Hospital Training Lab

7/28/2019 Hospital Training Lab

1/83

VEL TECH MULTI TECH

Dr.RANGARAJAN Dr.SAKUNTHALA

ENGINEERING COLLEGE(Approved by AICTE, New Delhi & Affiliated to Anna University, Chennai)

No.60,AvadiVel Tech Road, Chennai600 062.

BM2356- HOSPITAL TRAINING LAB

NAME :ROLL NO. :

REGISTER NO.:

BRANCH : BIOMEDICAL ENGINEERING

YEAR : IV year


2/83

VEL TECH MULTI TECH

Dr. RANGARAJAN Dr. SAKUNTHALAENGINEERING COLLEGE

(Approved by AICTE, New Delhi & Affiliated to Anna University,Chennai)No.60, AvadiVel Tech Road, Chennai600 062.

Name

Year IV Semester VII Branch Biomedical engineering

University Reg. No. College Roll No

Certified that this is the bonafide record of work done by the above student inthe Hospital Training Lab(BM) during the academic year 2012-2013

. ..

Signature of HOD Signature of Lab Incharge________________________________________________________________

Submitted for the University Practical Exam held on atVELTECH MULTI TECH Dr.RANGARAJAN Dr.SAKUNTHALA ENGINEERINGCOLLEGE,#60,AVADIVEL TECH ROAD,CHENNAI62.

Signature of Examiners

Internal: . External: .

Date:


3/83

ACKNOWLEDGMENT

I praise almighty GOD for his grace abundance blessings he has

showered upon me to complete this work.

I express my immense gratitude to respected chairman MR.

KISHORE for support to complete this record.

I express my immense gratitude to Principal

MR.HEMATHKUMAR for his support in providing permission for

training sessions.

I express my sincere thanks to HOD DR.C.CHELLARAM for the

guidance in completing my record successfully.

I cordially thank my parents & friends for the external support &

encouragement which they provided for me in preparing this record

successfully.


4/83

LIST OF DEPARTMENTS VISITED

1. LABORATORIES

Biochemistry

Histopathology & Cytology

Hematology

Immuno serology

Medical Genetics

Mycobacteriology

Culture area

2. ICU (Intensive Care Unit)

3. DIALYSIS

4. BLOOD BANK

6. NEONATAL/LABOR WARD

7. EMERGENCY WARD

8. OT (Operation Theatre)

9. PHYSIOTHERAPY


5/83

LABORATRIES


6/83

BIOCHEMISTRY


7/83

INTRODUCTION:A biochemistry lab is a facility in which people can perform tasks related to

the study of biochemistry. Biochemistry labs have equipment which can be used toexplore various topics in biochemistry, along with space for storage of specimens,

experiments, and other activities. Such labs can be found in colleges anduniversities with biochemistry departments, along with institutions which

perform biochemistry research, and as standalone structures which performresearch and analysis. Basic facilities for biochemistry can also be found in somecriminal laboratories, as many topics in biochemistry are useful in the analysis andevaluation of evidence.

Biochemistry is a science which involves the examination of variouschemical processes as they are found in living organisms. These can range fromthe processes involved in cell division to the signals sent by neurons to coordinate

the workings of the nervous system. Many tasks in biochemistry have to take placein a laboratory environment with special equipment, because there is no other wayto study biochemical processes which take place on the cellular or even molecularlevel.

A typical biochemistry lab includes workbenches for people to use, withequipment like spectrometers, microscopes, DNA sequencers, imagers,chromatographs, computers, and electrophoresis equipment, along with toolswhich can be used to manipulate samples. The lab also has protections such as

fume hoods and isolation boxes to protect people from hazardous substances, alongwith storage space and specially equipped facilities like cold rooms and negativepressure rooms. The biochemistry lab may be attached to offices used by scientistsaffiliated with the lab.At colleges and universities, a biochemistry lab can be used for instruction, withstudents being obliged to spend time in the lab working on projects and developinghands-on experience. College labs can also be used for research by graduatestudents and advanced undergraduates. Scientific institutions maintain labs forresearch and analysis of samples, from suspect viruses involved in an epidemic tonew species of plants.

Some biochemistry labs focus on analysis of materials by request, handlingmaterials such as samples from patients with medical problems, evidence fromcrime scenes, or DNA samples which need to be processed. These labs charge feesfor handling such materials and generating reports. They may serve a large area,handling materials from a variety of sources, or they may only offer their servicesto specific companies and individuals. This type of biochemistry lab may have
http://www.wisegeek.com/what-is-biochemistry.htmhttp://www.wisegeek.com/what-is-biochemistry-research.htmhttp://www.wisegeek.com/what-is-dna.htmhttp://www.wisegeek.com/what-is-dna.htmhttp://www.wisegeek.com/what-is-biochemistry-research.htmhttp://www.wisegeek.com/what-is-biochemistry.htm


8/83

additional concerns such as security of evidence and patient privacy which must beaddressed with lab protocols.

INSTRUMENTS STUDIED IN THE LABORATORY:

Centrifuge:

A centrifuge is a piece of equipment, generally driven by an electric motor(some older models were spun by hand), that puts an object in rotation around afixed axis, applying a force perpendicular to the axis. The centrifuge works usingthe sedimentation principle, where the centripetal acceleration causes densersubstances to separate out along the radial direction (the bottom of the tube). Bythe same token lighter objects will tend to move to the top (of the tube; in therotating picture, move to the centre).

CENTRIFUGE APPARATUS

Applications:

Centrifuges with a batch weight of up to 2,200 kg per charge are used in thesugar industry to separate the sugarcrystals from the mother liquor.

Standalone centrifuges for drying (hand-washed) clothesusually with a wateroutlet.
http://en.wikipedia.org/wiki/Rotation_around_a_fixed_axishttp://en.wikipedia.org/wiki/Rotation_around_a_fixed_axishttp://en.wikipedia.org/wiki/Sedimentationhttp://en.wikipedia.org/wiki/Centripetal_accelerationhttp://en.wikipedia.org/wiki/Sugarhttp://en.wikipedia.org/wiki/Mother_liquorhttp://en.wikipedia.org/wiki/File:High-speed_centrifuge.jpghttp://en.wikipedia.org/wiki/File:High-speed_centrifuge.jpghttp://en.wikipedia.org/wiki/Mother_liquorhttp://en.wikipedia.org/wiki/Sugarhttp://en.wikipedia.org/wiki/Centripetal_accelerationhttp://en.wikipedia.org/wiki/Sedimentationhttp://en.wikipedia.org/wiki/Rotation_around_a_fixed_axishttp://en.wikipedia.org/wiki/Rotation_around_a_fixed_axis


9/83

Centrifuges are used in the attraction Mission: SPACE, located at Epcot in WaltDisney World, which propels riders using a combination of a centrifuge anda motion simulatorto simulate the feeling of going into space.

In soil mechanics, centrifuges utilize centrifugal acceleration to match soil

stresses in a scale model to those found in reality. Large industrial centrifuges are commonly used

in waterand wastewatertreatment to dry sludges. The resulting dry product isoften termed cake, and the water leaving a centrifuge after most of the solidshave been removed is called centrate.

Large industrial centrifuges are also used in the oil industry to remove solidsfrom the drilling fluid.

Disc-stack centrifuges used by some companies in Oil Sands industry toseparate small amounts of water and solids from bitumen.

Auto analyzer:

AutoAnalyzer is an automated analyzerusing a special flow techniquenamed "continuous flow analysis (CFA)" first made by the TechniconCorporation. The instrument was invented 1957 by Leonard Skeggs, PhD andcommercialized by Jack Whitehead's Technicon Corporation. The first applicationswere for clinical analysis, but methods for industrial analysis soon followed.

The AutoAnalyzer profoundly changed the character of the chemical testinglaboratory by allowing significant increases in the numbers of samples that couldbe processed. The novel design based on separating a continuously flowing streamwith air bubbles all but eliminated slow, clumsy, and error prone manual methodsof analysis. This instrument single handedly changed the concept of days persample to a mindset that hundreds, or even thousands, of tests are possible per day.
http://en.wikipedia.org/wiki/Mission:_SPACEhttp://en.wikipedia.org/wiki/Epcothttp://en.wikipedia.org/wiki/Walt_Disney_Worldhttp://en.wikipedia.org/wiki/Walt_Disney_Worldhttp://en.wikipedia.org/wiki/Motion_simulatorhttp://en.wikipedia.org/wiki/Spacehttp://en.wikipedia.org/wiki/Soil_mechanicshttp://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Wastewaterhttp://en.wikipedia.org/wiki/Sludgehttp://en.wikipedia.org/wiki/Oil_industryhttp://en.wikipedia.org/wiki/Drilling_fluidhttp://en.wikipedia.org/wiki/Drilling_fluidhttp://en.wikipedia.org/wiki/Oil_Sandshttp://en.wikipedia.org/wiki/Bitumenhttp://en.wikipedia.org/wiki/Automated_analyzerhttp://en.wikipedia.org/wiki/File:Cobas_u_411.JPGhttp://en.wikipedia.org/wiki/Automated_analyzerhttp://en.wikipedia.org/wiki/Bitumenhttp://en.wikipedia.org/wiki/Oil_Sandshttp://en.wikipedia.org/wiki/Drilling_fluidhttp://en.wikipedia.org/wiki/Oil_industryhttp://en.wikipedia.org/wiki/Sludgehttp://en.wikipedia.org/wiki/Wastewaterhttp://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Soil_mechanicshttp://en.wikipedia.org/wiki/Spacehttp://en.wikipedia.org/wiki/Motion_simulatorhttp://en.wikipedia.org/wiki/Walt_Disney_Worldhttp://en.wikipedia.org/wiki/Walt_Disney_Worldhttp://en.wikipedia.org/wiki/Epcothttp://en.wikipedia.org/wiki/Mission:_SPACE


10/83

Technicon sold its business to Revlon in 1980[1]

who later sold the companyto separate clinical (Bayer) and industrial (Bran+Luebbe - now SEAL Analytical)

buyers in 1987. At the time, industrial applications accounted for about 20% ofCFA machines sold.

