simple face mask.
2.2-Medical uses:
Oxygen is used as a medical treatment in both chronic and acute cases, and can be used in hospital, pre-
hospital or entirely out of hospital, dependent on the needs of the patient and their medical professionals'
opinions.
1-Chronic conditions:
A common use of supplementary oxygen is in patients with chronic obstructive pulmonary disease (COPD), the
occurrence of chronic bronchitis or emphysema, a common long-term effect of smoking, who may require
additional oxygen to breathe either during a temporary worsening of their condition, or throughout the day and
night. It is indicated in COPD patients with arterial oxygen partial pressure PaO2 ≤ 55 mmHg (7.3 kPa) or
arterial oxygen saturation SaO2 ≤ 88% and has been shown to increase lifespan.
Oxygen is often prescribed for people with breathlessness, in the setting of end-stage cardiac or respiratory
failure, advanced cancer or neurodegenerative disease, despite having relatively normal blood oxygen levels.
A 2010 trial of 239 subjects found no significant difference in reducing breathlessness between oxygen and air
delivered in the same way
71
Equipment
2-Acute conditions:
Oxygen is widely used in emergency medicine, both in hospital and by emergency medicalSection 3 or those
services
giving advanced first aid.
In the pre-hospital environment, high flow oxygen is indicated for use in resuscitation, major
trauma, anaphylaxis, major bleeding, shock, active convulsions, and hypothermia.
It may also be indicated for any other people where their injury or illness has caused low oxygen levels,
although in this case oxygen flow should be moderated to achieve oxygen saturation levels, based on pulse
oximetry (with a target level of 94–96% in most, or 88–92% in people with COPD).Excessively use of oxygen in
those who are acutely ill however increases the risk of death.
For personal use, high concentration oxygen is used as home therapy to abort cluster headache attacks, due
to its vaso-constrictive effects.
People who are receiving oxygen therapy for low oxygen following an acute illness or hospitalization should not
routinely have a prescription renewal for continued oxygen therapy without a physician's re-assessment of the
person's condition.
If the person has recovered from the illness, then the hypoxemia is expected to resolve and additional care
would be unnecessary and a waste of resources.
2.3-Storage and sources:

Oxygen can be separated by a number of methods, including chemical reaction and fractional distillation, and
then either used immediately or stored for future use. The main types of sources for oxygen therapy are:
1) Liquid storage – Liquid oxygen is stored in chilled tanks until required, and then allowed to boil (at a
temperature of 90.188 K (−182.96 °C)) to release oxygen as a gas. This is widely used at hospitals due
to their high usage requirements, but can also be used in other settings. See Vacuum Insulated
Evaporator for more information on this method of storage.
2) Compressed gas storage – The oxygen gas is compressed in a gas cylinder, which provides a
convenient storage, without the requirement for refrigeration found with liquid storage. Large oxygen
cylinders hold 6,500 liters (230 cu ft) and can last about two days at a flow rate of 2 liters per minute. A
small portable M6 (B) cylinder holds 164 or 170 liters (5.8 or 6.0 cu ft) and weighs about 1.3 to 1.6
kilograms (2.9 to 3.5 lb.). These tanks can last 4–6 hours when used with a conserving regulator,
which senses the patient's breathing rate and sends pulses of oxygen. Conserving regulators may not
be usable by patients who breathe through their mouths.
3) Instant usage – The use of an electrically
powered concentrator or a chemical
reaction based unit can create sufficient
oxygen for a patient to use immediately,
and these units (especially the electrically
powered versions) are in widespread
usage for home oxygen therapy and
portable personal oxygen, with the
advantage of being continuous supply
without the need for additional deliveries of
bulky cylinders.
FIGURE 3.13
Gas cylinders containing oxygen to be used at home. When in use a pipe
is attached to the cylinder's regulator and then to a mask that fits over
the patient's nose and mouth.
72
Equipment
Section 3
FIGURE 3.14
A home oxygen concentrator in situ in an emphysema patient's house
2.4-Delivery:
Various devices are used for administration of oxygen. In most cases, the oxygen will first pass through
a pressure regulator, used to control the high pressure of oxygen delivered from a cylinder (or other source) to
a lower pressure. This lower pressure is then controlled by a flowmeter, which may be preset or selectable,
and this controls the flow in a measure such as liters per minute (lpm). The typical flowmeter range for medical
oxygen is between 0 and 15 lpm with some units able to obtain up to 25 liters per minute. Many wall
flowmeters using a Thorpe tube design are able to be dialed to "flush" which is beneficial in emergency
situations.
3.2.4.1-Low-dose Oxygen:
Many people only require a slight increase in oxygen in the air they breathe, rather than pure or near-pure
oxygen. This can be delivered through a number of devices dependent on the situation, the flow required and
in some instances patient preference.
A nasal canola (NC) is a thin tube with two small nozzles that protrude into the patient's nostrils. It can only
comfortably provide oxygen at low flow rates, 2–6 liters per minute (LPM), delivering a concentration of 24–
40%.
There are also a number of face mask options, such as the simple face mask, often used at between 5 and 8
LPM, with a concentration of oxygen to the patient of between 28% and 50%. This is closely related to the
more controlled air-entrainment masks, also known as Venturi masks, which can accurately deliver a
predetermined oxygen concentration to the trachea up to 40%.
In some instances, a partial rebreathing mask can be used, which is based on a simple mask, but featuring a
reservoir bag, which increases the provided oxygen concentration to 40–70% oxygen at 5–15 LPM.
Non-rebreather masks draw oxygen from attached reservoir bags, with one-way valves that direct exhaled air
out of the mask. When properly fitted and used at flow rates of 8–10 LPM or higher, they deliver close to 100%
oxygen. This type of mask is indicated for acute medical emergencies.
Demand oxygen delivery systems (DODS) or oxygen resuscitators deliver oxygen only when the person
inhales, or, in the case of a non-breathing person, the caregiver presses a button on the mask. These systems
greatly conserve oxygen compared to steady-flow masks, which is useful in emergency situations when a
limited supply of oxygen is available and there is a delay in transporting the patient to higher care. They are
very useful in performing CPR, as the caregiver can deliver rescue breaths composed of 100% oxygen with the
73
Section 3
Equipment
press of a button. Care must be taken not to over-inflate the patient's lungs, and some systems employ safety
valves to help prevent this. These systems may not be appropriate for unconscious patients or those in
respiratory distress, because of the effort required breathing from them.
2.4.2-High Flow Oxygen Delivery:

In cases where the patient requires a high concentration of up to 100% oxygen, a number of devices are
available, with the most common being the non-rebreather mask (or reservoir mask), which is similar to the
partial rebreathing mask except it has a series of one-way valves preventing exhaled air from returning to the
bag. There should be a minimum flow of 10 L/min. The delivered FIO2 (Inhalation volumetric fraction of
molecular oxygen) of this system is 60–80%, depending on the oxygen flow and breathing pattern. Another
type of device is a humidified high flow nasal cannula which enables flows exceeding a patient's peak
inspiratory flow demand to be delivered via nasal cannula, thus providing FIO 2 of up to 100% because there is
no entrainment of room air, even with the mouth open. This also allows the patient to continue to talk, eat and
drink while still receiving the therapy. This type of delivery method is associated with greater overall comfort,
and improved oxygenation and respiratory rates than with face mask oxygen.
In specialist applications such as aviation, tight fitting masks can be used, and these also have applications
in anesthesia, carbon monoxide poisoning treatment and in hyperbaric oxygen therapy
2.4.3-Positive Pressure Delivery:

Patients who are unable to breathe on their own will require positive pressure to move oxygen into their lungs
for gaseous exchange to take place. Systems for delivering this vary in complexity (and cost), starting with a
basic pocket mask adjunct which can be used by a basically trained first aider to manually deliver artificial
respiration with supplemental oxygen delivered through a port in the mask.
Many emergency medical service and first aid personnel, as well as hospitals, will use a bag-valve-
mask (BVM), which is a malleable bag attached to a face mask (or invasive airway such as an end tracheal
tube or laryngeal mask airway), usually with a reservoir bag attached, which is manually manipulated by the
healthcare professional to push oxygen (or air) into the lungs. This is the only procedure allowed for initial
treatment of cyanide poisoning in the UK workplace. Automated versions of the BVM system, known as
a resuscitator or pneupac can also deliver measured and timed doses of oxygen direct to patient through a
facemask or airway. These systems are related to the anesthetic machines used in operations under general
anesthesia that allows a variable amount of oxygen to be delivered, along with other gases including
air, nitrous oxide and inhalational anesthetics.
2.4.4-As a Drug Delivery Route:

Oxygen and other compressed gasses are used in conjunction with a nebulizer to allow the delivery of
medications to the upper and/or lower airways. Nebulizers use compressed gas to propel liquid medication into
an aerosol, with specific therapeutically sized droplets, for deposition in the appropriate, desired portion of the
airway. A typical compressed gas flow rate of 8–10 L/min is used to nebulize medications, saline, sterile water,
or a mixture of the preceding into a therapeutic aerosol for inhalation. In the clinical setting room air (ambient
mix of several gasses), molecular oxygen, and Heliox are the most common gases used to nebulize a bolus or
a continuous volume of therapeutic aerosols.
2.5-parts of The Oxygen Delivery System:

Each system will vary.
 An oxygen gauge shows you the amount of oxygen in the system.

 A flow control valve allows you to turn on the flow of oxygen at the ordered flow rate, such as 2 L/min.
 Some oxygen systems come with a humidifier bottle. When the bottle is filled with distilled water and
connected to the oxygen tubing, the water bubbles, creating moist humidified oxygen that flows
74
Equipment
through the person’s nose, mouth or tracheostomy. Oxygen can dry the nasal tissue and throat.
Humidified oxygen benefits people who need to receive oxygen continuously.
 A cannula or connecting tubing will connect the humidifier and oxygen delivery system to the delivery
device, such as a nasal cannula or mask.
Section 3
FIGURE 3.15
parts of the oxygen delivery
2.6-Clean Oxygen Equipment.

 Clean a nasal cannula daily. Take a clean, damp cloth and wipe down the cannula tubing after
removing it from the person’s nose. Start cleansing at the entrance to the nose and wipe down toward
the base of the tubing.
 If you are using a humidifier, clean the bottle twice a week in warm soapy water and rinse with clean
hot water. Do not just swish the suds around, use a soft cloth and clean thoroughly. Then soak in a 1
part to 3-part mixture of white vinegar and water for a minute. Always rinse the bottle thoroughly with
water after soaking and shake off excess water. Do not reuse the vinegar and water mixture.
 Refill the humidifier with distilled water as needed, but do NOT overfill the bottle. Too much water in the
bottle causes water to collect in the oxygen tubing.
 Always allow pieces of equipment to dry thoroughly before continuing use.
 Wipe off oxygen tubing daily with a clean, damp cloth.
 The extension tubing does not need to be washed. Check regularly for major kinks or possible splitting.
 Use a damp cloth to dust off oxygen tanks and concentrators. A dry cloth may cause static electricity
and create a fire risk.
2.7-Check an Oxygen System Daily:
When you care for someone receiving oxygen, make these daily checks:
 Check your equipment for any damage, including tears or leaks in tubing, signs of wear or problems
with any of the electrical components, or damage to any parts of the equipment.
 If you have compressed oxygen tanks, check to see that they are properly secured.
 If the person has an ambulatory container, check the carrier regularly for signs of wear and tear.
 Check the pressure gauge. Note any unusual changes in oxygen use. For example, is the amount
remaining in a tank less than what you expect? The HOP will tell you if you need to order more
oxygen.
75
Equipment
 Make sure the flow meter shows oxygen is being given at the proper rate. Do not adjust the flow meter
except under the doctor’s orders.

 Always refill the humidifier with the recommended type of water (usually distilled). Only fill to the proper
level. When oxygen is at a flow rate of 1-4 liters/minute by mask or nasal cannula, the body will
usually have enough moisture in the mouth, nose and throat to provide for
adequate humidification (moisture). However, when a person has a respiratory infection, wears the
Section 3
oxygen continuously, needs oxygen at higher flow rates, or when oxygen is delivered through a
tracheostomy, humidification is needed.
2.8-Maintaining and Cleaning Equipment:

 A Home Oxygen Provider (HOP) is usually a durable medical equipment (DME) or home health service
that offers 24-hour emergency service and can be reached through an answering service. This gives
you the ability to contact the HOP in an emergency such as a power or equipment failure.
 The HOP will provide a backup system or extra oxygen cylinders in the event of a power outage. This is
important if the person is on an oxygen concentrator and there is a chance that the power may be out
for a long period of time. When using a concentrator, contact the electric company and tell them that
you are caring for someone who relies on electricity for their oxygen. The electric company will keep
this information on file and it allows for priority when re-establishing service.
 When a person is on liquid oxygen the reservoir is a back-up system since liquid oxygen does not use
electricity to operate.
2.9-Advantages:
 Provides an accuracy of +/- 5% (of full scale reading) and is pressure compensated to ensure that the
flowmeter maintains its accuracy independent of varying gas supply

 Flow limiting output orifice and fail-safe shroud protects the patient from excessive flows in the event of
excessive gas pressures

 Dual-taper needle valve prevents damage to the seat and eventual leaks
 Color coded inlet fittings, outlet fittings and control knobs for quick recognition of the gas used by the
flowmeter
 Incorporates durable, impact resistant polycarbonate outer and metering tubes
 The flow-tube design provides clear readability with large bold print lines and numbers providing 180
visibility
 Weighs approximately 300 grams
76
Equipment
2.10-References:
http://www.crto.on.ca/pdf/PPG/Oxygen_Therapy_CBPG.pdf
https://www.clements.net.au/images/pdf/oxygen/Oxygen-Flowmeter-User-Manual.pdf
Section 3
3-Nebulizers
FIGURE 3.16
Nebulizers
FIGURE 3.17
Nebulizers
77
Equipment
3.1-Introduction:
Section
Is a drug delivery device used to administer medication in the form of a mist inhaled into 3 Nebulizers
the lungs.
are commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases or
disorders.
Analytical nebulizers are another form of nebulizer and are used primarily in laboratory settings for elemental
analysis.
Nebulizers use oxygen, compressed air or ultrasonic power to break up solutions and suspensions into
small aerosol droplets that can be directly inhaled from the mouthpiece of the device. An aerosol is a mixture of
gas and solid or liquid particles.
3.2-Operation:
1.) Wash your hands with soap and water, and dry them with a clean towel.
2.) Measure your medicine.
 Always wash your hands before preparing the treatment.

