Notes

Therapeutical Medical Equipment
Malisa F
Arusha Technical College
May 7, 2023
Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 1 / 62

INFANT INCUBATOR
Introduction
Incubator is an apparatus for maintaining an infant,especially a

premature infant, in an environment of controlled
temperature, humidity, and oxygen concentration.

Principle of Incubator
Infant incubator is in the form of trolley normally with mattress on

the top covered by plastic cover.
This chamber provides a clean environment and helps to protect the
baby noise, infection, and excessive handling.
A temperature sensor is tapped into the baby’s skin and the incubator
heater adjusts to maintain the baby at a constant temperature or the
temperature is controlled by thermostat in the heated air stream.
Born before 37 completed weeks of gestation. (less than 2.5kg)
Unable to control there temperature with the new environment.
Have some problems with their respiratory system.

Working Principle
Light bulbs heat air in the bottom part of the incubator. the air
passes over a container with evaporating water, so that its humidity
increases.
The warm, humid air then flows upwards (chimney effect) into the
baby compartment. a thermostat in an exit hole compares the air
temperature with the desired temperature.
If it is too high, the light bulbs will be switched off; if it is too low,
the bulbs will be switched on.
The baby can be viewed through plexiglass and it can be handled via
two armholes with sleeves.
The plexiglass front and top can be hinged back for full access.

Purpose of Incubator
Main purpose of keeping and caring a neonate in incubator are

Maintenance of thermoneutral ambient temperature
Provision of desired humidity and oxygenation
Observation of very sick neonates
Isolation newborn babies from infections, unfavorable external
environment
Main functions of infant incubators
Temperature control
O2 Concentration
Humidity control
Breathing gas filtration

Working Principle of infant incubator

Temperature control
HEATER
The heater is adjustable and helps maintain an infant’s core body
temperature.
The temperature is always monitored through a temperature
controller. once set, the heater regulates itself just as a thermostat
does on a home heating unit.
O2 Concentration
Port holes allow nurses and caretakers to handle the baby without
contaminating the infant’s environment.
Port holes are holes sealed with rubber gloves that you must insert
your hands into in order have limited and contamination-free access
to the inside of the incubator.

Breathing gas filtration
FILTERS
Filters clean the air before it is pulled into the incubator, preventing
harmful particles from entering the incubator and possibly infecting
the infant’s lungs.
CANOPY
The canopy is a clear, acrylic covering that protects the baby from
the outside world and harmful germs that may infect the child. It also
makes the perfect warm and oxygenated environment for a baby
that’s similar to a mother’s womb.
Humidity control
Air distributors distribute air evenly to ensure equal temperature and

humid level is accurate throughout the incubator. this prevents spaces
of cold or stale air.
Humidity sensor will ensure the moisture content in the circulated air
is within normal range
This part of the incubator measures the amount of humidity inside
the incubator. It’s also responsible for breathing warm and humidified
air into the baby’s lungs through endotracheal tubes that run from
the baby’s nostril into the lungs.

PARAMETERS MONITORED
ECG MONITORING
Three electrodes are placed on the babies chest for ECG continuous
monitoring. The same electrodes that are used for ECG monitoring
are also used for respiration monitoring, since PMS can measure and
display both the ECG and the respiration rate
NEONATAL JAUNDICE
Phototherapy lights are used when babies are jaundiced (yellow).

Some degree of jaundice, which is caused by the presence of a
molecule called bilirubin in the blood, is common and even normal
newborns
Certain wavelengths of light (in the blue part of the spectrum) can
cause a chemical reaction that converts bilirubin into a harmless form
as blood passes through the skin

TEMPERATURE & HUMIDITY MONITORING
Temperatures range around 30 to 37ºc, humidity levels range from 50

to 90%, depending on the babies size and age.
The incubator keeps the baby warm with moistened air in a clean
environment, and helps to protect the baby from noise, drafts,
infection, and excess handling.

Block diagram of an infant incubator

Performance function check for an incubator
Check the Incubator exterior especially the plexi glass for any signs of
damage.
Check the braking system in the wheels work properly.
Check the Hood seals are placed properly.
Check that the access ports can be opened and closed properly.
Check the Hood tilt latch. Verify its locking and release mechanism is
OK.