In 1974 Ruzicka and Hansen carried out in Denmarkand in Brasil initialexperiments on a competitive technique, that they termed Flow InjectionAnalysis (FIA). Since then the technique found world wide use in research androutine applications, and was further modified through micro miniaturization and

by replacing continuous flow with computer controlled programmable flow (seeSequential Injection and Lab-on-valve technology).

Clinical Analysis:

AutoAnalyzers were used mainly for routine repetitive medicallaboratory analyses, but they had been replaced during the last years more and

more by discrete working systems which allow lower reagent consumption. Theseinstruments typically determine levels ofalbumin, alkaline phosphatase, aspartatetransaminase (AST), blood ureanitrogen, bilirubin, calcium, cholesterol, creatinine, glucose, inorganic

phosphorus, proteins, and uric acid in blood serum or other bodily samples.AutoAnalyzers automate repetitive sample analysis steps which would otherwise

be done manually by a technician, for such medical tests as the ones mentionedpreviously. This way, an AutoAnalyzer can analyze hundreds of samples every daywith one operating technician. Early AutoAnalyzer instruments each tested

multiple samples sequentially for individual analytes. Later model AutoAnalyzerssuch as the SMAC tested for multiple analytes simultaneously in the samples.

In 1959 a competitive system of analysis was introduced by Hans Baruch ofResearch Specialties Company. That system became known as Discrete SampleAnalysis and was represented by an instrument known as the "Robot Chemist."Over the years the Discrete Sample Analysis method slowly replaced theContinuous Flow system in the clinical laboratory.

Uses:

AutoAnalyzers are still used for a few clinical applications such as neonatalscreening or Anti-D, but the majority of instruments are now used for industrialand environmental work. Standardized methods published by the ASTM (ASTMInternational), the US Environmental Protection Agency (EPA) as well asthe International Organization for Standardization (ISO) for environmentalanalytes such as nitrite,nitrate, ammonia, cyanide, and phenol. Autoanalyzers are
http://en.wikipedia.org/wiki/AutoAnalyzer#cite_note-0http://en.wikipedia.org/wiki/AutoAnalyzer#cite_note-0http://en.wikipedia.org/wiki/AutoAnalyzer#cite_note-0http://en.wikipedia.org/wiki/Denmarkhttp://en.wikipedia.org/wiki/Brasilhttp://en.wikipedia.org/wiki/Flow_Injection_Analysishttp://en.wikipedia.org/wiki/Flow_Injection_Analysishttp://en.wikipedia.org/wiki/Medical_laboratoryhttp://en.wikipedia.org/wiki/Medical_laboratoryhttp://en.wikipedia.org/wiki/Chemical_analysishttp://en.wikipedia.org/wiki/Human_serum_albuminhttp://en.wikipedia.org/wiki/Alkaline_phosphatasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Bilirubinhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Technicianhttp://en.wikipedia.org/wiki/Hans_Baruchhttp://en.wikipedia.org/wiki/ASTMhttp://en.wikipedia.org/wiki/International_Organization_for_Standardizationhttp://en.wikipedia.org/wiki/Nitritehttp://en.wikipedia.org/wiki/Nitratehttp://en.wikipedia.org/wiki/Ammoniahttp://en.wikipedia.org/wiki/Cyanidehttp://en.wikipedia.org/wiki/Phenolhttp://en.wikipedia.org/wiki/Phenolhttp://en.wikipedia.org/wiki/Cyanidehttp://en.wikipedia.org/wiki/Ammoniahttp://en.wikipedia.org/wiki/Nitratehttp://en.wikipedia.org/wiki/Nitritehttp://en.wikipedia.org/wiki/International_Organization_for_Standardizationhttp://en.wikipedia.org/wiki/ASTMhttp://en.wikipedia.org/wiki/Hans_Baruchhttp://en.wikipedia.org/wiki/Technicianhttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Phosphorushttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Bilirubinhttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Alkaline_phosphatasehttp://en.wikipedia.org/wiki/Human_serum_albuminhttp://en.wikipedia.org/wiki/Chemical_analysishttp://en.wikipedia.org/wiki/Medical_laboratoryhttp://en.wikipedia.org/wiki/Medical_laboratoryhttp://en.wikipedia.org/wiki/Flow_Injection_Analysishttp://en.wikipedia.org/wiki/Flow_Injection_Analysishttp://en.wikipedia.org/wiki/Brasilhttp://en.wikipedia.org/wiki/Denmarkhttp://en.wikipedia.org/wiki/AutoAnalyzer#cite_note-0


11/83

also commonly used in soil testing laboratories, fertilizer analysis, process control,seawater analysis, air contaminants, and tobacco leaf analysis.

Autoanalyzers are used because they decrease costs, save time, conservereagents and materials, minimize errors, and improve productivity. A laboratory

should consider using an autoanalyzer if there is a significant backlog of samples, alot of overtime just to get things done on time, or continuous repeating of mistakesdue to human error. Not all laboratories should consider continuous flow. If thesample load is less than 20 samples per week, other options should be considered.Before adding an autoanalyzer, management needs to seriously consider that theoperators need to understand the basic concepts of flow analysis. Instrumentmanufacturers, eager to make a sale, will tout simplicity, rapid start up and shutdown, and flat learning curves. While these things may be possible when runningstandards, the laboratory runs real samples that have an effect on the reagents used.In the real world, methods may need to be modified and slight modifications canhave significant impacts on the basic operation of the chemical system. Once anoperator understands flow analysis the incredible capabilities of the instrument can

be realized, allowing methods to be added, improved, enhanced, and developed.

SETUP FOR RADIOIMMUNOASSAY OR RIA:

Previously it was widely used to detect various things in bold fluidslike proteins (natural, infective, those produced by the body in reaction to disease,cancer related), tumor markers, hormones, viruses(hepatitis, HIV, etc.), etc.
http://en.wikipedia.org/wiki/Proteinshttp://en.wikipedia.org/wiki/Tumor_markershttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Tumor_markershttp://en.wikipedia.org/wiki/Proteins


12/83

URINE ANALYZER:

Automated urine analyser having 3 modes of operation: general, one by oneand quick mode. It provide complete urine profile analysis (leucocyctes, nitrite,urobiinogen, protein, pH, blood specific gravity, ketones, bilirubin, glucose and

ascorbic acid). Throughput is nearly of 300 test/hr (max. of 8oo test/hr). It is basedon reflectance photometry priniciple and 2000 sample memory.

It have external keyboard to input patient ID(14 digits), optional barcode reader

andRS232 data connectivity facility.


13/83

HISTOLOGY ANDCYTOLOGY


14/83

Introduction:

The histology and cytology lab is equipped to prepare tissue for microscopicanalysis. Animal and human hard tissues (bone, ligament, cartilage, tendon) are

processed routinely. Contract work on orthopedic, neurologic,and selected forensicsamples is frequently carried out. Here is a partial listing of the equipmentavailable in this lab:

1. Tissue-Tek VIP Tissue Processor

Stores up to ten processing programs Memory capabilities include: station time periods, chamber temperature,

vacuum/pressure needs and delay operations All decalcified tissues are processed through fourteen stations from formalin to

final paraffin infiltration Tissue Embedding Console System is attached, providing efficient embedding

of tissue specimens in paraffin; contains Dispensing, Thermal, and CryoConsoles


15/83

2. ISOMET Low-Speed Bone Saw

Cuts un-decalcified bone, some having biomaterial implants within

Designed to perform high-precision, low deformation materials sectioning Samples are held in suitable chuck and introduced through gravity of a

known weight to a rotating diamond wafering blade

3. Vibratome Semi-automatic Sectioning System

Cuts flesh or fixed specimens without embedding or freezing by means of avibrating blade

Amplitude of vibration, speed of blade advance, and section thickness areoperation selectable

Used for tissue; ganglia, spinal cord, preservation of enzymatic activity, etc.


16/83

HEMATOLOGY


17/83

Introduction:

Hematology, also spelled haematology, is the study ofblood, the blood-

forming organs, and blood diseases. Hematology includes the studyofetiology, diagnosis, treatment, prognosis, and prevention of blood diseases thataffect the production of blood and its components, such as bloodcells, hemoglobin, blood proteins, and the mechanism ofcoagulation. Thelaboratory work that goes into the study of blood is frequently performed bya medical technologist. Hematologists physicians also very frequently do furtherstudy in oncology - the medical treatment ofcancer.

