FORCE Biomedical Biomedical Equipments

Short Learning Topics

On Biomedical Equipments

Author
Ms Heer Thosani

August 2020

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FORCE Biomedical Biomedical Equipments

Table of Contents
1. Angiography ....................................................................................... 4

2. Angioplasty and Stents ..................................................................... 5

3. Artificial Lung .................................................................................... 6

4. Automated External Defibrillator (AED) ...................................... 7

5. Bronchoscope ...................................................................................... 8

6. Capsule Endoscopy ............................................................................ 9

7. Cardiac Ablation System ................................................................ 10

8. Cardiac Mapping System ............................................................... 11

9. Cardiac Stress Test ........................................................................... 12

10. Cardiovascular Information System (CVIS)............................... 13

11. Colonoscope ...................................................................................... 14

12. Cystoscope ......................................................................................... 15

13. Dilation and curettage ..................................................................... 16

14. Electrocardiogram (ECG) ................................................................ 17

15. ECG Holter Monitor ........................................................................ 18

16. Echocardiogram ................................................................................ 19

17. Electroencephalography (EEG) ..................................................... 20

18. Electromyography (EMG)............................................................... 21

19. Gastroscope ....................................................................................... 22

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20. Heart-Lung Machine ....................................................................... 23

21. High-Frequency Chest Wall Oscillation (HFCWO) .................. 24

22. Oxygen concentrator ........................................................................ 25

23. Pacemaker .......................................................................................... 26

24. Polysomnography ............................................................................ 27

25. Positive Expiratory Pressure Device ............................................ 28

26. Prosthetic heart valves .................................................................... 29

27. Pulmonary function test (PFT) ...................................................... 30

28. Resectoscope ..................................................................................... 31

29. Respiratory Monitor ........................................................................ 32

30. Resuscitator ....................................................................................... 33

31. Ureteroscope ...................................................................................... 34

32. Ventilator ........................................................................................... 35

33. Ventricular Assist Device (VAD).................................................. 36

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Angiography

Angiography is a medical
imaging technique that uses
X-rays to visualize the inside
of blood vessels and organs
of the body. A coronary
angiogram or an arteriogram
is an X-ray of the arteries in
the heart. This shows the
extent and severity of any
heart disease and can help
figure out how well the heart
is working.

To create the X-ray images, a contrast liquid dye will be injected through a thin,
flexible tube, called a catheter. The catheter is threaded into the desired artery from
an access point (usually in your arm). The dye makes the blood flowing inside the
blood vessels visible on an X-ray and shows any narrowed or blocked area in the
blood vessel. The dye is later eliminated from your body through your kidneys and
your urine.

Angiograms aren't usually done until after non-invasive heart tests have been
performed (ECG, an echocardiogram or a stress test etc.) due to risk factors.
Minor risks include,
• Injury to the catheterized artery
• Bruising or bleeding at the access point
• Irregular heartbeat
• Chest pain

If a blockage is found, angioplasty (with stent) /percutaneous coronary intervention

(PCI) may be performed to open the blockage.

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Angioplasty and Stents

Angioplasty, also known as balloon angioplasty and percutaneous transluminal

angioplasty (PTA), is a procedure used to widen narrowed or obstructed arteries or
veins and restore blood flow.

A thin tube is
threaded through a
blood vessel in the
arm or groin up to
the involved site in
the artery. The tube
has a tiny balloon
on the end. When
the tube is in place,
the balloon is
inflated to push the
plaque outward
against the wall of the artery. This widens the artery and restores blood flow.
Sometimes you may need one or more stents to keep the artery from re-narrowing.

A stent is a tiny coil of wire mesh, which is collapsed around a balloon at the tip of
the catheter. It is guided through the artery to the blockage. There, the balloon is
inflated, and the spring-like stent expands and locks into place inside the artery. The
stent stays in the artery permanently to hold it open and improve blood flow to your
heart. Once the stent is in place, the balloon catheter is deflated and removed.