Infant Radiant Warmer

Infant Radiant Warmer
Heater unit provides uniform warmth rapidly all over the bed.
The heater can be operated in Servo and Manual modes.
The heater unit may be swiveled to accommodate X-ray units.
Working Principle -Warmer
The parabolic reflector in the heater unit reflects the heat radiated
from the heating element into parallel rays and heats up the infant’s
bed uniformly

Heat Radiation From Radiant Warmer

Heater Unit
Quartz infrared heating element in a parabolic reflector Advantage of

Quartz- faster warming up and cooling down time
Heater Unit can be swivelled ±90° on both sides , allowing mobile
x-ray’s without transporting the baby .
The height of the heater unit maybe adjusted for different bed heights
on field by trained personnel
Warmer has two modes
Manual mode:
When you are anticipating a baby to be brought under warmer care
Manual mode is used. Before baby has arrived keep warmer on with
100 % heater output, which than drops to 60% after a particular time.
Servo mode:
Once baby is placed servo mode is used. A temperature probe is
connected to the baby . Heater provides output according to baby’s
current temperature and set temperature
Difference between Infant incubator and Infant warmer

Functional Checks- Operation
Switch on the machine and make sure that the self check passes
successfully.
Check whether the Manual and Servo mode can be selected.
Check the switch for Selection of Temperature unit (Centigrade or
Fahrenheit)
Check whether the set Temperature can be raised and lowered.
Check whether the set Humidity can be raised and lowered.

PHOTOTHERAPY

PHOTOTHERAPY
PHOTOTHERAPY It is the use of ultraviolet radiation or visible light for

therapeutic purposes.
Consists of application of fluorescent/LEDs light to the infant’s skin
Most commonly used treatment for unconjugated hyperbilirubinemia
MECHANISM OF ACTION
Geometric photoisomerization of unconjugated bilirubin resulting in a

more soluble form of Bilirubin.
(Accounts for 80 % of conversion)
Converting bilirubin to lumirubin through structural isomerization
which can be excreted into bile without need for further hepatic
conjugation
Oxidation mechanism resulting in colourless by products and excreted
by liver and kidney without need for conjugation
Mechanism of phototherapy

INDICATIONS
Used when level of bilirubin may be hazardous to the infant

Prophylactic phototherapy may be indicated in circumstances like
extremely low birth weight or severely bruised infants
TECHNIQUE
Bilirubin absorbs light maximally in the blue light ranges ( 420-500

nm)
Daylight and cool white lamps have a spectral peak between 550-600
nm & are less effective than special blue lamps, which have an
average of 420-480 nm
The Phototherapy helps the liver break down the bilirubin and the
waste is excreted through urine and sweat
Distance of the baby from the light source affects the effectiveness.
Typically a distance of 45 cm is used
Precautions during therapy procedure
Keep the baby naked, except for diapers , as larger the surface
exposed , more effective is the phototherapy.
Eyes must be shielded to prevent potential adverse effects on the
retina
closely monitor temperature for hyper/hypothermia
Maintaining baby in a flexed position with rolled blankets along the
sides helps to maintain heat and provide comfort
Oily lubricants should be avoided to prevent tanning / frying effect

Factors important to effectiveness of phototherapy
Total power input (wattage) of fluorescent tubes used. The

greater the power used the greater the irradiance (See box for
meaning of Irradiance) and effectiveness, provided the percentage of
light wasted does not increase.
The freshness (or hours of use) of fluorescent tubes. This is a
major, often under-recognised factor. The light energy output of
fluorescent tube decreases substantially with the number of hours for
which they have been used. Users report that the light output
decreases by 35% by the end of 1200 hours (e.g. 120 days at 10
hours per day) of use.
Proximity of the light source to the skin. The intensity of light
(irradiance) reaching the skin decreases with the distance from the
light source. This means that a greater amount of energy is wasted
on other surfaces and less light energy falls on the skin.

Factors important to effectiveness of phototherapy...
Energy lost through screens between the light source and the
skin. Safety screens must be used between fluorescent tubes and the
user. Typically these are clear acrylics that absorb less than 5% of the
irradiance. In some systems netting beds are also used and these
typically absorb about 15% of the irradiance.
The area of skin exposed. The effectiveness of phototherapy is
proportional to the amount of surface area of skin irradiate.
Irradiance is measured in milliwatts per square centimetre (of skin).
The larger the skin area exposed the greater amount of light energy is
received to transform bilirubin.
The amount of time the skin is exposed. The effectiveness of
phototherapy is proportional to the phototherapy time. The amount
of phototherapy time required has often been used to indicate the
seriousness of a persons CN condition.

