Al Salam University College

Medical Instrumentation Technologies

Engineering

Endoscopes
Lab 4
3rd stage
Medical instrumentation
Dr. Hajir M. Ali

Endoscopes
Function
Endoscopy means looking inside the body using an endoscope, an instrument used to
examine the interior of a hollow organ or cavity of the body. Endoscopes are inserted
directly into the organ. An endoscope can consist of a rigid or flexible tube, a light
delivery system (light source), an optical fiber system, a lens system transmitting the
image to the viewer, an eyepiece and often an additional channel to allow entry of
medical instruments, fluids or manipulators. There are many different types of
endoscopy, including arthroscopy, bronchoscopy, colonoscopy, colposcopy,
cystoscopy, laparoscopy and laryngoscopy.

How it works
Endoscopes may be rigid or flexible, although most endoscopes in routine use are
flexible. Both use lenses, tubes and light to magnify and view the internal structures
of the body. Water and air, as well as surgical instruments that may be necessary to
take a tissue sample, can also be passed along the hollow center of the endoscope.
The view can be recorded by a camera and displayed on a computer screen.
Rigid endoscopes are usually much shorter than flexible endoscopes. They are often
used to look at the surface of internal organs, and may be inserted through a small cut
in the skin or a natural orifice. Gas or fluid is sometimes used to move the surface
tissues of organs in order to see them more clearly. Rigid endoscopes are commonly
used to examine the joints and bladder.

1
Troubleshooting- Endoscopes

2
How to Thoroughly Clean and Disinfect Immersible GI Endoscopes
1. Pre-Cleaning
THIS STEP IS TO BE PERFORMED IN THE EXAMINATION ROOM.
A.) Wipe Insertion Tube - Immediately after the procedure, wipe down the
insertion tube with a clean soft cloth or gauze saturated with enzymatic detergent
formulated for use with endoscopes.
B.) Aspirate Enzymatic Detergent Through Channel Systems - Suction the
enzymatic detergent solution through the endoscope. Dual-channel scopes
require aspiration of detergent through both channels.
C.) Clear the Air / Water Channels - Follow the manufacturer’s instructions.
D.) Detach Removable Components - Soak in detergent solution.
- Air / Water Valve
- Suction Valve
- Biopsy Port Cap

2. Leak Testing
TO BE PERFORMED IN THE DECONTAMINATION AREA.
Always leak test per manufacturer’s instructions found in the endoscope’s
owner’s manual. If a leak is detected, you MUST keep positive pressure in the
endoscope throughout the disinfection process either with a manual leak tester or an
automatic leak testing
unit (shown to right). Failure to do this could result in a costly fluid invasion of the
scope.
A.) Perform a DRY Leak Test.
Prior to immersing into any fluid, a dry leak test needs to be
performed. Visually inspect the water resistant cap for damage
or wetness. If it is either, please use a different cap. Attach the
water resistant cap to the endoscope. Never attach or disconnect
this cap while the scope is immersed. Attach the automatic leak
testing unit (or manual tester) to the endoscope and introduce
positive air pressure into the scope. Follow documented steps
to ensure the fluid-tight integrity of the scope. If using a manual
tester (shown to left), pay close attention to the needle gauge for any significant
movement that would indicate loss in pressure and a possible leak.

3
B.) Perform a WET Leak Test.
If there is a failure during the dry test with the automatic leak testing unit, a wet test
is required to determine where the leak is located. Attach a manual leak tester (or
maintenance unit) to the endoscope and continue constant pressurization.
Immerse the endoscope into a pan of clean water. Angulate the distal tip in all
directions. Deflecting the tip will assist in exposing potential pin holes in the bending
section rubber.
Wipe away any bubbles on the endoscope. If no additional bubbles are visible, the
endoscope is air and fluid tight.
Note: If a leak is detected, to avoid further damage please contact
Life Systems, Inc. for instructions on how to safely decontaminate the endoscope to
safely send it in for repair. All scopes must be decontaminated prior to shipment.