Physicians specialized in hematology are known as hematologists. Theirroutine work mainly includes the care and treatment of patients with hematological

diseases, although some may also work at the hematology laboratoryviewing blood films and bone marrow slides under the microscope, interpretingvarious hematological test results. In some institutions, hematologists also managethe hematology laboratory. Physicians who work in hematology laboratories, andmost commonly manage them, are pathologists specialized in the diagnosis ofhematological diseases, referred to as hematopathologists. Hematologists andhematopathologists generally work in conjunction to formulate a diagnosis anddeliver the most appropriate therapy if needed. Hematology is a distinctsubspecialty of internal medicine, separate from but overlapping with thesubspecialty of medical oncology. Hematologists may specialize further or havespecial interests, for example in:

treating bleeding disorders such as hemophilia and idiopathic thrombocytopenicpurpura

treating hematological malignacies such as lymphoma and leukemia

treating hemoglobinopathies

in the science ofblood transfusion and the work of a blood bank

in bone marrow and stem cell transplantation

General Principle of Hematology:

Flow cytometry measures optical and fluorescence characteristics of singlecells (or any other particle, including nuclei, microorganisms, chromosome

preparations, and latex beads). Physical properties, such as size (represented byforward angle light scatter) and internal complexity (represented by right-anglescatter) can resolve certain cell populations. Fluorescent dyes may bind or
http://en.wikipedia.org/wiki/American_and_British_English_spelling_differences#Simplification_of_ae_and_oehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Preventive_medicinehttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Blood_proteinshttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Medical_technologisthttp://en.wikipedia.org/wiki/Oncologyhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Blood_filmhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Oncologyhttp://en.wikipedia.org/wiki/Hemophiliahttp://en.wikipedia.org/wiki/Idiopathic_thrombocytopenic_purpurahttp://en.wikipedia.org/wiki/Idiopathic_thrombocytopenic_purpurahttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Leukemiahttp://en.wikipedia.org/wiki/Hemoglobinopathieshttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Blood_bankhttp://en.wikipedia.org/wiki/Stem_cell_transplantationhttp://en.wikipedia.org/wiki/Stem_cell_transplantationhttp://en.wikipedia.org/wiki/Blood_bankhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Hemoglobinopathieshttp://en.wikipedia.org/wiki/Leukemiahttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Idiopathic_thrombocytopenic_purpurahttp://en.wikipedia.org/wiki/Idiopathic_thrombocytopenic_purpurahttp://en.wikipedia.org/wiki/Hemophiliahttp://en.wikipedia.org/wiki/Oncologyhttp://en.wikipedia.org/wiki/Microscopehttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Blood_filmhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Oncologyhttp://en.wikipedia.org/wiki/Medical_technologisthttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Blood_proteinshttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Preventive_medicinehttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/American_and_British_English_spelling_differences#Simplification_of_ae_and_oe


18/83

intercalate with different cellular components such as DNA or RNA. Additionally,antibodies conjugated to fluorescent dyes can bind specific proteins on cellmembranes or inside cells. When labeled cells are passed by a light source, thefluorescent molecules are excited to a higher energy state. Upon returning to theirresting states, the fluorochromes emit light energy at higher wavelengths. The useof multiple fluorochromes, each with similar excitation wavelengths and differentemission wavelengths (or colors), allows several cell properties to be measured

simultaneously. Commonly used dyes include propidium iodide, phycoerythrin,and fluorescein, although many other dyes are available. Tandem dyes withinternal fluorescence resonance energy transfer can create even longerwavelengths and more colors.Automated Hematology Instruments:

During the first half of the twentieth century, the complete blood count

(CBC), one of the most commonly ordered laboratory tests, was performed usingexclusively manual techniques:

Blood cell counts (red cells, white cells, platelets) were performed usingappropriately diluted blood samples and a ruled counting chamber(hemocytometer).

Hemoglobin concentration was analyzed colorimetrically by thecyanomethemoglobin method.

The hematocrit (packed cell volume) was measured by high speedcentrifugation of a column of blood, either in a specially designed tube (theWintrobe tube) , or in sealed microcapillary tubes (ie, the "spun" hematocrit,often obtained by fingerstick blood collection).

The white blood cell differential was obtained by examining andenumerating by class (eg, granulocytes, lymphocytes, monocytes) 100 to200 individual white blood cells on a suitably stained blood smear.

In 1932, Wintrobe developed a set of calculated indices that estimatederythrocyte size and hemoglobin content based on the red blood cell count (RBC),hemoglobin concentration (HGB), and hematocrit (HCT). These indices included:

Mean corpuscular volume (MCV) the volume (in femtoliters, fL) of theaverage circulating red blood cell

Mean corpuscular hemoglobin (MCH) the hemoglobin content (inpicograms) of the average circulating red blood cell


19/83

Mean corpuscular hemoglobin concentration (MCHC) the hemoglobinconcentration within circulating red blood cells (grams of hemoglobin100mL of packed red blood cells)

AUTOMATED HEMATOLOGY INSTRUMENT

Methods and Materials:

Instrument evaluations were conducted at 3 laboratory sites in theOhioHealth group. The systems evaluated and the site at which they wereevaluated were:

Riverside Hospital: Coulter GenS, Sysmex SE9500

Grant Medical Center: Coulter HmX, Sysmex SF3000

Doctors North: Coulter AcT diff, Sysmex KX-21

Riverside Hospital, which has the largest daily volume of complete bloodcounts (CBCs) in the system, evaluated the Coulter GenS and Sysmex SE9500.

These are the high-volume fully automated hematology systems with cutting-edgetechnology from their respective manufacturers. At Grant Medical Center, we

evaluated the Coulter HmX and the Sysmex SF3000. These systems were designedfor the midvolume laboratory and feature automated sampling with cap-piercecapability. They also include a 5-part white blood cell (WBC) differential andreticulocyte analysis. The AcT diff and KX-21 are systems well suited for the low-volume laboratory. Both analyzers have cap piercing and a 3-part differential.Reagents used on all systems were those recommended and provided by themanufacturers. All systems were calibrated and controlled according to the


20/83

manufacturers recommendations. The manufacturers also provided calibration and

control materials. Service representatives from each company set up thehematology instruments. The manufacturers provided training for the technologistsdesignated to perform the instrument evaluations. These technologists at each siteoperated the instrument systems and analyzed all samples throughout theevaluation. During the actual evaluation period, no representatives from the

participating companies were present in the laboratory. After all study data hadbeen collected, other technologists in the laboratories had the opportunity toreview and operate the evaluation instruments. These technologists received in-services and training from the manufacturers and were given time to run sampleson each analyzer for several weeks. At the conclusion of the evaluation period,these technologists also completed surveys for each analyzer they used.

Applications in Hematology:

Erythrocyte analysis:

The use of flow cytometry for the detection and quantification of fetal redcells in maternal blood has increased in recent years. Currently in the UnitedStates, rhesus D-negative women receive prophylactic Rh-immune globulin at 28weeks and also within 72 h of delivery. The standard single dose is enough to

prevent alloimmunization from 15 mL of fetal rhesus D+ red cells. If feto-maternal hemorrhage is suspected, the mothers blood is tested for the presence

and quantity of fetal red cells, and an appropriate amount of Rh-immune globulin

is administered. The quantitative test most frequently used in clinical laboratoriesis the Kleihauer-Betke acid-elution test. This test is fraught with interobserver andinterlaboratory variability, and is tedious and time-consuming. The use of flowcytometry for the detection of fetal cells is much more objective, reproducible, andsensitive than the Kleihauer-Betke test. Fluorescently labeled antibodies to therhesus (D) antigen can be used, or more recently, antibodies directed againsthemoglobin F.This intracellular approach, which uses permeabilization of the redcell membrane and an antibody to the chain of human hemoglobin, is precise and

sensitive This method has the ability to distinguish fetal cells from F-cells (adultred cells with small amounts of hemoglobin F).Histogram of a positive test for

feto-maternal hemorrhage. Although the flow cytometry method is technicallysuperior to the Kleihauer-Betke test, cost, instrument availability, and stat accessmay limit its practical utility.

Leukocyte analysis:


21/83

Immunologic monitoring of HIV-infected patients is a mainstay of theclinical flow cytometry laboratory. HIV infects helper/inducer T lymphocytes viathe CD4 antigen. Infected lymphocytes may be lysed when new virions arereleased or may be removed by the cellular immune system. As HIV disease

progresses, CD4-positive T lymphocytes decrease in total number. The absoluteCD4 count provides a powerful laboratory measurement for predicting, staging,and monitoring disease progression and response to treatment in HIV-infectedindividuals. Quantitative viral load testing is a complementary test for clinicalmonitoring of disease and is correlated inversely to CD4 counts. However, CD4counts directly assess the patients immune status and not just the amount of virus.It is likely that both CD4 T-cell enumeration and HIV viral load will continue to beused for diagnosis, prognosis, and therapeutic management of HIV-infected

persons.