Dialysis

Renal Dialysis
Introduction
Renal failure, causes, symptoms and ways to keep kidney health.
Importance of kidney dialysis
Dialysis machine and parts
Maintenance and quality control
Inlet water quality, water treatment plant and water quality control

Dialysis ...
Dialysis is the procedure used to correct fluid and electrolyte

imbalances and to remove waste products in renal failure.
What dialysis can do and can not do?
DO:
DO: waste removal and fluid removal.
Do Not:
Do not correct the endocrine functions of the kidney. Hence , dialysis
is not a cure for kidney failure.

Renal failure or kidney failure
Function of Kidney
The kidneys’ job is to filter blood. They remove wastes, control the
body’s fluid, and keep the right levels of electrolytes.
All blood comes into the kidney, waste gets removed, salt, water, and
minerals are adjusted, if needed.
Renal Failure
Is a medical condition in which the kidney fail to filter waste products
from the blood Causes a build up of toxins in the body which can
affect the blood, brain and heart as well as other complications.
Renal failure is very serious and even deadly if left untreated.

Types of kidney failure
The two main forms of kidney failure are:

Acute kidney failure and
Chronic kidney failure
Acute kidney failure

Acute kidney failure occurs when kidneys suddenly become unable to
filter waste products from blood. When kidneys lose their filtering
ability, dangerous levels of wastes may accumulate, and blood’s
chemical get out of balance.
Acute renal failure (ARF), is a rapidly progressive loss of renal
function, decreased urine production, quantified as less than 400 mL
per day in adults; fluid and electrolyte imbalance. If treated properly
can be reversible

Causes of Acute kidney failure
Usually occurs when the blood supply to the kidneys is suddenly

interrupted or when the kidneys become overloaded with toxin.
Accidents, injuries, or complications from surgeries in which the
kidneys can not get normal blood flow for extended periods of time.
Example: Heart-bypass surgery.
Drug overdoses, accidental or from chemical overloads of drugs such
as antibiotics or chemotherapy.
Chronic kidney failure (CKF)

Chronic kidney disease (end stage kidney disease) can also develop
slowly and shows few symptoms.
Kidneys do not get better and will need dialysis for the rest of the life
or may need to replace new kidney.

Causes of Chronic kidney disease
The most common causes of CKD are diabetes, uncontrolled

hypertension etc.
Overuse of common drugs such as aspirin, paracetamol etc Some
infectious diseases, such as hantavirus, can attack the kidneys,
causing kidney failure
High levels of urea in the blood, which can result in:
Vomiting and/or diarrhea, which may lead to dehydration
Weight loss
Night-time urination
More frequent urination, or in greater amounts than usual, with pale
urine
Less frequent urination, or in smaller amounts than usual, with dark
colored urine
Blood in the urine
Difficulty urinating
10 Ways to Keep Kidneys Healthy
Exercise regularly
Don’t overuse painkillers
Control weight
Get an annual physical checkup
Follow a healthful diet
Know your family’s medical history
Monitor blood pressure & cholesterol
Learn about kidney disease
Don’t smoke or use alcohol
Talk to your doctor about getting tested if you’re at risk for CKD

Physiological principles of dialysis
Diffusion ⇒ Osmosis ⇒ Ultra-filtration

What is semipermeable membrane?
A thin layer of material with pores that allow smaller molecules to pass
through but not larger molecules
Diffusion
Diffusion- movement of solutes from an area of greater concentration

to an area of lower concentration.
In renal failure urea, creatinine, uric acid, and electrolytes( Potassium,
phosphate), move from the blood to the dialysate with the net effect
of lowering their concentration in the blood.
But WBC’s, RBC’s and other contents within the blood are too large
to diffuse across the membrane.

Physiological principles of dialysis...
Osmosis
The movement of fluid from an area of lesser to an area of greater

concentration of solutes.
Glucose is added to the dialyzing solution and creates an osmotic
gradient across the membrane to remove excess fluid from the blood.
Ultra-filtration
Ultra filtration is defined as water moving under high pressure to an

area of lower pressure. This process is much more efficient at water
removal than osmosis.
Ultra filtration is accomplished by applying negative pressure or a
suctioning force to the dialysis membrane.