3. Manual Cleaning
TO BE PERFORMED IN THE DECONTAMINATION AREA.
Failure to properly perform this step can pose an infection control risk.
Soak in Enzymatic Cleaner - All steps should be performed while the scope is
completely
immersed in cleaner. To prepare the detergent, follow the manufacturer’s
instructions.
A.) Submersion - Gently coil the endoscope and completely submerge it into a basin
of freshly
prepared detergent. All steps below should be performed with
the scope submersed.
B.) Components - Transfer the previously removed
components into the cleaning tub. Scrub,
the suction valve areas, depress the button
and then brush all areas.
C.) Exterior Cleaning - Use a soft brush or lint
free cloth to clean the exterior surface of the
endoscope. Take care when cleaning the distal
tip as to avoid scratching the small lenses.
D.) Brushing the Channels - Use cleaning brushes to scrub ALL areas of the suction
/ biopsy channel system. This includes the insertion tube, all channel inlets, suction
valve housing and suction port connector. To remove debris, always clean the brush
each time it exits the distal tip and umbilical cable. Repeat process until there is no
visible debris on the brush.
E.) Flush the Channels - Attach cleaning adapters to the appropriate ports on the
endoscope. Aspirate the detergent through all channels to remove any loose debris.
Continue until there is no visible debris is present.
F.) Soak Channels with Cleaning Solution - Using a syringe, fill the channels full
of the detergent solution. Remove cleaning adapter.

4
G.) Soak endoscope and components in cleaning solution - Refer
to the detergent manufacturer’s instructions for recommended length
of time required to clean scopes.

4. Rinsing & Drying:

TO BE PERFORMED IN THE DECONTAMINATION AREA.
A.) Thoroughly Rinse Detergent from the Endoscope - This
includes all surfaces, the removed components and internal channels
with clean water. Use a clean, lint-free cloth to wipe outside of the
endoscope.
Reconnect the suction cleaning adapter and aspirate rinse water
through the channels.
B.) Purge All Channels with Air - Hold distal tip above
water and aspirate all channels with air.
C.) Thoroughly Dry All Areas of the Endoscope -
To ensure the effectiveness of the high-level disinfectant utilized in the next step, all
areas – including the channels – must be completely dried. Use a clean, lint-free cloth
to dry the exterior areas of the endoscope.
Internal channels should be dried by utilizing forced air.

5. Disinfection
TO BE PERFORMED IN THE DECONTAMINATION AREA.
A.) Prepare the High Level Disinfectant - According to manufacturer’s
instructions.
B.) Immersion - Attach suction cleaning adapter and immerse scope completely into
the disinfectant solution.
C.) Disinfecting the Channels - Attach a syringe to the cleaning adapter and
withdraw
the plunger to pull the disinfecting solution into the channels. To make sure the
channels are full, check both hoses of the cleaning adapter. If they are filled with the
solution, so are the channels. Disconnect the syringe and adapter from the scope.
D.) Soak the Endoscope, Components and Cleaning Adapter - Consult the
disinfectant manufacturer’s instructions for appropriate length of time to properly
soak the equipment for disinfection. Use a timer to ensure that this is achieved.

Note: If using an automatic endoscope

reprocessor (AER), follow the
instruction manual that came with the
unit.

5
6. Rinsing & Drying
TO BE PERFORMED IN THE DECONTAMINATION AREA.
Failure to properly perform this step can pose a toxic risk to future patients.
A.) Dispel Disinfectant - After soaking for recommended amount of time, reconnect
the suction cleaning adapter and then connect a sterile syringe to it. Inject air to
purge the disinfectant solution from the channels.
B.) Rinsing Disinfectant - Transfer the endoscope and components into a basin of
fresh rinse water. Fully submerge the equipment. Use a lint free cloth to wipe the
exterior surfaces of the endoscope. Connect the cleaning adapter to a suction unit and
pull fresh water through the channels. If using an AER, rinsing is performed by the
unit.
C.) Remove Endoscope from Rinse Water - Transfer the endoscope and
components onto a sterile towel.
D.) Drying the Endoscope - Use a sterile, lint-free cloth to thoroughly dry all
external areas of the endoscope and cleaning adapter.

