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MODULE 5
Ventilators - Heart lung machine - Infant incubators.
Instruments for clinical laboratory – Test on blood cells – Chemical tests.
Electrical safety– Physiological effects of electric current.
Shock hazards from electrical equipment - Method of accident prevention.
Introduction to tele- medicine.
Introduction to medical robotics.

VENTILATORS

Introduction

 Mechanism of respiration: Process of supplying oxygen to tissues and removing carbon

dioxide from the tissues.

 These gases are carried in blood, oxygen from lungs to the tissues and carbon dioxide from
the tissues to the lung.

 Respiration process:

Inspiration – breathing in (air to lungs). Results from contraction of the diaphragm

Expiration – breathing out (air out from lungs). Expiration results from relaxation of the
diaphragm

 For reduced or respiratory failure, mechanical ventilators or artificial respirators are

used in hospitals

VENTILATOR

 A mechanical ventilator is a machine that makes it easier for patients to breath, until they
can breathe completely on their own

 These devices provide artificial ventilation, supply enough oxygen and eliminate right
amount of CO2.

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 When artificial ventilation needs to be maintained for a long time, a ventilator is used to
provide oxygen enriched medicated air to a patient at a controlled temperature.

Fig: Block diagram of ventilator

 A tube is inserted through the patient‘s mouth into the lungs, and is hooked up to the
ventilator.
 The ventilator pumps air and oxygen into the patient‘s wind pipe through the tube.
 A ventilator can be used to either assist a patient with breathing or it can completely take
over the breathing.
 In ventilator system, humidifier is used to humidify the air delivered to the patient.
 The HME filter (Heat and Moisture Exchange) is used to help to prevent complications
due to drying.
 Ventilators can operate in different modes:

1. Controlled mode:

 For patients who are unable to breath themselves

 A timer is set to provide desired respiration rate
 Ventilator completely controls the patient’s respiration

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2. Assisted mode/Supported mode

 Patient is able to control the breathing

 But the patient is unable to take sufficient amount of air

 In this, inspiration is triggered by patient’s attempt to breath

3. Assist control mode:

 Has features of both assist mode and control mode.

Microprocessor Based Ventilator

 It consists of a microprocessor with RAM, EPROM, A/D converter and a CRT

controller.
 The input signals to the microprocessor are obtained from a CO2 analyser, a lung
machine, gas analyser, oxygen consumption monitor and a servo ventilator.
 The proper controlling signals are delivered to the servo ventilator so as to get correct
ventilation adjustment in response to a patient‘s metabolism.

.HEART-LUNG MACHINE

 During open heart surgery, the heart cannot maintain the circulation.
 It is then necessary to provide extra corporeal (outside the body) circulation with a
special machine called heart lung machine.
 Heart-Lung Machine is a blood pumping machine that takes over the functions of the
heart and lungs during surgery (i.e. open-heart surgery).

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 It is most commonly used to perform a cardiopulmonary bypass (CPB), which is the

technique whereby blood is totally or partially diverted from the heart into a machine
with the gas exchange capacity and subsequently returned to the arterial circulation at
appropriate pressures & flow rates.
 CPB allows for the heart to stop beating as its function is taken over by Heart Lung
Machine, which makes it easier to operate on, and surgeons can operate in a blood-free
area
Functions of a Heart Lung Machine
 RESPIRATION: Within which it includes Ventilation and Oxygenation.
 CIRCULATION: Maintaining circulation at appropriate pressures and flow rates.
 TEMPERATURE REGULATION: It involves controlled hypothermia.

The Components of Heart Lung Machine

PUMPS:

 The pumps are designed to minimize the damage to blood cells and effective in
pumping within physiological range.

MEMBRANE OXYGENATOR:

 It imitates the function of lungs.

 Membrane oxygenator are more common now a days.
 Here O2 & CO2 Exchange takes place.

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 Gas exchange take place by the process of diffusion across a thin membrane
separating blood and gas made of highly permeable silicon rubber or microporous
polypropylene, Teflon & polyacrylamide.

HEAT EXCHANGER:

 Heat exchangers control body temperature by heating or cooling blood passing

through the perfusion circuit.
 Arterial filter/bubble trap: It is used to filter small air bubbles that may have entered,
or been generated by the machine.
 Aortic/atrial/vena caval cannulae through which blood is taken and returned to body.