Platelets Analysis:The analysis of platelets by flow cytometry is becoming more common in

both research and clinical laboratories. Platelet-associated immunoglobulin assaysby flow cytometry can be direct or indirect assays, similar to other platelet-associated immunoglobulin immunoassays. In autoimmune thrombocytopenic

purpura, free serum antibodies are not found as frequently as platelet-boundantibodies .In contrast, in cases of alloantibody formation, serum antibodies may

be detected without evidence of platelet-associated antibodies. Flow cytometry isan excellent method for direct analysis of platelet-bound antibodies, and it has also

been shown to be of benefit in detection of free plasma membrane.The use of thiazole orange, a fluorescent dye that binds RNA, allowsimmature platelets (also referred to as reticulated platelets) to be quantified .Thereticulated platelet count can be used to determine the rate of thrombopoiesis. Thismeasurement can separate unexplained thrombocytopenias into those withincreased destruction and those with defects in platelet production.The pathogenesis and molecular defects of many primary thrombocytopathies arewell known and relate to defects in structural or functional glycoproteins, such asthe abnormal expression of gpIIb/IIIa in Glanzmann thrombasthenia and gpIb inBernard-Soulier disease .Flow cytometry is a rapid and useful method of obtaining

a diagnosis.Until recently, functional analysis of platelet activation was used primarily inresearch. Many immunological markers of platelet activation have been described,and the commercial availability of antibodies permits flow cytometricdetermination of platelet activation. Platelet activation may be clinically importantin stored blood components, after cardiopulmonary bypass and renal dialysis, andin the treatment of patients with myocardial infarction or thrombotic events.


22/83


23/83

IMMUNO

SEROLOGY


24/83

Introduction:

Immunology is the study of the body's immune system and its functions and disorders.Serology is the study of blood serum (the clear fluid that separates when blood clots).

Immunology and serology laboratories focus on the following:

Identifying antibodies (proteins made by a type of white blood cell in response to anantigen, a foreign protein, in the body)

Investigating problems with the immune system such as autoimmune diseases (when thebody's immune system turns on its own tissues) and immunodeficiency disorders (when abody's immune system is underactive)

Determining organ compatibility for transplantation Common immunology and serology tests

Immunology Laboratory Equipment and Reagents:

RNA Preanalytical Systems:

(a)Identification. RNA Preanalytical Systems are devices intended to collect,store, and transport patient specimens, and stabilize intracellular RNA from thespecimens, for subsequent isolation and purification of the intracellular RNA forRTPCR used in vitro molecular diagnostic testing.

(b) Classification. Class II (special controls). The special control is FDA'sguidance document entitled Class II Special Controls Guidance Document: RNA

Preanalytical Systems (RNA Collection, Stabilization and Purification System forRTPCR Used in Molecular Diagnostic Testing document.

Complement reagent:

(a)Identification. A complement reagent is a device that consists of complement, anaturally occurring serum protein from any warm-blooded animal such as guinea

pigs, that may be included as a component part of serological test kits used in thediagnosis of disease.

Immunoelectrophoresis Equipment:

(a)Identification. Immunoelectrophoresis equipment for clinical use with itselectrical power supply is a device used for separating protein molecules.Immunoelectrophoresis is a procedure in which a complex protein mixture is

placed in an agar gel and the various proteins are separated on the basis of theirrelative mobilities under the influence of an electric current. The separated proteinsare then permitted to diffuse through the agar toward a multispecific antiserum,allowing precipitation and visualization of the separate complexes.


25/83

Immunofluorometer Equipment:

(a)Identification. Immunofluorometer equipment for clinical use with its electricalpower supply is a device used to measure the fluorescence of fluorochrome-labeledantigen-antibody complexes. The concentration of these complexes may be

measured by means of reflected light. A beam of light is passed through a solutionin which a fluorochrome has been selectively attached to serum protein antibodymolecules in suspension. The amount of light emitted by the fluorochrome label isdetected by a photodetector, which converts light energy into electrical energy. Theamount of electrical energy registers on a readout system such as a digitalvoltmeter or a recording chart. This electrical readout is called the fluorescencevalue and is used to measure the concentration of antigen-antibody complexes.

Automated fluorescence in situ hybridization (FISH) enumeration

systems:

(a)Identification. An automated FISH enumeration system is a device that consistsof an automated scanning microscope, image analysis system, and customizedsoftware applications for FISH assays. This device is intended for in vitrodiagnostic use with FISH assays as an aid in the detection, counting andclassification of cells based on recognition of cellular color, size, and shape, and inthe detection and enumeration of FISH signals in interphone nuclei of formalin-fixed, paraffin-embedded human tissue specimens.

Radial Immunodiffusion Plate:

(a)Identification. A radial immunodiffusion plate for clinical use is a device thatconsists of a plastic plate to which agar gel containing antiserum is added. In radialimmunodiffusion, antigens migrate through gel which originally contains specificantibodies. As the reagents come in contact with each other, they combine to forma precipitate that is trapped in the gel matrix and immobilized.

Rocket Immunoelectrophoresis Equipment:

(a)Identification. Rocket immunoelectrophoresis equipment for clinical use is adevice used to perform a specific test on proteins by using a procedure called

rocket immunoelectrophoresis. In this procedure, an electric current causes theprotein in solution to migrate through agar gel containing specific antisera. Theprotein precipitates with the antisera in a rocket-shaped pattern, giving the name tothe device. The height of the peak (or the area under the peak) is proportional tothe concentration of the protein.


26/83

Rocket Immunoelectrophoresis Equipment


27/83

INTENSIVE CAREUNIT


28/83

INTRODUCTION:

An Intensive Care Unit (ICU), also known as a Critical Care

Unit (CCU), Intensive Therapy Unit orIntensive Treatment Unit (ITU) is aspecial department of a hospital that provides intensive-care medicine.

Intensive Care Units cater to patients with the most serious injuries and illnesses,most of which are life-threatening and need constant, close monitoring and supportfrom specialist equipment and medication in order to maintain normal bodilyfunctions. They are staffed by highly trained doctors and critical care nurses whospecialise in caring for the most severely ill patients.[

Patients may be transferred to an Intensive Care Unit from a ward if they requireconstant monitoring, or immediately after surgery if the surgery is invasive or the

patient is at risk of complications.

Hospitals may have ICU's that cater to a specific medical speciality or patient, suchas those listed below:

Neonatal Intensive Care Unit (NICU)

Pediatric Intensive Care Unit (PICU)

Psychiatric Intensive Care Unit (PICU)

Coronary Care Unit (CCU) - Also known as Cardiac Intensive Care Unit(CICU)

Post Anesthesia Care Unit (PACU) - Also known as the Post-OperativeRecovery Unit, or Recovery Room, the PACU provides immediate post-opobservation and stabilisation of patients following surgical operations andanesthesia. Patients are usually held in such facilities for a limited amount oftime, and must meet a set physiological criteria before transfer back to a wardwith a qualified nurse escort takes place. Due to high patient flow in RecoveryUnits, and owing to the bed management cycle, if a patient breaches a timeframe and is too unstable to be transferred back to a ward, they are normallytransferred to a High Dependency Unit (HDU) or Post-Operative Critical Care

Unit (POCCU) for closer observation. High Dependency Unit (HDU) - Many hospitals have a transitional High

Dependency Unit (HDU) for patients who require close observation, treatmentand nursing care that cannot be provided on a general ward, but whose care isnot at a critical enough level to warrant an ICU bed. These units are also calledstep-down, progressive and intensive recovery units and are utilised until a
http://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Human_homeostasishttp://en.wikipedia.org/wiki/Human_homeostasishttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Critical_care_nursinghttp://en.wikipedia.org/wiki/Neonatal_intensive-care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Psychiatric_intensive-care_unithttp://en.wikipedia.org/wiki/Coronary_care_unithttp://en.wikipedia.org/wiki/Post-anesthesia_care_unithttp://en.wikipedia.org/wiki/Physiologicalhttp://en.wikipedia.org/wiki/Bed_managementhttp://en.wikipedia.org/wiki/Bed_managementhttp://en.wikipedia.org/wiki/Physiologicalhttp://en.wikipedia.org/wiki/Post-anesthesia_care_unithttp://en.wikipedia.org/wiki/Coronary_care_unithttp://en.wikipedia.org/wiki/Psychiatric_intensive-care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Neonatal_intensive-care_unithttp://en.wikipedia.org/wiki/Critical_care_nursinghttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Human_homeostasishttp://en.wikipedia.org/wiki/Human_homeostasishttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Hospital


29/83

patient's conditions stabilises enough to qualify them for discharge to a generalward.