Dialyzer(Artificial kidney)

Dialyzer(Artificial kidney)...
In HEMO DIALYSIS, blood is removing from the body and filtered

through a man made membrane called a dialyzer or artificial kidney
and then the filtered blood is returned o the body.
It contains two compartments:
Blood and dialysate
Compartments are separated by a semipermeable membrane
Hollow fibers
Compartments are encased in a clear plastic cylinder which acts a
support for the fibers
Replacing the renal glomeruli and tubules as the filter for the impaired
kidney
In hemodialysis, the blood, laden with toxins and nitrogenous wastes
is diverted from the patient to a machine, a dializer, in which the
blood is cleansed and then returned to the patient

Dialyzer...
The boundary area between the tow compartment is maximized by

using a membrane divided into multiple hollow fibers or parallel plates

Types of Dialyzer
1. Flat-Plate Dialyzer
The blood is routed between sheets of membranes laid on top of one
another
The dialyzer is configured so that blood and dialysis solution pass
through alternate spaces between the membrane sheets

Advantage:
Blood volume is about 70-100 ml at 100 mmHg increase with high

TMP
Heparin requirement usually low, minimal clotting in the blood
compartment
Ultrafiltration is reasonably predictable and controllable
Disadvantage:
Formation of local thrombi around inlet and outlet ports and corners
May lead to bacterial growth and endotoxin formation therefore plates
are not often reused.

Types of Dialyzer...
2. Hollow fiber Dialyzer

The hollow-fiber artificial kidneys contain thousands of tiny
cellophane tubules that act as semipermeable membrane
The blood flows through the tubules, thousands of capillaries tightly
bound in a bundle, while the dialysate circulates around the tubules
The exchange of wastes from the blood to the dialysate occurs
through the semipermeable membrane of the tubules

Advantage:
TLow blood volume 60-90ml

Resistance to blood flow is low
Ultrafiltration can be precisely controlled
Well adapted to reuse
Disadvantage:
Deaeration of fiber predialysis is necessary to prevent air lock of the

fibers
More heparin is required for most of the patients
Adverse patient reaction

Types of kidney dialysis machine
Hemodialysis dialysis
Peritoneal dialysis.
Peritoneal dialysis.
peritoneal dialysis involves pumping dialysis fluid into the space inside
abdomen (tummy) to draw out waste products from the blood
passing through vessels lining inside of the abdomen
In peritoneal dialysis, a sterile solution containing minerals and
glucose is run through a tube into the peritoneal cavity, the
abdominal body cavity around the intestine, where the peritoneal
membrane acts as semi-permeable membrane
There are 2 main types of peritoneal dialysis:
1. Continuous ambulatory peritoneal dialysis (CAPD) – where blood is
filtered several times during the day.

There are 2 main types of peritoneal dialysis:
2. Automated peritoneal dialysis (APD) – where a machine helps filter

blood during the night as you sleep
Both treatments can be done at home once you have been trained to
carry them out yourself.

Hemodialysis
Before haemodialysis can start, usually need to have a blood vessel

called an arteriovenous fistula (AV fistula) created in arm. This blood
vessel is created by connecting an artery to a vein.
Joining a vein and an artery together makes the blood vessel larger
and stronger. This makes it easier to transfer blood into the dialysis
machine and back again.
The operation to create the AV fistula is usually carried out around 4
to 8 weeks before haemodialysis begins. This allows the tissue and
skin surrounding the fistula to heal.

Blood access for dialysis

Blood Delivery system
Blood Pump – moves blood from access site through the dialyzer &
back to the patient
Blood flow Rate – 250-500 ml/min
Acess for Haemodialysis

Arterio venous fistula ( AVF )
Arterio venous graft ( AVG )
Cuffed tunneled dialysis catheter
Temporary access sites
Internal jugular vein
Femoral Vein
Subclavian Vein

Haemodialysis

Haemodialysis

Indications For Dialysis
Acidosis ( pH< 7.1)

Electrolyte imbalance ( K+ > 6.5 mEq/ L)
GFR < leq 10ml/min
Overload of fluids ( pulmonary oedema)
Uremic symptoms (^ed level of nitrogenous waste products)
Principle Of Haemodialysis
DIFFUSION : Passive movement of solute across a semipermeable
membrane
ULTRAFILTRATION : Solute + fluid removal across
semipermeable membrane down a pressure gradient

Haemodialysis Apparatus
Dialyzer
Dialysate
Blood delivery system
Dialysate
Solution used in dialysis which has same solute concentration as those
in plasma.
Water used in the dialysate is purified by reverse osmosis.
Dialysate...
Dialysate is a fluid that is made up of water, electrolytes and salts.

During dialysis, dialysate helps to clean blood inside the dialyzer by
removing waste products and balancing electrolytes and minerals.
Nephrologist will prescribe the dialysate that is right for body’s needs.