7. Alcohol Flush :
TO BE PERFORMED IN THE DECONTAMINATION AREA.
Alcohol promotes drying of the endoscope channels and inhibits the growth of
bacteria.
A.) 70% Ethyl or Isopropyl Alcohol -Fill a beaker or sterile container
with alcohol.
B.) Aspirate Alcohol Through Channels - Reconnect the suction
cleaning adapter to the suction device. Immerse distal tip into the beaker of alcohol
and aspirate through the channels.
C.) Aspirate Air Through Channels - Remove the distal tip from the beaker and
aspirate air through the channels to aid in drying the alcohol. Remove suction
cleaning adapter.
D.) Alcohol Wipe - Soak a sterile, lint-free cloth in alcohol and wipe off any
remaining water on the external surface of the endoscope and components. Next,
soak a clean cotton swab and use it to dry the internal suction and instrument ports.

8. Storage
THE ENDOSCOPE IS NOW READY FOR PATIENT USE OR STORAGE.
A.) Remove Water Resistant Cap - From the light guide connector.
B.) Check Angulation Lock - For storage, this lock needs to be set in
the free position.
C.) Transfer to Storage Cabinet - Do NOT store
reprocessed endoscopes in carrying case. Carefully transfer the
endoscope to a well-ventilated storage cabinet. Hang the endoscope
vertically with the insertion tube as straight as possible.
D.) Suction and Air / Water Valves - Do NOT replace removable
parts until the endoscope is going to be used in a procedure.

6
Discussion:
1. What is endoscopy and how many type of endoscopy (four only)?
2. Mention faults for endoscope?
3. Which body part is investigated in a cystoscope?

7
 Al Salam University College

Medical Instrumentation Technologies

Engineering

Cardiac Monitoring
Lab 3
3rd stage
Medical instrumentation
Dr. Hajir M. Ali

Cardiac Monitoring
Cardiac Monitoring: A device that shows the electrical and pressure waveforms
of the cardiovascular system for measurement and treatment. It records your heart
rate and rhythm and used when you need long-term monitoring of
symptoms that occur less than daily.

Function
Continuous cardiovascular and pulmonary monitoring allows for prompt
identification and initiation of treatment.
Monitor is used to monitor patient’s physiological parameters such as ECG
SPO2 NIBP IBP and TEMP continuously in dynamic and longtime Its
intended to be used in various hospital rooms such as Coronary Care Unit
Intensive Care Unit Neonatal Intensive Care Unit and Operating Room to
provide additional information to medical and nursing staff about the
physiological condition of the patient.

Function Buttons and Trim Knob on the Front Panel

1
Appearance and Structure of the Monitor

The appearance of multi-parameter monitor

Various sockets on the panel at the right side Various sockets on the panel at the back

2
Notes on the signs on the right-side panel

3
Preparation before placement of cardiac monitoring

 Connecting to Power : (AC Power, Battery Power)

 Connecting to the Central Monitor System: If the user intends to
connect the monitor to the central monitoring system, plug its
connecting electrical cable into the Network Connector interface at the
back of the monitor.
 Start up: Press the power switch on the front panel of the monitor About
50 seconds after the monitor is switched on, after passing the self-
examination of the system, the monitor enters the monitoring screen.
 Connecting to Various Kinds of Sensors: Connect various kinds of
sensors needed to the relevant sockets on the monitor and the
monitored locations on the body of the patient.
 Preparation of Recorder: If the monitor you use has been provided with
a recorder, before starting of monitoring please check if the recorder has
had recording thermal paper installed.