Common equipment in an ICU includes mechanical ventilators to assistbreathing through anendotracheal tube or a tracheotomy; cardiac monitors

including those with telemetry;external pacemakers; defibrillators; dialysis equipment forrenalproblems;equipment for the constant monitoring of bodily functions; a webofintravenous lines, feeding tubes,nasogastric tubes, suction pumps, drains,and catheters; and a wide array ofdrugs to treat the primary condition(s) ofhospitalization. Medically induced comas, analgesics, andinducedsedation are common ICU tools needed and used to reduce pain and

preventsecondary infections.
http://en.wikipedia.org/wiki/Mechanical_ventilatorhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheotomyhttp://en.wikipedia.org/wiki/Telemetryhttp://en.wikipedia.org/wiki/Artificial_cardiac_pacemakerhttp://en.wikipedia.org/wiki/Defibrillatorshttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Medical_monitorshttp://en.wikipedia.org/wiki/Intravenous_fluidshttp://en.wikipedia.org/wiki/Nasogastric_intubationhttp://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Induced_comahttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Secondary_infectionhttp://en.wikipedia.org/wiki/Secondary_infectionhttp://en.wikipedia.org/wiki/Secondary_infectionhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Induced_comahttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Nasogastric_intubationhttp://en.wikipedia.org/wiki/Intravenous_fluidshttp://en.wikipedia.org/wiki/Medical_monitorshttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Defibrillatorshttp://en.wikipedia.org/wiki/Artificial_cardiac_pacemakerhttp://en.wikipedia.org/wiki/Telemetryhttp://en.wikipedia.org/wiki/Tracheotomyhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Mechanical_ventilator


30/83

ICU SETUP

EQUIPMENTS AVAILABLE IN ICU:

BLOOD GAS ANALYSER:

An arterial blood gas (ABG) is a blood test that is performedusing blood from an artery. It involves puncturing an artery with a thin needle andsyringe and drawing a small volume of blood. The most common puncture site isthe radial artery at the wrist, but sometimes the femoral artery in the groin or othersites are used. The blood can also be drawn from anarterial catheter. Pulseoximetryplus transcutaneous carbon dioxide measurement is an alternative method
http://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Arterial_catheterhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Arterial_catheterhttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Blood_test


31/83

of obtaining similar information as well. An ABG is a test that measuresthe arterial oxygen tension (PaO2), carbon dioxide tension (PaCO2), and acidity(pH). In addition, arterial oxyhemoglobin saturation (SaO2) can be determined.Such information is vital when caring for patients with critical illness or respiratorydisease. As a result, the ABG is one of the most common tests performed on

patients in intensive care units (ICUs).

The test is used to determine the pH of the blood, the partial pressure ofcarbondioxide and oxygen, and the bicarbonate level. Many blood gas analyzers will alsoreport concentrations oflactate, hemoglobin,several electrolytes, oxyhemoglobin, carboxyhemoglobin andmethemoglobin.ABG testing is mainly used in pulmonology and critical care medicine todetermine gas exchange which reflect gas exchange across the alveolar-capillarymembrane. ABG testing also has a variety of applications in other areas of

medicine. Combinations of disorders can be complex and difficult to interpret, socalculators, nomograms, and rules of thumb are commonly used.

BLOOD GAS ANALYZER

Sampling and analysis:

Arterial blood for blood gas analysis is usually drawn by a respiratorytherapist and sometimes a phlebotomist, nurse or doctor. Blood is most commonlydrawn from the radial arterybecause it is easily accessible, can be compressed tocontrol bleeding, and has less risk for occlusion, the selection of which radialartery to draw from is based on the outcome of an Allen's test. The femoral

artery (or less often, the brachial artery) is also used, especially during emergencysituations or with children. Blood can also be taken from an arterial catheteralready placed in one of these arteries.

The syringe is pre-packaged and contains a small amount ofheparin, toprevent coagulation or needs to be heparinised, by drawing up a small amount ofheparin and squirting it out again. Once the sample is obtained, care is taken toeliminate visible gas bubbles, as these bubbles can dissolve into the sample and
http://en.wikipedia.org/wiki/Arterial_oxygen_tensionhttp://en.wikipedia.org/wiki/Carbon_dioxide_tensionhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Partial_pressurehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Oxyhemoglobinhttp://en.wikipedia.org/wiki/Carboxyhemoglobinhttp://en.wikipedia.org/wiki/Methemoglobinhttp://en.wikipedia.org/wiki/Pulmonologyhttp://en.wikipedia.org/wiki/Gas_exchangehttp://en.wikipedia.org/wiki/Nomogramshttp://en.wikipedia.org/wiki/Respiratory_therapisthttp://en.wikipedia.org/wiki/Respiratory_therapisthttp://en.wikipedia.org/wiki/Phlebotomisthttp://en.wikipedia.org/wiki/Nursehttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Allen%27s_testhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/File:BGA.jpghttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Allen%27s_testhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Nursehttp://en.wikipedia.org/wiki/Phlebotomisthttp://en.wikipedia.org/wiki/Respiratory_therapisthttp://en.wikipedia.org/wiki/Respiratory_therapisthttp://en.wikipedia.org/wiki/Nomogramshttp://en.wikipedia.org/wiki/Gas_exchangehttp://en.wikipedia.org/wiki/Pulmonologyhttp://en.wikipedia.org/wiki/Methemoglobinhttp://en.wikipedia.org/wiki/Carboxyhemoglobinhttp://en.wikipedia.org/wiki/Oxyhemoglobinhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Bicarbonatehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Partial_pressurehttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Carbon_dioxide_tensionhttp://en.wikipedia.org/wiki/Arterial_oxygen_tension


32/83

cause inaccurate results. The sealed syringe is taken to a blood gas analyzer. If thesample cannot be analyzed within 1015 minutes, it must be placed on ice for validresults. Even when placed on ice, samples should still be analyzed within 1 hour.

Standard blood tests can also be performed on arterial blood, such as

measuring glucose, lactate, hemoglobins,dyshaemoglobins,bilirubin and electrolytes.

MULTIPARAMETER MONITER:

Its monitor are used to monitor different body conditions of patients likeheart beat, ECG, pulse oxygen saturation, noninvasive blood pressure andrespiration. Further, these portable patient monitor are capable of working on bothalterative current as well as direct current.

Application:

Able to measure in-phase 3-7-channel ECG, heart rate, respiration, animaltemperature, pulse, blood oxygen saturation, non-invasive blood pressure and

pulse conduction time. 12.1"TFT big-screen, real-color, wide-visual-angle and highbrightness display. In built with chargeable, maintenance-free and high-capacity batteries, thus

able to work more than 2 hours without additional power supply. With the link formed by network, bed-side machines and central multi-

parameter monitor system, thus form a monitor network is formed.

Able to display trend data, and manual printing and alarm trigger printingfunctions available.
http://en.wikipedia.org/w/index.php?title=Blood_gas_analyzer&action=edit&redlink=1http://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Hemoglobinshttp://en.wikipedia.org/wiki/Bilirubinhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Bilirubinhttp://en.wikipedia.org/wiki/Hemoglobinshttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/w/index.php?title=Blood_gas_analyzer&action=edit&redlink=1


33/83

MULTI PARAMETER MONITOR(TMX-7000A)

These TMX-7000a multiparameter monitor areequipped with following:

Color TFT display : 8.4 visual alarms with adjustable alarm ranges Networkable data management and storage

capacity

ECG

Lead type:5-lead

Input: RA; LA; RL; LL; V Sweep Speed: 2.5mm/s, 25mm/s, 50mm/s Accuracy:+-lbpm or +-1% which is greater Protection: withstand 4000ac/50hz voltage in

isolation against elctro surgical and

Defibrillation

Have S-T detection and Arrhythmia analysisfacility

Have Alarm, audible and visual alarm, alarmevents recallable facility

Standard Configuration

ECG NIBP Sp02


34/83

Optional:

RESP2-TEMP 2-IBP

ET(02) Network Thermal Prinet Pacing Maker

PACEMAKER:

A pacemaker is a small device that's placed in the chest or abdomen to help

control abnormal heart rhythms. This device uses electrical pulses to prompt theheart to beat at a normal rate.

Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmiasare problems with the rate or rhythm of the heartbeat. During an arrhythmia, theheart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeatthat's too slow is called bradycardia (bray-de-KAR-de-ah).

During an arrhythmia, the heart may not be able to pump enough blood to thebody. This can cause symptoms such as fatigue (tiredness), shortness of breath, orfainting. Severe arrhythmias can damage the body's vital organs and may evencause loss of consciousness or death.

A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting.A pacemaker also can help a person who has abnormal heart rhythms resume amore active lifestyle.

Understanding the Heart's Electrical System:

Your heart has its own internal electrical system that controls the rate andrhythm of your heartbeat. With each heartbeat, an electrical signal spreads from thetop of your heart to the bottom. As the signal travels, it causes the heart to contractand pump blood.
http://www.nhlbi.nih.gov/health/health-topics/topics/arr/http://www.nhlbi.nih.gov/health/health-topics/topics/arr/


35/83

Each electrical signal normally begins in a group of cells called the sinusnode or sinoatrial (SA) node. As the signal spreads from the top of the heart to the

bottom, it coordinates the timing of heart cell activity.

First, the heart's two upper chambers, the atria (AY-tree-uh), contract. Thiscontraction pumps blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The ventricles then contract and pump blood to the rest of the body. Thecombined contraction of the atria and ventricles is a heartbeat.

IMPLANTED PACEMAKER

Overview

Faulty electrical signaling in the heart causes arrhythmias. Pacemakers uselow-energy electrical pulses to overcome this faulty electrical signaling.Pacemakers can:

Speed up a slow heart rhythm.

Help control an abnormal or fast heart rhythm.

Make sure the ventricles contract normally if the atria are quivering insteadof beating with a normal rhythm (a condition called atrial fibrillation).