Risks may include:

• Blood clots and bleeding

• Heart attack or stroke
• Coronary artery damage
• Kidney problems
• Abnormal heart rhythms

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Artificial Lung

An artificial lung (AL) is a prosthetic device that provides oxygenation of blood and
removal of carbon dioxide from the blood. It's intended to take over the functionality
of biological lungs for long periods of time. AL would be a better alternative
compared to heart-lung machine, Extracorporeal Membrane Oxygenation (ECMO)
and Mechanical Ventilation (MV) as these can be used on a temporary basis only.

ALs could provide a stopgap for people recovering from severe lung infections or
waiting for a lung transplant – although a transplant would still be a better long-term
solution for those with permanent lung damage. Currently, lung transplantation
remains the definitive curative treatment for end-stage lung disease, but many
patients die before finding an appropriate donor organ. ALs could overcome the
donor organ shortage and the need for immunosuppression (suppression of immune
response after surgery). It would provide physiologic functions through
bioengineered conducting airways, vasculature and gas exchange tissue.

ALs are still undergoing human clinical trials and are not yet open to the market but
have had successful animal trials.

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Automated External Defibrillator (AED)

An automated external defibrillator is a lightweight, portable electronic device that

automatically diagnoses life-threatening cardiac arrhythmias (irregular heartbeat). It
is able to treat them through defibrillation (delivery of electricity shock to stop
arrhythmia) allowing the heart to re-establish an effective rhythm.

This is usually used

during or after a
sudden cardiac arrest
(SCA), in which
the heart stops functioning abruptly. Most SCAs result from ventricular fibrillation
(VF). VF is a rapid and unsynchronized heart rhythm that originates in the heart’s
lower chambers (the ventricles).

A built-in computer checks heart rhythm through adhesive electrodes. The computer
calculates whether defibrillation is needed. If it is, a shock button is to be pressed on
the AED. This shock momentarily stuns the heart and stops all activity. AEDs advise
a shock only for VF or pulseless ventricular tachycardia (increased heart rate without
a pulse originating in the ventricles).

AEDs are safe to use by anyone. Studies show that 90% of the time AEDs cab detect
arrhythmias and decide whether to deliver a shock or not.

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Bronchoscope

Bronchoscopy is a test to view the airways and diagnose lung disease. It can be used
during the treatment of some lung conditions. A bronchoscope is a thin tube passed
through nose or mouth, down the
throat and into the lungs to see the
inside of the airways and lungs.

Bronchoscopy is most commonly

performed using a flexible
bronchoscope. However, sometimes,
a rigid bronchoscope may be
needed.

Reasons for doing bronchoscopy

include:
• Diagnosis of a lung problem
• Identification of a lung infection
• Biopsy of tissue from the lung
• Removal of mucus, a foreign body,
or other obstruction in the airways of lungs, such as a tumour
• Placement of a small tube to hold open an airway (stent)
• Treatment of a lung problem (interventional bronchoscopy), such as bleeding, an
abnormal narrowing of the airway (stricture) or a collapsed lung (pneumothorax)

During some procedures, special devices are passed through the bronchoscope, such
as a tool to obtain a biopsy, a probe to control bleeding, a laser to reduce the size of
an airway tumour or a bronchoscope with a built-in ultrasound probe.

Risks may include:

• Bleeding
• Collapsed lung
• Fever

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Capsule Endoscopy

Capsule endoscopy is a procedure that uses a tiny wireless camera to take pictures of
the digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule
that's to be swallowed. As the capsule travels through the digestive tract, the camera
takes pictures that are transmitted to a recorder, worn on a belt around the waist.
This procedure helps see the inside of the small intestine (which isn't easily reached
with traditional endoscopy).

The capsule camera takes thousands of

colour photos as it passes through your
digestive tract. The images saved on the
recorder are transferred to a computer
with a special software that strings the
images together to create a video. This
video shows abnormalities within the
digestive tract.

Reasons for a capsule endoscopy:

• To find the cause of gastrointestinal bleeding

• Diagnosis of inflammatory bowel diseases, cancer, celiac disease etc.

• Oesophagus examination

• Screen for polyps

• Follow-up testing after imaging tests

Capsule endoscopy is a safe procedure. However, it's possible for a capsule to

become lodged in your digestive tract rather than leaving your body in a bowel
movement.