 Always use clean measuring devices (eyedroppers or syringes).
 Use a separate measuring device for each solution used in your treatment.
 Measure your medicines exactly as you have been instructed.
 Wash your hands after measuring each solution used in your treatment.
FIGURE 3.18: Measure your medicine

3.) Remove the top part of the nebulizer cup.
FIGURE 3.19: Remove the top part

4.) Place the medicine in the bottom of the nebulizer cup.
78
Equipment
FIGURE 3.20: Place the medicine in the bottom
5.) Attach the top portion of the nebulizer cup, and connect the mouthpiece or face maskSection 3
to the cup.
6.) Connect the tubing to the nebulizer and compressor.
7.) Turn on the compressor with the on/off switch.
FIGURE 3.21: Turn on the compressor
8.) Once you turn on the compressor, you should see a light mist.
FIGURE 3.22: see a light mist
9.) If you are using a mouthpiece, place it in your mouth and seal your lips tightly around it.
FIGURE 3.23: seal your lips tightly around it
10.) If you are using a face mask, position it comfortably and securely on your face.
11.) Inhale slowly and deeply. Hold your breath for a count of five and exhale slowly.
12.) Continue to inhale slowly and deeply for about five to 10 minutes or until the medicine is gone.
13.) If you become dizzy, shaky, or feel an increased heart rate, stop your treatment and rest for about five
minutes. Then continue the treatment, but breathe more slowly. If these symptoms continue, call your health
care provider.
14.) When the medicine is gone, turn the compressor off and unplug it.
15.) Take several deep breaths and cough. Continue coughing and try to clear any secretions you might have
in your lungs. Cough the secretions into a tissue and dispose of it.
16.) Wash your hands with soap and water, and dry them with a clean towel.
79
Equipment
3.3-Types of Nebulizers:
3.3.1-Mechanical:
1-Soft mist inhaler:

The medical company Boehringer Ingelheim also invented a new device named Respimat Soft Mist Inhaler in
1997.
This new technology provides a metered dose to the user, as the liquid bottom of the inhaler is rotated
clockwise 180 degrees by hand, adding a buildup tension into a spring around the flexible liquid container.
Section 3
When the user activates the bottom of the inhaler, the energy from the
spring is released and imposes pressure on the flexible liquid container,
causing liquid to spray out of 2 nozzles, thus forming a soft mist to be
inhaled. The device features no gas propellant and no need for
battery/power to operate. The average droplet size in the mist was
measured to a somewhat disappointing 5.8 micrometers, which could
indicate some potential efficiency problems for the inhaled medicine to
reach the lungs. Subsequent trials have proven this was not the case. Due
to the very low velocity of the mist, the Soft Mist Inhaler in fact has a FIGURE 3.24 Soft mist inhaler
higher efficiency compared to a conventional pMDI.In 2000, arguments
were launched towards the European Respiratory Society (ERS) to clarify/expand their definition of a
nebulizer, as the new Soft Mist Inhaler in technical terms both could be classified as a "hand driven nebulizer"
and a "hand driven pMDI".
3.3.2-Electrical:
1-Jet Nebulizer:
The most commonly used nebulizers are jet nebulizers, which are also called "atomizers”. Jet nebulizers are
connected by tubing to a compressor, that causes compressed air or oxygen to flow at high velocity through a
liquid medicine to turn it into an aerosol, which is then inhaled by the patient. Currently there seems to be a
tendency among physicians to prefer prescription of a pressurized Metered Dose Inhaler (PMDI) for their
patients, instead of a jet nebulizer that generates a lot more noise (often 60 dB during use) and is less portable
due to a greater weight. However, jet nebulizers are commonly used for patients in hospitals who have
difficulty using inhalers, such as in serious cases of respiratory disease, or severe asthma attacks. The main
advantage of the jet nebulizer is related to its low operational cost. If the patient needs to inhale medicine on a
daily basis the use of a PMDI can be rather expensive. Today several manufacturers have also managed to
lower the weight of the jet nebulizer down to 635 grams (22.4 oz), and thereby started to label it as a portable
device. Compared to all the competing inhalers and nebulizers, the noise and heavy weight is however still the
biggest drawback of the jet nebulizer. Trade names for jet nebulizers include Max in
FIGURE 3.25: Jet nebulizer
80
Equipment
2-Ultrasonic Wave Nebulizer:
Ultrasonic wave nebulizers were invented in 1965 as a new type of portable nebulizer. The technology inside
an ultrasonic wave nebulizer is to have an electronic oscillator generate a high frequency ultrasonic wave,
which causes the mechanical vibration of a piezoelectric element. This vibrating element is in contact with a
liquid reservoir and its high frequency vibration is sufficient to produce a vapor mist. As they create aerosols
from ultrasonic vibration instead of using a heavy air compressor, they only have a weight around 170 grams
(6.0 oz). Another advantage is that the ultrasonic vibration is almost silent. Examples of these more modern
type of nebulizers are: Omron NE-U17 and Breuer Nebulizer IH30. Section 3
FIGURE 3.26: Ultrasonic wave nebulizer
3-Vibrating mesh technology:

A new significant innovation was made in the nebulizer market around 2005, with creation of the ultrasonic
Vibrating Mesh Technology (VMT). With this technology a mesh/membrane with 1000-7000 laser drilled holes
vibrates at the top of the liquid reservoir, and thereby pressures out a mist of very fine droplets through the
holes. This technology is more efficient than having a
vibrating piezoelectric element at the bottom of the liquid
reservoir, and thereby shorter treatment times are also
achieved. The old problems found with the ultrasonic
wave nebulizer, having too much liquid waste and
undesired heating of
the medical liquid, have also been solved by the new
vibrating mesh nebulizers.
Available VMT nebulizers include: Parie Flow,
Respironics i-Neb,Beurer Nebulizer IH50, and Aerogun
Aeroneb. As the price of the ultrasonic VMT FIGURE 3.27
Nebulizers is higher than models using previous technologies, Vibrating mesh technology
Most manufacturers continue to also sell the classic jet nebulizers.
3.4- Clean and Store a Nebulizer:

After each treatment:
 Wash hands well.
 Wash the medicine cup and mouthpiece or mask with warm water
 Mild soap. Do not wash the tubing.
 Rinse well and shake off excess water. Air dry parts on a paper towel.
Once a week:
 Disinfect nebulizer parts to help kill any germs. Follow instructions for each nebulizer part listed in the
package insert. Always remember:
 Do not wash or boil the tubing.
 Air dry parts on a paper towel.
 Between uses:
81
Equipment
 Store nebulizer parts in a dry, clean plastic storage bag.
 If the nebulizer is used by more than one person, keep each person’s medicine cup, mouthpiece or
mask, and tubing in a separate, labeled bag to prevent the spread of germs.
 Wipe surface with a clean, damp cloth as needed. Cover nebulizer machine with a clean, dry cloth and
store as manufacturer instructs.
 Replace medicine cup, mouthpiece, mask, tubing, filter, and other parts according to manufacturer’s
instructions or when they appear worn or damaged.
Section 3
3.5-precautions:
1. Wash your hands thoroughly before opening the cup of nebulizer.
2. Unit dose vials should be carefully opened and the contents poured into a thoroughly clean and fresh
nebulizer cup.
3. When measuring medications from multi-dose containers, use an eye dropper or syringe as
instructed by the pharmaceutical company or doctor. Do not touch the dropper to any surface other
than the medication inside the container. Promptly replace bottle caps tightly. Once opened,
medication bottles should be stored in the refrigerator.
3.6-Advantages:
 Invaluable for small children who just cannot use any other inhalation device.
 Useful for old people who cannot coordinate inhalers.
 Useful in an acute attack situation for home self-use.
 Having a nebulizer at home is a psychological support to the patient that effective help is at hand.
 Some very severe asthmatics get more relief with nebulizer medicines as compared to the usual inhaler
devices.
3.7-Disadvantages:
 The cost of treatment goes up considerably. If the same usual asthma medication by inhaler is about 6
rupees a day, by nebulizer it would cost 60 to 80 rupees a day. For a few day’s treatments that would
not matter much. But for long term treatment it would be a concern for most.
 There are chances of carrying the infection from unsterile chambers or tubings into the lungs, especially
with long term use.
 A lot of drug is wasted – that vapor which is coming out from the side.
3.8-References:
http://www.aiolos.se/filer/Samlingsbroschyr_471414.pdf
https://www.nhlbi.nih.gov/files/docs/public/lung/asthma_tipsheets.pdf
https://pdfs.semanticscholar.org/336d/1e5a9dde5831db3e6099b20293efca566c15.pdf
https://omronhealthcare.com.au/pdf/Omron-NEC28-Instruction-manual.pdf
https://my.clevelandclinic.org/health/drugs/4254-home-nebulizer
82
Equipment
Section 3
4-Electrosurgical Units (ESU) and

Cautery Machines
FIGURE 3.28: ESU
83
Equipment
4.1-Introduction:
Section
Diathermy is a therapeutic treatment commonly prescribed for muscular and joint associated 3 The term
pains.
‘diathermy’ means ‘through heating’ or producing deep heating directly in the tissues of the body. It simulates
the circulation, relieves pain, enhances rate of recovery of healing the tissue.
Devices intended for surgical cutting and for controlling bleeding by causing coagulation (homeostasis) at the
surgical site.
Electro-surgery is commonly used in dermatological, gynecological, cardiac, plastic, ocular, spine, ENT,
maxillofacial, orthopedic, urological, neuro- and general surgical procedures as well as certain dental
procedures.
4.1.1 – Principle of Diathermy:
1. Before injury, the dipole molecules of the body tissue are arranged on the basis of polarity.
2. When the tissue is damaged the dipoles distribution becomes irregular and deviates from
polarity based arrangement.
3. Under the influence of an electric field, they rotate according to the polarity of their charge in the
direction of the field lines and get rearranged and tend to acquire its previous stage of polarity.
FIGURE 3.29: dipole molecules of the body

tissue are arranged on the basis of polarity
4.1.2-Electrocautery is Not Electro surgery:

The terms electrocautery and electrosurgery are frequently used interchangeably; however, these
terms define two distinctly different modalities.
• Electrocautery: use of electricity to heat an object that is then used to burn a
specific site e.g. a hot wire
• Electrosurgery: the electrical current heats the tissue. The current must pass
through the tissue to produce the desired effect.
84
Equipment
FIGURE 3.30:
Electrocautery
is NOT
Electrosurgery
4.2- Electrosurgery:
4.2.1-Principle
 Radiofrequency starts at about 3 KHz and extends through about 300 GHz In this frequency neither
muscular nor neural cells depolarize.
 The ESU converts electrical energy drawn from the mains supply to a high frequency current.
 This high frequency current is passed through a supply cable and a handle to an active spot electrode.
 At the point of application, this electrode builds up a highly concentrated field in the tissue surrounding
the contact point.
 The concentration of energy within a small area produces the desired electrosurgical effect in the
region around the active electrode.
 As the energy is conducted through the patient to a neutral electrode, in contact with a large surface.
(Therefore in the vicinity of the neutral electrode, there is, as is intended, no thermal effect.)
 Alternating current at frequencies from
 1 to 100,000 Hertz will interfere with the neuro-muscular system.
 Above 100,000 Hertz these stimuli occur too quickly to affect the neuro-muscular system.

Electrosurgery works by cutting, fulguration or desiccation.
Section 3 85
Equipment
4.2.2-Components of Electrosurgery Device
FIGURE 3.33
Components of a modern electrosurgical system
FIGURE 3.34
Electrosurgery Generator (ESU)
FIGURE 3.35
Bipolar Forceps
Section 3 86
Equipment
FIGURE 3.37
FIGURE 3.36
Patient Return Electrode
Footswitch
4.2.3-Types of ESU
1-Monopolar
2-Bipolar
4.2.3.1-Monopolar Electrosurger
 Most commonly used electrosurgical modality.
 The active electrode is in the wound.
 Patient return electrode is attached somewhere else on the patient.
 The narrow active electrode concentrates the current (and therefore the power), at the designated site.
 4 components: generator, active electrode, patient, patient return electrode
 Produce variety of tissue effects depending on waveform
 Modes: Cutting and Coagulation
 High power output, peak voltages and rated load than bipolar type.
FIGURE 3.38:
Monopolar electrosurger
4.2.3.1-2-Basic Electro-Surgical Circuit – (Mono-polar)
FIGURE 3.39: Monopola FIGURE 3.40: Basic electro-surgical circuit
Section 3 87
Equipment
4.2.3.1.3-Monopolar Electrosurgery
FIGURE 3.41: Monopolar
4.2.3.1.4-Electrosurgical Tissue Effects:
 Cutting: divide tissue with electric sparks that focus intense heat at surgical site
- By sparking we achieve maximum current concentration
 Fulguration: sparking with coagulation waveform
- coagulates and chars the tissue over a wide area, result in coagulum
- High voltage coag current is used (duty cycle 6%)
 Desiccation: occurs when electrode is in direct contact with the tissue

- Achieved most efficiently with cutting current
- by touching electrode to the tissue, current concentration reduced, result in less heat and no cutting
action
- cells dry out and form a coagulum
FIGURE 3.42: Electrosurgical tissue effects
Section 3 88
Equipment
4.2.3.1.5-Wave Forms
Only variable that determines vaporization or coagulation is rate of heat
High heat, more rapidly: vaporization
Low heat, more slowly: coagulum
FIGURE 3.43: Wave Forms
4.2.3.1.6-Patient Return Electrode:

 Designed with an adhesive to facilitate continuing contact with the patient and prevention of a clinically
significant local thermal effect.
 If there is partial detachment, the current (or power density) will increase, and the dispersive electrode
can become “active” and capable of creating thermal injury, often called a burn.
FIGURE 3.44:low FIGURE 3.45:high
 To avoid this, they are designed in the form of a “split pad” (which effectively is two dispersive
electrodes in one) to measure the impedance at the level of the electrode.
 A difference in the measured impedance in the two dispersive electrodes will generally reflect partial
attachment (or detachment) and the machine will not start.
FIGURE 3.46
 Surface area impedance can be compromised by: excessive hair, adipose tissue, bony prominences,
fluid invasion, adhesive failure, scar tissue, and many other variables.
Section 3 89
Equipment
4.2.3.2- Bipolar
 Both electrodes mounted on the device
 Usually located on or near to the distal end so that only the tissue located between the two electrodes
is included in the circuit.
 Patient Return Electrode is absent.
 Three types of operations
- Precise
- Standard
- Macro
FIGURE 3.47: Bipolar
FIGURE 3.48: Bipolar
4.2.4-Safety Considerations
Direct Coupling
 Occurs when the active electrode touches another metal instrument.
 The electrical current flows from one to the other and then proceeds to tissue resulting in unintended
burn.
 This can also occur if an active electrode is activated while in contact with a metal clip.
 So, do not activate the generator while the active electrode is touching a metal object or not in vision.
Section 3 90
Equipment
FIGURE 3.49: Direct Coupling
4.2.5-Insulation failure:
 Coagulation waveform is high in voltage, which can spark through compromised insulation. Also high
voltage can blow holes in weak insulation.
FIGURE 3.50: Insulation failure
 We can get the desired coagulation effect without high voltage, simply by using the „cutting‟ current by
holding the electrode in direct contact with tissue
91
Section 3
Equipment
4.3-Electrocautery
FIGURE 3.51: Electrocautery
4.3.1-Difintion:
is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys
some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other
potential medical harm, such as infections when antibiotics are unavailable.
4.3.2-Types:
1-Unipolar:
 Has a large “Indifferent Plate “for electricity return and a small “active electrode”;
- Causes high current density and very high heat at active electrode.
 CAUTIONS: N B
- Causes deeper injury, hence is bad choice to control active bleeding (high perforation risk except
with non-contact technique like APC).
- There must be absence of flammable gases (bowel lavage) to avoid explosion.
 Indifferent plate should:
- A) be near to site of active electrode, to decrease resistance from other tissues,
- B) have conductive gel to decrease skin resistance,
- C) Remain in complete contact all the time (dual plate w monitoring circuit confirms contact) to
maximize energy in active electrode.
 Examples: hot snare, hot biopsy, Argon Plasma Coagulator, sphincter tome, needle knife.
2-Bipolar:
 Usually gives low-energy or “micro-bipolar”. Has two or more small active electrodes very close to each
other (active and return electrode)
 Does not use “indifferent plate”.
 Risk of explosion with flammable gases (needs colon prep)
92
Section 3
Equipment
 Less depth of injury. Saline pillow further decreases depth of injury (very important in colon & small
bowel).
 Excellent desiccation and coagulation at low settings (15-20 W). Excellent for hemostasis.
 Example: BICAP, Gold-Probe.
.
4.3.3-Basic Physics Terminology
FIGURE3.52:
Electrocautery
 •Voltage (volts): force that pushes the current (“Potential Energy”). – More force = more destruction
 Resistance (ohm): quality of tissue that impedes flow of current. – More resistance = less current flow.
– Resistance of skin > bone > fat > muscle > bowel wall (326 ohms) > blood.
 Intensity (amps): amount of electricity crossing an area (wire), per second.
 Current Density (amp/cm 2): amount of current flowing through
a cross sectional area = Current Intensity(amps)/area(cm 2)
 Generated heat: is proportional to the square of the current
density: (Intensity/area) 2. – Small area of lesion/stalk causes disproportional high heat.
 Power output: Is given in Watts = amps x volts. Voltage is constant; hence higher output increases the
intensity of current (amps). – Higher output = higher current density = much higher heat
 Delivered Energy: Is given in Joules. Energy (watts) x time (seconds)
93
Section 3
Equipment
4.3.4-Electrocautery Modes:
1-Same energy (W):
CUT vs. COAGULATION “peak voltage”: Cut <<< Coagulation
FIGURE 3.53:
Electrocautery
2-Same “peak voltage”:

CUT vs. COAG Energy (W): CUT >>> COAGULATION
3.4.3.5-Complications of Electrocautery
FIGURE 3.54:
Electrocautery
4.4-References:
http://www.srmuniv.ac.in/sites/default/files/downloads/esu.pdf
http://www.pfiedler.com/ce/1256/files/assets/common/downloads/Electrosurgery.pdf
https://pdfs.semanticscholar.org/presentation/fc92/e95bee55ff2b8eb1e8381ef6bb04cb823e2d.pdf
http://www.boviemedical.com/2016/09/05/3-key-differences-between-electrosurgery-electrocautery/
Section 3 94
Equipment
Section 3
Section 4
Life Support &
General Devices
1-Incubators (Infant)
2-Defibrillator
3-Infusion and syringe pumps
4-Autoclaves and Sterilizers
5-Suction Machines (Aspirators)
6-Operating Theatre and Delivery (Tables(
95
Equipment
Section 4:
Life support and General Devices
1-Infant Incubator
FIGURE 4.1
Infant Incubator
Section 4 96
Equipment
1.1- Definition:
A microenvironment to place newborns that are at high risk, for maintenance of temperature and humidity.
Infant incubator is a Bio Medical Device which provides Warmth, Humidity and Oxygen all in a controlled
environment as required by the New born
Purposes
 Maintenance of thermo neutral ambient temperature.
 Provision of desired humidity and oxygenation.
 Observation of very sick neonates.
 Isolation of newborn babies from infection, unfavorable external environment and stimulations.
Functional Requirements and Constraints:

 Functional Requirements:
 Maintain a temperature range 35-37 C
 Monitor infant temperature
 Ventilation
 Humidification 40-80% relative humidity
Constraints:
 Affordable FIGURE 4.2
Infant Incubator
 Durable
 Easy to maintain and repair
 Portable
 Biocompatible and comfortable
 Intuitive and easy to use
 Useable in a variety of incubators and cribs
 Low powered
 Allow for high infant visibility
1.2-Parameters:
 Temperature.
 Humidity.
 Air velocity.
 Sound.
 Oxygen.
FIGURE 4.3: Temperature
Section 4 97
Equipment
1.3-Axillary temperature in the newborn:

1.3.1-Hypothermia:
Low body temperature is called Hypothermia
OCCURANEC REMEDY
It occurs when core body temperature drops Skin-to-skin contact with the mother
to 95°F or lower
Happens when heat loss exceeds heat gain Use a heated water-filled mattress
New born with temperature below 36.0- Use radiant heater
36.4°C (96.8-97.5°F) is in moderate Use Incubator
Hypothermia
1.3.2-Hyperthermia:
High body temperature is called Hyperthermia.
 Hyperthermia can be defined as a core temperature greater than 98.6° F (37.0° C)

 In adults it may lead to Fever, Heat syndromes like collapse, cramps, stroke etc.
1.4-Thermoregulation:
Thermo regulation is the ability of the body to balance the heat produced in the body with the heat lost by the
body thereby maintaining temperature in the body normal range.
 The temperature of the body is regulated by hypothalamus
 Sweating begins almost precisely at a skin temperature of 37°C
 If the skin temperature drops below 37°C, a variety of responses are initiated to conserve the heat in
the body and to increase heat production.
1.4.1-Heat Production
 Due to metabolic activities
1.4.2-Heat Loss
1. Evaporation:
Occurs when air flow carries heat to or away from the body
2. Conduction:
Radiant energy exchange occurs between two objects that are not in direct
contact with each other.
3. Convection:
Heat exchange that occurs between objects that are in direct contact with
one another
4. Radiation:
Occurs when liquid is turned to vapor, as with amniotic fluid on a newly
delivered infant.
98
Section 4
Equipment
FIGURE 4.4
Four ways a newborn may lose heat to the environment
1.4.2.1-Strategies to Prevent Heat loss:
1-CONVECTIVE HEAT LOSS can be prevented by:

Providing warm ambient air temperature
 Placing infants less than 1500 grams in incubators
 Keeping portholes of the incubator closed
 Warming all inspired oxygen
 On open warmers keeping sides up and covering infant if possible
 Using Infant Servo Temperature Control
2-RADIANT HEAT LOSS can be prevented by:

 Avoiding placement of incubators, warming tables and bassinets near cold windows, walls, air
conditioners, etc.
 Placing a knit hat on the infant’s head
 Wrapping tiny babies in saran or “bubble” wrap environmental temperature
3-CONDUCTIVE HEAT LOSS can be prevented by:

 Placing a warm diaper or blanket between the neonate and cold surfaces
 Placing infant on pre-warmed table at time of delivery
 Warming all objects that come in contact with the neonate
 Admitting infant to a pre-warmed
 Skin to skin contact
4-EVAPORATIVE HEAT LOSS can be prevented by:

 Keeping the neonate and his/her environment dry.
 Drying the baby immediately after delivery.
 Placing preterm or SGA infant in occlusive wrap/bag at delivery
 Delay bath until temperature is stable
Section 4 99
Equipment
1.5-Infant Warming Devices
FIGURE 4.5
Infant Warming Devices
1.5.1 - Differences Incubator:

 Closed care
 Convection principle
 Humidity Adjustment
 Less disturbances
 Oxygen control available
Radiant warmer
 Open care
 Radiation Principle
 No Hy.Adjust
 External Disturbances more
 No O2 control
Transport Incubator
 Battery powered
 Air (Manual) Mode only
 Resuscitation apparatus attached
 Compactable in size
NICU Incubator
 Mains operated
 Both Air & Patient mode of operation
 Not attached
 Bigger
Section 4 100
Equipment
FIGURE 4.8
FIGURE 4.6 FIGURE 4.7 Radiant warmer
Baby incubator Transport baby incubator
1.6-Parts of an incubator:
 Hood / canopy
 Cabinet
 Access panel
 Mattress
 Arm port holes
 Bassinet
 Latch release
 Control panel
 Oxygen inlet
 Thermostat
 Air inlet filter
 Access port
 Caster lock
 Levers FIGURE 4.9: Parts of an incubator
FIGURE 4.10: Parts of an incubator
101
Section 4
Equipment
1.7-Hardware Parts:
Fan
 The fan takes the filtered room air and blows it over or through the heating element and the humidifier.
 Without the fan the incubator would overheat.
Filter
 Simple incubators are equipped with washable foam filters. After washing and drying they can be
reused.
 Modern incubators however usually have disposable bacterial filters. They
cannot be cleaned and have to be renewed
Heater
 A heating element made from coiled resistance wire as known from hair dryers or
the tube type (flat or coiled) as seen in autoclaves are used to heat up the air.
But unlike in autoclaves, the heater has much less power and thus does not get
so hot.
 The power rating is between 100 W and 300 W.
 The heater is controlled by an electronic temperature control unit via a relay or
simply by a thermostat.
FIGURE 4.11:
Heater
Front Panel
 Air temperature
 Patient temperature
 Control temperature
FIGURE 4.12 :
Front Panel
:
Head Hood
 Single piece, Round Shape, made of auto-clavable Polycarbonate
material.
 Trauma free Silicone neck adjustment flap.
 Bilateral oxygen nozzle (prevents direct flow of cold oxygen on
patient’s head.
 Height: 7.5”. • Width: 8.5”.
FIGURE 4.13:
Head Hood
X-ray tray
 An X-ray tray may be fitted beneath the bassinet to enable X-rays to be taken without disturbing the
infant. This may be done with the canopy up or down.
 X-rays taken using the tray may result in a higher dose to the patient because of the bedding, the
mattress and other plastics.
 In a previous user assessment of incubators incorporating X-ray trays or slots.
Section 4 102
Equipment
1.8-Modes of Temperature control:

1. The Air Controlled mode:
 In air control mode, the air temperature is sensed and used to provide the feedback to the system to
turn on or off according to the set value.
 Under the air control, the hot air flow is turned on whenever the incubator air temperature goes below
the set temperature; maximum flow of hot air is allowed from the heater into the incubator. This causes
rapid rise in the incubator air temperature.
 When the air temperature reaches the desired value, the flow of hot air is turned off. With this on-off
control, there is an overshoot and undershoot in the air temperature
2. The Skin Controlled mode:
 In skin control mode, the skin temperature is sensed and used to provide the feedback to the system to
turn on or off according to the set value.
 Under the skin control, the hot air flow is turned on whenever the skin temperature goes below the set
temperature, and maximum flow of hot air takes place into the incubator. This causes a rise in air
temperature
 Skin temperature also goes up through convection of heat from air to skin. When the skin temperature
reaches the desired value the flow of hot air is turned off.
 Under this on-off control while skin temperature is maintained constant there are high fluctuations in air
temperature
FIGURE 4.14:
BLOCK DIGRAM
1.9-Alarms & Remedies:

 Low Temp – check Alarm limits, sensor& calibrate if required
 High Temp- check Alarm limits, sensor& calibrate if required
 Probe Fail – check probe for any damage & calibrate if required
 Power fail- check mains present, power cord, fuse, power supply PCB
 Fan fail- check Fan, Fan voltage, Fan control circuit.
 Heater Fail- checks Heater resistance, heater voltage, heater control circuit.
 Air probe, Patient probe, safety probe- respective sensors, calibrate if necessary.
Section 4 103
Equipment
1.10-Noise:
Premature babies are fragile.
One of their special needs is quiet environment. However, in the neonatal intensive care unit (NICU), high
noise levels and frequent handling leave the babies sleep deprived and may disrupt their normal growth and
development
 Hearing Impairment
 Sleep disturbance
 Somatic Effects
 Auditory Perception and Emotional Development
1.11-Avoiding Noise:
 No tapping or writing on top of the Incubator or hood.
 Careful and soft closure of the Incubator pot whole doors.
 Neonatal Noise mufflers can be used.
 Medical staff should be advised to wear soft shoe.
 To identify noisy areas and to isolate them.
 Check existing machines for noise level.
 Check all incoming new machines for their noise level before being put to use.
1.12-Cleaning:
Some manufacturers suggest cleaning the incubator every day with a mild soap water solution, some don't.
But at least the incubator has to be cleaned and disinfected thoroughly
After each change of infant
At least once a week.
Therefore all inserts have to be removed and cleaned with hot soapy water added with antiseptic. Then the
inserts and the cabinet have to be dried and ventilated before they can be reused.
The disinfection products which can be used or should not be used are noted in the user manual.
The humidifier reservoir has to be cleaned and the water changed every day.
The air inlet filter should be changed or washed according to the user manual or every 3 months.
1.13-Maintenance:
Start the maintenance with a visual check. Ensure that the hood is free of cracks and the hinges move
smoothly and all switches and knobs are OK. Check all probes, cables, and tubes for cracks and the port
sleeves for tears. Check or replace also the alarm battery, if there is one.
Continue with a test run with a function test and a temperature check and a calibration if needed. The
temperature check and the calibration procedure are described in the service manual.
When the service manual is not present, a typical temperature check can be performed as follows:
Use a reference thermometer with an accuracy of 0.5° or better and place it in the center
of the mattress.
Set the temperature to 36°C, wait at least 30 min and then check the temperature for
6 hours. The temperatures should not differ more than 1°.
When the temperature differs more, the control unit has to be calibrated. In electronic controls there is always
is a trim-pot for doing the adjustments. Mechanical thermostats usually do not have a calibration point. But
here the knob or the pointer can be twisted.
The safety thermostat or over-temperature cut-off can be tested by bypassing the main thermostat.
Section 4 104
Equipment
Then the temperature will rise above 40°C, an alarm should be given and the safety function has to switch off
the heater. It is also possible to use a hair dryer to warm up the sensor, or to move it closer to the heating
element.
Check also the humidity. The incubator should be able to create up to 80% humidity. On the other hand it
should be possible to reduce the humidity down to 40%.
An important task during the maintenance is the thorough cleaning of the technology compartment under the
cabinet.
A vacuum cleaner helps a lot to clean the inside of the incubator but it is not essential. A brush will also do.
Plastic parts and everything that is water resistant should be washed with hot soapy water added with
antiseptic. Do not forget the air inlet filter.
A dusty fan can be cleaned easily with a brush, but this should not really be needed because of the inlet filter.
1.14-REFRENC:
https://aut.researchgateway.ac.nz/bitstream/handle/10292/975/AlTaweelY.pdf?sequence=3&isAllowed=y
https://www.inspiration-healthcare.com/downloads/brochure-378.pdf
http://www.srmuniv.ac.in/sites/default/files/downloads/unit_1_incubator_radiant_warmer_phototherapy_unit.pdf
Section 4 105
Equipment
2-Defibrillator
FIGURE 4.15
Defibrillator
Section 4 106
Equipment
2.1-DIFINITION:
A device that reverses the Fibrillation of the heart.
 Fibrillation causes the heart to stop pumping blood, leading to brain damage.
 Defibrillation is a process in which an electronic device sends an electric shock to the heart to stop an
extremely rapid, irregular heartbeat, and restore the normal heart rhythm.
 It is a common treatment for life threatening cardiac dysrhythmia, ventricular fibrillation, and pulse less
ventricular tachycardia.
2.2-Principle:
A high voltage electric current is applied to the Heart muscle either directly (Internal Defibrillator)
through the open chest or indirectly (External Defibrillator) through the chest wall to terminate
Ventricular Fibrillation.
1-Normal ECG tracing
FIGURE 4.16: Normal ECG tracing