Coordinate electrical signaling between the upper and lower chambers of theheart.

Coordinate electrical signaling between the ventricles. Pacemakers that dothis are called cardiac resynchronization therapy (CRT) devices. CRTdevices are used to treat heart failure.
http://www.nhlbi.nih.gov/health/health-topics/topics/af/http://www.nhlbi.nih.gov/health/health-topics/topics/hf/http://www.nhlbi.nih.gov/health/health-topics/topics/hf/http://www.nhlbi.nih.gov/health/health-topics/topics/af/


36/83

Prevent dangerous arrhythmias caused by a disorder called long QTsyndrome.

Pacemakers also can monitor and record your heart's electrical activity andheart rhythm. Newer pacemakers can monitor your blood temperature, breathingrate, and other factors. They also can adjust your heart rate to changes in youractivity.

Pacemakers can be temporary or permanent. Temporary pacemakers are usedto treat short-term heart problems, such as a slow heartbeat that's caused by a heartattack, heart surgery, or an overdose of medicine.

Temporary pacemakers also are used during emergencies. They might beused until your doctor can implant a permanent pacemaker or until a temporary

condition goes away. If you have a temporary pacemaker, you'll stay in a hospitalas long as the device is in place.

Permanent pacemakers are used to control long-term heart rhythm problems.This article mainly discusses permanent pacemakers, unless stated otherwise.

Doctors also treat arrhythmias with another device called an implantablecardioverter defibrillator(ICD). An ICD is similar to a pacemaker. However,

besides using low-energy electrical pulses, an ICD also can use high-energy pulsesto treat life-threatening arrhythmias.

INTRA-AORTIC BALLOON PUMP (IABP):

The Intra-aortic balloon pump(IABP) is a mechanical device thatincreases myocardial oxygenperfusion while at the same time increasing cardiacoutput. Increasing cardiac output increases coronary blood flow and thereforemyocardial oxygen delivery. It consists of a cylindrical polyethylene balloon thatsits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavianarteryand counterpulsates. That is, it actively deflates in systole, increasing forward

blood flow by reducingafterload. It actively inflates in diastole, increasing blood

flow to the coronary arteries. These actions combine to decrease myocardialoxygen demand and increase myocardial oxygen supply.

A computer-controlled mechanism inflates the balloon with helium from a cylinderduring diastole, usually linked to either an electrocardiogram (ECG) or a

pressure transducerat the distal tip of thecatheter; some IABPs, such as theDatascope System 98XT, allow asynchronous counterpulsation at a set rate, thoughthis setting is rarely used. Helium is used because its low viscosity allows it to
http://www.nhlbi.nih.gov/health/health-topics/topics/qt/http://www.nhlbi.nih.gov/health/health-topics/topics/qt/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/http://www.nhlbi.nih.gov/health/health-topics/topics/hs/http://www.nhlbi.nih.gov/health/health-topics/topics/icd/http://www.nhlbi.nih.gov/health/health-topics/topics/icd/http://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Subclavian_arteryhttp://en.wikipedia.org/wiki/Subclavian_arteryhttp://en.wikipedia.org/wiki/Systole_(medicine)http://en.wikipedia.org/wiki/Afterloadhttp://en.wikipedia.org/wiki/Diastolehttp://en.wikipedia.org/wiki/Coronary_arteryhttp://en.wikipedia.org/wiki/Heliumhttp://en.wikipedia.org/wiki/Electrocardiogramhttp://en.wikipedia.org/wiki/Transducerhttp://en.wikipedia.org/wiki/Distalhttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Distalhttp://en.wikipedia.org/wiki/Transducerhttp://en.wikipedia.org/wiki/Electrocardiogramhttp://en.wikipedia.org/wiki/Heliumhttp://en.wikipedia.org/wiki/Coronary_arteryhttp://en.wikipedia.org/wiki/Diastolehttp://en.wikipedia.org/wiki/Afterloadhttp://en.wikipedia.org/wiki/Systole_(medicine)http://en.wikipedia.org/wiki/Subclavian_arteryhttp://en.wikipedia.org/wiki/Subclavian_arteryhttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Myocardiumhttp://www.nhlbi.nih.gov/health/health-topics/topics/icd/http://www.nhlbi.nih.gov/health/health-topics/topics/icd/http://www.nhlbi.nih.gov/health/health-topics/topics/hs/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/http://www.nhlbi.nih.gov/health/health-topics/topics/qt/http://www.nhlbi.nih.gov/health/health-topics/topics/qt/


37/83

travel quickly through the long connecting tubes, and has a lower risk of causingan embolism should the balloon rupture.

INTRA-AORTIC BALLOON PUMP

The following situations may benefit from this device.

Cardiogenic shockwhen used alone as treatment formyocardial infarction. 9-22% survive the first year.

Reversible intracardial mechanical defects complicating infarction, i.e.acute mitral regurgitation and septalperforation.

Unstable angina pectorisbenefits from counterpulsation.

Post cardiothoracic surgerymost common and useful is counterpulsation inweaning patients from cardiopulmonary bypass after continued perioperativeinjury to myocardial tissue.

Preoperative use is suggested for high-risk patients such as those withunstable angina with stenosis greater than 70% of main coronary artery,in ventriculardysfunction with an ejection fraction less than 35%.

Percutaneous coronary angioplasty

In high riskcoronary artery bypass graft surgery where cardiopulmonary

bypass time was shortened, as well as during intubation period and hospitalstay.

Thrombolytic therapy of acute myocardial infarction.
http://en.wikipedia.org/wiki/Embolismhttp://en.wikipedia.org/wiki/Cardiogenic_shockhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Septalhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Cardiothoracic_surgeryhttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Anginahttp://en.wikipedia.org/wiki/Stenosishttp://en.wikipedia.org/wiki/Ventricle_(heart)http://en.wikipedia.org/wiki/Ejection_fractionhttp://en.wikipedia.org/wiki/PTCAhttp://en.wikipedia.org/wiki/Coronary_artery_bypasshttp://en.wikipedia.org/wiki/Thrombolytichttp://en.wikipedia.org/wiki/Thrombolytichttp://en.wikipedia.org/wiki/Coronary_artery_bypasshttp://en.wikipedia.org/wiki/PTCAhttp://en.wikipedia.org/wiki/Ejection_fractionhttp://en.wikipedia.org/wiki/Ventricle_(heart)http://en.wikipedia.org/wiki/Stenosishttp://en.wikipedia.org/wiki/Anginahttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Cardiothoracic_surgeryhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Septalhttp://en.wikipedia.org/wiki/Mitral_valvehttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Cardiogenic_shockhttp://en.wikipedia.org/wiki/Embolism


38/83

SYRINGE PUMP:

A syringe driver orsyringe pump is a small infusion pump (some includeinfuse and withdraw capability), used to gradually administersmall amounts offluid (with or without medication) to a patient or for use in chemical and

biomedical research.The most popular use of syringe drivers is in palliative care, to continuously

administeranalgesics (painkillers), antiemetics (medication tosuppress nausea and vomiting) and other drugs. This prevents periods duringwhich medication levels in the blood are too high or too low, and avoids the use ofmultiple tablets (especially in people who have difficultyswallowing). As themedication is administered subcutaneously, the area for administration is

practically limitless, although edema may interfere with the action of some drugs.

Syringe drivers are also useful for delivering IV medications over several

minutes. In the case of a medication which should be slowly pushed in over thecourse of several minutes, this device saves staff time and reduces errors.

Syringe pumps are also useful in microfluidic applications, such asmicroreactor design and testing, and also in chemistry for slow incorporation of afixed volume of fluid into a solution. In enzyme kinetics syringe drivers can beused to observe rapid kinetics as part of a stopped flow apparatus

A syringe driver orsyringe pump is a small infusion pump (some includeinfuse and withdraw capability), used to gradually administersmall amounts offluid (with or without medication) to a patient or for use in chemical and

biomedical research.

The most popular use of syringe drivers is in palliative care, to continuouslyadministeranalgesics (painkillers), antiemetics (medication tosuppress nausea and vomiting) and other drugs. This prevents periods duringwhich medication levels in the blood are too high or too low, and avoids the use ofmultiple tablets (especially in people who have difficultyswallowing). As themedication is administered subcutaneously, the area for administration is

practically limitless, although edema may interfere with the action of some drugs.

Syringe drivers are also useful for delivering IV medications over severalminutes. In the case of a medication which should be slowly pushed in over thecourse of several minutes, this device saves staff time and reduces errors.

