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BEDSIDE & CENTRAL

MONITORING SYSTEM

BY:
VISHAL UPADHYAY
ICE-B
110115098
INTRODUCTION TO PATIENT MONITORING
SYSTEMS
Used for monitoring physiological signals including
Electrocardiograph (ECG), Respiration, Invasive and Non-
Invasive Blood Pressure, Oxygen Saturation in Human Blood,
Body Temperature and other Gases etc.
Multiple sensors and electrodes used for receiving physiological
signals like ECG Electrodes, SpO2 Finger Sensor, Blood
Pressure Cuff and Temperature Probe to measure the
physiological signals.
During treatment, it is highly important to continuously monitor
the vital physiological signs of the patient. Therefore, patient
monitoring systems has always been occupying a very
important position in the field of medical devices.
CLASSES OF PATIENT MONITORING SYSTEM

Single-Parameters Multi-Parameter Patient


Monitoring Systems Monitoring Systems
The single parameter A multi-parameter Patient
monitoring system is Monitoring System (PMS) is
available for measuring blood used for multiple critical
pressure of a human body, physiological signs of the
ECG(Electrocardiograph) patient to transmit the vital
monitor, SpO2 (Oxygen information like
Saturation inBlood) monitor Electrocardiograph,Respiration
etc. Rate, Blood pressure etc.
Most diseases of the heart and of the circulatory
system,referred to as cardiovascular diseases, strike
without warning and prompt treatment is required if
death is to be averted. Such treatment is best provided
in a specialized area of hospital referred to as
Intensive Care Unit(ICU).
These specialized hospital units provide constant
observation of the subject, constant monitoring of the
subjects physiological condition and provide
immediate emergency treatment whenever it is
required.
THREE IMPORTANT INTENSIVE
CARE UNITS
Coronary intensive care units
Used for treatment of diseases of the heart such as the
heart attacks.
Stroke intensive care Units
Used for treatment of diseases of the circulatory system
such as stroke.
Pulmonary intensive care unit
Used for treatment of respiratory diseases
Who requires patient monitoring?
Patients with unstable physiologic regulatory systems;
Example: a patient whose respiratory system is suppressed by
a drug overdose or anesthesia.
Patients with a suspected life-threatening condition;
Example: a patient who has findings indicating an acute
myocardial infarction (heart attack).
Patients at high risk of developing a life-threatening condition;
Example: patients immediately post open-heart surgery, or a
premature infant whose heart and lungs are not fully developed.
Patients in a critical physiological state;
Example: patients with multiple trauma or septic shock.
Mother and baby during the labor and delivery process.
Why patient monitoring?
Data Acquisition and Signal Processing
General Block Diagram of Medical
Instrumentation System
Block Diagram of Bedside Monitoring System
Interfacing Analog Signals to
Microprocessors
Display

Digital Storage Oscilloscope(DSO) are used.


Advanced trigger.
High Speed Sampling.
Data not lost.
Nursing Flowsheet
Present Parameters in Patient Monitoring System

ECG 3/5/10 leads


Respiration
Invasive Blood Pressure (IBP)
Non Invasive Blood Pressure (NIBP)
Dual Temperature
Pulse Oxy Meter (SpO2)
Common Patient Monitoring
Systems
Cardiac(ECG) Monitoring
Cardiac monitoring is used
to continuously monitor the
hearts rhythm.
A normal heartbeat is
called a sinus rhythm.
It can be represented by
six distinct waves,
identified in the image to
the left by the letters P, Q,
R, S, T, and U.
Cardiac(ECG) Monitoring
Cardiac(ECG) Monitoring
Driven right leg circuit
A Driven Right Leg Circuit or DRL circuit is an electric circuit
that is often added to biological signal amplifiers to reduce
Common-mode interference.
Biological signal amplifiers such as ECG (Electrocardiogram)
EEG (Electroencephalogram) or EMG circuits measure very
small electrical signals emitted by the body, often as small as
several micro-volts.
The patient's body can also act as an antenna which picks up
electromagnetic interference, especially 50/60 Hz noise from
electrical power lines.
Right Leg Driver circuitry is used to eliminate interference noise
by actively canceling the interference.
Driven right leg circuit
Measurement of Heart Rate

ECG is sampled every 2ms.