General Safety
Safety precautions for safe installation
The input socket of Monitor can be connected to the electrical wires and
common electrical wire can be used.
Connect the electrical wire to a properly grounded socket. Avoid putting
the socket used for it in the same loop of such devices as the air conditioners,
which regularly switch between ON and OFF.
Avoid putting the monitor in the locations where it easily shakes or
wobbles.
Enough room shall be left around the monitor so as to guarantee normal
ventilation.
Make sure the ambient temperature and humidity are stable and avoid the
occurrence of condensation in the work process of the monitor.

4
 Error Information

Discussion:
1. What is cardiac monitor and where we use in?
2. What are the parameters shows on the monitor screen?

5
 Al Salam University College

Medical Instrumentation Technologies

Engineering

Electrocardiogram machine (ECG)

Lab 2
3rd stage
Medical instrumentation
Dr. Hajir M. Ali
Electrocardiogram machine (ECG) ECG: is an
electromechanically instrumentation system used to detect, amplify,
display and record the electrical potentials produced by the heart that
appear at the surface of the skin.

Function
ECG machines are used to monitor the electrical activity of the
heart and display it on a small screen or record it on a piece of
paper. The recordings are used to diagnose the condition of the
heart muscle and its nerve system.
How it works
The electrical activity is picked up by means of electrodes placed
on the skin. The signal is amplified, processed if necessary and
then ECG tracings displayed and printed. Some ECG machines
also provide preliminary interpretation of ECG recordings. There
are 12 different types of recording displayed depending upon the
points from where the recordings are taken. Care must be taken to
make the electrode sites clean of dirt before applying electrode
jelly. Most problems occur with the patient cables or electrodes.

1
Component

1. Sensing electrode
2. Amplifier protection CCT
3. Lead selector
4. Preamp: for signal come from patient.
5. Isolation CCT
6. Recorder
7. Power Cable.
8. Patient Cable.
9. Heater Pinter
10. Battery.
11. Monitor
12. Paper.
.
leads types:
1-lead (I-II-III) :
Lead I (- Right Arm + Left Arm)
Lead II (- Right Arm + Left Foot)
Lead III (- Left Arm + Left Foot)
2-Augmented Lead :
Lead AVR (- Right Arm + Zero Electrode)
Lead AVL (- Left Arm + Zero Electrode)
Lead AVF ( - Left Foot + Zero Electrode)
3- Chest Lead : six types (V1-V2-V3-V4-V5-V6)

2
3
Troubleshooting of ECG Device

4
 User Maintenance Checklist ECG Device

Discussion:

1. What is The “ECG” and what is the principle of working?

2. What is the main parts of ECG Explain it briefly?
3. What are the types of Electrodes?
4. How many leads must connected to the body, and where
should be connected?

5
 Al Salam University College

Medical Instrumentation Technologies

Engineering

X-Ray Machine
Lab. 1
Stage.
Medical Instrumentation
Lec. Hamdan H. Shehab
Function
X-Ray machines are used for imaging bones and hard tissues and
diagnosing fractures, joint defects, choked lungs etc. Sometimes contrast
agents are also used to highlight any defects in the abdomen under X-
rays.
How it works
X-rays are high energy electromagnetic waves. The transformer produces
a high voltage that directs electrons onto a target in the machine head. X-
rays are produced by the target and are directed into beams by a
collimator towards the human body. Soft body tissue absorbs less X-rays,
i.e., passes more of the radiation, whereas bone and other solids prevent
most of the X-rays from going through. A photographic film or electronic
sensor displays how much X ray has passed through, forming an image of
the interior of the body. Bone appears nearly white, because few X-rays
strike the corresponding part of the film, leaving it largely unexposed;
soft tissue allows much more radiation to pass through, darkening the
film in those places. Users must ensure proper radiation safety protocols
and supervision are in place.

(control panel and transformer not shown)

1
Troubleshooting X-Ray Machines

2
 User Maintenance Checklist X-Ray Machines

Discussion:

1. What is X-ray and what is the principle of working?

2. What is the main parts of X-ray Explain it briefly?
3. What does mean visible light and what is the deferent
between X-ray and Visible light?
3