2- ABNORMALITIES:
1) Ventricular Fibrillation
Ventricular Fibrillation is a very fast, irregular heart rhythm in the lower heart chambers (ventricles). During VF
the heart quivers and pumps little or no blood to the body. Consciousness is lost in seconds. If not treated
immediately, VF will cause sudden cardiac arrest
FIGURE 4.17:
Ventricular Fibrillation
NEED FOR A Defibrillator:

 Ventricular fibrillation can be converted into a more efficient rhythm by applying a high energy shock to
the heart.
 This sudden surge across the heart causes all muscle fibers to contract simultaneously.
 The instrument for administering the shock is called a DEFIBRILLATOR.
 Possibly, the fibers may then respond to normal physiological pace making pulses.
2) Atrial Fibrillation
Atrial Fibrillation is a very fast, irregular heart rhythm in the upper heart chambers. During AF, the waveform is
almost similar to normal waveform but for the loss of 'P' waveform.
FIGURE 4.18:
Atrial Fibrillation
3) AF treatment:
 For Atrial fibrillation, the shock should be avoided to be delivered in the T period otherwise it will lead to
Ventricular Fibrillation
 This is achieved by Synchronous mode
Section 4 107
Equipment
FIGURE 4.19
AF treatment
2.3-Schematic Diagram of a defibrillator:

 A variable auto-transformer T1 forms the primary of
 A high voltage transformer T2
 Rectifying the output of the transformer by a diode D (half wave rectification)
 High voltage change-over switch 1, 2 (vacuum type)
 Oil-filed 16 micro-farads [ micro farad] capacitor C
 L current limiting inductor to protect the patient (disadvantage: own resistance → dissipation of a part of
energy during the discharge process
 The voltmeter AC is to indicate the energy stored in C
 RS: limits the charging current to protect the circuit and determine the time for full charge on C (T=RC)
 R: discharge resistance which the patient represents (50 to 100
 In 1 position the capacitor charges to a voltage VP set by the positioning of the autotransformer (≈4000
V)
 When the shock is to be delivered to the patient, a foot switch or a push button mounted on the handle
of electrode is operated.
 After that the high voltage switch changes over to position 2 and the capacitor is discharged across the
heart through the electrodes
FIGURE 4.20
Schematic diagram of a
defibrillator
Section 4 108
Equipment
2.4-Components of a Defibrillator:
1) Power supply
2) Capacitor
3) Inductor
FIGURE 4.21
components of a
defibrillator
2.4.1-Power supply/ Voltage source:

 Step-up transformers are transformers that increase voltage
 Allow the doctor to choose among different amounts of charge
 This output voltage is then fed to a capacitor, which stores the high voltage charge.
 As an additional energy source, many defibrillators also have internal rechargeable batteries.
 Step up transformers used to convert 240 VAC to 5000 VAC
 This is converted to DC by rectifier
 In battery mode the DC is converted to AC by inverter
 This AC is amplified and then again rectified to DC.
FIGURE 4.22: Power supply
2.4.2-Capacitors:
 Capacitors store a large amount of energy in the form of electric charge
 This stored energy is released over a short period of time “Capacitance” describes a capacitor
quantitatively
C = Q/V
 Capacitance is directly proportional to area and indirectly proportional to the distance between plates
FIGURE 4.23
Capacitor FIGURE 4.24: Capacitor
109
Section 4
Equipment
2.4.3 – Inductors:
 Coils of wire that produce a magnetic field when current flows
through them, prolong the duration of current flow
 Used to prolong the duration of current flow
 This opposition is called “inductance”.
FIGURE 4.25:
Inductor
2.5- Operating Principle:

 Monophasic Defibrillator
 Bi- Phasic Defibrillator
2.5.1 - Monophasic Defibrillator

 Delivers its current in one forward direction (positive)
 Requires higher escalating energy levels (200-300J) to convert VF/ pulse-less VT
FIGURE 4.26: Monophasic Defibrillator
2.5.2-Bi-phasic Defibrillator:
 Bi-phasic waveform: The delivered energy through the patient's chest is in two directions.
 Deliver current in two directions
 The Bi-phasic waveform reverses the direction of the electrical energy near the midpoint of the
waveform
 Low-energy biphasic shocks may be as effective as higher-energy monophasic shocks
 Biphasic waveform defibrillation used in implantable cardioverter- defibrillators (ICDs) and automated
external defibrillators (AEDs).
Section 4 110
Equipment
FIGURE 4.27: Bi-phasic

Defibrillator FIGURE 4.28:
wave
2.6-Defibrillator electrodes:
a) Spoon Shaped Electrode
 Applied directly to the heart.
b) Paddle Type Electrode
 Applied against the chest wall
c) Pad Type Electrode
 Applied directly on chest wall
FIGURE 4.29:
Defibrillator electrodes
Section 4 111
Equipment
2.7-Types of Electrodes:
External defibrillation electrode:
 The electrodes for external defibrillation are metal discs about 3-5 cm in diameter (or rectangular flat
paddle 5x10 cm) and attached to highly insulated handles
 Big size because of the large current, which is needed by the external defibrillation (avoiding of burning
under the electrodes)
 The size of electrodes plays an important part in determining the chest wall impedance, which influence
the efficiency of defibrillation.
 Contain safety switches inside the housing
 The capacitor is discharged only when the electrodes are making a good and firm contact with the
chest of the patient
Internal Defibrillation Electrode:

 For internal defibrillation when the chest is open, large spoon-shaped electrodes are used
FIGURE 4.30:
Types of Electrodes
2.8-Paddle Placement:
There are two notable methods of paddle placement recommended by
AHA
 Anterior- Anterior
 Anterior-Posterior
1-Anterior- Anterior
Place one paddle near the second or the third right sternal
border and the other on the cardiac apex.
FIGURE 4.31:
Anterior- Anterior
Section 4 112
Equipment
2-Anterior-Posterior
One paddle on sternum and the other on
the left infra-scapular region.
FIGURE 4.32:
Anterior-Posterior
2.9-Important Factors:
1. Time:
 Early defibrillation allows more success or the longer period of VF, the less success of defibrillation.
 Early initiation of CPR improves the success rate
 > 8 mins neurological damage sets in
 > 10 mins survival probability becomes very low
2. Energy Level
 AHA Recommendation for Adults
 First shock 200 j
 Second shock 200 j to 300 j
 Third and above shocks 360 j
 AHA Recommendation for Paeds
 First shock 2 joules per Kg
 Subsequent shock double the energy
 Defibrillation for Ventricular fibrillation and Pulseless ventricular tachycardia:
Monophasic: 360 J
Biphasic: 120-200 J
 If unknown – Use maximum available dose (manufacturer recommended)
 Pediatric defibrillation: 2J per Kg
 Defibrillation using INTERNAL PADS/PADDLES:
 Monophasic: 50 J maximum
 Biphasic: 5J, 10J, 20J, 30J, 50J (max)
3. Paddle Size
 Adult paddles should be 8 to 13 cm in diameter
 Child paddles should be 4.5 cm in diameter
 Infants use Anterior Posterior position
4. Skin to Paddle Interface
 Use the right gel
 Too little gel increases possibility of burn
 Too much gel causes electric current to arc from one electrode to another
 If disposable paddles are used check the expire date
Section 4 113
Equipment
2.10-Types:
FIGURE 4.33:
Types
1. Manual
 Clinical expertise is needed to interpret the heart rhythm and decide whether to charge the defibrillator
and deliver the shock to patient.
 Energy selection and delivery is given to the patient manually.
2. Automatic
 These defibrillators are small, safe, simple and lightweight with two pads that can be applied to the
patient.
 The defibrillator guides the operator step-by-step through a programmed protocol.
 It records and analyses the rhythm and instructs the user to deliver the shock using clear voice
prompts, reinforced by displayed messages
3. External
 External Defibrillator is the device which delivers the high energy shock to patients Heart externally on
patient's chest by using a Defibrillator Paddle.
 The maximum energy deliver to the patient is about 360 Joules in Monophasic & 200 Joules in Biphasic
Defibrillator.
4. Internal
Internal defibrillator consists of sterilized internal Handle/Paddle through which shock is delivered directly to the
heart.
5. AED
Automatic External Defibrillator
 AED can be classified as either fully automatic or semiautomatic. In fully automatic models disposable
paddles are kept connected to the patient whilst the AED analyzes the ECG rhythm, decides and
determines whether a defibrillation counter-shock is needed. Then the device automatically charges
and discharges.
Section 4 114
Equipment
 Semi-Automatic AED analyzes the patient's ECG and notifies the operator when defibrillation is
indicated. The operator then activates defibrillator and discharge.

Semi Automatic Fully Automatic
6. ICD
Implantable Cardioverter Defibrillator
If it detects an abnormally fast heart rhythm, it either electrically paces
the heart very fast or delivers a small electrical shock to the heart to
convert the heart rhythm back to normal. The rapid pacing is not felt by
the patient but the electrical shock, if used, is felt as a strong jolt in the
chest. The ICD is used to treat life-threatening heart rhythms that lead
to sudden death.
FIGURE 4.36: ICD

7. Pacemaker
Internal Pacemaker
A pacemaker is an electronic stimulator that produces periodic electric
stimulation to the heart
It is classified into two types:
 Internal Pacemaker
 External Pacemaker
FIGURE 4.37
Internal Pacemaker FIGURE 4.38
External Pacemaker
Section 4 115
Equipment
2.11-Synchronization Time:
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative
refractory period) of the cardiac cycle, which could induce ventricular fibrillation.
FIGURE 4.39: Synchronization Time
2.12-Defibrillator Maintenance:
Reports of Damage
Follow the manufacturer’s recommendations for all scheduled defibrillator maintenance checks. Report any
performance discrepancies, device defects, or missing, expired, and/or damaged accessories to the Early
Defibrillation Program Coordinator immediately.
Calibration
The defibrillator requires no calibration or verification of energy delivery. The defibrillator has no user-
serviceable parts. The defibrillator performs regular self-tests to assure that it is ready for use. While the
maintenance required for the defibrillator is minimal, it is important that a regular check of the defibrillator be
performed to assure readiness, as described in the defibrillator Instructions for Use.
Suggested Maintenance Schedule
Refer to the suggested maintenance schedule in the defibrillator Instructions for Use, which also provides
detailed instructions for responding to each maintenance task.
Cleaning
When necessary, clean the defibrillator using recommended cleaning agents, per the defibrillator Instructions
for Use.
2.13-Refrence:
http://www.who.int/medical_devices/innovation/defibrillator_manual.pdf
https://my.clevelandclinic.org/ccf/media/Files/nursing/2014-dicc-handouts/Session9_1030_1103_Donatello.pdf
https://www.me.washington.edu/files/students/docs/ME_defibrillator.pdf
https://www.aedbrands.com/resourcecenter/maintain/aed-maintenance/
Section 4 116
Equipment
3-Infusion and syringe pumps
FIGURE 4.40:
FIGURE 4.41
Section 4 117
Equipment
3.1-Introduction:
 Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.
 The word intravenous simply means "within a vein".
 It is commonly referred to as a drip because many systems of administration employ a drip chamber,
which prevents air entering the blood stream (air embolism) and allows an estimate of flow rate.
 Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids
and medications throughout the body.
 Some medications, as well as blood transfusions can only be given intravenously.
3.2-Types of Pump:
 There are two basic classes of pumps.
 Large volume pumps can pump nutrient solutions large enough to feed a patient.
 Small-volume pumps infuse hormones, such as insulin, or other medicines, such as opiates.
3.3-Infusion Pumps:
 Use pumping action to infuse fluids, medication or nutrients into patient
 Suitable for intravenous, subcutaneous, enteral and epidural infusions
 Usually electrically powered infusion devices
 To provide accurate and controllable flow over a prescribed period or on demand
 Wide range of drugs and therapies including
- Chemotherapy
- Pain management
- Total parental nutrition
- Anesthesia/sedation
- Etc. etc.
TYPES:
1-Volumetric Pumps:
FIGURE 4.42: Volumetric Pumps
Section 4 118
Equipment
 Preferred for medium and high flow rates and large volumes
 Generally, not suitable for rates < 5ml/h
 Variable short term accuracy
 Specialized volumetric pumps for ambulatory use, epidural infusions etc.
1.1 - Techniques for the pumping action:

 One method is peristaltic action where fingers or rollers on a drum squeeze the fluid tubing in a
controlled manner to force the fluid down the tubing.
 A second method is obtained by using a cassette (or chamber) that fills with
fluid & is then emptied out by the pumping mechanism in a controlled manner
1-Peristaltic Pumps:
 Peristalsis – a natural process of involuntary wave-like successive muscular contractions by which food
is moved through the digestive tract.
 Operates by batching a certain volume of water and forcing it along a tube.
 A rotor attached to an external circumference compresses and releases a flexible tube with rollers,
creating a squeezing action that draws fluid through the tubing.
FIGURE 4.43: Peristaltic Pumps FIGURE 4.44: Peristaltic Pumps
 Parts
- Pump Head
- Drive Mechanism
- Tubing
2-quasi-peristaltic:
 The Infusion Pump uses a combination of these two techniques described as quasi-peristaltic.
 Peristaltic pumps derive their name by the “wave-like” action of the medication when it is delivered to
the patient.
 A three-chambered cassette is employed with the pumping mechanism operating on these three
chambers in turn.
 The user can set the rate of fluid delivery in milliliters per hour (ml/hr) together with the volume of fluid
that should be delivered in milliliters (ml).
Section 4 119
Equipment
FIGURE 4.45: 2-quasi-peristaltic
1. 2- Detector Circuit:
 It has a sensor circuitry of syringe size, occlusion detector, syringe plunger Detector and low power
detector.
 Once the syringe barrel clamp is lift, the sensor (potentiometer) incorporated with the shaft of syringe
barrel will rotate. The resistor value changes according to rotation angle.
 The syringe plunger clamp moves along with nut drive shaft of motor. When the occlusion occurs, there
is a reverse load and obstructs plunger to move ahead.
 The occlusion sensor equipped with strain
 The syringe plunger clamp operates the syringe plunger sensor (micro switch).
 If the syringe is clamped and sensor is ON, the respective information is sent to CPU.
 If the instrument is using the external power or internal power, the controller recognizes immediately
and checks the required voltage and current.
 It monitors and sends the information to CPU.
1.3-Controller Board:
 This is the main board of syringe infusion pump, which has a motor controller, Detector circuitry, power
supply and battery charging monitoring, Key pad and Display controller circuitry.
 It has a microcontroller CPU with ROM, RAM and data converter. It is inter-connected to all PCB’s to
control.
1.4-Motor:
 In earlier infusion system, a DC motor was utilized to drive the piston pump at rate set by the unit. But
now days, a stepper motor is being used and angular velocity is controlled by digital electronics.
 The internal diameter of syringe is stored in ROM.
 Also the applicable internal diameter of syringe can be loaded as per the setting of syringe size and
brand selected.
1.5-Motor Controller:
 It monitors and detects the rotation of motor by encoder and controls the actual speed with the
calculated speed according to program set up.
 The motor rotation pulses are given by main CPU to drive the motor and simultaneously encoded input
pulse from motor is sent to CPU to calculate and control the drive.
 It also generates an error.
Section 4 120
Equipment
1.6-Pump Unit:
 The pump is driven by stepper motor. Motor controller board drives the motor by applying number of
pulses.
 Infusion pump motor has two slots, which is detected by sensor.
 This monitors the direction of rotation and speed of pump.
1. 7-Power Supply module:

 The power supply has AC line input and transformer.
 It generates the DC voltage of +/- 5VDC, +/- 12 VDC, +/- 15VDC,7.5VDC after step down transformer
and bridge rectifier.
 The power is given to each PCB and battery charging circuitry.
1.8-Battery Operation:
 The fully charged battery gives constant supply to the unit and simultaneously monitored by CPU.
 It monitors the charging current, discharge current and time. If the minimum requirement of voltage is
not reached, a battery alarm is activated.
1.9-Front Panel:
 The Front panel of pump consists of LCD display and keypad control.
 The LCD display shows in a plain text, green background and shows the status of Unit.
 It displays whether the unit is connected on AC mains or Battery operation, Alarm status, History of
Drug infused, time interval, bolus doses and quantity delivered to patient.
 While keypad controls the data feeding for the patient’s drug delivery and patient set up
2-Syringe Pumps
FIGURE 4.46: Syringe Pumps
 Generally used for low volume, low flow rate infusions

 Good short term accuracy
 Long start up time at low flow rates
– Prime and purge line before connecting to patient
 Alarms: End/near end of infusion; drive disengaged, occlusion, battery low
 Specialized syringe pumps for ambulatory use, PCA, sedation, insulin etc.
Section 4 121
Equipment
2.1-Features & Benefits:
FIGURE 4.47: Features & Benefits
2.2-Safety:
FIGURE 4.48: Safety
Section 4 122
Equipment
3.4- Options and Alarms:
FIGURE 4.49: Options and Alarms
1-Fast Start
 When Fast Start is enabled and an administration set having a pressure sensing disc is used,
 When Fast Start is enabled and an administration set having a pressure sensing the instrument runs at
an increased rate when an infusion is first started, taking-up any slack in the drive mechanism
2-Multi dose Mode

 The Multi dose Mode option allows 2 to be programmed at equally spaced intervals on the same
Syringe Module over a 24 period.
 This mode is designed to allow delivery of multiple, equal doses from the same syringe at regularly
scheduled intervals.
3-Near End of Infusion (NEOI)

 The NEOI option allows an alert to be configured to sound anywhere from 1 to 60 minutes before the
infusion is complete.
4-Occlusion Pressure
 A complete range of downstream occlusion detection options is provided.
 With pressure sensing disc: occlusion alarm threshold is selectable between 25 and 1000 mmHg, in 1
mmHg increments.
 Without pressure sensing disc: occlusion alarm threshold can be set to low, medium, or high.
5-Occlusion alarm (all pumps)

 Occurs when pump is unable to sustain set flow rate and pressure in line increases
 Caused by partial or complete blockage in delivery tubing (kinked tube, clamp or tap closed) or cannula
(clotted off, position changed)
Section 4 123
Equipment
6-Air-in-line
 Volumetric pumps have a risk of air being delivered due to poor priming of set, upstream leak or
pumping action drawing air out of solution
 Volumetric pumps have either a mechanism for preventing pumping of air or an air-in-line detector &
alarm
3.5-Refreces:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/40
3420/Infusion_systems.pdf
http://www.srmuniv.ac.in/sites/default/files/downloads/unit_2_infusion_devices.pdf
https://florida.theorangegrove.org/og/file/f85aae25-d8ad-4aa4-80dd-
4d796ac85769/1/og3d%20syringe%20pump.pdf
Section 4 124
Equipment
4 -Autoclaves and Sterilizers
FIGURE 4.50: Autoclaves and Sterilizers
Section 4 125
Equipment
4.1 - Autoclave Sterilization

Autoclave Sterilizers are used to decontaminate certain biological waste and sterilize media, instruments
and lab ware. Regulated medical waste that might contain bacteria, viruses and other biological material
are recommended to be inactivated by autoclaving before disposal.
An autoclave is used to sterilize surgical equipment, laboratory instruments, pharmaceutical items, and
other materials. It can sterilize solids, liquids, hollows, and instruments of various shapes and sizes.
Autoclaves vary in size, shape and functionality. A very basic autoclave is similar to a pressure cooker;
both use the power of steam to kill bacteria, spores and germs resistant to boiling water and powerful
detergents.
4.2-Autoclave Sterilizers:
To be effective against spore forming bacteria and viruses, autoclaves need to have steam in direct contact
with the material being sterilized (i.e. loading of items is very important).
Create vacuum in order to displace all the air initially present in the autoclave and replacing it with steam
Implement a well-designed control scheme for steam
evacuation and cooling so that the load does not perish.
The efficiency of the sterilization process depends on two
major factors. One of them is the thermal death time, i.e.
the time microbes must be exposed to at a particular
temperature before they are all dead. The second factor is
the thermal death point or temperature at which all
microbes in a sample are killed.
The steam and pressure ensure sufficient heat is
transferred into the organism to kill them. A series of
negative pressure pulses are used to vacuum all possible
air pockets, while steam penetration is maximized by
application of a succession of positive pulses.
FIGURE 4.51: Autoclave Sterilizers
4.3 - Autoclave Uses & Advantages:

An autoclave chamber sterilizes medical or laboratory instruments by heating them above boiling point.
Most clinics have tabletop autoclaves, similar in size to microwave ovens. Hospitals use large autoclaves,
also called horizontal autoclaves. They’re usually located in the Central Sterile Services Department
CSSD) and can process numerous surgical instruments in a single sterilization cycle, meeting the ongoing
demand for sterile equipment in operating rooms and emergency wards.
They are important in tattoo shops, beauty and barber shops, dentist offices, veterinarians and many other
fields.
4.4 - Autoclave disadvantages:

Autoclave is unsuitable for heat sensitive objects.
126
Section 4
Equipment
4.5 - Autoclaves Working Principle:

Autoclaves use pressurized steam as their sterilization agent. The basic concept of an autoclave is to have
each item sterilized -whether it is a liquid, plastic ware or glassware- come in direct contact with steam at a
specific temperature and pressure for a specific amount of time. Time, steam, temperature, and pressure
are the four main parameters required for a successful sterilization using an autoclave.
The amount of time and temperature required for sterilization depends on the type of material being
autoclaved. Using higher temperatures for sterilization requires shorter times. The most common
temperatures used are 121 C and 132 C. In order for steam to reach these high temperatures, steam has
to be pumped into the chamber at a pressure higher than normal atmospheric pressure.
Now that we have covered the basic principle of how autoclaves use pressurized steam to sterilize
contaminated materials, we will now go over how autoclaves operate.
4.6 - Autoclave Design Diagram & Parts
Similar to pressure cookers, steam sterilizer autoclaves

work quickly and effectively because of their high
temperature. The machine’s temperature and unique
shape make it easier to hold the heat inside much longer.
The autoclave also does a great job of efficiently
penetrating each piece of equipment. The autoclave’s
chambers are usually in the shape of a cylinder because
cylindrical shapes are more equipped to handle the high
pressure that is needed for the sterilization process to
work. For safety reasons, there is an outside lock and a
safety valve that prevents the autoclave steam sterilizer’s
pressure from getting too high.
Once you close the autoclave sterilizer chamber, a
vacuum pump removes all the air from inside the device or
it is forced out by pumping in steam. If done the first way,
the sterilizer is pumped with high pressured steam to
quickly raise the internal temperature. On every autoclave
FIGURE 4.52: Parts
there is a thermometer that is waiting for the thermal
sweet point, 268-273 degrees Fahrenheit, and then it
starts its timer. During the sterilizing process, steam is continuously entering the autoclave to thoroughly kill
all dangerous microorganisms. Once the required time of sterilization has the elapsed, the chamber will be
exhausted of pressure and steam allowing the door to open for cooling and drying of the contents.
Mode of Action Autoclave Sterilizers:
Moist heat destroys microorganisms by the irreversible coagulation and denaturation of enzymes and
structural proteins. In support of this fact, it has been found that the presence of moisture significantly
affects the coagulation temperature of proteins and the temperature at which microorganisms are
destroyed.
Section 4 127
Equipment
4.7-Autoclave Working – Operation:

Place containers in the autoclave.
Check the strainer to see if it is clogged. The strainer is located on the bottom of the chamber near the
door. The autoclave will not come up to pressure if the strainer is clogged.
Close door.
For the SMALL autoclave, rotate the handle clockwise until it is snugly closed.
For the LARGE autoclave, rotate the small, inner handle clockwise first until it locks. Then rotate the large
outer handle clockwise until it is snug.
Open the glass-faced door in the upper right corner. Set STERILIZE time and, if needed, set DRY time.
Select the setting you want by pushing in the colored button that corresponds to:
GREEN= FAST EXHAUST: Pressure will decrease rapidly at the end of sterilization. Fluids will bubble
over if you use this setting.
YELLOW= Fluids: Pressure decreases more slowly at the end of sterilization.
BLUE=Dry: Use this setting for paper goods, cotton swabs, etc.
Push in the RED button to turn the autoclave on.
Wait until the temperature reaches 121°C and the RED sterilization light in the glass-faced box turns on
before recording the Chamber Pressure on the Log. The chamber pressure should be 16-20 psi once the
sterilization cycle starts. Anything below 16 psi should be reported to your lab manager.
At the end of the run, insure the CHAMBER PRESSURE has returned to ZERO before attempting to open
the door. The FLUIDS cycle takes much longer than FAST EXHAUST – be patient. If the door cannot be
easily opened, WAIT 10 minutes before trying again. If you wrench on the door and attempt to force it
open, the internal metal rod that connects to the door handle will twist from the pressure.
To open the door:
SMALL autoclave: rotate the handle counterclockwise. Be careful, steam burns! Step to the side and crack
open the door. Allow the steam to escape from the chamber then open the door and remove your items.
LARGE autoclave: First rotate the LARGE OUTER handle counterclockwise until it is loose. Next, rotate
the SMALL INNER handle counterclockwise until the door opens. Be careful, steam burns! Step to the
side and crack open the door. Allow the steam to escape from the chamber then open the door and
remove your items.
As a courtesy to others needing to use the autoclave, promptly remove your items when the cycle is
completed and you can easily open the door. Wear protective, heat resistant gloves when removing items.
Autoclaved waste materials are to be taken directly to the dumpster for disposal. Orange autoclave bags
must be put into black trash bags before disposing in the dumpster.
4.8-Autoclave Cycles
To be effective, the autoclave must reach and maintain a temperature of 121° C for at least 30 minutes by
using saturated steam under at least 15 psi of pressure. Increased cycle time may be necessary depending
upon the make-up and volume of the load.
The rate of exhaust will depend upon the nature of the load. Dry material can be treated in a fast exhaust
cycle, while liquids and biological waste require slow exhaust to prevent boiling over of super-heated
liquids.
4.8.1-Liquids cycle:
Liquids rely on the Liquids Cycle to avoid a phenomenon known as “boil-over.” Boil-over is simply a liquid
boiling so violently that it spills over the top of its container. Boil-over will occur if the pressure in your
autoclave chamber is released too quickly during the exhaust phase of the cycle. Significant liquid volume
can be lost to boil-over, and this can result in unwanted spills on the bottom of the autoclave chamber that
must be cleaned up to avoid clogging the drain lines and the subsequent repair costs to the department.
128
Section 4
Equipment
To help prevent boil-over during the exhaust phase, the chamber pressure must be released slowly. This
process is controlled by the sterilizer’s control system. Controlling the exhaust rate allows the liquid load to
cool off as the surrounding chamber pressure is decreased.
The exhaust rate for a Liquids Cycle is different from a standard Gravity or Vacuum Cycle, where the
chamber pressure is released quickly. To prevent boil-over, the chamber pressure must decrease slowly to
allow the temperature of the load to remain below the boiling point. If the pressure is exhausted all at once,
the temperature of the load will be above its boiling point, resulting in instant and violent boiling.
(Slow Exhaust)
Material Recommended for:
Use with glass containers with vented closures; 2/3 full only
 Liquid media
 Nonflammable liquids
 Aqueous solutions
 Liquid biological waste
4.8.2-Solids or Dry cycle:

(Fast Exhaust)
Glassware: empty and inverted
No tight or impermeable closures
Dry hard items, either unwrapped or in porous wrap
Metal items with porous parts
Other porous materials
4.8.3-Gravity Cycle: Wrapped Goods or Pre vacuum cycle:

(Clean: Fast Exhaust
Dirty: Slow Exhaust)
The traditional “Gravity Cycle” is the most common and simplest steam sterilization cycle. During a Gravity
Cycle, steam is pumped into a chamber containing ambient air. Because steam has a lower density than
air, it rises to the top of the chamber and eventually displaces all the air. As steam fills the chamber, the air
is forced out through a drain vent. By pushing the air out, the steam is able to directly contact the load and
begin to sterilize it.
At the end of the cycle, the steam is discharged through the drain vent. However, the load can still be hot
and possibly wet. To address this issue, gravity autoclaves can be equipped with a post-cycle vacuum
feature to assist in drying the load. The sterilizer runs a normal Gravity Cycle and after the load is sterilized,
a vacuum pulls steam and condensation through the drain vent. The longer the vacuum system runs during
the dry phase, the cooler and dryer the goods will be when removed from the chamber.
Gravity Cycles are commonly used on loads like glassware, bio-hazardous waste (autoclave bag waste),
and wrapped and unwrapped instruments.
Glassware that must be sterilized upright and/or can trap air
Wrapped dry items that can trap air
Pipette tip boxes
Sharps decontamination
(In collection containers)
Biohazard waste decontamination, in autoclave bags; can be wet or dry.
Section 4 129
Equipment
4.9-Autoclave Validation:
4.9.1-Chemical Indicators
4.9.2-Tape Indicators:
Tape indicators are adhesive-backed paper tape with heat sensitive, chemical indicator markings. Tape
indicators change color or display diagonal stripes, the words “sterile” or “autoclaved” when exposed to
temperatures of 121°C. Tape indicators are typically placed on the exterior of the waste load. If the
temperature sensitive tape does not indicate that a temperature of at least 121°C was reached during the
sterilization process, the load is not considered decontaminated. If tape indicators fail on two consecutive
loads, notify your Department Safety Manager.
Tape indicators are not designed nor intended to prove that organisms have actually been killed. They
indicate that a temperature of 121°C has been achieved within the autoclave. EHS recommends that you
DO NOT use autoclave tape as the only indicator of decontamination or sterilization.
4.9.3-Integrated Chemical Indicator Strips:

Integrated chemical indicator strips provide a limited validation of temperature and time by displaying a
color change after exposure to normal autoclave operating temperatures of 121ºC for several
minutes. Chemical color change indicators can be placed within the waste load. If the chemical indicators
fail on two consecutive loads, notify your Department Safety Manager.
4.9.4-Biological Indicators:
Biological indicator vials contain spores from B. stearothermophilus, a microorganism that is inactivated
when exposed to 121.1oC saturated steam for a minimum of 20 minutes. Autoclaves used to treat
biological waste will be evaluated with a biological indicator by EHS on a quarterly basis.
4.10-Refrence:
https://www.uoguelph.ca/cbs/sites/uoguelph.ca.cbs/files/CBS%20SOP%20-%20Autoclave.pdf
http://research.uthscsa.edu/safety/Biological/handbook/Autoclave%20SOP%202016.pdf
https://www.uoguelph.ca/cbs/sites/uoguelph.ca.cbs/files/CBS%20SOP%20-%20Autoclave.pdf
https://pharmawiki.in/autoclave-sterilization-principle-working-pdf-ppt-autoclave-validation-autoclave-
diagram/#Mode_of_Action_Autoclave_Sterilizers
Section 4 130
Equipment
5- Suction Machines (Aspirators)
FIGURE 4.53: Aspirators
Section 4 131
Equipment
5.1-Difintion:
Suction machines or aspirators are tracheotomy-care devices used for removing obstructions from a
person’s airway. The machine uses suction to pull out mucus, saliva, blood, secretions or other fluids
clearing the airway for easy breathing. These machines are designed either for stationary use at home or
the portable variety for a patient on the move. We have a diverse range of portable and non-portable
aspirators which can be used in hospitals, clinics, doctor’s office and ambulances or at home. Our range of
aspirators is designed to carry out a wide range of suction procedures
Have you ever stopped to think about the fact that one of your most important pieces of EMS equipment is
also one of your simplest? Such is the case with medical suction machines.
The ability to generate effective negative pressure that is then channeled via a portable suction unit means
that even the most clogged airway can be cleared. And there’s nothing that can replace this most valuable
of machines.
That’s not to say that medical suction has remained unchanged over the past several decades.
Today’s suction units have evolved into durable, lightweight, technologically sophisticated machines. So,
let’s take a quick look at the fundamentals of modern medical suction machines.
5.2-Suction Machines/Aspirators Uses:

 Suction machines used in the homes are usually for helping people with respiratory problems. When a
patient or an elderly person is not able to clear the lungs and airway of mucus or serum, then an
aspirator can be used to suck out the fluids.
 Tracheotomy care also involves use of suction machines for removal of secretions from the trachea,
nasopharynx and oropharynx thereby maintaining hygiene of the trachea. Suction machines may also
be used in cases when someone has a moist cough and is not able to clear secretions from the throat
effectively.
 Components of a suction machine typically include suction pump, connection and patient tubings,
disposable canister with lid, rechargeable battery, power cord and bacteria filter.
 The bacteria filter prevents back flow from the canister and airborne contaminants from entering and
damaging the pump.
 A yankauer is used to aspirate secretions from either a surgical site or a body orifice. Its tip is slightly
crooked so as to prevent smooth passage into the throat without fragile tissue being damaged.
 Our selection of suction machines or aspirators stands out for their powerful suction force, reliability and
high performance. Portable suction machines are small enough to be fit into a travel bag and can easily
be transported anywhere.
 Suction machines today are lightweight, portable and technologically sophisticated. The most clogged
airway can be cleared up quickly through strong, powerful machines returning the patient to the state of
comfort. Some of these aspirators have adjustable vacuum pressure
needed especially when working with children or the elderly.
5.3-Products for Suction Therapy:

 Suction Aspirators: Suction Aspirators are medical equipment that is
basically used to extract mucus and other fluids from the mouth of an
individual. HPFY offers an extensive range of aspirators is perfect for
patients with a tracheotomy.
Durable, high-performance aspirators make tracheotomy care FIGURE 4.54: Suction
132
Section 4
Equipment
convenient and hassle free. Aspirators produce vacuums in a constricted stream of bodily fluids to
remove them.
 Suction Catheters: Suction catheters are used to extract secretions from the airways. A suction catheter
often connects to a collection canister or an aspirator to collect fluids. The catheter is connected to the
tracheotomy tube to extract secretions directly from the airway.
 Yankauers: A yankauer is a tube that is used in the mouth to suck saliva and other fluids. The large
lumens of yankauers are designed to provide rapid aspiration thereby resisting clogging. Features of a
yankauer:
- Sturdy shatter-resistant construction
- Can be used for retraction
- Transparency for clear view of fluids
- Single use,
- Sterile to prevent cross contamination
- Reduced chances for tissue grab with side eyes
Browse our range of suction therapy products and be sure to find the right product that suits your
requirements. We deliver high quality products at best prices.
5.4-Power:
Some of the earliest suction machines relied on hand-cranking to generate a vacuum, which was then used
to funnel bodily fluids into a collection receptacle. Modern portable suction machines typically rely on
rechargeable batteries, although some units utilize alkaline and even defibrillator batteries. Battery power
enables these machines to be highly portable, while still delivering effective suction. Sophisticated units
even include a battery maintenance system that alerts the user when the batteries are running low and
prevents deep discharge by disengaging the batteries from the vacuum pump, thereby lengthening the life
of the batteries.
5.5-Technology:
Today’s technology not only provides efficient power sources, but also makes medical suction machines
more lightweight and durable, as well as safer. Tough, weather-resistant exteriors protect the high-tech
electronics that produce the vacuum, while disposable, high-grade plastics guard against pathogens and
make cleaning the units a snap.
5.6-Portability:
Modern construction using lightweight materials means today’s suction machines are smaller and more
portable than ever. Some even fit snugly within an airway bag and are ideal for tactical medical scenarios.
With portability like this, there’s no excuse not to include the suction unit on each and every call!
5.7-Maintenance Time and Costs:

In a perfect world, your suction machine would never break or need maintenance. Our world is sadly
imperfect, and there’s a huge continuum of maintenance costs among suction machines. Ask the company
you’re considering buying from how long you can expect the unit to last and how frequently it will need
maintenance. The best units offer a solid warranty.
Ask also about a testing kit. You don’t want to find out that a unit doesn’t work while you’re tending to an
ailing patient. Many companies offer testing kits that enable you to assess battery life and stability, as well
as suction power, each time you turn on the unit.
Section 4 133
Equipment
To learn more about the right portable suction unit for your needs, download our free comprehensive
guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
5.8-Cleaning and Part Replacement:

The collection bottle on suction machines must be cleaned after each use. Because the collection bottles
can be made of different materials (glass, plastic etc.), the cleaning directions will be different between
suction machine models and the manufacturer will supply directions for each model.
The tubing that the catheter is connected to also needs to be cleaned after every use. Generally, the tubing
should be rinsed thoroughly after every use by running hot tap water through it followed by a solution of
one-part vinegar to three parts hot water. Rinse with hot tap water and air dry. Individual manufacturers
may have different cleaning directions and the suction machine owner’s manual should be consulted.
Suction catheters can also be cleaned but may need to be replaced more often than the other suction
machine parts. Check with either the prescriber or catheter supplier for replacement and cleaning
guidelines.
5.9-Refrences:
http://apps.who.int/medicinedocs/documents/s17083e/s17083e.pdf https://www.gillettechildrens.org/assets/DIS056.pdf
http://www.jointcommissioninternational.org/assets/3/7/JCI_WP_Med_Suction_and_Fluid_Waste_Mgt_Final_(1).pdf
Section 4 134
Equipment
6-Operating Theatre and Delivery (Tables(
FIGURE 4.55: Operating Theatre
Section 4 135
Equipment
6. 1-Definition:
An operating table, sometimes called operating room table, is the table on which the patient lies during a
surgical operation.
This surgical equipment is usually found inside the surgery room of a hospital.
An operating table system is basically made up of three components: an operating table column, the table top
and the transporter. Modern operating table systems are available as both stationary and mobile units. There
are a wide range of table tops that can be used for both general surgery and for specialist disciplines. Mobile
operating tables, however, tend to be equipped with a specific discipline in mind. The base, column and table
top form a unit.
Since the table column for a stationary operating table system is firmly anchored to the floor, the additional
necessary medical devices can easily be brought to the operating area and positioned. These devices include,
for example, x-ray equipment, which can easily be slid under the table top. For personnel, the system offers
improved leg space since disruptive foot geometry is no longer present.
Additional elements can be adapted to the operating
table. This flexibility is very important since it enables
the table to be adapted to suit the relevant patient or
the surgical discipline.
The advantage of the mobile operating table, on the
other hand, is that the position of the table can be
changed within the operating room. However, the
foot of the table limits the leg space available to the
surgical team. The individual segments of the table
top can be
easily removed and replaced. They also permit x-
rays
and conduct electricity.
FIGURE 4.56
Another special feature of the operating table system is the Operating table system with a stationary unit
ability to use appropriate interface modules to establish communication with diagnostics systems, for example,
angiography, MR and CT. This is only possible with stationary columns since the systems require a fixed point.
6.2-Properties and Requirements Made of an Operating Table:

There are a number of basic functions that every operating table must fulfill in order to meet the requirements
made of it. For example, the height of an operating table must be adjustable. This is the only way a surgeon
can adapt it to their height and thus work ergonomically.
In addition it must be possible to tilt the table to the left and to the right to ensure a better overview into body
cavities or to use gravity to move organs (e.g. laparoscopy). In addition, the individual operating table
segments must also be adjustable. This is the only way to ensure the necessary anatomical bends of the body
and enable extremities to be positioned suitable for operating. A further property of the operating table top
is radiolucency. The radiolucent surface should be as large as possible to ensure the largest possible image
without disruption. The padding of the table is also important; this must be both soft and radiolucent. Soft
because it must distribute the pressure optimally otherwise the patient may suffer pressure ulcers which staff
may be liable for.
Section 4 136
Equipment
6. 3-Comparison: Operating Table System and Mobile Operating Table:

The operating table system has a number of advantages. Transportation is easier since this unit is generally
firmly secured to the floor and thus the foot and column of the unit no longer need to be transported. In
addition, the transporter has light and large casters which are gentle not just to the floor. The entire operating
area is more hygienic since the casters are not attached to the system, like on a mobile operating table. These
are hard to clean and more unhygienic as a result. The operating table column can be rotated by 360° and
offers ideal space for the feet of the team. The table top is, thanks to the use of x-ray-capable materials, almost
completely radiolucent. The universal operating table is available as both stationary, mobile and moveable
units. A mobile operating table is, however, used as a special table. The table top cannot be removed or
replaced. Operation may, according to version, be manual, pedal or motorized.
6. 4-Operating Table Positions:

Patients may suffer pressure ulcers as a result of lying incorrectly on an operating table or lying on an
operating table for too long. Nursing staff and doctors try to prevent this from happening. Typical standard
positions are, for example, back, stomach, side, Trendelenburg and a seated/half-seated position. The patient
should always be positioned or optimally positioned in cooperation with the anesthetist, surgeon and operating
room staff. Prior to the operation, the decision must be made as to exactly how the patient is to be positioned.
This decision not only takes account of the type of operation, it also considers the age, weight and health of the
patient with regard to the heart, lungs, circulation, metabolism, blood circulation problems etc.
6. 5-Advantages of an Operating Table System:

Unlike a mobile operating table which is usually employed in hospitals with small operating departments, for
example, in ambulant operating rooms, modern operating table systems are characterized by their great
mobility. They also have special table tops designed for a variety of surgical disciplines and, thanks to the
ability to change these tops, they enable versatile use of an operating room. An operating table system with a
stationary column is more stable and more hygienic. The better transport options improve the patient flow from
the patient transfer unit and the operating room considerably. Finally, operating table systems with stationary
columns enables control elements to be integrated into image procedures, for example, angiography, MR and
CT.
Section 4 137
Equipment
6.6-Accessories:
FIGURE 4.57
Operating table system with a stationary unit
Section 4 138
Equipment
6.7-Positions:
FIGURE 4.58:
Positions
FIGURE 4.59:
Positions
6.8-Refrences:
https://www.researchgate.net/publication/239326893/download
https://www.alibaba.com/product-detail/multi-function-hospital-patient-surgical-operation_60202787509.html
Section 4 139
Equipment
Section 5
Imaging Modalities
1-Define basic parts of Ultrasound Machines

