DIPLOMA IN CRITICAL CARE UNIT IN HOSPITAL

DIPLOMA IN CRITICAL CARE
TECHNOLOGY
HEALTHCITY HOSPITAL,KOINADHARA, GUWAHATI, ASSAM-781022
B By- RESHMA FAROOQUI, BTECH
BIOMEDICAL ENGINEER

SYLLABUS: Preliminary Course-160 hours
Principles underlying different procedures and
equipments and clinical application:47 hours
1) BLOOD GAS ANALYSIS
2) BLOOD ELECTROLYTE ANALYSIS
3) PULSE OXYMETRY
4) CAPNOMETRY
5) MECHANICAL VENTILATION
6) MULTIMODALITY BEDSIDE MONITOR & CENTRAL MONITOR
7) ECG
8) DEFIBRILATOR-MONITOR
9) TEMPORARY PACEMAKER
10) OXYGEN-STORAGE &SUPPLY

11) SUCKER MACHINE
12) NEBULISER
13) BRONCHOSCOPY
14) GLUCOMETER
15) STERILIZATION
16) CHEST PHYSIOTHERAPY

BLOOD GAS ANALYSIS (abg)
An arterial blood gas analysis (ABG) measures the
balance of oxygen and carbon dioxide in your
blood to see how well your lungs are working. It
also measures the acid-base balance in the blood.
• PRINCIPLE : ABG sensors measure the partial
pressures of oxygen (PaO2), carbon dioxide
(PaCO2), and hydrogen-ion concentration (pH)
used for monitoring the acid-base
concentration essential for sustaining life.

ABG Machine
• Principle: A modern blood gas analyzer such as the ABL300 directly accepts samples from syringes or capillary
tubing. The ABL300 measures pH, carbon dioxide tension, and oxygen tension on 85-µl samples by using specific
electrodes, and estimates hemoglobin concentration from the optical density of a nonhemolyzed sample.
• PROCEDURE :A respiratory therapist may perform a blood circulation test called an Allen test before taking a
sample for an arterial blood gas test from your wrist. An Allen test involves holding your hand high with a clenched
fist. The respiratory therapist will then apply pressure to the arteries in your wrist for several seconds. This simple test
makes sure both of the arteries in your wrist are open and working properly. The respiratory therapist then processes
the sample or sends it to a lab very quickly where medical laboratory scientists process the sample.A respiratory
therapist usually takes the sample from an artery inside your wrist known as the radial artery. Sometimes they may
take a sample from an artery in your arm (brachial artery) or groin (femoral artery).
If a newborn needs an arterial blood gas test, a provider may take the sample from the baby's heel or umbilical
cord
EQUIPMENT USE: ABG needle(23g),syringe, cotton/tap, bandage,
gloves, gauze.
Alcohol wipe (70% isopropyl), Lidocaine 1% (1 mL),

Clinical application of ABG Machine
• Asthma
• Copd(chronic obstruction pulmonary disease)
• Cystic fibrosis
• Heart disease
• Cardiac arrest
• Acute heart failure
• Acute respiratory failure
• DKA(diabetic related ketoacidosis)
• Hypovolemic shock
• Septic shock
• Severe shock
• ARDS(acute respiratory distress syndrome0

ABG
• Procedure of an ABG test blood draw includes the following steps:
Ask the patient to sit in a chair or lie in bed and clench their fist, and a respiratory
therapist will look for an artery, usually in your inner wrist. Apply pressure over the
radial and ulnar artery to occlude both vessels.
Once they’ve located an artery, they’ll clean and disinfect the area.
They’ll then insert a small needle into your artery to take a blood sample. You may feel a
sharp pain as the needle goes into your artery.
After they insert the needle, a small amount of blood will collect in a syringe.
Once they have enough blood to test, they’ll remove the needle and hold a cotton ball
or gauze on the site to stop the bleeding. They may apply pressure for five to 10
minutes or longer if you’re taking blood-thinning medication. Ask the patient to open
their hand, which should now appear blanched. If the hand does not appear it suggests
you are not completely occluding the arteries with your fingers.
They’ll place a bandage over the site, and you’ll be finished.

BLOOD ELCTROLYTE ANALYSIS
PRINCIPLE: An electrolyte panel, also
known as a serum electrolyte test,
is a blood test that measures levels of
the body's main electrolytes: Sodium,
which helps control the amount of
fluid in your body. It also helps your
nerves and muscles work properly.
Chloride, which also helps control the
amount of fluid in your body.
• .

Blood Electrolyte analysis
An electrolyte test is a blood test that measures if there's an
electrolyte imbalance in the body. Electrolytes are salts and
minerals, such as sodium, potassium, chloride and bicarbonate,
which are found in the blood. They can conduct electrical
impulses in the body.
• Abs measure electrolytes by looking at the concentration of
the substance in a specific amount of blood. In general, these
are the normal ranges for electrolytes:
• Sodium: 136 to 144 mmol/L.
• Potassium: 3.7 to 5.1 mmol/L.
• Calcium: In adults, 8.5 to 10.2 mg/dL.
• Chloride: 97 to 105 mmol/L.
• Magnesium: 1.7 to 2.2 mg/dL.
• Phosphate: 2.5 to 4.8 mg/dL.
• Bicarbonate: 22 to 30 mmol/L.

Blood electrolyte analysis
PROCEDURE: An electrolyte test is a simple and quick procedure that can be
carried out at your doctor's office or a lab. You can drink and eat as usual
before taking the test. Using a small needle, your doctor will take a small
blood sample from a vein in your arm. The blood will be collected into a test
tube and will be sent to the laboratory for diagnosis.
EQUIPMENT USE : needle, cotton, aspirin.
CLINICAL APPLICATION: in clinical laboratories, electrolyte analyzers are
commonly used to assess the electrolyte levels in patients' blood samples.
This information is critical for diagnosing and managing conditions such as
dehydration, kidney disease, heart conditions, and acid-base imbalances.

Pulse Oximeter
Pulse oximetry is a noninvasive test that measures the oxygen
saturation level of your blood.
The pulse oximeter is a small, clip-like device. It attaches to a body
part, most commonly to a finger.
PRINCIPLE: Pulse oximetry uses spectrophotometry to determine the
proportion of hemoglobin that is saturated with oxygen (ie,
oxygenated hemoglobin; oxyhemoglobin) in peripheral arterial blood.
Light at two separate wavelengths illuminates oxygenated and
deoxygenated hemoglobin in blood.
It is a non-invasive method of measuring haemoglobin saturation with
light signal transmitted through the tissue
PULSE oximeter probe contains:
• Led, which emit 2 wavelength of light(red & near infrared)
• Photodetector, measures intensity of transmitted light at each
wavelength

Pulse oximeter works on the principle of:
1. Beer’s law
2. Lambert’s law
Beers law states that the amount of light absorbed increases or
transmitted light decreases as the concentration of the substance
increases
Lamberts law states that intensity of transmitted light decreases
exponentially as the distance travelled through the distance increases.
Pulse oximeter is used in hospital .

MONITORING
It is an easy, painless measure of how well oxygen is being sent to parts
of our body furthest from our heart, such as the arms and legs. A clip-
like device called a probe is placed on a body part, such as a finger or
ear lobe. The probe uses light to measure how much oxygen is in the
blood.
TROUBLESHOOTING:
A number of factors can impair the functioning or accuracy of a pulse
oximeter. Nail polish and artificial nails may block the red and infrared
light emitted by the device. Certain dyes used for diagnostic tests or
medical procedures can also hinder light transmission.

Capnometry
Capnometers measure carbon dioxide (CO2) in expired
air and provide clinicians with a noninvasive measure of
systemic metabolism, circulation, and ventilation. If two of
these systems are held relatively constant, changes in
CO2 excretion will reflect the third.
Capnometry is a noninvasive method that measures the
end-tidal partial pressure of carbon dioxide in the expired
gas.
A capnometer is a device that measures carbon dioxide (CO2)
concentrations in respired gases.
PRINCIPAL: Capnography is a continuous, real time,
noninvasive and rapid monitoring technique to measure and
display carbon dioxide (CO2) in the gases breathed in and out
during respiration. This can be used reliably to monitor changes
in ventilation, circulation and metabolism

PROCEDURE OF Capnometry
• Capnography refers to the use of a capnograph
to measure the levels of exhaled carbon
dioxide, or CO2, in the bloodstream. This is
commonly known as End-Tidal CO2 or EtCO2
measurement.
• During the test, you will be sitting upright. A
clip is placed on your nose and you will be
given a plastic mouthpiece connected to the
spirometry machine. You will place your lips
tightly around the mouthpiece and be asked to
take in as big and deep a breath as possible and
then blow out as hard and fast as you can.

Mechanical ventilation
Mechanical ventilation (MV) works by applying a positive
pressure breath and is dependent on the compliance and
resistance of the airway system. During spontaneous
inspiration, the lung expands as transpulmonary pressure
(P) is produced mainly by a negative pleural pressure
generated by the inspiratory muscles.
PRINCIPLE: Air exchange (an open ventilation system)
means bringing in air from outside the closed area to
replace the air that is already there; the air also moves
around in the process, creating circulation. Temperature,
gas exchange, and humidity can all be affected positively
through the exchange process.
PROCEDURE: When a person needs to be
on a ventilator, a healthcare provider will
insert an endotracheal tube (ET tube)
through the patient's nose or mouth and into
their windpipe (trachea). This tube is then
connected to the ventilator. The
endotracheal tube and ventilator do a
variety of jobs.