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Cardiac Ablation System

Cardiac ablation is a
procedure that can correct
heart rhythm problems
(arrhythmias). When the heart
beats, the electrical impulses
that cause it to contract must
follow a precise pathway
through the heart. Any
interruption in these impulses
can cause an abnormal
heartbeat (arrhythmia).

This process includes scarring

or destroying the tissue that
triggers or sustains an
abnormal heart rhythm. This
process uses long, flexible
tubes (catheters) inserted
through a vein or artery (in
your groin or arm) and
threaded to your heart to
deliver energy in the form of
heat (radiofrequency ablation)
or extreme cold (cryoablation) to modify the tissues in your heart that cause an
arrhythmia. It is sometimes done through open-heart surgery.

Cardiac Ablation has a 95% success rate, but risks may include:
• Bleeding or infection at the site of insertion
• Blood clots and damage to the blood vessels
• Heart damage like puncture or damaged valves
• Arrhythmias
• Stroke or heart attack
• Narrowing of veins that carry blood between your lungs and heart (pulmonary
vein stenosis)
• Kidney damage (from dye used)
• Death (rare cases)

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Cardiac Mapping System

Cardiac mapping is an electrophysiology (EP) study that tests the electrical activity of
your heart. Electrical signals usually travel through the heart in a regular pattern.
Arrhythmias (abnormal heartbeat) occur when these electrical impulses don't work
properly. Cardiac mapping helps find exactly where an arrhythmia is coming from.

More commonly, cardiac

mapping is performed with
catheters. A small incision is
made in your thigh or neck.
Then, one or more thin,
flexible tubes called
catheters are inserted into
the incision and guided
through blood vessels and
to the heart. The ends of
these catheters have tiny
electrodes that help gather
data about the electrical
signals and pinpoint the
cause of the problem.

Various medications can then be tested to identify the best-suited one. In some cases,
ablations can also be performed. Ablations can often cure an arrhythmia by
painlessly targeting a small region of abnormal tissue inside the heart.

Risks may include:

• Arrhythmia
• Blood clots can form at the tip of the catheter, break off and block a blood vessel.
• Infection, bleeding or bruising at the site of incision.

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Cardiac Stress Test

A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary
exercise test, or CPX test) is a cardiological test that measures the heart's ability to
respond to external stress in a controlled clinical environment. The stress response is
induced by exercise or by intravenous pharmacological stimulation and the level is
progressively increased by raising the difficulty and speed. Cardiac stress tests
compare the coronary circulation while the patient is at rest with the same patient's
circulation during maximum cardiac exertion, showing any abnormal blood flow to
the myocardium (heart muscle tissue).

Sticky patches (electrodes) are placed on the patient's chest, legs and arms. The
electrodes have wires connected to an ECG, which records the electrical signals that
trigger heartbeats. A cuff on
the arm checks blood pressure
during the test. The test
administrator or attending
physician then examines the
symptoms and blood
pressure response. To measure
the heart's response to the
stress, the patient may be
connected to
an electrocardiogram (ECG),
echocardiogram (for ultrasonic
imaging of the heart), or
a gamma camera to
image radioisotopes injected
into the bloodstream (called a
nuclear stress test).

The results can be interpreted as a reflection on the general physical condition of the
test patient. This test can be used to diagnose coronary artery disease and assess
patient prognosis after a heart attack.

The stress test has certain limitations:

• It does not detect Atheroma and vulnerable plaques.
• It also has relatively high rates of false positives and false negatives compared to
other clinical tests.

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Cardiovascular Information System (CVIS)

CVIS (Cardiovascular Information Management System) is a unique software

solution that improves the clinical and financial performance of the cardiology
department. It connects to the overall patient electronic medical record
(EMR), cardiac imaging, echo reporting, diagnostic test (ECG) reporting, and other
components to aggregate all cardiac patient data, imaging and waveforms into one
location.

In cardiac care, immediate access to complete patient information is key to

improving both patientcare and workflow. CVIS is becoming an integral part of all
multi-speciality hospitals. These systems have significant benefits including:
• Image/Cardiology Asset Accessibility (Immediate access to current and historical
images and reports)
• Increased performance and workflow (simplified, speedy, structured and
consistent reporting)
• Streamlined patient care
• Data mining to facilitate clinical trials and drug eligibility notification
• Virtual cardiac care (view images and data in multiple locations)
• Reduced costs

Some famous cardiovascular information systems include MUSE, Xcelera, Physiolog

etc.

