DIAGNOSTIC EQUIPMENT

Stethoscopes
S tethoscop es require little m aintenance apart from replacem ent o f lost, cracked, or
broken parts, such as ear-pieces and diaphragms (Fig. 3.3). O n the older types, the
tubing m ay perish and need replacing. W hile it is possible to buy proper, but
expensive, stethoscop e tubing, ordinary tubing o f a suitable size m ay be fitted.
M o st new er stethoscop es have tubing that does n o t perish, though it can becom e
sticky if certain chemicals com e into contact w ith it.

If nothing can be heard through a stethoscope, check w hether:

— The earpieces are blocked; if they are, unscrew them, push the blockage out and
clean w ith a little spirit.
— The diaphragm is m issing or split; replacem ents can be purchased or can be made
out o f a piece o f radiographic film or similar plastic sheet.
— The tube is split.

Fetal stethoscop es require no maintenance. T h e servicing o f electronic steth o ­

scopes is outside the scope of this manual.

Electrocardiograph machines and cardiac monitors

Electrocardiograph (ECG) m achines are used to m o n ito r the electrical activity of
the heart and display it on a small screen or record it on a piece o f paper. The
electrical activity is picked up b y means of electrodes placed on the skin. T h e signal
is amplified, processed if necessary, and then displayed.

T here are m any types o f EC G machine and cardiac m onitor, ranging from the very
basic, w hich will ju st show or write the EC G trace, to com plex m achines that will
give much m ore inform ation about the status o f the heart, and m ay com bine a
screen and a paper-w riter. T hese machines run off the mains electricity supply and,
in addition, often have internal rechargeable batteries.

Maintenance and safety checking

T h e follow ing item s o f test equipm ent are required:

— a digital m ultim eter or a goo d analogue m eter;

— a "M e g g e r" (for h ig h-voltag e insulation testing);
— a safety checker;
— an EC G sim ulator (this is an instrum ent that produces a signal similar to that of
the heart and makes w orkshop testing much easier).

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MAINTENANCE AND REPAIR OF LABORATORY AND HOSPITAL EQUIPMENT

The first tw o item s are essential. A safety checker is n o t essential, but testin g will
be limited w ithout it. (If a safety checker is n o t available, make up an earth-leakage
current tester, as described below .) Follow the instructions and the service manual
supplied b y the manufacturers.

Safety checking is m ost im portant. Faulty insulation or earth connections can be

serious. Safety checks should be undertaken at least tw ice a year. K eep a log b ook
w ith details o f each safety check and each reported fault.

The follow ing four tests should be carried out as a minimum (additional tests are
possible w ith a safety checker).

• Earth continuity: using a m ultim eter, a reading o f less than 0.1 ohm s should be
obtained b etw een the earth pin on the mains plug and the chassis o f the unit.
• M ains circuit insulation: using a "M e g g e r", check that there is at least
5 0 M ohm s betw een the earth pin and live pin, and b etw een the earth pin and
the neutral pin, on the mains plug.
• Patient circuit insulation: using a "M e g g e r", check that there is at least
5 0 M o h m s b etw een the patient lead connections and the earth pin and the live
pin and the neutral pin on the mains plug. (Conduct the tw o insulation tests at
5 0 0 volts.)
• Earth leakage: using the test equipm ent illustrated in Fig. 3.4, check that the
leakage current is less than 5 0 0 microamps.

A fter safety checking, carefully clean the m achine b oth inside and outside.

Earth-leakage current tester

The 1 kohm resistor should be of a non-inductive type, i.e., a carbon-film resistor,

and n ot wire-w ound. M o u n t the circuit show n in Fig. 3 .4 in a b o x. O n e side o f the
b o x should be fitted w ith a mains plug. The other side should be w ired to a socket
into which the appliance to be tested m ay be plugged. The tw o test points are
m ounted on the same face o f the b o x as the socket, but clear o f it. C onn ect the
instrum ent to the mains supply, and plug the equipm ent under test into the socket
o f the instrum ent, then sw itch on the power.

Fig. 3.4. Earth-ieakage current tester.

1 kohm

0 : test points

This test equipm ent is used w ith a multimeter. Select the A C m illivolts settin g on
the m eter and conn ect it to the points shown. The m illivolts reading during the
test will be equivalent to m icroam ps. Thus, it should read less than 5 0 0 millivolts.

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DIAGNOSTIC EQUIPMENT

Important spares

Patient electrodes
Patient leads
Styli
Paper

Common faults

W hen an EC G m achine does n o t w ork check the follow ing points before taking off
the covers to look for electrical/electronic problem s:

• Check that the m achine is correctly conn ected to the patient.

• Check that the patient electrode connections are clean and in g o o d condition;
dirty or corroded connections will g ive problem s.
• C heck that the leads to the patient are in g o o d condition, that the conductor is
not broken, and that there is n o t a short circuit to the cable screening.
• If the m achine is being run off its battery, check that the b attery is in good
condition and that the charger is w orking correctly.
• C heck that the stylus of the writer is heating correctly, and is n ot w orn or
damaged.
• Check that there is no m echanical damage, e.g., a broken on/off switch.

If there is no fault w ith any o f these, it is likely that there is an electrical/electronic

problem . Send the m achine to the manufacturer or appointed agent.

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