Forms of Mechanical Ventilation

EQUIPMENT USE:electric power, oxygen, and compressed air
Power supply usually supplied via external power source as well as via hospital’s central gas supply
(with supply pressure of approximately 3–6 bar.
Breathing system forms interface between patient and the ventilator
• Clinical ventilators are usually connected to patient via inspiratory and expiratory hose (dual-hose circuit).
• Expiratory valve is closed during the inspiratory phase.
• Gas flow delivered through inspiratory port passes through breathing gas humidifier before entering patient’s lungs
• Expiratory gas passes through ventilator again, but not reused for following inspiration.
Humidifiers are used to warm and humidify inspiratory gas

Principle of ventilator
Unlike ventilator circuits used for anesthesia or critical care
which have two limbs, one taking fresh gas to the patient and
a second returning expired gas to the ventilator, breathing
circuits for non-invasive ventilation (NIV) only have one limb for
taking fresh gas to the patient

Gas humidifier of ventilation
• Passive breathing gas humidifiers, termed
heat and moisture exchangers
• (HMEs), are placed close to patient and
designed to buffer significant
• fraction of moisture and heat expired by
patient.
• Retained moisture is then used to condition
inspired gas passing through HME
• during next inspiration
• Using HME together with active breathing
gas humidifier in single breathing
• circuit is not permitted as it would
significantly impair resistance of HME

Mandatory(M), Spontaneous(S) and Triggered
Inspiratory Cycling(T)

Clinical application of Ventilator
• Acute respiratory distress syndrome (ARDS)
• Head injury or stroke.
• Asthma.
• COPD (chronic obstructive pulmonary disease) or other lung diseases.
• Cardiac arrest.
• Drug overdose.
• Neonatal respiratory distress syndrome, which is a breathing problem that can
affect newborns, especially premature babies.
• Pneumonia.
• Bradypnea or apnea with respiratory arrest. Acute lung injury and the acute
respiratory distress syndrome. Tachypnea (respiratory rate >30 breaths per
minute)

Parts of mechanical ventilator

Different types of ventilator
Mechanical ventilators are of 2 types:
• Invasive mechanical ventilation: This means you have a tube
in your airway connected to a ventilator. This tube can go
through your mouth (intubation) or neck (tracheostomy).
• Noninvasive ventilation: This uses a face mask connected to
a ventilator. Straps hold the mask to your head to hold it tight.
The ventilator pushes air into your lungs. Forms of noninvasive
ventilation include devices you might use at home, like CPAP or
BiLevel positive airway pressure (often known under the trade
name BiPAP

Operating procedure
When a person needs to be on a ventilator, a healthcare provider will insert an
endotracheal tube (ET tube) through the patient's nose or mouth and into their
windpipe (trachea). This tube is then connected to the ventilator.
Ventilator is a machine that helps you breathe. Just like crutches support your weight, the ventilator
partially or completely supports your lung functions. A ventilator:
•Provides oxygen to your lungs.
•Helps remove carbon dioxide (CO2) from your lungs.
•Provides pressure to keep the small air sacks in your lungs (alveoli) from collapsing.
Modern mechanical ventilators use positive pressure to push air into your lungs. Positive pressure ventilation
can be invasive or noninvasive.
•Invasive mechanical ventilation: This means you have a tube in your airway connected to a ventilator. This
tube can go through your mouth (intubation) or neck (tracheostomy).
•Noninvasive ventilation: This uses a face mask connected to a ventilator. Straps hold the mask to your head
to hold it tight. The ventilator pushes air into your lungs. Forms of noninvasive ventilation include devices you
might use at home, like CPAP or BiLevel positive airway pressure (often known under the trade name BiPAP

Troubleshooting
Check to be sure that the airway is patent, the ET
tube is appropriately placed and secured, and the
circuit has no air leak. Brief physical exam (listen to
the lungs and watch the chest rise). Disconnect the
patient from the ventilator and ask for help from
RT. Bag ventilate the patient by hand at 100% FiO2.

Multimodality Bedside Monitor
&Central Monitor
• Patient monitor: are devices used to measure, record, and display
various patient parameters such as heart rate and rhythm, SPO2,
blood pressure, temperature, respiratory rate, blood pressure, blood
oxygen saturation, et cetera to keep a track of the patient's health
and provide them with high-quality health care.
• Central monitoring is a unique approach of monitoring clinical trial
data that involves the collation of data from all trial sites in a remote,
central location, where it is evaluated by sponsor personnel or
representatives. This may involve teams that include clinical monitors,
data managers, and statisticians.

Block diagram of patient monitor

Working principle of patient monitor
• The ADC sends the data to a
microprocessor based signal processor
which extracts features such as heart
rate and blood pressure. After
processing, the physiological signals
are displayed on a display device and
usually sent to a centralized ICU
display system and frequently to a
electronic patient record.

Patient monitor working principle

CENTRAL MONITOR
• Nurses in the Central Monitoring Station (CMS) function as a
consultant for the cardiopulmonary technicians who monitor and
interpret cardiac physiological data, detecting and documenting any
changes in heart rhythm and arrhythmias according to department
standards.

ECG(Electrocardiogram)
An electrocardiogram (ECG or EKG) is a test to record the electrical signals in the
heart. It shows how the heart is beating. Sticky patches called electrodes are
placed on the chest and sometimes on the arms or legs. Wires connect the
patches to a computer, which prints or displays results.
Normal ECG of patient

SETTING OF CENTRAL MONITOR
DISPLAY:
The practical aspects of setting up your central monitoring system. Before you begin, ensure you have all the necessary
components, including cameras, motion sensors, door/window sensors, and a central control panel. Depending on your needs,
you might also want to integrate smoke detectors, carbon monoxide detectors, or smart locks into your system.
1.Choose the Right Location: Start by selecting the optimal locations for your cameras and sensors. This decision should be
based on your property layout and the areas you want to monitor.
2.Wiring and Connectivity: Make sure all devices are properly connected and wired to the central control panel. Many modern
systems offer wireless options for easy installation.
3.Programming: Configure the system settings, including your preferred alert methods, such as text messages or email
notifications.
4.Testing: Test your system to ensure all components are working correctly and that alerts are being delivered as expected.

RECORDING
• Blood pressure readings:
• Click into the NIBP section on the main
screen to bring up the NIBP set up menu.
• Change measure mode and inflation mode to
AUTO
• Select the interval of your choice — 1-5
minutes, 10 minutes, 15 minutes, 30
minutes, 60 minutes, 90 minutes, or all the
way up to every 480 minutes.
PRINTING
Trigger printing:
1.To set trigger printing based off the automatic blood
pressure readings, go into the main menu and select
maintenance
2.Go to user maintain, use the password “ABC,” and
select other set ups
3.Turn NIBP trigger recording on.

TROUBLESHOOTING
MAINTENANCE-WARNING
•Check & clean the filter.
•Wipe the monitor.
•Check the water traps.
•Calibrate per manufacturer's specifications.
•Have preventative maintenance performed.

MAINTENANCE
• Maintenance Plans in Patient Monitor
• To avoid false diagnostics and malfunction of patient monitors, it is advisable to create program at defined intervals that includes
specific maintenance tasks such as lubrication, filter cleaning, replacement of parts that are commonly worn out, or have a limited
service life (e.g. tubes). Generally, it is the manufacturer who sets out the procedures and intervals. Likewise, there is the
technician in repairs of medical equipment, being able to modify the frequency according to the conditions of the medium.
Preventive maintenance is sometimes called “planned maintenance” or “scheduled maintenance,” based on making appropriate
adjustments. In the same way, maintenance is classified according to the need for it and are presented as follows:
• Minor Maintenance: It is developed through the routine activities performed in preventive maintenance visits, such as calibration,
lubrication, measurement of the quality of the results to be delivered by the equipment, change or washing of filters, verification
of the operation.
• Major Maintenance: They are performed at longer time intervals (every six months, annually depending on the case) and the
duration of the visit is longer because the routines are more complex and in some cases pieces of equipment must be changed.
• Phase Maintenance: it is developed through a technical description, with manuals, that record the characteristics of each
equipment, in addition to lists of work to be done periodically, frequency control, exact indication of the date to carry out the
work.

CAUTIONS
• Warnings and Precautions : For safe operation of the implanted
device, the monitor's reader should only be used as described in the
Patient Manual and as directed by the physician. Patients should
always turn the monitor on before positioning the reader over the
implanted device.

CLEANING
CLEANING PROCEDURE:
• Wipe the outer surfaces, sensors, and cables of the device from top to bottom with clean
microfiber cloth or disposable wipe with small amount of distilled water.
• Soaked in detergent and clean water and then wipe off any remaining detergent residue with a
dry lint-free cloth.
• To avoid permanent damage, do not use excessive amounts of liquids to clean the device.
• Turn off the monitor and the computer, and then disconnect the power cables.
• Gently wipe the monitor's screen to remove dust and fingerprint.
PREVENTIVE MAINTENANCE:
• Having preventative maintenance performed on your machine is not only wise but also
necessary for the life of your machine. Preventative maintenance ensures that your machine
is in correct working condition and that it doesn’t have any foreseeable problems present.
• Making sure the proper care is taken to keep your equipment working and looking like new is
easy and important and will increase the lifespan of your investment by years.

Preventive maintenance
Testing, servicing, calibration, inspection, adjustment, alignment, and installation are the seven elements
of a preventive maintenance plan, which are explained below: Inspection: It is critical to check the
condition of assets on a regular basis in order to determine their value and future requirements.
Mechanical / Physical / Visual Inspection - Annually Suggested Inspections for Wear and Abuse:
1. Inspect outer case, line cords, rolling stands, wall mounts, modular accessories and interconnecting
cables.
2. Inspect patient interface connections (ECG, IBP, SpO2, Temp, CO2, and NIBP).
Visual test
a) Perform when first installed or reinstalled.
b) Power on test
c) Perform following any maintenance or the replacement of any main unit parts.
d) Perform NIBP Verification and Calibration – Annually
e) Perform NIBP test. See “NIBP Verification”
f) Perform NIBP calibration. See “NIBP Calibration”

• Perform CO2 Verification and Calibration – Annually
• Perform CO2 test. See “CO2 Operation Verification”
• Perform every 12 months thereafter, and each time the unit is serviced.
• Perform CO2 calibration. See “CO2 Calibration”
• Perform every 12 months thereafter, and each time the unit is serviced.
• For DPM CO2, replace the CO2 assembly after 20,000 operating hours or as required by the service code.
• Perform IBP Verification and Calibration – Annually
• Perform IBP test. See “IBP 1 and IBP 2 Verification”
• Perform IBP calibration. See “IBP Calibration”
• Perform ECG Verification – Annually
• Perform ECG test. See “ECG”
• Perform ECG channels check.
• “ECG Channels Check”
• Perform Verification and Gas Calibration – Annually
• 1.Perform Gas test. See “Verification”
• Perform Gas calibration. See “Gas Calibration”
• Temperature Perform Verification – Annually
• Perform temperature test. See “Temperature Verification”
• SpO2 Perform Verification – Annually 1. Perform SpO2 test. See “SpO2 Verification”
• Electrical Safety Tests – Annually 1. Perform test. See “Leakage Current Tests”

BEDSIDE MONITOR
INTRODUCTION:
The "Bedside patient monitoring system" is a crucial medical
technology designed to monitor and record real-time physiological
parameters of patients at the bedside, providing healthcare
professionals with accurate data for timely decision-making.
EXTERNAL DEVICE:
vital signs monitoring devices monitor crucial medical parameters of a
patient, such as heart rate, blood pressure, oxygen saturation, and
body temperature. Examples of these devices include at-home blood
pressure monitors, pulse oximeters, and remote ECG device.