Dialysis machine monitoring
During dialysis session, detailed information will shown on the

machine’s monitoring screen.
Every function will be monitored, including the pump speed, blood
pressure and dialysate temperature.
Every check is designed to make sure dialysis session is safe and
effective.
An alert will sound if anything needs attention. An alert may simply
mean the machine needs to be checked or something needs to be
adjusted.
Three major part of dialysis machine

Blood monitor
Fluid monitor
System control

It controls all parameters concerning blood flow from the body and back
to the body:
Blood flow rate
Arterial and venous pressure
Accumulated blood volume
System pressure
Ultrafiltration rate (UFR)
Ultrafiltration volume ( UFV)
Air detector
Volume detector
Blood pumps
Heparin syringe
Treatment screen
Operator panel
Blood leak detector
Dialysate preparation control

Hydraulic parts of the machine
1 Inlet water control
2 Concentrates mixture control
3 Temperature control
4 Conductivity control
5 Pressure control
Four types of maintenance for dialysis machine

User maintenance
Planned preventive maintenance
Breakdown maintenance
Quality assurance

User maintenance
Daily cleaning and decontamination

Cleaning and disinfection is important to maintain the specified
performance of the machine.
Before treatment
Between patients
After treatment
Maintenance of outside of the machine; top tray, blood pump, blood
leak detector and Bp cuff. (Clean and disinfect is very important.)

Preventive maintenance
It depends on manufacture and model

Service manual should prescribe which maintenance to be done and
at what interval.
PM kit is required
Maintenance check list should be in place
Analyzers and other tools should be prepared before starting PM.

Break down maintenance
Repair technique depends on the type of malfunction

Most of faults are shown through error message
Special tools might be needed to rectify faults
Error book and service manual should be used during repair.
Common problems in dialysis machine

Caused by improper operation
Improper rinsing and disinfection may cause:
Blockage of dialysate system.
Water flow alarms.
Valves can stuck
Blockage of pumps

Quality control in dialysis machine is very important

Check and calibrate fluid pumps
Blood pump and
Dialysate pump
Check and calibrate temperature and conductivity
Routine testing sample for dialysate chemical contaminant level.
Routine testing sample for dialysate bacteria contaminant level.
Routine sterilization of inlet water loop system

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Therapeutical Medical Equipment

Arusha Technical College

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 1 / 62

Incubator is an apparatus for maintaining an infant,especially a

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 2 / 62

Infant incubator is in the form of trolley normally with mattress on

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 3 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 4 / 62

Main purpose of keeping and caring a neonate in incubator are

Main functions of infant incubators

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 5 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 6 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 7 / 62

Air distributors distribute air evenly to ensure equal temperature and

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 9 / 62

Phototherapy lights are used when babies are jaundiced (yellow).

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 10 / 62

Temperatures range around 30 to 37ºc, humidity levels range from 50

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 11 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 12 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 13 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 14 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 15 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 16 / 62

Quartz infrared heating element in a parabolic reflector Advantage of

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Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 19 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 20 / 62

PHOTOTHERAPY It is the use of ultraviolet radiation or visible light for

Geometric photoisomerization of unconjugated bilirubin resulting in a

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 22 / 62

Used when level of bilirubin may be hazardous to the infant

Bilirubin absorbs light maximally in the blue light ranges ( 420-500

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 24 / 62

Total power input (wattage) of fluorescent tubes used. The

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 25 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 26 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 27 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 28 / 62

Dialysis is the procedure used to correct fluid and electrolyte

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 29 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 30 / 62

The two main forms of kidney failure are:

Acute kidney failure

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 31 / 62

Usually occurs when the blood supply to the kidneys is suddenly

Chronic kidney failure (CKF)

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 32 / 62

The most common causes of CKD are diabetes, uncontrolled

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 34 / 62

Diffusion ⇒ Osmosis ⇒ Ultra-filtration

Diffusion- movement of solutes from an area of greater concentration

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 35 / 62

The movement of fluid from an area of lesser to an area of greater

Ultra filtration is defined as water moving under high pressure to an

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 36 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 37 / 62

In HEMO DIALYSIS, blood is removing from the body and filtered

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 38 / 62

The boundary area between the tow compartment is maximized by

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 39 / 62

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 40 / 62

Blood volume is about 70-100 ml at 100 mmHg increase with high

Malisa F (Arusha Technical College) Therapeutical Medical Equipment May 7, 2023 41 / 62