Lembar Kerja Patient Monitor Pemeliharaan Qualitative dan Quantitative /

PROSIM 8

Kode Dokumen : Revisi ke : Tanggal Terbit : Halaman ke :

A. PENDATAAN ALAT

Nama Rumah Sakit : ............................................ Merek / Tipe : .....................................

Nama Ruangan : ............................................ Nomor Seri : .....................................
User / Operator Alat : ............................................ Tanggal Pelaksanaan : .....................................
Nama Alat : ............................................ Petugas Pelaksana : ......................................

B. ALAT UKUR DAN BAHAN YANG DIGUNAKAN

Nama Alat Merek Tipe/Model No. Seri

Vital Sign Simulator Fluke Biomedical Prosim 8
Electrical Safety Analyzer Fluke Biomedical
Thermohygrometer

C. KONDISI RUANGAN

Parameter Terukur
Suhu ºC
Kelembaban nisbi %

D. PEMERIKSAAN KONDISI FISIK DAN FUNGSI ALAT ( QUALITATIVE TASKS )

P F NA Descriptions P F NA Descriptions
1. Chassis/Housing 12. Accessories
2. Labeling d. NIBP interconnection tubing
3. Mount b. Cuff
4. Alarm /Interlock c. Bulb
5. Indicators/Displays
6. Line Cord
7. Recorder
8. Circuit Breaker/Fuse
9. Controls/Switches
10. Back Up Battery Powered
11. Charging Systems

Ket. : P = Pass ( Lulus ), F = Fail ( Gagal ),NA = Not Available ( Tidak Tersedia ).
 Lembar Kerja Patient Monitor Pemeliharaan Qualitative dan Quantitative /
PROSIM 8

Kode Dokumen : Revisi ke : Tanggal Terbit : Halaman ke :

E. PENGUKURAN KESELAMATAN LISTRIK ( SAFETY TEST )

Ambang
No. Parameter Terukur
Batas
a. Mains Voltage / Live - Neutral V 220 ± 10 % V
b. Current Amp A -
c. Protective Earth Resistance Ω  0,2 Ω
d. Insulation Resistance ( Mains – PE ) MΩ ≥ 20 MΩ
e. Earth Leakage Current Normal Polarity A  500 A
f. Earth Leakage Current Reverse Polarity A  500 A
f. Enclosure Leakage Current Normal Polarity Close Earth A  100 A
g. Enclosure Leakage Current Normal Polarity Open Earth A  500 A
h. Enclosure Leakage Current Reverse Polarity Close Earth A  100 A
i. Enclosure Leakage Current Reverse Polarity Open Earth A  500 A
i. Patient Leakage Current RA – Closed Earth ,Off Polarity A <10 A
j. Patient Leakage Current LL – Closed Earth ,Off Polarity A <10 A
k. Patient Leakage Current LA - Closed Earth ,Off Polarity A <10 A
l. Patient Leakage Current RL - Closed Earth ,Off Polarity A <10 A
m. Patient Leakage Current V1 – Closed Earth ,Off Polarity A <10 A
n. Patient Auxiliary Current Normal Polarity RA – All ,Closed Earth A <10 A
o. Patient Auxiliary Current Normal Polarity LL – All ,Closed Earth A <10 A
p. Patient Auxiliary Current Normal Polarity LA – All ,Closed Earth A <10 A
q. Patient Auxiliary Current Normal Polarity RL – All ,Closed Earth A <10 A
r. Patient Auxiliary Current Normal Polarity V1 – All ,Closed Earth A <10 A
 Lembar Kerja Patient Monitor Pemeliharaan Qualitative dan Quantitative /
PROSIM 8

Kode Dokumen : Revisi ke : Tanggal Terbit : Halaman ke :

F. PENGUKURAN KINERJA ( QUANTITATIVE TASKS )

1. NIBP / TEKANAN DARAH

HASIL PENGUKURAN
Setting
No TOLERANSI
Pada Standar

Systole 80
1. MAP 60 10 % mmHg
Diastole 50
Systole 100
2 MAP 77 10 % mmHg
Diastole 65
Systole 120
3 MAP 93 10 % mmHg
Diastole 80
Systole 150
4 MAP 117 10 % mmHg
Diastole 100
Systole 200
5 MAP 167 10 % mmHg
Diastole 150

2. Saturasi Oksigen ( SPO2 )

Hasil
Parameter Setting Standar Terukur Toleransi
P F
80
SpO2 85
(%) 90 ± 2%
95
100
 Lembar Kerja Patient Monitor Pemeliharaan Qualitative dan Quantitative /
PROSIM 8

Kode Dokumen : Revisi ke : Tanggal Terbit : Halaman ke :

3. ECG

Hasil
Parameter Setting Standar Terukur Toleransi
P F
30
60
ECG 80 ± 10 %
(bpm)
120
140

4. Respirasi

Hasil
Parameter Setting Standar Terukur Toleransi
P F
10
15
Respirasi ( brpm ) 30 ± 10 %
45
60

G. KESIMPULAN

Hasil Pengamatan
Parameter
P F
Kondisi Fisik Alat
Keselamatan Listrik
Kinerja alat

Catatan :

Ttd. Pelaksana Ttd. User

Anjar Nugraha,A.Md.
NIP:199509182023211001