MONITORING BASICS
Aside from heart rate and rhythms, bedside monitors can be used to display and
analyze several other features. three of the most important areas that bedside
monitors display are body temperature and blood pressure, and blood oxygen ( SpO2 )
levels.
Patient monitors are devices used to measure, record, and display various patient
parameters such as heart rate and rhythm, SPO2, blood pressure, temperature,
respiratory rate, blood pressure, blood oxygen saturation, et cetera to keep a track of
the patient's health and provide them with high-quality health care.
SETTING DIFFERENT PARAMETER:
The 5 parameters of a patient monitor are ECG, body temperature, respiratory rate,
SpO2 and blood pressure.
7 parameter patient monitor is a portable monitor with touch screen, which can
monitor such parameters as ECG, RESP, SpO2, PR, NIBP and dual- channel TEMP. It
integrates parameter measurement module, display and recorder in one device to
form a compact and portable equipment

SETTING ECG
1.Skin preparation: The quality of ECG waveform displayed on the monitor is a direct result of the quality of the electrical signal
received at the electrode. Proper skin preparation is necessary for good signal quality at the electrode. A good signal at the
electrode provides the monitor with valid information for processing the ECG data. To ensure enough electrolyte material on
the skin of patients, you need to moisten the measuring sites with 70% isopropyl Ethanol. This will usually be sufficient for ECG
monitoring for a short time (30 to 60 minutes).
2. Connect the cable to the connector marked with the “ECG” icon on the signal input panel.
3. Place the electrode to the patient.
4. Attach the ECG lead wires to the electrode
5. Make sure the monitor is turned on and is ready for monitoring.
6. After starting the monitor, if the electrodes become loose or disconnected during monitoring, the system will display “LEAD
OFF” on the screen to alarm the operator.
7.It might not display ECG waveform when using ECG cable with 3 lead wires while the setting of “Cable” is set as “5” in the
ECG parameter setup menu. Only single channel of ECG signal can be obtained while using 3 lead wires and the “Cable” is set
as “3”, this ECG signal can be selected between Lead I, Lead II and Lead III.
In order to obtain other Leads of the ECG signals, such as aVL, aVR, aVF and V, the ECG cable with 5 lead wires should be used
and the “Cable” should be set to “5”. At this situation, 7 Leads of ECG signal (lead I, II, III, aVL, aVR, aVF, V) can be obtained and
displayed simultaneously
Preparing the Patient and Device for ECG

PATIENT MONITOR DISPLAY SETTING
TEMPERATURE: “System Menu” screen, select “Setup”→“TEMP” to enter into temperature related settings.
Respiration: On “System Menu” screen, select “Setup”→“RESP” to enter into Respiration related settings.
NIBP: System Menu” screen, select “Setup”→“NIBP” to enter into NIBP related settings.
SPO2:System Menu” screen, select “Setup”→“SpO2 ” to enter into SpO2 related settings.
INVASIVE BP: The arterial catheter should be connected to the tubing, the transducer secured in a position
approximately level with the heart and transducer 'zeroed' - that is, closed to the patient and opened to
atmosphere to obtain a reading of atmospheric pressure.
CARDIAC OUTPUT: Enter the patient's height and weight into the bedside monitor (BSA will automatically be
calculated, which is required to confirm measured and calculated variables into indexed values (e.g., Cardiac Index,
SVRI).Plug in cardiac output module
SPIROMETRY:On the main display, click into the ECG section to bring up the ECG setup menu
Change “HR from” to SpO2.
Go to the SpO2 section to bring up the SpO2 set up menu to make sure the pitch tone is turned on. You can also
increase or decrease the volume of the pitch tone in this menu.
ETCO2: turn on monitor, tubing for end tidalco2, attaching the sensor, attaching the mouthpiece

ECG
• Working principle of electrocardiograph:
• It works on the principle that a contracting muscle generates a small electric current that
can be detected and measured through electrodes suitably placed on the body.
• For a resting electrocardiogram, a person is made to lie in the resting position and
electrodes are placed on arms, legs and at six places on the chest over the area of the
heart. The electrodes are attached to the person’s skin with the help of a special jelly.
• The electrode picks up the current and transmit them to an amplifier inside the
electrocardiograph. Then electrocardiograph amplifies the current and records them on a
paper as a wavy line.
• In an electrocardiograph, a sensitive lever traces the changes in current on a moving
sheet of paper.
• A modern electrocardiograph may also be connected to an oscilloscope, an instrument
that display the current on a screen.

• Normal ECG wave: A normal ECG makes a specific pattern of three recognizable waves in a cardiac cycle. These wave are- P wave,
QRS wave and T-wave, P-R interval, S-T segment
• P-wave:
• It is a small upward wave that appears first
• It indicates atrial depolarization (systole), during which excitation spreads from SA node to all over atrium
• About 0.1 second after P-wave begins, atria contracts. Hence P-wave represents atrial systole
• QRS wave:
• It is the second wave that begins as a little downward wave but continues as a large upright triangular wave and ends as downward wave
• It represents the ventricular depolarization (systole)
• Just after QRS wave begins, ventricles starts to contracts. Hence QRS wave represents ventricular systole.
• T- wave:
• It is third small wave in the form of a dome-shaped upward deflection.
• It indicates ventricular repolarization (diastole)
• It also represents the beginning of ventricular diastole
• ** ATRIAL DIASTOLE MERGES WITH QRS-WAVE
• P-R interval:
• It represents the time required for an impulse to travel through the atria, AV node and bundle of his to reach ventricles.
• S-T segment:
• It is measured from the end of S to the beginning of T- wave
• It represents the time when ventricular fibres are fully depolarized.

ECG
• Application of ECG:
• it indicates the rate and rhythm or pattern of
contraction of heart
• it gives a clue about the condition of heart muscle
and is used to diagnose heart disorders
• it helps the doctors to determine whether the heart
is normal, enlarged or if its certain regions are
damaged
• it can also reveal irregularities in heart’s rhythm
known as ‘arrhythmia’
• it is used by doctors to diagnose heart damage in
conditions like high blood pressure, rheumatic fever
and birth defects
• an ECG also helps to determine the location and
amount of injury caused by heart attack and later
helps to assess the extent of recovery
• Significance of different waves in an ECG
deviating from normal ECG
• Enlarged P-wave:
• It indicates enlarged atrium (it occurs in a condition called mitral stenosis in which due
to narrowing of mitral valve, blood backs up into left atrium)
• Enlarged Q-wave: downward wave
• It indicates a myocardial infraction ( heart attack)
• Enlarged R- wave:
• It indicates enlarged ventricles
• Long P-Q interval:
• It indicates more time taken by impulse to travel through atria and reach ventricles
• It happens in coronary artery disease and rheumatic fever when a scar tissue may form
in heart
• Elevated S-T segment:
• When S-T segment is above the base line, it may indicates acute myocardial infraction
• Depressed S-T segment:
• It indicates that heart muscles receive insufficient oxygen
• Flatter T-wave:
• It indicates insufficient supply of oxygen to heart muscle as it occurs in coronary artery
disease
• Elevated T-wave:
• It may indicates increased level of potassium ions in blood as in hyperkalemia
• Electrocardiogram (ECG): working principle, norm

ECG
OPERATION
The electrodes are connected to an ECG
machine by lead wires. The electrical activity
of the heart is then measured, interpreted,
and printed out. No electricity is sent into
the body. Natural electrical impulses
coordinate contractions of the different parts
of the heart to keep bloat every beat, the
heart is depolarized to trigger its
contraction. This electrical activity is
transmitted throughout the body and can be
picked up on the skin. This is the principle
behind the ECG. An ECG machine records
this activity via electrodes on the skin and
displays it graphically flowing the way it
should be.
MONITORING
Our healthcare provider may
request a Holter monitor ECG if
you have symptoms such as
dizziness, fainting, and low blood
pressure. They may also request a
Holter monitor if you have
ongoing tiredness, palpitations, or
a resting ECG doesn't show a clear
cause.

Troubleshooting ECG artifact
Factors that can impact trace quality
• Skin impedance - The skin’s opposition or resistance to electrical signals flowing through it. This
resistance of the skin, can impede the transmission of the electrical signal from the heart, to the
sensing element in the electrode.
• Muscle movement - Patient movement can create artifact on an ECG trace, which can make it more
difficult for the monitor to correctly identify alarms.
• Electrical continuity - Any break in the ECG signal path will stop the ECG signal from reaching the
monitor. A cable or lead wire that isn't fully plugged in can also stop the ECG signal from reaching the
monitor.
• Electrodes - Using fresh, high quality electrodes ensures good contact with the skin, providing reliable
adhesion and conduction.
• Cabling - Broken cables or lead wires can prevent the ECG signal from reaching the monitor.
• Interference - Unwanted artifact on the ECG trace from nearby interfering sources such as power
cords, infusion pumps, ventilators, etc. can easily be reduced by abrading the patient's skin.
• Equipment - Your monitor settings can have significant impact on the trace quality and alarm accuracy.

Lead(s) Off" Error Message
• Electrical continuity: Check all electrode, leadwire and ECG cable connections.
• Equipment Check: verify number of leads is correctly set on the monitor.
• Electrodes: Check for electrode gel dry out.
• Skin impedance: Clean, then abrade the skin* prior to replacing the electrode.
• Cabling: Replace ECG cable and/or leadwires.
Base Line Wander ECG Artifact
• Skin impedance: Abrade the skin* prior to replacing the electrode.
• Muscle movement: Move electrodes off of major muscle masses.
• Equipment: Adjust monitor filter settings to reduce artifact.
• Electrodes: Use the same ECG electrode on all sites.
• Cabling: Replace ECG cable and/or leadwires

AC Noise (thick baseline) ECG Trace
• Interference: Move all power cords away from ECG cable and leadwires.
• Equipment: Adjust monitor ﬁlter settings to reduce artifact.
• Muscle movement: May be untreatable involuntary muscle tremor.
Intermittent Signal ECG Trace
• Interference: Remove possible static charge, touch metal (bedrail) prior to touching the patient.
• Cabling: Replace ECG cable and/or leadwires

Motion Artifact ECG Trace
• Muscle movement: Move electrodes off of large muscle masses.
• Skin impedance: Abrade the skin prior to replacing the electrode.
• Equipment: Adust monitor ﬁlter settings to reduce artifact.
• Interference: Move ECG cable away from other equipment such as an infusion pump.
• Cabling: Replace ECG cable and/or leadwire
Low Amplitude ECG Trace
• Equipment: Adust monitor settings to increase ECG amplitude.
• Skin impedance: Abrade the skin prior to replacing the electrode.
• Interference: Move ECG cable away from other equipment such as an infusion pump.