The work flow of Heart Lung Machine

 It composed of a chamber that receives all the blood from the body (right atrium of
the heart), pumps that move the blood through an oxygenator (that mimic function
right ventricle), oxygenator removes the carbon dioxide and adds oxygen to the blood
(mimic lungs).
 Machine continues by pumping the oxygenated blood back to the body (that mimic
function of left atrium and ventricle) using a series of tubes.

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 Advantage of using Heart Lung machine: The ability of a surgeon to perform an

open-heart surgery in a blood-free zone while the heart is not beating.
 It also allows for medications and anesthetics to be administered directly into the
blood, adding them to the blood in the heart-lung reservoir, arriving immediately to
the patient

INFANT INCUBATORS

 Infant incubator is a biomedical device which provides warmth, humidity and O2, all in a
controlled environment for the new born baby.
 The temperature is maintained within specific temperature range.
 Infant incubators are used in premature newborns susceptible to respiratory problems.
 The control system of incubator uses a bridge circuit. One arm of the bridge circuit will
be a thermistor. Another arm will be a set point resistance.

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 The bridge output is amplified giving the voltage V1 at the output which is proportional to
the difference in temperature between thermistor and the set point.

 Some incubators instead of controlling air temperature directly use the skin temperature
of infant as a control parameter.

 Thermistor is placed against the skin of infant and controller is set to maintain the infant skin
at a given temperature.

 If the infant is cooler than the set point, air entering the chamber of incubator is heated
by an amount proportional to difference between the set temperature and baby‘s actual
temperature.

 Incubators also have a simple alarm system to alert the clinical staff if there is any
dangerous overheating of the device.

 The infant incubator is normally in the form of a trolley with a small mattress on the top

 Incubator chamber provides a clean environment, and helps to protect the baby from
noise, dust and infection

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INSTRUMENTS FOR CLINICAL LABORATORY

 The clinical laboratory is responsible for analysing patient specimens.

 This provide information that helps in diagnosis of disease.
 The hospital department that performs these functions are called the department of clinical
pathology or the department of laboratory medicine.
 The major sections of the clinical laboratory are the chemistry, haematology, and
microbiology sections and the blood bank.
TESTS ON BLOOD CELLS

 Ԝhen ԝhole blood is centrifuged, the blood cells sediment and form a packed column at the
bottom of the test tube.
 Most of this column consists of the red blood cells, ԝith the other cells forming a thin layer
on top of the red cells.
 The volume of the packed red cells is called the hematocrit. It is expressed as a percentage
of the total blood volume.
 The active component in the red blood cells is the hemoglobin, the concentration of ԝhich is
expressed in grams/100 ml.
 The hematocrit can be determined by collecting a blood sample into a capillary tube and
closing one end of the tube with a plastic sealing material.
 The tube is then spin 3 to 5 minutes in a special high-speed centrifuge to separate the blood
cells from plasma.
 Because the capillary tube has a uniform diameter, the blood and cell volumes can be
compared by measuring the lengths of the columns.

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AUTOMATIC BLOOD CELL COUNTER

 The blood cells have important functions in our body.

 The red blood cell is used for the transport of oxygen and carbon dioxide.
 The white blood cells are part of the body’s defences against infections and foreign
substances.
 The platelets are involved in the clotting of blood .
 The red blood cells in the blood consist of haemoglobin.

 Automatic blood cell counters are based on the fact that red cells have a higher electrical
resistivity than the saline solution in which they are suspended.
 The above figure shows the automatic blood cell counter using electronic circuitry.
 A diluted blood sample (diluted with saline solution) is drawn through a small orifice
(opening) having diameter less than 100 μm by means of a suction pump.
 The electrodes are placed such that one in the surrounding sample chamber and other
in the suctioned blood.
 The electrodes are attached with the conductivity meter.
 Before suctioning, the resistance of the electrode arm is equal to R.

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 After suctioning of blood, each red cell moving through orifice will produce a sudden
increase in resistance such that the resistance is now equal to (R + ΔR) or Rout.
 The conductivity meter gives the amplified output voltage Vout as an impulse which is
directly proportional to the ΔR.
 The number of impulses is counted by a counter and this gives the density of red blood cells.