High amplitude component & artifacts are reduced by Slew Rate
Limiter.
High Frequency component & DC offset voltage is removed with help
of filters.
Filtered ECG signal is passed through QRS matched filter.
Detector recognizes QRS complex that has occurred since last heart
beat.
If this value exceeds threshold value, a heart beat is counted.
Hemodynamic monitoring

Blood pressure (BP) and blood flow are monitored by a


hemodynamic monitor and can be done in two ways:
Blood pressure cuff (Non-invasive)
With an intra-arterial catheter.(Invasive)
Non-invasive Blood Pressure
Monitoring
Manual or automated
devices
Different Methods of
measurement:
Oscillometric (Electronic
Pressure sensor)
The Rheographic Method
Auscultatory (Korotkoff
sounds)
Oscillometric Method
The Rheographic Method
Direct Arterial Blood Pressure Measurement
(Invasive Method)
Direct Arterial Blood Pressure Measurement
(Invasive Method)
Pulse Oximeter
(Respiratory monitoring)
Sensors used to continuously measure the Oxygen saturation
(SPO2) of haemoglobin in blood. It displays the percentage of
blood that is loaded with oxygen.
Principle of Pulse Oximeter
Principle of pulse oximetry is based on the differential
absorption characteristics of oxygenated and the de-
oxygenated hemoglobin.
Oxygenated hemoglobin absorbs more infrared light and allows
more red light to pass through. Whereas Deoxygenated
hemoglobin absorbs more red light and allowing more infrared
light to pass through.
Whats inside the Sensor?
Each pulse oximeter sensor probe contains two light
emitting diode:
one emitting red light and the other emitting near
infrared light.
It also has a photo-detector.
The photo-detector measures the intensity of transmitted
light at each wavelength.
And using the differences in the reading the blood oxygen
content is calculated.
The probe is placed on a suitable part of the body, usually
a fingertip or ear lobe.
Methods for Monitoring Oxygen Saturation in
Blood
Transmission Method Reflectance Method
Transmission Method

Transmitter (LED) & the receiver(photo-detector) are placed on


opposite side of the finger.
Finger will be placed between the LEDs & the photo-detector.
When the finger is placed a part of the light will be absorbed by
the finger and some part will reach the photo detector.
Now with each heart beat there will be increase in volume of
blood flow this will result in more light getting absorbed by the
finger so less light reaches the photo-detector.
Hence if we see the waveform of received light signal it will
consist of peaks in between heart beats and trough (bottom) at
each heartbeat.
This difference between the trough & the peak value is the
reflection value due to blood flow at heart beat
Reflectance Method
LED & photo-detector are placed on the same side i.e.
next to each other.
In the reflective method there will be some fixed light
reflection back to the sensor due to finger.
With each heart-beat there will be an increase in blood
volume in the finger this will result in more light reflection
back to the sensor.
Hence if we see the waveform of the received light signal it
will consist of peaks at each heartbeat.
A fixed low value reading is there in between the heart
beats this value can be considered as constant reflection
and this difference of the peak subtracted from the
constant reflection value is the reflection value due to
blood flow at heart beat.
Body temperature monitoring: An adhesive pad containing a
thermoelectric transducer is used to monitor body temperature.

Blood glucose monitoring: In this technique for testing the


amount of glucose (sugar) in the blood, a small amount of blood
(usually a drop), is extracted from from the fingertip and placed
on the end of a coated strip, called a testing strip. The strip
changes color according to the amount of glucose in the blood.
Modern hospitals often allow the results of the testing to be
transmitted wirelessly to the patients EMR.

Childbirth monitoring: Also called fetal monitoring, it can be


done by fetoscope, ultrasound, or electrode and pressure
catheter.
General Considerations In Monitoring System

Inaccessibility of the Signal Source


Variability of Physiological Signals
Interference among Physiological System
Transducer Interface Problems
High Possibility of Artifacts
Safe levels of Applied Energy
Patient Safety Considerations
Reliability Aspects
Human factor Considerations
Government Regulations
THANK YOU