DEFIBRILATOR-Monitor
• Defibrillators are devices that apply an electric charge or current to
the heart to restore a normal heartbeat. If the heart rhythm stops
due to cardiac arrest, also known as sudden cardiac arrest (SCA), a
defibrillator may help it start beating again.
• Defibrillators can detect sudden, dangerous heart rhythms or a
cardiac arrest. If a defibrillator detects a cardiac arrest or a dangerous
arrhythmia, it can send an electric charge to the heart to try to
restore a normal heartbeat or rhythm

Principle of Defibrilator
• Most defibrillators are energy-based, meaning that the devices charge
a capacitor to a selected voltage and then deliver a pre-specified
amount of energy in joules. The amount of energy that arrives at the
myocardium is dependent upon the selected voltage and the
transthoracic impedance (which varies by patient).
• Working principle of AED: An AED is a type of computerized
defibrillator that automatically analyzes the heart rhythm in people
who are experiencing cardiac arrest. When appropriate, it delivers an
electrical shock to the heart to restore its normal rhythm

Procedure
• The act of defibrillation delivers an electrical shock across the chest,
either by placing a pair of manual paddles on the chest or through the
application of adhesive “hands-free” pads. Current defibrillators
typically utilize a biphasic waveform that needs a lower energy level
to achieve effective defibrillation.
• Block diagram of defibrilator

Clinical application
Defibrillators are devices that apply an electric charge or current to the heart
to restore a normal heartbeat. If the heart rhythm stops due to cardiac
arrest, also known as sudden cardiac arrest (SCA), a defibrillator may help it
start beating again.
MONITORING:
The defibrillator unit is carried on a waist belt. Two ECG channels can be
monitored with the two pairs of ECG electrodes from front-to-back and right-
to-left lead sets. Bipolar lead monitoring provides a single-lead display and is
often used for portable monitor-defibrillators because the system allows for
evaluation of the heart rate and time relation between different waves of the
cardiac cycle, detection of R waves for synchronized cardioversion, and
detection of ventricular fibrillation.

TROUBLESHOOTING OF DEFIBRILATOR
Disconnect defibrillator from ac power line. Turn the device on.
• If battery/status indicator is red then battery needs to be charged or
replaced (non-‐rechargeable).
• If defibrillator fails to power on then battery is fully depleted or damaged.
• Attach the external and internal paddles if the monitor reads,” no paddles”.
• Check to ensure that the leads are securely attached if the monitor reads,”
no leads.”
• Connect the unit to AC power if the message reads,” low battery’
• Verify that the Energy select control settings are correct if the defibrillator
does not change

Temporary pacemaker
A temporary pacemaker is
used in these instances,
such as when you have a
change in heart rate from
open-heart surgery, heart
attack, infection,
medication or other issues.
The pacemaker will stay in
place until your heart rate
is stabilized, typically for
just a few days.

Pacemaker
The duration of temporary pacing was 4.2 days (range, 1-31). A total of
369 patients (69.6%) required a permanent pacemaker during
hospitalization. There were a total of 148 complications in 116 patients
(22%)
Principle: The box sits in the upper left chest, below the collarbone. A
pacemaker senses through its wires what the heart is doing. If it senses
that the heart has slowed down or missed a beat, then it will send an
electrical impulse to stimulate the heart to restore it to its normal rate.

Oxygen- storage and supply
Equipments needed for oxygen administration
• oxygen source : cylinder or pipeline system
• flowmeter
• humidifier filled with sterile water
• oxygen therapy tubings (Nasal prong ,Simple mask, NRBM)
Oxygen systems must consist of an oxygen source, or
production combined with storage. Common oxygen sources
are: oxygen generating plants and liquid oxygen in bulk storage
tanks, and oxygen concentrators. The most common source of
oxygen storage used in health-care settings is a cylinder.

OXYGEN STORAGE
Oxygen storage in hospitals is a crucial aspect of ensuring patient care. Let’s delve into the regulations and considerations
related to oxygen storage:
1. Types of Oxygen Sources:
1. Bulk Storage Tanks: Hospitals store oxygen in large outside bulk storage tanks. These tanks hold liquid oxygen,
which is then vaporized and distributed throughout the facility via an internal piping system.
2. Oxygen Generating Plants: Some hospitals have on-site oxygen generating plants that produce oxygen for
immediate use.
3. Oxygen Concentrators: These devices extract oxygen from the air and provide it directly to patients.
2. Cylinder Regulations:
1. Oxygen cylinders come in various sizes, ranging from small E-cylinders (approximately 23 cubic feet of oxygen) to
cylinders (approximately 244 cubic feet of oxygen).
3. Compliance with the 2012 edition of NFPA 99 (Health Care Facilities Code) is essential. This code ou
1. Full, Partial, or Empty: Properly identifying each cylinder as full, partial, or empty is critical. Empty cylinders must
be marked to avoid confusion during emergencies. Separation of empty and full cylinders within the same enclosure
required.
2. Partial Cylinders: While NFPA 99 doesn’t specifically address partial cylinders, The Joint Commission allows
organizations to develop policies for storing partial cylinders based on risk assessments.

Components a medical gas supply include:
• Central supply
• Piping extending to locations where the gas is required (copper)
• Terminal units at each use point
• Hoses that extend from terminal units to anesthesia machine,
Ventilator

Oxygen source
Cylinders Manifold system Concentrator Oxygen plant
LMO

Oxygen sources
Manifold system
• Cylinder based
• Require supply chain
• Require facility to have piping
• Relatively low maintenance
• Difficult to repair
Oxygen plant
• Do not require supply chain
• Require electricity
• Require maintenance
• May need piping
• Capable of filling cylinders

PRINCIPLE of oxygen supply
Oxygen delivery from lungs to tissueDo2 is defined as the product of
cardiac output (Qt) and oxygen content of blood (Cao2). Cao2 is derived
from the saturation (Sao2), haemoglobin content (Hb), and a constant K
(the coefficient for haemoglobin-oxygen binding capacity).
OPERATION:
Oxygen is generally delivered through tubing and a nasal cannula,
sometimes called nasal prongs. The nasal cannula end of the tubing fits
into your nose, and is the most common delivery accessory. The
stationary equipment for home use comes with 50-foot tubing, so you
can freely move about the house.

MONITORING
TROUBLESHOOTING
Turn the device on by pressing the power button twice.
1.Make sure all the cords are connected properly.
2.Check for any wire damage.
3.The power supply adapter should be well-ventilated.
4.Do not use an extension cord to power your unit as it may not
provide ample power to operate the device.

PORTABLE OXYGEN CYLINDER & ACCESORIES
Principal: our portable cylinder system consists of the following parts: the
cylinder, which stores pressurized oxygen. The regulator or OCD consists of the
pressure gauge, which tells you how much oxygen is left in the cylinder, and a
flowmeter, which provides the prescribed flowrate of oxygen.
Operation:
The Oxygen Cylinder Regulator Cylinders use a regulator to control the flow of
oxygen. Each regulator has: A control knob to set the oxygen flow rate. A
content gauge to show you how much oxygen remains in the cylinder.
A compressor inside the machine will pressurise the air through a system of
chemical filters known as a molecular sieve. This chemical filter is made up of
silicate granules called Zeolite. The Zeolite will sieve the nitrogen out of the
“air” concentrating the oxygen.

Monitoring
The amount of oxygen present inside the cylinder is measured by the
pressure at the outlet nozzle. The pressure is measured using a high
precision MEMS Pressure Sensor.
Troubleshooting of Cylinder:
If you are experiencing no or limited flow, please follow the advice below:
• Check the cylinder is switched on properly and set to the correct flow rate
• Check nasal prong tubing for kinks, splits or blockages
• Check the contents gauge to ensure the cylinder is not empty
• If using a micro flow or low flow valve, ensure that they are securely fitted,
and that the nasal prongs or mask are connected correctly.

OXYGEN CONCENTRATOR
Principle: An oxygen concentrator is a device that concentrates the
oxygen from a gas supply (typically ambient air) by selectively removing
nitrogen to supply an oxygen-enriched product gas stream. They are
used industrially, to provide supplemental oxygen at high altitudes, and
as medical devices for oxygen therapy.
Operation: Oxygen concentrators take air from your surroundings,
extract oxygen and filter it into purified oxygen for you to breathe.
Oxygen can be drying to your nose so some patients use a humidifier
bottle that can be attached to your home unit to help moisten the
oxygen you inhale.

OXYGEN CONCENTRATOR
Monitoring
If you need to detect the air/oxygen mix while making
your measurements, use the model 4070 Certifier
Flow Analyzer with the 4073 Oxygen Measurement Kit.
This will allow you to detect the concentration of
oxygen from 21% to 100% while simultaneously
measuring the volume and rate of the gas flow.
These machines have a built in Oxygen Purity sensor
built in to the circuit board. After about 20 minutes of
run time, your sensor will turn on and monitor the
output oxygen purity. If your green light is illuminated,
this means your machine is putting out at least 87%
purity which is considered medical grade.

TROUBLESHOOTING
1.Check the filters-they may be reducing oxygen flow if they are dirty or need replacing.
2.Check the tubing kinks or twists to reduce oxygen flow.
3.Look for damage to tubing-leaks can reduce oxygen flow.

Sucker machine
A suction machine, also known as suction pump
or aspirator, is a vital medical device used in various
healthcare settings to remove unwanted fluids, secretions,
or debris from a patient’s body.
A suction machine creates a vacuum to suction out substances such as
mucus, blood, saliva or other secreations from a patients airways or surgical
sites.
TYPES:
1. Electric suction machine
2. Manual suction pump
3. Wall mounted suction system
4. Portable battery powered suction device
Wall mounted suction
Portable battery powered suction
Electric suction
Manual suction

Preventive maintenance of suction pump

Principles of operation of suction machine
Alternative positions for pressure gauge

Working principle of suction pump:

Operation of suction machine
Portable suction machines generate negative pressure, which is
channeled through a special type of plastic connecting tube called a
single-use catheter. The negative pressure creates a vacuum effect that
pulls any blood, mucus, or similar secretions out of the throat.