CHEMICAL TESTS

 Blood serum is a complex fluid that contains numerous substances in solution.

 The determination of the concentration of these substances is performed by specialized
chemical techniques.
 The commonly performed chemical blood tests are;
A. Spectro photometer
B. Flame photometer

Spectrophotometer

 Figure shows the spectrometer.

 Here light from halogen lamp is passed through an entrance slit S1 and incident on a
concave reflector.
 The concave reflector focuses the light on a prism G to disperse light.
 The selective wavelength from the dispersed light is again allowed to incident on the
reflector.
 From the reflector, the light beam is directed to the sample through a narrow exit slit S2.

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 A sensitive photodetector D detects the transmitted light and gives an electrical output
corresponding to the intensity of the transmitted light.
 The amplifier amplifies the output from the detector and finally the indicator indicates
the concentration of the substance.
 By rotating the prism, the measurements can be made at different wavelengths.

Flame Photometer

 A flame photometer is used to analyse urine or blood in order to determine the

concentration of potassium (K), sodium (Na) and lithium (Li).

 Whenever a sample solution is sprayed onto a flame, the sample molecules are converted
into gaseous molecules.

 These gaseous molecules are decomposed into gaseous atoms

 Some gaseous atoms absorb the heat energy from flame and get excited to higher
energy levels.

Nebuliser: Converts the solution into mist form.

 These atoms return to ground state by emitting radiations of its own characteristic
wavelength.
 The intensity of the emitted light is indicates the concentration of element.

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 For potassium, the wavelength is 4047 Ả (violet). For sodium, the wavelength is 5890 Ả
(yellow). For lithium, it is 6708 Ả (red).
ELECTRICAL SAFETY
 Electric shock burns and fire hazards happen from the careless use of electricity.
 When electricity is used to support life with devices like external pacemakers, respirators,
etc. power failure is a continuous threat.
 Shock resulting from electric power is a common experience.
 Electric current can flow through the human body either accidentally or
intentionally.
 Electrical currents are used intentionally in the following cases:
o In measurement of respiration rate by impedance method.
o High frequency currents are passed through the body for therapeutic and
surgical purposes,
o When recording signals like EGG and EEG, the amplifiers used in the
preamplifier stage delivers small currents themselves to the patient.

 Accidental transmission of electrical current can take place because of a defect in

the equipment; due to defect in design; operational error (human error).

Electric Shock Hazards

 Hazards due to electric shock are associated with medical equipments. Some such
special situations are as follows:
 A patient who is either ill, unconscious, or anaesthetized may not be able to
withdraw himself from the electrified object, when feeling a tingling in his skin,
before any danger occurs.
 The patient may not realize when a potential hazard exists. This is because potential
differences are small and of high frequency and are not directly indicated.
 A considerable natural protection and barrier to electric current is provided by human
skin. In certain applications of electromedical equipment, the natural resistance of
the skin may be by-passed. Such situations arise when the tests are carried out on the
patient with a catheter in his heart.

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 Electro-medical equipment, e.g. pacemakers are used either temporarily or

permanently in the human body. An interruption in power supply or failure of the
equipment may give rise to hazards, which may cause permanent injuries.
 In some treatments, there are combinations of high power equipment and extremely
sensitive low signal equipment. Each of these devices are safe when used alone but
can become dangerous when used in combination with others.
 The environmental conditions in hospitals, particularly in the operating theatres,
cause an explosion or fire hazards due to presence of anaesthetic agents, humidity
and cleaning agents, etc.
 There are two situations which account for hazards from electric shock. They are
(a) Gross shock and (b) Micro-current shock.
a. Gross Shock

 In the case of gross shock, the current flows through the body of the subject, e.g. as from
arm to arm.
 This type of hazard is dangerous not only to the patient but also to the medical and attending
staff.
b. Micro-current shock.

 The other case is that of micro-current shock in which the current passes directly through the
heart wall. Here, even very small amounts of currents can produce fatal results.

PHYSIOLOGICAL EFFECTS OF ELECTRIC CURRENT ON THE HUMAN BODY

 Threshold of Perception:
 The threshold of perception of electric shock is about 1 mA. At this level a tingling
sensation is felt by the patient when there is a contact with an electrified object through
the intact skin.