Syringe pumps are also useful in microfluidic applications, such asmicroreactor design and testing, and also in chemistry for slow incorporation of afixed volume of fluid into a solution. In enzyme kinetics syringe drivers can beused to observe rapid kinetics as part of a stopped flow apparatus.
http://en.wikipedia.org/wiki/Infusion_pumphttp://en.wikipedia.org/wiki/Route_of_administrationhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Swallowinghttp://en.wikipedia.org/wiki/Subcutishttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Enzyme_kineticshttp://en.wikipedia.org/wiki/Stopped_flowhttp://en.wikipedia.org/wiki/Infusion_pumphttp://en.wikipedia.org/wiki/Route_of_administrationhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Swallowinghttp://en.wikipedia.org/wiki/Subcutishttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Enzyme_kineticshttp://en.wikipedia.org/wiki/Stopped_flowhttp://en.wikipedia.org/wiki/Stopped_flowhttp://en.wikipedia.org/wiki/Enzyme_kineticshttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Subcutishttp://en.wikipedia.org/wiki/Swallowinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Route_of_administrationhttp://en.wikipedia.org/wiki/Infusion_pumphttp://en.wikipedia.org/wiki/Stopped_flowhttp://en.wikipedia.org/wiki/Enzyme_kineticshttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Subcutishttp://en.wikipedia.org/wiki/Swallowinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Route_of_administrationhttp://en.wikipedia.org/wiki/Infusion_pump


39/83

SUCTION APPARATUS:

A suctioning machine is an portable apparatus used in the medical field foraspirating fluids from a person's airways and mouth. There are many parts that go

into the manufacturing of an electric suctioning machine. Several types of

suctioning machines are on the market; some are portable, some are for home useand others are strictly for hospital use.

There are several different varieties of suctioning machines. Some suctioningmachines are battery-powered and portable, others are not. Electric suctioningmachines are widely used in the medical field for their relative ease-of-use andaccuracy. Portable tracheal suction machine are available for those who need themto remove mucus from their airways. Each type of suctioning machine has itsadvantages and disadvantages.

The purpose of using any suctioning machine is to remove unwantedmaterials from the stomach, mouth or throat. Some suctioning machines are moresophisticated and offer more features than others. Tracheostomy suction machinesremove mucus and secretions from the trachea that cannot be cleared by coughing.

The main parts of an electronic suctioning machine are a vacuum pump,bacterial filter, vacuum gauge, moisture or debris trap, a reservoir for aspiratedmaterial and a suction catheter. Reservoirs are usually glass bottles with markingsindicating volume. Tracheostomy suction machines are simple machines consistingof a suction catheter with a hard plastic end and a connecting tube.

Many electric suctioning machines are available with high or low levels ofsuction. The levels relate to the rate of suction produced. High suction machinesare usually employed for rapid aspiration of fluids or debris. Low suction machinesare ideal for post-op drainage of wounds. Some suction machines have compactdesigns making them easy to store.

SUCTION APPARATUS


40/83

To avoid risk of injury and unnecessary wear, suctioning machines shouldonly be used when needed and as recommended. Suctioning machines should bekept clean and free of bacteria to avoid the risk of infecting the user.

There are quite a few portable suctioning machines designed for the home that

are available to the public. Portable suction machines can be purchased foranywhere from one to several hundred dollars depending on the specifications ofeach model. If any servicing or replacement part is needed, a licensed professionalshould do the servicing.

PRESSURE BAG:

A pressure bag is a device that is used to pressurize a bag filled with

intravenous fluid for the purpose of regulating how quickly the fluid is dispensed

to the patient. Sometimes also called pressure pumps, pressure bags can be used in

numerous clinical settings. Companies that manufacture pressure bags usually sellseveral different versions, including disposable ones designed for use with a single

patient, which are thrown away after one use. This reduces the amount of time and

energy spent on sterilization and storage.

When a patient is set up with an intravenous line, the size of the intravenous

catheterand the width of the line have an impact on how quickly fluids can be

delivered. For a basic drip, a bag of fluids may be elevated on a pole above the

patient, with gravity doing the work. Some fine tuning may be possible with clips.

Using a pressure bag increases the rate of flow by pressurizing the bag and forcingthe contents out more quickly.

Pressure bags are inflatable cuffs that can be manually inflated to a desired

level of pressure. The rate of the drip can be controlled by increasing or decreasing

the pressure. Emergency release valves allow care providers to relieve pressure if

there is a problem. Historically, people improvised pressure bags by putting bags

under the patient and using the patient's weight as a source of pressure, or by

inflating a blood pressure cuff around the IV bag. The pressure bag is a somewhat

neater solution to the problem.

The major complication that can arise when using a pressure bag is the risk

that the bag of fluid will burst. This will not injure the patient, although it can be

startling, and if the bag is filled with something like a blood product or a hazardous

medication, it can present a safety risk to health care providers in the
http://www.wisegeek.com/what-is-an-intravenous-line.htmhttp://www.wisegeek.com/what-is-an-intravenous-catheter.htmhttp://www.wisegeek.com/what-is-an-intravenous-catheter.htmhttp://www.wisegeek.com/what-is-blood-pressure.htmhttp://www.wisegeek.com/what-is-an-iv-bag.htmhttp://www.wisegeek.com/what-is-an-iv-bag.htmhttp://www.wisegeek.com/what-is-blood-pressure.htmhttp://www.wisegeek.com/what-is-an-intravenous-catheter.htmhttp://www.wisegeek.com/what-is-an-intravenous-catheter.htmhttp://www.wisegeek.com/what-is-an-intravenous-line.htm


41/83

room. Pressure relief valves are installed to limit the possibility of such events and

care providers also use their judgment when inflating apressure bag.

For very controlled delivery ofintravenous fluids, a patient can be connected

to an infusion pump. Infusion pumps can deliver very precise doses of medication

over the period of time programmed into the device, which may be hours or days.They are especially useful when patients only need small amounts of a medication

or when an intravenous drip needs to be tightly controlled to reduce the risk of

giving the patient too much.

NEBULIZER:

Nebulizers are commonly used for the treatment ofcysticfibrosis, asthma, COPD and otherrespiratory diseases.

Nebulizers use oxygen, compressed airorultrasonicpower to break upmedical solutions and suspensions into small aerosol droplets that can be directlyinhaled from the mouthpiece of the device. The definition of an aerosol is a"mixture of gas and liquid particles," and the best example of a naturally occurringaerosol is mist, formed when small vaporized water particles mixed with hotambient air are cooled down and condense into a fine cloud of visible airbornewater droplets. When using a nebulizer forinhalation therapywith medication to beadministered directly to the lungs, it is important to note that inhaled aerosoldroplets can only penetrate into the narrow branches of the lower airways if theyhave a small diameter of 15 micrometers. Otherwise they are only absorbed by

the mouth cavity, where the effect is low.

The most commonly used nebulizers are Jet nebulizers, which are alsocalled "atomizers". Jet nebulizers are connected by tubing to a compressor, thatcauses compressed airoroxygen to flow at high velocity through a liquid medicineto turn it into an aerosol, which is then inhaled by the patient. Currently thereseems to be a tendency among physicians to prefer prescription of a pressurizedMetered Dose Inhaler(pMDI) for their patients, instead of a Jet nebulizer thatgenerates a lot more noise (often 60dB during use) and is less portable due to aheavier weight. However Jet nebulizers are commonly used for patients in

hospitals who have difficulty using inhalers, such as in serious cases of respiratorydisease, or severe asthma attacks. The main advantage of the Jet nebulizer isrelated to its low operational cost. If the patient needs to inhale medicine on a daily

basis the use of a pMDI can be rather expensive. Today several manufacturershave also managed to lower the weight of the Jet nebulizer down to 635 grams(22.4 oz), and thereby started to label it as a portable device. Compared to all the
http://www.wisegeek.com/what-are-intravenous-fluids.htmhttp://www.wisegeek.com/what-is-an-infusion-pump.htmhttp://www.wisegeek.com/what-is-an-intravenous-drip.htmhttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Compressed_airhttp://en.wikipedia.org/wiki/Ultrasonicshttp://en.wikipedia.org/wiki/Aerosolhttp://en.wikipedia.org/wiki/Misthttp://en.wikipedia.org/wiki/Inhalation_therapyhttp://en.wikipedia.org/wiki/Gas_compressorhttp://en.wikipedia.org/wiki/Compressed_airhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Aerosolhttp://en.wikipedia.org/wiki/Pressurized_Metered_Dose_Inhalerhttp://en.wikipedia.org/wiki/Pressurized_Metered_Dose_Inhalerhttp://en.wikipedia.org/wiki/Pressurized_Metered_Dose_Inhalerhttp://en.wikipedia.org/wiki/Pressurized_Metered_Dose_Inhalerhttp://en.wikipedia.org/wiki/Aerosolhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Compressed_airhttp://en.wikipedia.org/wiki/Gas_compressorhttp://en.wikipedia.org/wiki/Inhalation_therapyhttp://en.wikipedia.org/wiki/Misthttp://en.wikipedia.org/wiki/Aerosolhttp://en.wikipedia.org/wiki/Ultrasonicshttp://en.wikipedia.org/wiki/Compressed_airhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/COPDhttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://www.wisegeek.com/what-is-an-intravenous-drip.htmhttp://www.wisegeek.com/what-is-an-infusion-pump.htmhttp://www.wisegeek.com/what-are-intravenous-fluids.htm


42/83

competing inhalers and nebulizers, the noise and heavy weight is however still thebiggest draw back of the Jet nebulizer.