Monitoring of suction machine
Regularly monitor the suction
pressure during the procedure.
Maintain a steady and controlled
suctioning motion to prevent
pressure fluctuations. Check for any
potential blockages in the suction
catheter that could affect pressure.
TROUBLESHOOTING

Nebuliser
A nebulizer is a medical device used to administer
medication directly to the lungs for individuals with certain
respiratory conditions. Here’s how it works:
•A nebulizer converts liquid medicine into a very fine
mist.
•The mist can be inhaled through a face
mask or mouthpiece.
•This method allows the medication to reach
the respiratory system and lungs where it is needed.
People with the following lung disorders often use
nebulizers:
1.Asthma
2.Chronic obstructive pulmonary disease (COPD)
3.Cystic fibrosis
4.Bronchiectasis

Nebuliser The principle of a nebulizer involves transforming liquid
medication into a fine mist that can be inhaled into the
lungs. Here’s how it works:
1.Compressed Nebulizer Principle:
1. Compressed air is used to create a high-speed
airflow through a small nozzle.
2. The generated negative pressure drives the liquid
or other fluids onto a barrier.
3. Under the high-speed impact, the droplets turn into
mist-like particles and are ejected from the outlet
pipe
2.Function:
1. Nebulizers use electricity to generate compressed
air.
2. This compressed air converts the liquid medicine
into vapors.
3. The nebulizer consists of a power lead, tubing, a
compressor, and a plastic chamber where the
medicine is placed.
4. When turned on, the aerosol is released and can
be inhaled through a mask or mouthpiece

Bronchoscopy
Bronchoscopy is a procedure to look directly at the
airways in the lungs using a thin, lighted tube
(bronchoscope). The bronchoscope is put in the nose or
mouth. It is moved down the throat and windpipe
(trachea), and into the airways.

BRONCHOSCOPE
• Devices that are introduced at the nose or mouth to observe distal branches of the bronchi. Through working channels
in the bronchoscope, the physician can sample lung tissue (e.g., when pulmonary malignancies are suspected), instill
radiographic media for bronchographic studies, perform laser therapy, remove foreign objects, suction sputum for
microbiological culturing, insert catheters, and perform difficult intubations These devices consist of a proximal
housing, a flexible insertion tube ranging from 0.5 to 7.0 mm in diameter, and an “umbilical cord” connecting the light
source and the proximal housing. The proximal housing, which is designed to be held in one hand, typically includes the
eyepiece (fiberoptic models only), controls for distal tip (bending section) angulation and suction, and the working
channel port.
• Principle : The bronchoscope (either flexible or rigid) is inserted into the airways, usually through the mouth or nose.
nose. Sometimes the bronchoscope is inserted via a tracheostomy. Rigid bronchoscopes are used for the removal of
foreign bodies while flexible video bronchoscopes are intended to provide images of a patient’s airways and lungs.
Images provided by the bronchoscope can be focused by adjusting the ocular on the scope’s proximal housing. A video
bronchoscope uses a charge coupled device (CCD) located at the distal tip of the scope to sense and transmit images,
replacing the image guide and eyepiece. These images can then be recorded, printed, stored on digital media, or
transmitted to another location for simultaneous viewin

Flexible bronchoscope Rigid bronchoscope

Clinical application
Healthcare provider perform a bronchoscopy to evaluate symptoms and other indications that something may be wrong with the lungs or
airways. Examples include:
• A chronic cough—one that has lasted for more than three months with no obvious cause
• Hemoptysis(coughing up blood)
• Shortness of breath or low oxygen levels
• A suspicion there may be something lodged in your airways
• An imaging test that showed a tumor or growth on a lung, scarring or other changes to the lung tissue, or the collapse of an area of a lung.
• Symptoms of infection in the lungs or bronchi that can't be diagnosed another way or require a special type of evaluation
• Signs of rejection after a lung transplant
A bronchoscopy also can be used to take a biopsy of abnormal lung or airway tissue, to biopsy the lymph nodes in the central chest
adjacent to airways for evidence of cancer involvement, and to visualize tumors within the lungs that do not extend into the bronchi using a
technique known as endobronchial ultrasound .
• In this procedure, a tumor deep in the airways may be visualized with ultrasound and biopsied during a bronchoscopy (an ultrasound-
guided needle biopsy). EBUS can also be used to obtain a sample from lymph nodes that are adjacent to the airways.
• In addition to techniques designed to look deeper than the airways during a bronchoscopy, there are also several new technologies used to
diagnose early lung cancers. These include radial EBUS bronchosopy, robotic assisted bronchoscopy, narrowband imagery, and high
magnification video bronchoscopy.

Fibreoptic Bronchoscope
Flexible fiberoptic bronchoscopy (FFB) is an invasive procedure that has been
used for a long time for diagnostic and therapeutic purposes. It contains a
light source, fiber optics, and a camera that allows direct visualization of the
upper and lower airways.
Principle: During a bronchoscopy procedure, a scope will be inserted through
the nostril until it passes through the throat into the trachea and bronchi. A
bronchoscope is used to provide a view of the airways of the lung
(tracheobronchial tree).
Operation:Fibreoptic bronchoscopy is a routine procedure to look into your
lungs. It is done with a thin flexible telescope, which passes down the
windpipe while you are sedated. This may allow the doctors to learn more
about your lungs and any illness that may be affecting them.

Monitoring
Fiberoptic bronchoscopy allows direct visualization of the bronchial tree. It is
useful for diagnosing conditions that require culture of a lower respiratory
tract infection by bronchoalveolar lavage (BAL), or conditions such as
bronchogenic carcinoma, that require tissue diagnosis by transbronchial
biopsy.
Troubleshooting:
Cruicial tip and that is withdrawal mainly in the neural position otherwise
you can harm the structures within the trachea don’t damage the patient
and the scope because they can come out to be quite really expensive.
We have to remove potentially and lubricate the tip , if the image is foggy
then have to wipe the tip with alcohol which will remove fogging
We can put oxygen on board which will block away the sputum by oxygen.

Glucometer
• A small device called a glucose meter or glucometer measures how
much sugar is in the blood sample. The drop of blood you get with a
finger prick is often enough to use on a test strip. A finger prick can be
done with a special needle (lancet) or with a spring-loaded device
that quickly pricks the fingertip.
• BLOCK DIAGRAM

Block diagram of glucometer
A glucose meter, also referred to as a "glucometer", is a medical device for determining the approximate concentration
of glucose in the blood. It can also be a strip of glucose paper dipped into a substance and measured to the glucose
chart. It is a key element of home blood glucose monitoring (HBGM) by people with diabetes mellitus or hypoglycemia.
A small drop of blood, obtained by pricking the skin with a lancet, is placed on a disposable test strip that the meter
reads and uses to calculate the blood glucose level. The meter then displays the level in units of mg/dL or mmol/

PRINCIPAL
The glucometer works on the well-established principle of amperometry, where the
peak current obtained during an electrochemical reaction, maintaining a constant
potential between the electrodes, is taken as an indicator of the concentration of
the analyte.
OPERATION:
You place the drop of blood on the test strip. Depending on the type of meter used,
you may put the strip into the meter before or after you put the drop of blood on
the test strip. The meter then reads the blood sugar level. Most meters are made to
be used with the finger prick blood drop.

MONITORING
Squeezing from the base of the finger, gently place a small amount of blood onto the test strip.
Place the strip in the meter. After a few seconds, the reading will appear. Track and record your
results. A continuous glucose monitor (CGM) estimates what your glucose level is every few minutes
and keeps track of it over time. A CGM has three parts. First, there is a tiny sensor that can be
inserted under your skin, often the skin on your belly or arm, with a sticky patch that helps it stay
there.
TROUBLESHOOTING:
• Some common ways that your glucose monitoring may be reporting inaccurate results: Improper
test strip use: Be sure you don't test with damaged or used strips. All glucose strips are one-time
use and can give incorrect results if they are expired, torn, or otherwise damaged.
• Not washing your hands before checking your blood glucose readings. One of the most important
tips to follow when testing your glucose levels with a glucometer is to wash your hands properly,
even if your hands do not look dirty. This is because not washing your hands before testing can
screw up the results.
• Blood test sample smeared or not large enough. Test strip incorrectly inserted. Wrong test strip
used. Temperature of the strip is too warm or cold.

THE TABLE BELOW TO TROUBLESHOOT GLUCOMETER

Sterilization
• It defines sterilization as killing all microorganisms including bacterial
spores. It categorizes dental clinic items as critical, semi-critical, and
non-critical based on contact with tissues and describes appropriate
handling for each. Critical items that cut or penetrate tissues must be
sterilized after every use.

CSSD
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.

Sterilization by autoclave
•Autoclaves provide a physical method
for disinfection and sterilization. They
work with a combination of steam,
pressure and time. Autoclaves operate
at high temperature and pressure in
order to kill microorganisms and spores.
They are used to decontaminate certain
biological waste and sterilize media,
instruments and lab ware.
Commonly recommended temperatures for steam sterilization are 250° F (121° C), 270°F (132°C) or 275°F
(135° C). To kill any microorganisms present, the items being sterilized must be exposed to these
temperatures for the minimum time recommended by the manufacturer of the device being processed

Chest Physiotherapy
Chest physical therapy (CPT or Chest PT) is an airway
clearance technique (ACT) to drain the lungs, and may
include percussion (clapping), vibration, deep breathing,
and huffing or coughing.
Chest physiotherapy includes
techniques and devices used to
make it easier to cough up excess,
thick or sticky mucus from your
lungs. Some of them work to break
up the mucus using vibration or by
applying percussion (force) to the
area of the lungs has mucus.

Chest physiotherapy
It is a group of therapies used in combination to mobilize pulmonary
secretions. Chest physiotherapy is the removal of excess secretions from the
lungs by physical means.
Uses:
• Assist in coughing.
• Re-educate breathing muscles.
• Improve ventilation of lungs.
THERAPIES included in chest physiotherapy:
Postal drainage,Chest percussion, vibration
Chest physiotherapy should be followed by productive coughing & suctioning
of the patient. Chest physiotherapy should never be done straight after a
meal or drink.

Equipment use in chest physiotherapy
• Trendelenberg bed
• Pillow, patient gown, towl
• Sterilized clothes
• Basin, Stethoscope
• Suction apparatus
• Mechanical precursor
• Chest radiograph
• Cardiac monitoring, pulse oximeter
• Emergency airway

Sphygnomanometer
An instrument for measuring blood pressure, typically
consisting of an inflatable rubber cuff which is applied to
the arm and connected to a column of mercury next to a
graduated scale, enabling the determination
of systolic and diastolic blood pressure by increasing and
gradually releasing the pressure in the Cuff which is more
oftenly known as blood pressure cuff.. The name
sphygmomanometer is derived from the Greek word
‘sphygmo,’ which means the pulse or heartbeat.