 Let-go Current:
 As the magnitude of alternating current is increased the sensation of tingling results in
contraction of muscles. The muscular contraction increases as the current is increased

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and finally a value of current is reached at which the patient cannot release his grip on
the current carrying conductor.
 The maximum current at which the patient is still capable of releasing a conductor by
using muscles directly stimulated by that current is called "let-go current".
 Physical Injury and Pain:
 At current levels higher than the ‘let-go current’, the patient loses the ability to control
his own muscle actions and he is unable to release his grip on the electrical conductor.
Such currents are very painful and hard to bear. This type of accident is caused by
currents in the range of 20-100mA.
 Ventricular Fibrillation:
 If current comes in contact with skin and passes through the body at about 100 mA and
above, the rhythmic action of the heart stops, pumping action stops and the pulse
disappears. This condition is ventricular fibrillation.
 Ventricular fibrillation is a serious cardiac emergency because once it starts; it
practically never stops spontaneously, even when the current that triggered it is
removed.
 Sustained Myocardial Contraction:
 At currents in the range of 1 to 6 A. the entire heart muscle contracts. Although the heart
stops beating while the current is applied, it may come back to a normal rhythm if the
current is discontinued in time, just as in fibrillation.
 Burns and Physical Injury:
 At very high currents of the order of 6 amperes and above there is a danger of temporary
respiratory paralysis and also of serious burns. The brain and other nervous tissue loose
all functional excitability when high currents pass through them.
PRECAUTIONS TO MINIMIZE ELECTRIC SHOCK HAZARDS (METHODS OF
ACCIDENT PREVENTION)

The following precautions should be observed to prevent hazardous situations:

 In the vicinity of the patient, use only apparatus or appliances with three-wire power
cords.

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 Provide isolated input circuits on monitoring equipment.

 Have periodic checks of ground wire continuity of all equipment.

 No other apparatus should be put where the patient monitoring equipment is

connected.

 Staff should be trained to recognize potentially hazardous conditions.

 Connectors for probes and leads should be standardized so that currents intended for
powering transducers are not given to the leads applied to pick up physiologic electric
impulses.

 The functional controls should be clearly marked and the operating instructions be
clearly displayed so that they can be easily familiarized.

 Many of the portable medical equipment such as dialysis units, physiotherapy apparatus,
respirators and humidifiers are used with adapter plugs that do not ensure a proper
grounding circuit.

 The operating instructions should give directions on the proper use of the equipment.

 The mechanical construction of the equipment must be such that the patient or operator
cannot be injured by the mechanical system of the equipment, if properly operated

INTRODUCTION TO TELE - MEDICINE

 Tele-medicine or Bio-telemetry is the electrical technique for conveying biological

information from a living organism and its environment to another location where this
information can be observed or recorded.
 Thus it refers to the communication between a living system and an observer.
 Today tele-medicine is extended for monitoring patients in a hospital from a remote
location.
 The size and weight of the tele-medicine system should be small.
 It should have more stability and reliability.

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Components of Tele-Medicine System

 The essential blocks of a tele-medicine system are shown in the figure.

 The transducer converts the biological variable into electrical signal.
 The signal conditioner amplifies and modifies this signal for effective transmission.
 The transmission link connects the signal input blocks to the readout device by wire or
wireless mean.

 The tele-medicine system should be selected to transmit the bio-electric signals with
maximum fidelity and simplicity.
 There would not be any constraint for living system due to these telemetry systems and
there would not be any reaction or any interference with the living system.
 The size and weight of the tele-medicine system should be small.
 It should have more stability and reliability.
 The power consumption should be very small to extend the source life time in the case of
implanted units.
 For wire transmission, shielding of cable is a must to reduce noise level. At the
transmitter side, the amplifiers should be differential amplifier to reject common mode
interference.
 The miniaturized radio telemetering system should be used to reduce noises.