2-Demonstrate basic parts of X-Ray
Machines
140
Section 5
Equipment
Section 5:
Imaging Modalities
1-Ultrasound Machines
FIGURE 5.1:
Ultrasound
141
Section 5
Equipment
1.1-Dinition:
Ultrasound or ultrasonography is a medical imaging technique that uses high frequency sound waves and their
echoes. The technique is similar to the echolocation used by bats, whales and dolphins, as well as SONAR
used by submarines. In ultrasound, the following events happen:
1) The ultrasound machine transmits high-frequency (1 to 5 megahertz) sound pulses into your body using
a probe.
2) The sound waves travel into your body and hit a boundary between tissues (e.g. between fluid and soft
tissue, soft tissue and bone).
3) Some of the sound waves get reflected back to the probe, while some travel on further until they reach
another boundary and get reflected.
4) The reflected waves are picked up by the probe and relayed to the machine.
5) The machine calculates the distance from the probe to the tissue or organ (boundaries) using the
speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of each echo's return (usually on the
order of millionths of a second).
6) The machine displays the distances and intensities of the echoes on the screen, forming a two
dimensional image like the one shown below.
FIGURE 5.2
Ultrasound image of a growing fetus (approximately 12 weeks old) inside a

mother's uterus. This is a side view of the baby, showing (right to left) the head,
neck, torso and legs.
1.2-Parts:
1. Transducer probe - probe that sends and receives the sound waves
2. Central processing unit (CPU) - computer that does all of the calculations and contains the
electrical power supplies for itself and the transducer probe
3. Transducer pulse controls - changes the amplitude, frequency and duration of the pulses
emitted from the transducer probe
4. Display - displays the image from the ultrasound data processed by the CPU
5. Keyboard/cursor - inputs data and takes measurements from the display
6. Disk storage device (hard, floppy, CD) - stores the acquired images
7. Printer - prints the image from the displayed data
Section 5 142
Equipment
FIGURE 5.3
Parts
1.2.1-Transducer Probe:
The transducer probe is the main part of the ultrasound machine. The
transducer probe makes the sound waves and receives the echoes. It is,
so to speak, the mouth and ears of the ultrasound machine. The
transducer probe generates and receives sound waves using a principle
called the piezoelectric (pressure electricity) effect, which was
discovered by Pierre and Jacques Curie in 1880. In the probe,
there are one or more quartz crystals called piezoelectric crystals.
When an electric current is applied to these crystals, they change shape

rapidly. The rapid shape changes, or vibrations, of the crystals produce
sound waves that travel outward. Conversely, when sound or pressure
waves hit the crystals, they emit electrical currents. Therefore, the same
crystals can be used to send and receive sound waves. The probe also
FIGURE 5.4 :Transducer Probe
has a sound absorbing substance to eliminate back reflections from the
probe itself, and an acoustic lens to help focus the emitted sound waves
1.2.2-Central Processing Unit (CPU):

The CPU is the brain of the ultrasound machine. The CPU is basically a computer that contains
the microprocessor, memory, amplifiers and power supplies for the microprocessor and transducer
probe. The CPU sends electrical currents to the transducer probe to emit sound waves, and also
receives the electrical pulses from the probes that were created from the returning echoes. The CPU
does all of the calculations involved in processing the data. Once the raw data are processed, the
CPU forms the image on the monitor. The CPU can also store the processed data and/or image on
disk.
143
Equipment
1.2.3-Transducer Pulse Controls:

Section 5
The transducer pulse controls allow the operator, called the ultra-sonographer, to set and change the
frequency and duration of the ultrasound pulses, as well as the scan mode of the machine. The commands
from the operator are translated into changing electric currents that are applied to the piezoelectric crystals in
the transducer probe.
1.2.4-Display
The display is a computer monitor that shows the processed data from the CPU. Displays can be black-and-
white or color, depending upon the model of the ultrasound machine.
1.2.5 -Keyboard/Cursor
Ultrasound machines have a keyboard and a cursor, such as a trackball, built in. These devices allow the
operator to add notes to and take measurements from the data.
1.2.6- Disk Storage:

The processed data and/ or images can be stored on disk. The disks can be hard disks, floppy disks, compact
discs (CDs) or digital video discs (DVDs). Typically, a patient's ultrasound scans are stored on a floppy disk
and archived with the patient's medical records.
1.2.7- Printers:
Many ultrasound machines have thermal printers that can be used to capture a hard copy of the image from
the display.
1.3-Different Types of Ultrasound:

The ultrasound that we have described so far presents a two dimensional image, or "slice," of a three
dimensional object (fetus, organ). Two other types of ultrasound are currently in use, 3D ultrasound
imaging and Doppler ultrasound.
1.3.1-3D Ultrasound Imaging:

In the past two years, ultrasound machines capable
of three-dimensional imaging have been developed.
In these machines, several two-dimensional images
are acquired by moving the probes across the body
surface or rotating inserted probes. The two-
dimensional scans are then combined by specialized
computer software to form 3D images.
3D imaging allows you to get a better look at the
organ being examined and is best used for:
 Early detection of cancerous and benign
tumors
 examining the prostate gland for early
FIGURE 5.5
detection of tumors 3D ultrasound images
144
Equipment
 looking for masses in the colon and rectum
 detecting breast lesions for possible biopsies
 Visualizing a fetus to assess its development, especially for observing abnormal development of the
face and limbs Section 5
 Visualizing blood flow in various organs or a fetus
1.3.2-Doppler Ultrasound:
Doppler ultrasound is based upon the Doppler Effect. When the object reflecting the ultrasound waves is
moving, it changes the frequency of the echoes, creating a higher frequency if it is moving toward the probe
and a lower frequency if it is moving away from the probe. How much the frequency is changed depends upon
how fast the object is moving. Doppler ultrasound measures the change in frequency of the echoes to calculate
how fast an object is moving. Doppler ultrasound has been used mostly to measure the rate of blood flow
through the heart and major arteries.
FIGURE 5.6
Doppler ultrasound used to measure blood flow through the heart. The
direction of blood flow is shown in different colors on the screen.
1.4-Imaging:
He potential for ultrasonic imaging of objects, with a 3 GHZ sound wave producing resolution comparable to an
optical image, was recognized by Sokolov in 1939 but techniques of the time produced relatively low-contrast
images with poor sensitivity. Ultrasonic imaging uses frequencies of 2 megahertz and higher; the shorter
wavelength allows resolution of small internal details in structures and tissues.
The power density is generally less than 1 watt per square centimeter, to avoid heating and cavitation effects in
the object under examination.] High and ultra-high ultrasound waves are used in acoustic microscopy, with
frequencies up to 4 gigahertz. Ultrasonic imaging applications include industrial non-destructive testing, quality
control and medical uses.
145
Equipment
Section 5
FIGURE 5.7
Principle of an active sonar
1.5- wave:
1-Sound wave:
Propagate by longitudinal motion
(compression/expansion), but not transverse motion (side-to-side).
• Can be modeled as weights connected by springs
FIGURE 5.8: Sound wave
2-Ultrasonic Waves and properties:

• Mechanical waves are longitudinal compression waves
• “Ultrasound” refers to frequencies greater than 20kHz, the limit of human hearing
• For Medical imaging typically 100 Times higher frequency than audible by human typically 2 to
20 MHz
146
Equipment
FIGURE 5.9: Ultrasonic Waves
3-Transmission and Reflection

Section 5
FIGURE 5.10: Transmission and Reflection
4-Propagation of ultrasound waves in tissue

@Secular - echoes originating from relatively large, regularly shaped objects with
Smooth surfaces. These echoes are relatively intense and angle dependent. (I.e. valves) - Reflection from
large surfaces
@Scattered - echoes originating from relatively small, weakly reflective, irregularly
Shaped objects are less angle dependent and less intense. (I.e. blood cells) -
Reflection from small surfaces
FIGURE 5.11: Propagation of ultrasound waves in tissue

5-Generation of Ultrasound
• A 'transducer' converts energy from one form to another

• The “Piezoelectric effect” was described 1880 Pierre and Jacques Curie
• Lead zirconate titanate, or PZT, is the piezoelectric material used in nearly all medical ultrasound
transducers.
• It is a ceramic ferroelectric crystal exhibiting a strong piezoelectric effect and can be manufactured in
nearly any shape.
• The most common transducer shapes are the circle, for single crystal transducer assemblies, and the
rectangle, for multiple transducer assemblies such as those found in linear and phased arrays.
147
Equipment
FIGURE 5.12:
Generation of Ultrasound
6-Collect the Echo: Section 5
FIGURE 5.13: Collect the Echo
1.6-Major Uses of Ultrasound:

Ultrasound has been used in a variety of clinical settings, including obstetrics and gynecology, cardiology and
cancer detection. The main advantage of ultrasound is that certain structures can be observed without
using radiation. Ultrasound can also be done much faster than X-rays or other radiographic techniques. Here is
a short list of some uses for ultrasound:
1-Obstetrics and Gynecology

 Measuring the size of the fetus to determine the due date
 Determining the position of the fetus to see if it is in the normal head down position or breech
 Checking the position of the placenta to see if it is improperly developing over the opening to the
uterus (cervix)
 Seeing the number of fetuses in the uterus
 Checking the sex of the baby (if the genital area can be clearly seen)
 Checking the fetus's growth rate by making many measurements over time
 Detecting ectopic pregnancy, the life-threatening situation in which the baby is implanted in the
mother's Fallopian tubes instead of in the uterus
 Determining whether there is an appropriate amount of amniotic fluid cushioning the baby
 Monitoring the baby during specialized procedures - ultrasound has been helpful in seeing and
avoiding the baby during amniocentesis (sampling of the amniotic fluid with a needle for genetic
testing). Years ago, doctors use to perform this procedure blindly; however, with accompanying
use of ultrasound, the risks of this procedure have dropped dramatically.
 Seeing tumors of the ovary and breast
2-Cardiology
 Seeing the inside of the heart to identify abnormal structures or functions
 Measuring blood flow through the heart and major blood vessels
3-Urology
 Measuring blood flow through the kidney
 Seeing kidney stones
 Detecting prostate cancer early
148
Equipment
In addition to these areas, there is a growing use for ultrasound as a rapid imaging tool for diagnosis in
emergency rooms.
1.7-Dangers of Ultrasound: Section 5

There have been many concerns about the safety of ultrasound. Because ultrasound is energy, the question
becomes "What is this energy doing to my tissues or my baby?" There have been some reports of low birth
weight babies being born to mothers who had frequent ultrasound examinations during pregnancy. The two
major possibilities with ultrasound are as follows:
 development of heat - tissues or water absorb the ultrasound energy which increases their temperature
locally
 formation of bubbles (cavitation) - when dissolved gases come out of solution due to local heat caused
by ultrasound
However, there have been no substantiated ill-effects of ultrasound documented in studies in either humans or
animals. This being said, ultrasound should still be used only when necessary (i.e. better to be cautious).
1.8-An Ultrasound Examination:

For an ultrasound exam, you go into a room with a technician and the ultrasound machine. The following
happens:
1. You remove your clothes (all of your clothes or only those over the area of interest).
2. The ultra-sonographer drapes a cloth over any exposed areas that are not needed for the exam.
3. The ultra-sonographer applies a mineral oil-based jelly to your skin -- this jelly eliminates air between
the probe and your skin to help pass the sound waves into your body.
4. The ultra-sonographer covers the probe with a plastic cover.
5. He/she passes the probe over your skin to obtain the required images. Depending upon the type of
exam, the probe may be inserted into you.
6. You may be asked to change positions to get better looks at the area of interest.
7. After the images have been acquired and measurements taken, the data is stored on disk. You may get
a hard copy of the images.
8. You are given a towelette to clean up.
9. You get dressed.
1.9- Modes:
1-A-mode: A-mode (amplitude mode) is the simplest type of ultrasound. A single transducer scans a line
through the body with the echoes plotted on screen as a function of depth. Therapeutic ultrasound aimed
at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus of the destructive wave
energy.
149
Equipment
FIGURE 5.14
Transmission pulse in red, reflected waves in blue
2-B-mode or 2D mode: In B-mode (brightness mode) ultrasound, a linear array of transducers

simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen.
More commonly known as 2D mode now. Section 5
*B-flow is a mode that digitally highlights weak flow reflectors (mainly red blood cells) while
suppressing the signals from the surrounding stationary tissue. It can visualize flowing blood and
surrounding stationary tissues simultaneously. It is thus an alternative or complement to Doppler
ultrasonography in visualizing blood flow.
3- C-mode: A C-mode image is formed in a plane normal to

a B-mode image. A gate that selects data from a specific
depth from an A-mode line is used; then the transducer is
moved in the 2D plane to sample the entire region at this fixed
depth. When the transducer traverses the area in a spiral, an
area of 100 cm2 can be scanned in around 10 seconds.
FIGURE 5.15
B-mode image of a normal heart
4-M-mode: In M-mode (motion mode) ultrasound, pulses are emitted in quick succession
each time; either an A-mode or B-mode image is taken. Over time, this is analogous to
recording a video in ultrasound. As the organ boundaries that produce reflections move
relative to the probe, this can be used to determine the velocity of specific organ structures.
5-Doppler mode: This mode makes use of the Doppler Effect in measuring and visualizing
blood flow.
1-Color Doppler: Velocity information is presented as a color-coded overlay on top

of a B-mode image
2-Continuous wave (CW) Doppler: Doppler information is

sampled along a line
through the body, and all velocities detected at each time point
are presented
(on a time line)
3-Pulsed wave (PW) Doppler: Doppler information is sampled

from only a small
sample volume (defined in 2D image), and presented on a
timeline
150
Equipment
4-Duplex: a common name for the simultaneous presentation of 2D and (usually)
PW Doppler information. FIGURE 5.16
(Using modern ultrasound machines, color Doppler is almost always also
Redused;
- flow hence
towardsthe
transducer
alternative name Triplex.)
Section 5
6-Pulse inversion mode: In this mode, two successive pulses with opposite sign are
emitted and then subtracted from each other. This implies that any linearly
responding constituent will disappear while gases with non-linear compressibility
stand out. Pulse inversion may also be used in a similar manner as in Harmonic
mode.
7-Harmonic mode: In this mode a deep penetrating