Block diagram of sphygnomanometer

Sphygnomamometer
• A sphygmomanometer is a device that measures blood pressure. It is composes
of an inflatable rubber cuff, which is wrapped around the arm. A measuring
device indicates the cuff's pressure. A bulb inflates the cuff and a valve releases
pressure. A stethoscope is used to listen to arterial blood flow sounds. As the
heart beats, blood forced through the arteries cause a rise in pressure, called
systolic pressure, followed by a decrease in pressure as the heart's ventricles
prepare for another beat. This low pressure is called the diastolic pressure. The
sphygmomanometer cuff is inflated to well above expected systolic pressure. As
the valve is opened, cuff pressure (slowly) decreases. When the cuff's pressure
equals the arterial systolic pressure, blood begins to flow past the cuff, creating
blood flow turbulence and audible sounds. Using a stethoscope, these sounds are
heard and the cuff's pressure is recorded. The blood flow sounds will continue
until the cuff's pressure falls below the arterial diastolic pressure. The pressure
when the blood flow sounds stop indicates the diastolic pressure. Systolic and
diastolic pressures are commonly stated as systolic 'over' diastolic. For example,
120 over 80. Blood flow sounds are called Korotkoff sounds.

Types
• ANEROID SPHYGMOMANOMETERS
• DIGITAL SPYGMOMANOMETERS
Android Digital

SYLLABUS: Final Course-260 hours
THEORY: Different procedures & equipments:80 teaching hours
Blood gas analysis( ABG):
Specimen collection & handling
• The sample can be obtained either through a catheter placed in an artery, or by using a needle and syringe to puncture an
artery. These syringes are pre-heparinized and handled to minimize air exposure that will alter the blood gas values.
Procedure
Place the filter cap on the syringe lower tip and hold the
syringe vertically. And gently tap the syringe. So that air
bubbles are forced to the top expel.
Equipment used in arterial puncture
include; ABG syringe, for an adult, use
a 20-gauge, 2.5-inch needle for a
femoral sample and a 22 gauge, 1.25-
inch needle for a radial artery
puncture, Also 23 gauge and 25 gauge
needle can be used.

SPECIMEN COLLECTION FOR ABG
Specimen collection
• 1. General biochemical tests are performed by collecting venous blood in the morning on an empty stomach.
Fast for 8-12 hours prior to blood collection.
• 2. For items requiring non-anticoagulant blood, take the prescribed amount of blood into a clean, dry tube.
Allow the blood to clot at room temperature and then separate the serum.
• 3. for items requiring anticoagulation, be sure to see which anticoagulation tube is being used and what
volume of blood is required. Shake well after injection into the tube to achieve anticoagulation. especially
items in dedicated anticoagulation tubes.
• 4. Anti-contamination items should be operated aseptically when collecting specimens. Some items also
need to be operated in an anaerobic environment.
• 5. urine tests require the collection of fresh mid-stage urine. The appropriate preservative needs to be
added when doing biochemical tests.

How to take blood for ABG
1. STERILE
Clean the area we are going to puncture with spirit or sterillium
2. PALPATE
Palpate the radial artery with figure of your left hand.
3. HOLD
Hold the syringe in similar fashion
4. PUNCTURE
Puncture at the base of your index finger where you feel palpitation.
5. BACK FLOW
Fix the position of needle with left hand & pull out the blood.
6. PRESSURE
Withdraw syringe slowly & put pressure on puncture site

The specimen handling requirements for an
arterial blood gas specimen:
• Arterial specimens should be collected in a plastic syringe, left at room temperature and analyzed within 30 minutes. Blood collected for
special studies should be analyzed within 5 minutes. There are still situations in which a glass syringe should be selected as the collection
device.
• An arterial blood sample is collected from an artery, primarily to determine arterial blood gases.
• For an arterial blood gas test, a respiratory therapist will take a sample of blood from one of your arteries. This is because there are higher
oxygen levels in blood from an artery than blood from a vein. A respiratory therapist usually takes the sample from an artery inside your wrist
known as the radial artery.
ABG step by step:
1. Flush heparin through the needle.
2. Insert the ABG needle.
3. Advance the needle and observe for flashback.
4. Allow syringe to self-fill.
5. Remove the needle and apply immediate pressure.
6. Engage needle safety device.
7. Remove the needle from the syringe.
8. Dispose of the needle into a sharps bin.

ABG operation:
Blood gas analyzer is usually in the pipeline system of negative pressure suction, the sample blood is sucked into the
capillary tube, and the capillary wall of the pH reference electrode, pH, P02, PC02 four electrodes contact, electrodes
will be iBe0 amount of the parameters obtained converted to their respective electrical signals, these electrical signals
after amplification, analog-to-digital conversion sent to the instrument's microcomputer, after processing the display
and print out the measurement results. thus completing the entire detection process.
Principle of operation:
ABG sensors measure the partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and hydrogen-ion concentration
(pH) used for monitoring the acid-base concentration essential for sustaining life.
Maintenance:
Calibrating several parts is needed every time the PPM is performed to guarantee that the device measures accurate
values. Furthermore, some parts such as pump cartridge, gas I/O port are required to be replaced every year to avoid
sudden failure.
Regular calibration is necessary to ensure accurate results, but it can be time-consuming and costly. Some blood gas
analyzers require daily or weekly calibration, while others only need to be calibrated every few months.
A cylinder of a gas mixture used for calibration of blood gas analyzers in medical laboratories contains 5.0% CO 2 ,
12.0% , and the remainder at a total pressure of 146 atm.

Planned preventive maintenance
• Biomedical equipment maintenance department in any hospital is responsible for keeping this equipment and others in
proper condition to ensure that the device is working properly avoiding long periods of downtime and that the readings
measured by the device is accurate and precise and reflect the actual values in patients’ blood sample. In order to achieve
this task, planned preventive maintenance according to manufacturer’s recommendations is required at fixed intervals.
• The breakdown period of the blood gas analyzer were reduced significantly due to following the manufacturer guidelines
in performing the planned preventive maintenance. The replacement parts needed repeatedly for fixing the devices such
as pump tube, electrodes, tube sets and others should be kept in the hospital inventory to reduce the downtime of the
equipment.
• Table and graph show the main components of blood gas analyzer that collapse repeatedly during the period of study. Gas
Electrodes were the most common cause of breakdown in the 4 locations. It failed 25 times, which require that this part
should be purchased and kept in the inventory to avoid the long period of downtime while waiting the long procedure of
purchasing the mentioned part. Pump tube and tube set should also be kept in the hospital as standby. because the
figures were 17, and 18 respectively. Faulty Part Frequency of fault 1. Pump tube 17 2. Fill port 10 3. Pump head 8 4.
Electrodes 25 5. Docking mechanisms 9 6. Tube set 18 7. Analog board 5 8. Needle 7 Table 2 shows the main components
that collapse repeatedly during the period of study.
• The breakdown period of the blood gas analyzer were reduced significantly due to following the manufacturer guidelines
in performing the planned preventive maintenance. The replacement parts needed repeatedly for fixing the devices such
as pump tube, electrodes, tube sets and others should be kept in the hospital inventory to reduce the downtime of the
equipment.

Planned preventive maintenance
The frequency of fault due to several device components:
0
5
10
15
20
25
30
Frequency of fault
Series 1
Table shows the main components that collapse repeatedly
during the course of study.

Troubleshooting of ABG Machine
• Missing or wrong patient/sample identification;
• Use of the incorrect type or amount of anticoagulant.
• Inadequate stabilization of the respiratory condition of the patient.
• Inadequate removal of flush solution in arterial lines prior to blood collection.
• User-intervention-required mode is used to correct errors by suspending all wet-section activities
in case the following analyzer conditions occur:
• Problems with the inlet leaking
• Solution transport errors (e.g. leakage)
• Problems with Sensor Cassette or Solution Pack It might require several actions to correct the
condition. Until the condition has been corrected, the analyzer cannot be restarted.
• Press Test again to leave the User-intervention required screen.

Step 1 To replace the Solution Pack
1. Tap Menu > Analyzer status > Replacements > Replace > Replace solutions.
2. Lift the inlet to the capillary position and wait for the Solution Pack to unlock.
3. Remove the used Solution Pack and dispose of it as infectious waste according
to the regulations in your institution.
4. Activate the new Solution Pack by pulling out the safety pin.
5. Press the lid firmly down by pressing the elevated side (where the safety pin was)
down until the side taps click into the side tap holes.
6. Insert the new Solution Pack by pushing it fully into place until a click is heard.
7. When prompted by the analyzer, close the inlet.
8. Enter operator name and any notes, using the Keyboard or the Note button to
display the keyboard and to enter the operator name/note. Confirm the entry with
the Enter button on the keyboard.

STEP2: To flush the fluid transport system
• 1. Tap the Press to start video guidance button.
• 2. Lift the handle to the capillary position.
• 3. Remove the Solution Pack.
• 4. Close the inlet.
• 5. Place paper tissue below the inlet.
• 6. Attach the flush device to the waste connector.
• 7. Inject water and air in segments.
• 8. When it is possible to obtain a continuous unbroken stream of water, the fluidic path is
cleaned.
• 9. Remove the tube and paper tissue.
• 10. Lift the inlet handle to the capillary position.
• 11. Install Solution Pac. Close the inlet.

Step3: To replace the inlet gasket holder
! WARNING – Risk of infection
To avoid the risk of infection take care not to scratch or stab yourself on the probe
! WARNING – Risk of infection
Be aware that the inlet gasket has been in contact with blood and should be handled as
potentially infectious.
1. Tap the Menu > Analyzer status > Other activities > Inlet check > Repl. Inlet Gasket
Holder buttons.
2. Tap the Press to start video guidance button.
3. Pull off the inlet cover.
4. Lift the handle to the capillary position.
5. Pull out the Inlet Gasket Holder
6. Push a new Inlet Gasket Holder in place.
7. Close the inlet and put on the inlet cover.