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Applications
 Tele-medicine helps us to record the bio-signals over long periods and while the patient is
emerged in his normal activities.
 The medical attendant or computer can easily diagnose the nature of disease by seeing the
telemered bio-signals without attending the patient’s room.
 Patient is in his room without any mechanical or physical disturbance during recording
by means of biotelemetry.
 For future reference or to study the treatment effect, the tele-medicine is the essential one.
 For recording on animals, particularly for research, the tele-medicine is greatly used.
 For monitoring the persons who are in action, the biotelemetry is an ideal one.
 Although telemedicine can potentially affect all medical specialities, the greatest current
applications are found in radiology, pathology, cardiology and medical education.
 Tele-radiology: Radiological images such as X-ray, CT or MRI images can be
transferred from one location to another location for expert interpretation and
consultation.
 Tele-pathology: To obtain an expert opinion on the microscopic images of pathology
slides and biopsy reports from specialists.
 Tele-cardiology: It relates to the transmission of ECG, echocardiography, etc.

INTRODUCTION TO MEDICAL ROBOTICS

• Medical robots allow surgeons to more dexterously manipulate surgical instruments

or cathetersinside the patient's body during minimally invasive surgeries.
• During robotic procedures, surgeons control the surgical instruments with joysticks
or tele manipulators as easily as moving virtual objects in computer games.
• Medical robots assist with surgeries, streamline clinical workflow and hospital
logistics, andenhance patient care and workplace safety.
• They can be categorized into four main classes;
1.Surgical Robots 2.Rehabilitation Robots

3. Medical Asistant Robots 4.Hospital Service Robots

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Surgicl Robots : Surgical robots refer to medical robots that are routinely used in surgery and
used as medical equipment in integrated disciplines such as medicine, mechanics, biomechanics,
and computer science. The existing surgical robots offer increased dexterity to surgeons.
Rehabilitation Robots : Rehabilitation robots refer to the devices that can automatically
perform tasks to replace or assist certain functions of the human body, thereby playing a role in
the rehabilitation process . Rehabilitationrobots currently play an important role in the functional
reorganization and restoration, as well as metabolic compensation, of the nervous system, and
the remission ofmuscle atrophy and joint atrophy.

Medical Assistant Robots : Medical assistant robots are defined as robotic equipment, with
patients as their service objects. They are used to substitute or support the hospital staff to
perform medical transactions including examination, diagnosis, guidance, and disease analysis.
Themost prominent feature of medical assistant robots is that they replace nurses and physicians
to provide diagnostic and treatment-related services to patients. Throughout the detection of
disease and treatment, almost all operations related to medical procedures can be performed by
medical assisted robots.

Hospital Service Robots : Hospital service robots are robotic devices used in hospitals or other
medical institutions to provide services unrelated to medical operations. The usage of hospital
service robots greatly enhances the service quality for patients and reduces costs for medical
institutions. The usage of hospital service robots can effectively relieve staff pressure and
provide constant service on all days.

Characteristics

 Safety: procedures performed by robots or with the help of a robot need to be safe for
patientsand healthcare professional.
 Quality: must help to improve diagnosis confirmations and treatments, with accuracy
andconsistency for surgical procedures with precise geometry precision.
 Efficiency: robot medical procedures must be most efficient compared with traditional
approach,and Quick recovery, based in less invasive allows less time for recovery.

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 Overall cost of health care cheaper: though the initial cost of a robot is high, the
added benefits such as efficient operation, quicker recovery time, less hospital
stay make overall cost cheaper.
 Independent living: Robot systems can assist disable patients to perform their
daily activitiesindependently.

Applications

 Telepresence Physicians use robots to help them examine and treat patients in
rural orremote locations, giving them a telepresence in the room.

 Surgical Assistants These remote-controlled robots assist surgeons with

performingoperations, typically minimally invasive procedures.

 Rehabilitation Robots These robots can be programmed to adapt to the

condition of each patient as they recover from strokes, traumatic brain or spinal
cord injuries, or neurobehavioral or neuromuscular diseases such as multiple
sclerosis.

 Medical Transportation Robots Supplies, medications, and meals are delivered

to patients and staff by these robots, thereby optimizing communication between
doctors,hospital staff members, and patients.

 Sanitation and Disinfection Robots These robots can disinfect a room of any
bacteriaand viruses within minutes.

 Robotic Prescription Dispensing Systems Automated dispensing systems have

advanced to the point where robots can now handle powder, liquids, and highly
viscousmaterials, with much higher speed & accuracy.

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