NEBULIZER

Ultrasonic wave nebulizers were invented in 1964 as a new more portablenebulizer. The technology inside an ultrasonic wave nebulizer is to havean electronic oscillatorgenerate a high frequency ultrasonic wave, which causesthe mechanical vibration of apiezoelectric element. This vibrating element is incontact with a liquid reservoir and its high frequency vibration is sufficient to

produce a vapor mist.[11]As they create aerosols from ultrasonic vibration insteadof using a heavy air compressor, they only have a weight around 170 grams(6.0 oz). Another advantage is that the ultrasonic vibration is almost silent.Examples of these more modern type of nebulizers are: OmronNE-U17 and

Beurer Nebulizer IH30.

Effectiveness:

Recent evidence show that nebulizers are no more effective than metered-dose inhalers (MDIs) with spacers and that MDIs may offer advantages in childrenwith acute asthma. Those findings refer specifically to the treatment of asthma andnot to the efficacy of nebulisers generally, as for COPD for example.

European Respiratory Society highlighted a risk relating to dosagereproducibility caused by selling nebulizer devices separately from nebulizedsolution. They found this practice could vary dosages 10-fold or more by changingfrom an inefficient nebulizer system to a highly efficient one. Two advantagesattributed to nebulizers, compared to MDIs with spacers (inhalers), were theirability to deliver larger dosages at a faster rate, especially in acute asthma;
http://en.wikipedia.org/wiki/Electronic_oscillatorhttp://en.wikipedia.org/wiki/Ultrasonic_wavehttp://en.wikipedia.org/wiki/Piezoelectrichttp://en.wikipedia.org/wiki/Nebulizer#cite_note-Ultrasonic_humidifier-10http://en.wikipedia.org/wiki/Nebulizer#cite_note-Ultrasonic_humidifier-10http://en.wikipedia.org/wiki/Nebulizer#cite_note-Ultrasonic_humidifier-10http://en.wikipedia.org/wiki/Omronhttp://en.wikipedia.org/wiki/Metered-dose_inhalerhttp://en.wikipedia.org/wiki/Metered-dose_inhalerhttp://en.wikipedia.org/wiki/Metered-dose_inhalerhttp://en.wikipedia.org/wiki/Metered-dose_inhalerhttp://en.wikipedia.org/wiki/Omronhttp://en.wikipedia.org/wiki/Nebulizer#cite_note-Ultrasonic_humidifier-10http://en.wikipedia.org/wiki/Piezoelectrichttp://en.wikipedia.org/wiki/Ultrasonic_wavehttp://en.wikipedia.org/wiki/Electronic_oscillator


43/83

however, recent data suggests actual lung deposition rates are the same. Inaddition, another trial found that a MDI (with spacer)had a lower required dosefor clinical resultcompared to a nebulizer (see Clark, et al. other references).

HUMIDIFIER:

A humidifier is a household appliance that increases humidity (moisture) ina single room or in the entire house. There are point-of-use humidifiers, which arecommonly used to humidify a single room, and whole-house or furnacehumidifiers, which connect to a home'sHVAC system to provide humidity to theentire house.

Other types of humidifier include:

Vaporizer (or: steam humidifier, warm mist humidifier) boils water,releasing steam and moisture into the air. A medicated inhalant can also beadded to the steam vapor to help reduce coughs. Vaporizers may be morehealthful than cool mist types of humidifiers because steam is less likely toconvey mineral impurities or microorganisms from the standing water in thereservoir.Boiling water requires significantly more energy than othertechniques. The heat source in poorly-designed humidifiers can overheat,

causing the product to melt, leak, and start fires.

Impeller humidifier (cool mist humidifier) a rotating disc flings water at adiffuser, which breaks the water into fine droplets that float into the air.

Ultrasonic humidifier a metal diaphragm vibrating at an ultrasonicfrequency creates water droplets that silently exit the humidifier in the form ofa cool fog. Ultrasonic humidifiers use a piezo-electric transducer to create ahigh frequency mechanical oscillation in a body of water. The water tries tofollow the high frequency oscillation but cannot because of its comparativeweight and mass inertia. Thus, a momentary vacuum is created on the negativeoscillation, causing the water to cavitate into vapor. The transducer follows thiswith a positive oscillation that creates high pressure compression waves on thewaters surface, releasing tiny vapor molecules ofwater into the air. This is anextremely fine mist, about one micrometre in diameter, that is quicklyabsorbed into the air flow. Unlike the humidifiers that boil water, these water
http://en.wikipedia.org/wiki/Household_appliancehttp://en.wikipedia.org/wiki/Humidityhttp://en.wikipedia.org/wiki/HVAChttp://en.wikipedia.org/wiki/HVAChttp://en.wikipedia.org/wiki/Humidityhttp://en.wikipedia.org/wiki/Household_appliance


44/83

droplets contain any impurities that are in the reservoir, including mineralsfrom hard water(which then forms a difficult to remove white dust on nearbyobjects and furniture), and pathogens growing in the stagnant tank. UltrasonicHumidifiers should be cleaned regularly to avoid bacterial contamination whichmay be projected into the air.

Humidifier
http://en.wikipedia.org/wiki/Hard_waterhttp://en.wikipedia.org/wiki/Hard_water


45/83

DIALYSIS


46/83

INTRODUCTION:

Artificial kidney is often a synonym forhemodialysis, but may also, moregenerally, refer to renal replacement therapies (with exclusion ofrenaltransplantation) that are in use and/or in development. This article deals

with bioengineered kidneys/bioartificial kidneys that are grown fromrenal cell lines/renal tissue.

Kidneys are paired vital organs located behind the abdominal cavity, atabout the level of the bottom of the ribcage. They perform about a dozen

physiologic functions, and are fairly easily damaged. Kidney failure results in theslow accumulation of nitrogenous wastes, salts, water, and disruption of the body'snormal pH balance. Until the Second World War, kidney failure generally meantdeath for the patient. Several insights into renal function and acute renal failurewere made during the war, not least of which would be Bywaters and Beall's

descriptions of pigment-induced nephropathy drawn from their clinical experiencesduring the London Blitz.[1]

Hemodialysis is a method for removing waste products such as creatinineand urea, as well as free water from the blood when the kidneys are in renal failure.The mechanical device used to clean the patients blood is called a dialyser, alsoknown as an artificial kidney. Modern dialysers typically consist of a cylindricalrigid casing enclosing hollow fibers cast or extruded from a polymer or copolymer,which is usually a proprietary formulation. The combined area of the hollow fibersis typically between 1-2 square meters. Intensive research has been conducted by

many groups to optimize blood and dialysate flows within the dialyser, in order toachieve efficient transfer of wastes from blood to dialysate.

Need for a bioartificial kidney:

Over 300,000 Americans are dependent on hemodialysis as treatment forrenal failure, but according to data from the 2005 USRDS 452,000 Americanshave end-stage renal disease(ESRD).Intriguing investigations from groups inLondon, Ontario and Toronto, Ontario have suggested that dialysis treatmentslasting two to three times as long as, and delivered more frequently than,conventional thrice weekly treatments may be associated with improved clinical

outcomes[3]Implementing six-times weekly, all-night dialysis would overwhelmexisting resources in most countries. This, as well as scarcity of donor organs forkidney transplantation has prompted research in developing alternative therapies,including the development of a wearable or implantable device.

The main element in a dialyser is a semipermeable membrane through whichsmall molecules can pass by diffusion. Dialysers are encountered in medical work
http://en.wikipedia.org/wiki/Synonymhttp://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/Renal_replacement_therapyhttp://en.wikipedia.org/wiki/Renal_transplantationhttp://en.wikipedia.org/wiki/Renal_transplantationhttp://en.wikipedia.org/wiki/Bioengineeringhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Kidneyshttp://en.wikipedia.org/wiki/Kidney_failurehttp://en.wikipedia.org/wiki/Nephropathyhttp://en.wikipedia.org/wiki/The_Blitzhttp://en.wikipedia.org/wiki/Artificial_kidney#cite_note-0http://en.wikipedia.org/wiki/Artificial_kidney#cite_note-0http://en.wikipedia.org/wiki/Artificial_kidney#cite_note-0http://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/Chronic_kidney_diseasehttp://en.wikipedia.org/wiki/Artificial_kidney#cite_note-2http://en.wikipedia.org/wiki/Artificial_kidney#cite_note-2http://en.wikipedia.org/wiki/Artificial_kidney#cite_note-2http://en.wikipedia.org/wiki/Chronic_kidney_diseasehttp://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/Artificial_kidney#cite_note-0http://en.wikipedia.org/wiki/The_Blitzhttp://en.wikipedia.org/wiki/Nephropathyhttp://en.wikipedia.org/wiki/Kidney_failurehttp://en.wikipedia.org/wiki/Kidneyshttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Bioengineeringhttp://en.wikipedia.org/wiki/Renal_transplantationhttp://en.wikipedia.org/wiki/Renal_transplantationhttp://en.wikipedia.org/wiki/Renal_replacement_therapyhttp://en.wikipedia.org/wiki/Hemodialysishttp://en.wikipedia.org/wiki/Synonym


47/83

in renal dialysis where unwanted small molecules (e.g. urea) and water can beremoved from the body. Dialysers may also be encountered in the clinicalchemistry laboratory for purifying or modifying samples of fluid being analysed.

Haemodialysers (sometimes called artificial kidneys) take blood from thebody and pass it along one side of the dialysing membrane so that unwanted smallmolecules may dif

Documents

Hospital Training Lab