Installation of ABG
1. Seal pack box
2. Unpack the box
3. Accessories with the instrument
4. Unpacking the instrument
5. Instrument view 360degree
6. Installing of electrodes
7. Fixing of tubes/tubings
8. Installing of reagent pack
9. Installing of pump tubing
10. Installing of paper roll
11. Installing of power adapter
12. Reagent priming
13. Cal A mv Data
14. System Calibration
15. Analysis of Quality Control
77.. 6. 9
10
11.
12

Programming in ABG
• Blood Gas Analyzer is an automated, microprocessor-controlled electrolyte, blood gases and
metabolites system that uses current ISE technology to make imbalance of electrolyte
measurement, Impedance technology to make imbalance of HCT and Amperometry technology to
make imbalance of gases and it has external barcode scanner, keyboard, and mouse. ABG Blood
Gas Analyzer is used for quantitative determination/ measurement of Sodium, Potassium,
Calcium, Lithium, pH, Chloride, pCO2, pO2, Hct, in whole blood/ plasma/ serum/CSF.
• It is also used for quantitative determination/measurement of Sodium, Potassium and Chloride in
urine and measures the calculated parameters of SO2, Hb, nCa, HCO3, TCO2, SBC, O2Ct, pO%, BE,
BE-B, BE-ECF, AG-Na, AG-K, A, AaDO2, a/A in arterial blood, serum, plasma, and urine. Our ST 200
ABG Gas Analyzer acquires 25 different results (9 different measuring parameter results along
with 16 different calculated parameter results) Measurements obtained by this device are used
for the diagnosis, monitoring, and treatment of diseases involving Electrolytes, Blood Gases,
Blood Hematocrit and Metabolites Imbalance.
• ABG Blood Gas Analyzer is designed for near patient testing as well as laboratory testing also.
Snap-in electrode design, combined with precise control of calibrator volumes, ensure economical
operation and a low cost per sample in our analyzer.

CRRT (Continuous Renal Replacement Therapy)
Continuous renal replacement therapy (CRRT) is
an available renal replacement method that
includes intermittent hemodialysis and peritoneal
dialysis.

CRRT
Is an extracorporeal blood
purification therapy intended to
substitute for impaired renal
function over an extended period of
time and applied for or aimed at
being applied for 24hrs a day
PURPOSE
When the nephrons in the kidney
are failure or not working properly,
the ions like potassium, creatine etc
we go through dialysis.
Disease of renal failure are:
Nephrotoxins, diabetic,
nephropathy, hypertension,
glomerulonephritis, cystic kidney
disease.

Principle underlying in CRRT
OPERATION:
During the CRRT dialysis therapy, the patient’s blood
passes through blood purification machine, filter and
blood warmer. This blood purification therapy is a slow
and continuous process which can run continuously 24
hours a day to remove fluid and uremic toxins from the
blood and return the blood back to the patient’s body.

Maintenance & TROUBLESHOOTING
Maintenance:
• Regularly check all lines and connections for signs of wear or damage.
• Ensure that all fluid bags are correctly placed and have sufficient volume for the session.
• Monitor the patient’s vital signs and fluid balance closely.
• Follow the manufacturer’s instructions for the specific CRRT machine in use.
Troubleshooting:
• Low Arterial Pressure Alarm: Check for kinked or clamped lines, declot if necessary, and assess for hypovolemia
• High Venous Pressure Alarm: Again, check for kinks or clamps, declot if necessary, and consider positional changes if there’s a vascular access obstruction
• Disconnection Alarm: Verify all connections, check for kinks, and adjust the blood pump speed if required
• Air in the Circuit Alarm: Follow the machine’s instructions for degassing, stop the session if there’s a disconnection at arterial access
• Fluid Balance Error: Stabilize or reposition effluent or hemodialysis/filtration bags, remove any kinks in lines, and address machine errors as per the guidelines
• For detailed procedures and machine-specific instructions, it’s best to refer to the operational manual of the CRRT device or consult with a clinical specialist. If you’re
experiencing persistent issues, it may be necessary to contact technical support for assistance. Remember, patient safety is paramount, so any unresolved issues should be
addressed immediately.

QUALITY CONTROL OF CRRT
• Quality control in Continuous Renal Replacement Therapy (CRRT) is crucial for ensuring
effective treatment for critically ill patients with acute kidney injury. Here are some key
points to consider for maintaining high-quality CRRT:
• Standardization of Protocols: Implementing standardized protocols across healthcare
systems can help improve the performance and delivery of CRRT
• Performance Indicators: Establishing key performance indicators (KPIs) for CRRT can aid
in monitoring and reporting, which is essential for adjusting practice and delivering
optimal therapy
• Multidisciplinary Approach: Optimal delivery of CRRT requires coordination of care from
multiple providers and areas of expertise, highlighting the need for a multidisciplinary
team
• Quality Indicators: A systematic review of quality indicators in CRRT care can provide
evidence-based measures to support appropriate, safe, and efficient delivery of CRRT
• Technical Components: Monitoring technical components such as solute clearance,
prescribed/delivered dose, and anticoagulation is important for dynamic CRRT

CLINICAL APPLICATION
Continuous renal replacement
therapy (CRRT) is frequently utilized in
ICU settings, particularly in patients with
severe AKI, fluid overload, and
hemodynamic instability. The main goal
of CRRT is to timely optimize solute
control, acid-base, and volume status.

INFUSION PUMP
An infusion pump infuses fluids, medication or nutrients into a patient's
circulatory system. It is generally used intravenously, although subcutaneous,
arterial and epidural infusions are occasionally used.
PRINCIPLE
An infusion pump draws fluid from a standard bag of intravenous fluid and
controls the rate of flow. It provides accurate and continuous therapy.
Because it can use any size bag of intravenous fluid, an infusion pump can be
used to deliver fluids at either a very slow or very fast infusion rate. It is
suitable for intravenous, subcutaneous, enteral & epidural infusions.
OPERATION: The pump can be operated manually or remotely, using tubing
attached to the patient's body to deliver the medication. Infusion pumps are
used for various medical purposes, but they all have one thing in common:
they deliver a steady flow of medication over a set amount of time.

MONITORING
Nurses must also verify pump settings with each shift change. The nurse must follow the
PCP order for pump settings, dosage, and medications as it is written. The nurse
should monitor the patient's level of pain, level of consciousness, blood pressure, and
respiratory rate. A health care provider is responsible for regulating and monitoring the
amount of IV fluids being infused. IV fluid rates are regulated in one of two ways: Gravity.
The health care provider regulates the infusion rate by using a clamp on the IV tubing,
which can either speed up or slow down the flow of IV fluids.
TROUBLESHOOT:
The followings are common faults and troubleshooting methods of infusion pumps:
• Bubble false positive
• No external power supply
• Error alarm
• Inaccurate flow rate
• Inaccurate drops
• No alarm or false alarm in case of blockage
• The infusion pump does not start

TROUBLESHOOTING of infusion pump
1. BUBBLE FALSE POSITIVE:
No bubbles in the tubing of the infusion set, the bubble light is on and the buzzer
sounds.
• Check whether the power switch is turned on before installing the card infusion
set.
• Check whether the card is correctly installed in the infusion set. If it is not
correct, reinstall the card in the infusion set.
• Check whether the bubble probe is clean. If it is not, wipe it with alcohol cotton.
• After entering the high-level debugging program, press: "Start/Stop button" to
watch the bubble value change when the bubble light is on, and install the
infusion pump filled with liquid and exhausted air (it is immediately after the
pump door is opened). The starting value is 0-20, and the ending value is above
700 after closing the pump door).

2) No external power supply
This means that the external power indicator does not light up after the AC
power is plugged in, and the battery indicator lights up and the buzzer sounds
after the machine has been working for a period of time.
(1) Check whether the power socket has electricity and if the power socket is out
of power, supply power to the power socket.
(2) Check whether the power cord is in good contact with the socket. If the power
cord is not in contact with the socket, connect the socket to the power cord.
(3) Check whether the fuse in the socket at the back of the machine is in good
condition. If the fuse is intact, check whether the power switch is intact and
whether the power switch is working. If the power switch is not good, replace the
power switch.

3) Error alarm
This means that the fault indicator is on and the buzzer sounds.
(1) Check whether the card is installed correctly in the infusion set. If it is not correct, reinstall the infusion set.
(2) Check whether the infusion set used for calibration accuracy is used.
(3) Observe whether there are traces of liquid medicine in the pump body.
(4) Enter the debugging program to see the operation of the pump body. The pump does not respond: check the power supply and timing belt,
(5) Observe the voltage change of the photoelectric switch on the drive board (the high level should be greater than 4.5V, and the low level
should be less than 0.2V), and the drive board should not be changed.
(6) Check whether you can enter the debugging program. If you cannot enter the debugging program, check the cable, and observe whether
the main control chip and driver chip are inserted in place and whether the software version is compatible.
(7) Enter the debugging program to see if the accuracy value is normal, if not normal, adjust to 500
(8) Check whether the light barrier is loose or falling off.
(9) Open the door of the infusion pump in the shutdown state, and feel the resistance by turning the pump body by hand. If the resistance is
small, check whether the pump pressure is appropriate, and re-adjust the pressure if it is inappropriate. If the resistance is large, change the
pump body and re-adjust.

4) Inaccurate flow rate
This means that the given volume of liquid medicine has not been delivered in the
calculated time.
(1) Check whether the pump pressure is normal, and re-calibrate.
(2) Check whether the card is installed correctly in the infusion set. If it is not
correct, reinstall the card.
(3) Check whether the infusion set is selected correctly. If not, select the correct
gear.
(4) Check whether the infusion set used is consistent with the brand and batch
number of the infusion set used in the calibration accuracy. If it is inconsistent,
replace the infusion set with the same brand and batch number as the calibration
accuracy.

5) Inaccurate drops
This means that the number of drops in the drip pot of the infusion set
does not match the number of drops set by the infusion pump.
(1) Check whether the pump pressure is normal.
(2) Check whether the parameter setting of "Drops/ml" is correct.
(3) Check whether the flow rate is accurate.
(4) Check whether the actual number of drops per milliliter of the infusion
set is 20 drops.

6) No alarm or false alarm in case of blockage:
This means that in the normal infusion state, there is no alarm after the
pipeline is blocked or the block alarm occurs when there is no blockage.
(1) Check whether the blocking alarm sensitivity value is set correctly.
(2) Check blocking sensors and cables: you can judge the changes in the digital
quantity after A/D conversion in the debugging program. Enter the debugging
program, press Start/Stop to make the blocking light illuminate. Open the
pump door and press the obstruction sensor to see the value change. If the
value changes and can reach more than 700, it means that the Hall device is
good.

7) The infusion pump does not start
This means that the p2 infusion pump turns on the power switch when the external power
supply is turned on, the charging indicator, the external power indicator, and the infusion
set selection indicator are all on, and when the cumulative amount of infusion is displayed
as 0, the infusion flow rate and infusion volume are set after pressing the start button, the
infusion pump does not operate normally.
(1) Check whether the pump door of the infusion pump is closed, if not, close the pump
door.
(2) Check whether the infusion set selection light is flashing in the power-on state, and
check if it is flashing.
(3) Check whether the ambient temperature or the temperature of the environment where
the infusion pump is placed is higher than 18°C. If the temperature is lower than 18°C,
please use the infusion pump in an environment higher than 18°C.If you want to know
more about the infusion pump after reading the above, please contact BQ+ for
professional advice and solutions.