fundamental frequency is emitted into the body and
a harmonic overtone is detected. This way noise and
artifacts due to reverberation and aberration are
greatly reduced. Some also believe that penetration
depth can be gained with improved lateral resolution;
however, this is not well documented.
FIGURE 5.17:valve location
1.10-Attributes:
As with all imaging modalities, ultrasonography has its list of positive and negative attributes.
1- Strengths:
 It images muscle, soft tissue, and bone surfaces very well and is particularly useful for delineating the
interfaces between solid and fluid-filled spaces.
 It renders "live" images, where the operator can dynamically select the most useful section for diagnosing
and documenting changes, often enabling rapid diagnoses. Live images also allow for ultrasound-guided
biopsies or injections, which can be cumbersome with other imaging modalities.
 It shows the structure of organs.
 It has no known long-term side effects and rarely causes any discomfort to the patient.
 Equipment is widely available and comparatively flexible.
 Small, easily carried scanners are available; examinations can be performed at the bedside.
 Relatively inexpensive compared to other modes of investigation, such as computed X-ray
tomography, DEXA or magnetic resonance imaging.
 Spatial resolution is better in high frequency ultrasound transducers than it is in most other imaging
modalities.
 Through the use of an ultrasound research interface, an ultrasound device can offer a relatively
inexpensive, real-time, and flexible method for capturing data required for special research purposes for
tissue characterization and development of new image processing techniques
151
Equipment
2- Weaknesses:
 Sonographic devices have trouble penetrating bone. For example, sonography of the adult brain is
currently very limited.
Section 5
 Sonography performs very poorly when there is a gas between the transducer and the organ of interest,
due to the extreme differences in acoustic impedance. For example, overlying gas in the gastrointestinal
tract often makes ultrasound scanning of the pancreas difficult. Lung imaging however can be useful in
demarcating pleural effusions, detecting heart failure, and detecting pneumonia.
 Even in the absence of bone or air, the depth penetration of ultrasound may be limited depending on the
frequency of imaging. Consequently, there might be difficulties imaging structures deep in the body,
especially in obese patients.
 Physique has a large influence on image quality. Image quality and accuracy of diagnosis is limited with
obese patients, overlying subcutaneous fat attenuates the sound beam and a lower frequency transducer
is required (with lower resolution)
 The method is operator-dependent. A high level of skill and experience is needed to acquire good-quality
images and make accurate diagnoses.
 There is no scout image as there is with CT and MRI. Once an image has been acquired there is no exact
way to tell which part of the body was imaged
FIGURE 5.18
Double aort artifact in sonography due to difference in
velocity of sound waves in muscle and fat.
1.11-Refrences:
http://apps.who.int/iris/bitstream/handle/10665/43881/9789241547451_eng.pdf?sequence=1
https://www.researchgate.net/publication/226964331_Ultrasound_Physics_and_Equipment
http://www.oamk.fi/~jjauhiai/opetus/mittalaitteet/US.pdf
http://courses.washington.edu/bioen508/Lecture6-US.pdf
152
Equipment
Section 5
2-X-ray machine
FIGURE 5.19: X-ray
153
Equipment
2.1- Definition:
Section 5
X-ray, or radiography, is the oldest and most common form of medical imaging.
An X-ray machine produces a controlled beam of radiation, which is used to create an image of the inside of
your body. This beam is directed at the area being examined. After passing through the body, the beam falls
on a piece of film or a special plate where it casts a type of shadow. Different tissues in the body block or
absorb the radiation differently. Dense tissue, such as bone, blocks most of the radiation and appears white on
the film. Soft tissue, such as muscle, blocks less radiation and appears darker on the film. Often multiple
images are taken from different angles so a more complete view of the area is available. The images obtained
during X-ray exams may be viewed on film or put through a process called “digitizing” so that they can be
viewed on a computer screen.
Sometimes an X-ray exam includes contrast. For a contrast study, you will receive a drug called a contrast
agent, which will highlight or contrast parts of the body so they show more clearly on the X-ray image.
1.2 - Uses:
X-ray exams can be used to view, monitor, or diagnose
 bone fractures
 joint injuries and infections
 artery blockages
 abdominal pain
 cancer
2.3-X-rays Desorption:
1) The heart of an X-ray machine is an electrode pair a cathode and an anode
that sits inside a glass vacuum tube. The cathode is a heated filament, like
you might find in an older fluorescent lamp. The machine passes
current through the filament, heating it up. The heat sputters electrons off of
the filament surface. The positively-charged anode, a flat disc made
of tungsten, draws the electrons across the tube.
FIGURE 5.20: X-rays Descrbtion
2) The voltage difference between the cathode and anode is

extremely high, so the electrons fly through the tube with a
great deal of force. When a speeding electron collides with a
tungsten atom, it knocks loose an electron in one of the atom's
lower orbitals. An electron in a higher orbital immediately falls to
the lower energy level, releasing its extra energy in the form of
a photon. It's a big drop, so the photon has a high energy level -
- it is an X-ray photon.
FIGURE 5.21: The voltage difference between the cathode

and anode 154
Section 5
Equipment
3) Free electrons can also generate photons without hitting an

atom. An atom's nucleus may attract a speeding electron just
enough to alter its course. Like a comet whipping around the
sun, the electron slows down and changes direction as it
speeds past the atom. This "braking" action causes the
electron to emit excess energy in the form of an X-ray
photon.
The free electron is attracted to the tungsten atom
nucleus. As the electron speeds past, the nucleus alters its course.
The electron loses energy, which it releases as an X-ray photon.
FIGURE 5.22: Free electrons can also generate photons
without hitting an atom
4) Contrast Media
In a normal X-ray picture, most soft tissue doesn't show up clearly. To focus in on organs, or to
examine the blood vessels that make up the circulatory system, doctors must introduce contrast
media into the body.
Contrast media are liquids that absorb X-rays more effectively than the surrounding tissue. To bring
organs in the digestive and endocrine systems into focus, a patient will swallow a contrast media
mixture, typically a barium compound. If the doctors want to examine blood vessels or other elements
in the circulatory system, they will inject contrast media into the patient's bloodstream.
Contrast media are often used in conjunction with a fluoroscope. In fluoroscopy, the X-rays pass through the
body onto a fluorescent screen, creating a moving X-ray image. Doctors may use fluoroscopy to trace the
passage of contrast media through the body. Doctors can also record the moving X-ray images on film or
video.
The high-impact collisions involved in X-ray production generate a lot of heat. A motor rotates the
anode to keep it from melting (the electron beam isn't always focused on the same area). A cool oil bath
surrounding the envelope also absorbs heat.
The entire mechanism is surrounded by a thick lead shield. This keeps the X-rays from escaping in all
directions. A small window in the shield lets some of the X-ray photons escape in a narrow beam. The beam
passes through a series of filters on its way to the patient.
A camera on the other side of the patient records the pattern of X-ray light that passes all the way
through the patient's body. The X-ray camera uses the same film technology as an ordinary camera, but X-ray
light sets off the chemical reaction instead of visible light.
Generally, doctors keep the film image as a negative. That is, the areas that are exposed to more light
appear darker and the areas that are exposed to less light appear lighter. Hard material, such as bone,
appears white, and softer material appears black or gray. Doctors can bring different materials into focus by
varying the intensity of the X-ray beam.
2.4-Preparation:
1) For an X-ray exam: For most X-ray exams, there is no special preparation needed. You will be
asked to wear a hospital gown and remove all jewelry and metal objects before the test. For
contrast X-ray exams, you will be given a dose of contrast agent by mouth, as an enema, or as an
injection or by catheter (thin tube) into a specific area of the body. Your physician will provide any
specific instructions necessary for your contrast study.
2) During the Exam: You will be asked to either lie on an exam table or stand next to the X-ray
machine. The room may be cool in order to keep the equipment from overheating.
155
Section 5
Equipment
The technologist, or person performing the exam, may use pillows or sandbags to help you hold the
proper position. You will be asked to hold very still, without breathing for a few seconds. The
technologist will step behind a radiation barrier and activate the X-ray machine. Often multiple images
or views are taken from different angles, so the technologist will reposition you for another view and the
process will be repeated. You will not feel the radiation.
A mammogram is an X-ray exam of the breast. A special machine designed specifically to examine breast
tissue is used. It takes a different form of X-ray and uses lower doses of radiation than a usual X-ray. Because
these X-rays do not go through breast tissue as easily, the mammogram machine has two plates that
compress the breast to spread the tissue apart. A more accurate image is obtained with less radiation this way.
Time required: 5 to 60 minutes

Noise During Exam: Minimal clicking or buzzing noises.
Space during Exam: You will either lie on an exam table or stand next to the X-ray machine
with ample space around you.
Benefits:
 X-ray exams are fast and easy.

 The equipment used is relatively inexpensive and widely available.
2.5-Components of X-Ray Machine:

X-ray has three main components:
1) Operating Console
2) High Frequency Generator
3) X-ray Tube
• Internal
• External
Other Parts include
• Collimator
• Grid
• Bucky
• X-ray Film
1-The operating console:

Allows the radiologic technologist to control the x-ray tube current
and voltage so that the useful x- ray beam is of proper quantity
and quality.
• Radiation quantity refers to the number of x-rays or the intensity
of the x-ray beam.
• Radiation quantity is usually expressed in mill roentgens (mR) or
mill roentgens/mill ampere-second (mR/mAs).
FIGURE 5.23: The operating console
• The operating console usually provides for control of line compensation, kVp, mA, and exposure time. Meters
are provided for monitoring kVp, mA, and exposure time.
156
Section 5
Equipment
2-A high frequency generator powers the X-ray tube. Earlier, high
voltage generators were used.
• High frequency generators are used for X-ray because
they operate on single phase and give less voltage
ripples.
• Another reason for using is its small size, which makes
it portable.
FIGURE 5.24 high frequency generator
3-The X-ray tube can be classified as

1- External:
The external part includes:
• Tube Support
• Protective Housing
• Glass or Metal Envelope
2- Internal: The internal parts include

 Cathode : The filament that causes
thermionic emission
FIGURE 5.25: The X-ray tube
 Anode: A flat disc made of tungsten that

draws the electrons across the tube
 The inside of the tube is vacuumed so that the X-rays

are produced isotropic ally
Cathode Anode X-rays
FIGURE 5.26: The X-ray tube
4- Video
5-Collimator: is a device used to minimize the field of
view, avoid unnecessary exposure using lead plates.
Lead shutter are used to restrict the beam. The
collimator is attached to the X-ray below the glass
window where the useful beams is emitted.
Section 5 157
Equipment
FIGURE 5.27: Collimator
6- Grid: is similar to a collimator except they have different positions. Grid is placed right
after the patient. It is made up of lead strips, which is used to eliminate scattered light.
These strips only allow rays at 90º to pass through.
FIGURE 5.28: Grid FIGURE 5.29: Grid
7- Film: that is placed after the bucky. It turns

black when X-rays interact with it and stays
white where the X-rays are absorbed.
This causes an image to be formed that is in
black, grays and white.
FIGURE 5.30: Film
Section 5
2.6-Circuit Diagram:
158
Equipment
FIGURE 5.31: Circuit Diagram
2.7-Risks:
X-ray exams exposure patients to radiation. The amount of radiation exposure is variable depending upon the
X-ray type (for example, of the brain, lungs, or abdomen) and the X-ray machine type (for example, different
models and manufacturers). Because the radiation exposure is variable, the risks are also variable. Please
speak to your radiologist, or your physician who refers you for the X-ray exam, for specific details on radiation
exposure and possible risks.
 Women should inform their doctor if they are or may be pregnant or nursing prior to any radiological
imaging. Your doctor may recommend another type of test to reduce the possible risk of exposing your
baby to radiation.
 There is a rare risk of a major allergic reaction to the contrast agent.
2.8-Results:
X-rays are recorded on film or recorded digitally. A radiologist, who is a physician with specialized training in X-
ray and other imaging tests, will analyze and interpret the results of your X-ray and then send a report to your
personal physician. For non-emergency situations, it usually takes a day or so to interpret, report, and deliver
the results. Contact your personal physician for information on the results of your exam.
Section 5
159
Equipment
FIGURE 5.32 FIGURE 5.33 FIGURE 5.34

An X-ray Machine A Colon X-ray Image A Hand X-ray Image
2.9-Refrences:
http://www.austincc.edu/rudygarz/xRayMachine/xRayMachine.pdf
https://cw.fel.cvut.cz/old/_media/courses/a6m33zsl/x-rays.pdf
http://whqlibdoc.who.int/publications/2004/9241591633.pdf?ua=1
Section 5
160

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Introduction of

: ‫المستوى‬/ ‫الفرقة‬ ‫ مقدمة في تقنيات األجهزة الطبية‬:‫اسم المقرر‬ : ‫الرمز الكودى‬

- ‫ عملى‬4 ‫ نظرى‬2 : ‫عدد الوحدات الدراسية‬ : ‫التخصص‬

Students for Technical Health Institutes: ‫ المستهدف من تدريس المقرر‬-3

Having successfully completed this module, students will be able to:

Having successfully completed this module, students will be able to:

 Analyze different factors on which medical equipment

Section 2: Diagnostic Devices

Section 3: Therapeutic Devices

Section 4: Life support and General Devices

Section 5: Imaging Modalities

‫ أساليب التعليم والتعلم للطالب‬-6

“Introduction to Biomedical Equipment Technology for Technical ‫ كتب ملزمة‬-‫ب‬

 " Introduction to Biomedical Equipment Technology” 4th ‫ كتب مقترحة‬-‫ج‬

‫ الخ‬...... ‫ دوريات علمية أو نشرات‬-‫د‬

By the end of this course, students should be able to:

• Recognize principles and concepts of medical devices technologies.

By the end of this course, students should be able to:

 Analyze and demonstrate a solid understanding of electronics; by interpreting electronic

Methods of Teaching/Training with

Life Support Devices

TOTAL HOURS (72) 24 20 8 20

Section 2: Diagnostic Devices

Section 3: Therapeutic Devices

1.14-The Flow Meter Assembly .......................................................................... 62

Section 4: Life Support and General Devices

3-Infusion and Syringe Pumps ................................................................................. 113

4.5- Autoclaves Working Principle ...................................................................... 123

Section 5: Imaging Modalities

2-X-ray machine .......................................................................................................... 149

1-Introduce Medical Equipment technology

2-Medical Equipment Classification

FIGURE 1.1 FIGURE 1.2 FIGURE 1. 3

FIGURE 1.6 FIGURE 1.7

Life support Equipment:

FIGURE1. 8 FIGURE 1.9 FIGURE 1.10

2.2 - Laboratory Equipment:

2.3 - Research Equipment:

FIGURE 1.11 FIGURE 1.12 FIGURE 1.13

2 - POC (Point of Care) Devices

4 - Devices for Self-testing “home devices”

Sphygmomanometers (Blood Pressure. sets)

1-ECG (Electrocardiograph) Machines

1.3- Physiological Background:

FIGURE 2.2 Physiological Steps Of Heart

1.5- Electrical Circuit:

1.6- Measuring the ECG:

1.6.1-The Electrode Placements:

1.7- Operating Steps:

1.8- ECG Machine Types:

3-Muscle Tremor / Noise:

1.10- Safety Features:

Figure 2.16 :Sphygmomanometer

Figure 2. 17: Sphygmomanometer

Figure 2.18 :sphygmomanometer measure

 Aneroid sphygmomanometers (mechanical types with a

FIGURE 2.24: FIGURE 2.25 : Manometer

2.6-Care and Maintenance:

FIGURE 2.27 storage

2-Cuff Cleaning and Disinfecting:

1-Get a high quality stethoscope.

2-Adjust your stethoscope’s earpieces.