BLOOD ELECTROLYTE ANALYSIS
An electrolyte panel, also known as a serum electrolyte test, is a blood
test that measures levels of the body's main electrolytes: Sodium,
which helps control the amount of fluid in your body. It also helps your
nerves and muscles work properly. Chloride, which also helps control
the amount of fluid in your body.
SPECIMEN COLLECTION & HANDLING:
A health care professional will take a blood sample from a vein in your
arm, using a small needle. After the needle is inserted, a small amount
of blood will be collected into a test tube or vial. You may feel a little
sting when the needle goes in or out. This usually takes less than five
minutes.

Operation of blood electrolyte analyser:
An electrolyte test is a simple and quick procedure that can be carried
out at your doctor's office or a lab. A small amount of blood taken from
your arm is sent to a lab for analysis. The test results will help your
doctor understand how well your body can maintain fluid and
electrolyte balance.
Principle:
An electrolyte test is a blood test that measures if there's an electrolyte
imbalance in the body. Electrolytes are salts and minerals, such as
sodium, potassium, chloride and bicarbonate, which are found in the
blood. They can conduct electrical impulses in the body.

How to Use an Electrolyte Analyzer
Preparing the Analyzer
Before using an electrolyte analyzer, it's crucial to calibrate the device and perform quality control checks to ensure accurate results. Proper sample collection and
handling are essential to prevent contamination and ensure the integrity of the analysis.
Running a Test
Running a test on an electrolyte analyzer involves a step-by-step procedure. The device measures the ion concentration in the sample and provides results that
healthcare professionals can interpret to make informed decisions about patient care.
Maintenance and Troubleshooting
Regular maintenance is essential to keep the analyzer in optimal working condition. Healthcare professionals should also be aware of common issues and their
solutions to ensure the accuracy of test results.

Working Principle of Electrolyte Analyzers
Electrochemical Sensors
Electrolyte analyzers typically employ electrochemical sensors, such as ion-selective electrodes (ISEs), to detect specific ions in the sample. These sensors work
based on the principles of electrochemistry and ion exchange.
Measurement Techniques
The analyzers utilize various measurement techniques, including direct potentiometry and indirect ion-selective electrode methods, to determine ion concentrations
accurately.
Explanation of Ion Concentration Measurement
The device measures the electrical potential difference generated when the ions in the sample interact with the selective electrodes, allowing for the calculation of
ion concentration.

INSTALLATION of blood electrolyte analyser
The installation kit contain:
1. Analyzer
2. Reagent pack
3. Reference housing with electrode
4. Daily cleaner kit
5. Quality control kit
6. Urine diluent
7. Reference IFS
8. Troubleshooting kit
9. Waste bottle
10. Dust cover

Programming of blood electrolyte analyser
PROGRAMMING:
Ion selective electrodes technique is a more universal method for the
high throughput determination of electrolytes in physiological samples;
Beckman Coulter Synchron CX9 PRO is an example of such a system.

CARDIOPULMONARY RESUSCITATION
Cardiopulmonary resuscitation (CPR) combines rescue
breathing (mouth-to-mouth) and chest compressions to
temporarily pump enough blood to the brain until
specialised treatment is available. Chest compressions are
the priority in CPR.
7 basic steps of CPR
• Assess the situation. Make sure the person is on a firm
surface. ...
• Call for help. ...
• Open the airway. ...
• Check for breathing. ...
• Start chest compressions. ...
• Deliver rescue breaths. ...
• Continue CPR steps.

BASIC CPR
CPR works on the principle of 30 chest compressions and
2 breaths of rescue breathing (mouth-to-mouth) – known
as : Automated external defibrillators (AEDs) can be used
by anyone in an emergency and are easy to use. Voice
prompts guide you through what to do.
The Advanced Resuscitation course actually enhances
what you have already learned in CPR training. In addition
to being able to perform chest compressions, you will be
taught how to use certain equipment.

ADVANCED CARDIAC LIFE SUPPORT
Advanced Life Support (ALS), also referred to as Advanced Cardiac Life
Support (ACLS), is a set of life-saving protocols and skills that extend
beyond Basic Life Support (BLS). It is used to provide urgent treatment
to cardiac emergencies such as cardiac arrest, stroke, myocardial
infarction, and other conditions.
Oxygen Therapy
Oxygen therapy is a treatment that provides you with extra oxygen to
breathe in. It is also called supplemental oxygen. It is only available
through a prescription from your health care provider. You may get it in
the hospital, another medical setting, or at home.

AEROSOL THERAPY
Aerosol therapy is a technique of administering drugs by
inhalation through a nebulizer or compressor. The first is
used in clinics and hospitals while the second can be used
by the patient in daily life.
Aerosol medications can be delivered directly to the bloodstream through the lungs
without the complications of and IV such as pain and injection site infection. This
technique is used mostly for dosing medication for lung conditions like asthma, but it may
be beneficial for other therapies as well.
Nebulizers create an aerosol by agitating a medication
solution held in a small reservoir. The patient must load
the reservoir for each treatment.

PATIENT PARA MONITORING
Para monitors help provide information on multiple parameters like
ECG, blood pressure, respiration, oxygen saturation and temperature to
understand the condition of patients and monitor vital signs. It is used
for critical patients.

COMPLICATIONS OF ICU CARE
Delirium, hypotension, hypoxemia, prolonged sedation, and hypoglycemia may be important risk
factors for cognitive impairment related to an ICU stay. Consider a cognitive evaluation by a speech
pathologist in the hospital or as part of post-acute care in patients who are recovering from critical
illness.
• POST-INTENSIVE CARE SYNDROME & OTHER LONG-TERM PHYSICAL AND COGNITIVE DISABILITY.
• COMPLICATIONS ASSOCIATED WITH MECHANICAL VENTILATION.
• DELIRIUM.
• INFECTIONS.
• DVT/PE.
• DECUBITUS ULCERS.
• MALNUTRITION.
• CRITICAL ILLNESS POLYNEUROPATHY, CRITICAL ILLNESS MYOPATHY, AND ICU-ACQUIRED
WEAKNESS.

Nutrition for critically ill patient
• To actually measure energy use requires sophisticated equipment so requirements are more often estimated using formulae.
One such formula is the Harris Benedict Equation which estimates basal metabolic rate (BMR) in kcal/day.
• Harris Benedict Equation:
• For _: BMR = 13.75 x weight (kg) + 5 x height (cm) – 6.78 x age (years) + 66
• For _: BMR = 9.56 x weight (kg) + 1.85 x height (cms) – 4.68 x age (years) + 655
• This will usually give a result of around 25 kcal/kg/day. The equation estimates BMR in afebrile healthy individuals and will
therefore need to be modified according to the situation to calculate resting energy expenditure (REE).
• A careful balance of macronutrients (protein, lipid and carbohydrate) provides the energy requirements whilst micronutrients
(vitamins and minerals) are required in very small amounts to maintain health but not to provide energy.
• Protein around 1.5 – g/kg/day (range 1.2 to 2.0 g/kg/day for ICU patients) Use 2g/kg/day if severely catabolic eg. severe
sepsis/burns/trauma Provides 5.3 kcal/g
• Lipid – Provides 9.3 kcal/g Calories from lipid should be limited to 40% of total calories
• Carbohydrate – Provides 3.75 kcal/g in vivo Give the remaining the energy requirements as carbohydrate
• The proportion of a feed made up by protein is sometimes expressed as a calorie: nitrogen ratio. 6.25g of protein contains 1g
of nitrogen. The ratio is then calories (kcal) ÷ nitrogen (g). Recommended calorie: nitrogen ratios are around 100:1 which will
be achieved using the above figures. The optimal ratio for lipid: carbohydrate is not known.
• Micronutrients Vitamins are organic compounds that usually act as cofactors for enzymes involved in metabolic pathways.
Trace elements are ions that act as cofactors for enzymes or as structurally integral parts of enzymes and are often involved
in electron transfer. These will be discussed further with parenteral nutrition.

Daily Electrolyte requirements
Daily requirements for Trace Elements and Vitamins
for patients receiving TPN
Control of glucose has been shown to reduce
mortality and ICU morbidity. The benefits seem
to be greater for surgical rather than medical
patients but the results have been difficult to
reproduce so effectively elsewhere. However
most ICU’s now regulate glucose more tightly
but there is variation in target values. Treatment
generally starts if glucose climbs above 8.3 and
aims to reduce glucose to a varying degree (the
original research suggested a glucose target of
4.4-6.1 mmol/l)

INFECTION IN ICU
PREVENTION
Routine hand washing before and
after patient contact remains the
most important infection control
measure. Transmission of
exogenous Staphylococcus or
other potential pathogens,
especially in the ICUs where
patient care necessitates frequent
contact, by the hands of HCWs is
well-documented.
CONTROL
Standard Precautions
• Hand hygiene.
• Use of personal protective equipment (e.g.,
gloves, masks, eyewear).
• Respiratory hygiene / cough etiquette.
• Sharps safety (engineering and work practice
controls).
• Safe injection practices (i.e., aseptic
technique for parenteral medications).
• Sterile instruments and devices.
• Clean & disinfected environmental surface.

ETHICAL ISSUE OF ICU
The ethical problems in the context of ICU admission and discharge can be divided
into problems concerning full bed occupancy and problems related to treatment
decisions. The gap between the high level of care the ICU can provide and the
lower care level in the general ward sometimes leads to mutual misunderstandings.
Major sources of conflicts are behavioral issues, such as verbal abuse or poor
communication between physicians and nurses, and end-of-life care issues
including a lack of respect for the patient's autonomy. The ethical conflicts are
significantly associated with the job strain and burn-out syndrome of healthcare
workers, and consequently, may threaten the quality of care. To improve the quality
of care, handling ethical conflicts properly is emerging as a vital and more
comprehensive area. The ICU physicians themselves need to be more sensitive to
behavioral conflicts and enable shared decision making in end-of-life care. At the
same time, the institutions and administrators should develop their processes to
find and resolve common ethical problems in their ICUs.

BLOCK DIAGRAM OF ANESTHESIA MACHINE

Gas flow control system of anesthesia machine

Microcontroller based anesthesia injector

Design & implementation of anesthesia machine
monitoring

Methodology of Anesthesia machine

Anesthesia machine working principal

DIPLOMA IN CRITICAL CARE UNIT IN HOSPITAL

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