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Colonoscope

A colonoscopy is an exam used to detect changes or abnormalities in the large

intestine (colon) and rectum. During a colonoscopy, a long, flexible tube
(colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube
allows to view the inside of the entire colon.

A colonoscope is inserted into your rectum. The scope, which can reach the entire
length of your colon,
contains a light and a tube
(channel) that allows to
pump air or carbon dioxide
into the colon. The air or
carbon dioxide inflates the
colon, which provides a
better view of the lining of
the colon. The colonoscope
also contains a tiny video
camera at its tip. The camera
sends images to an external
monitor. Instruments can
also be inserted through the
channel to take tissue
samples (biopsies) or remove
polyps or other areas of abnormal tissue. A colonoscopy typically takes about 30 to
60 minutes.

A colonoscopy is considered negative if there are no abnormalities in the colon and

positive if any polyps or abnormal tissues are found in the colon.

Complications of a colonoscopy may include:

• Internal bleeding
• A tear in the colon or rectum wall (perforation)

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Cystoscope

Cystoscopy is a procedure that allows examination of the lining of the bladder and
the tube that carries urine out of your body (urethra). A hollow tube (cystoscope)
equipped with a lens is inserted into your urethra and slowly advanced into your
bladder.
It can be done to:
1. Diagnose and treat bladder diseases and conditions.
2. Diagnose an enlarged prostate.

A cystoscopy can take 5 to 30

minutes. The bladder should be
empty for the procedure to take
place. The cystoscope is then
pushed into your urethra, using
the smallest scope possible.
Larger scopes might be needed
to take tissue samples or pass
surgical tools into the bladder.
The cystoscope has a lens on the
end that works like a telescope
to magnify the inner surfaces of
the urethra and bladder. A
special video camera might be
placed over the lens to project the images onto a video screen. Your bladder will be
filled with a sterile solution, which inflates the bladder and allows a better look
inside. Tissue samples might be taken for lab testing or to perform other procedures.

Complications of cystoscopy can include:

• Infection
• Bleeding and blood clots
• Abdominal pain
• Fever

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Dilation and curettage

Dilation and curettage (D&C) is a procedure to remove tissue from inside the uterus.
It is performed to diagnose and treat certain uterine conditions, such as heavy
bleeding, or to clear the uterine lining after a miscarriage or abortion.

In a D&C, small instruments or a medication is used to open (dilate) the cervix. A

surgical instrument called a curette is then used to remove uterine tissue.

A D&C might be required to diagnose and treat diseases like

• Endometrial hyperplasia (a precancerous condition in which the uterine lining
becomes too thick)
• Uterine polyps
• Uterine cancer etc.

During the procedure, the person lies on their back on an exam table while the heels
rest in supports (stirrups). An instrument called speculum, is then inserted into the
vagina, in order to view the cervix. A series of thicker rods are inserted into the
cervix to slowly dilate it until it's adequately open. The dilation rods are then
removed and a spoon-shaped instrument with a sharp edge or a suction device is
inserted to remove uterine tissue.

Risks include:
• Perforation of uterus
• Damage to cervix
• Scar tissue on uterine wall
• Infection

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Electrocardiogram (ECG)

An electrocardiogram (EKG
or ECG) is a medical test
that measures the electrical
activity of the heartbeat.
With each beat, an electrical
impulse (or “wave”) travels
through the heart which
causes the muscle to
squeeze and pump blood
from the heart.

The atria (upper chambers) make the first wave called a “P wave" following a flat
line when the electrical impulse goes to the bottom chambers. The ventricles (bottom
chambers) make the next wave called a “QRS complex." The “T wave” represents
electrical recovery (return to a resting state) for the ventricles.

ECG can determine problems including:

• Heart rate
• Structural abnormalities
• Heart rhythm
• Inadequate blood and oxygen supply to the heart
• Heart attack history

ECG is a safe non-invasive procedure. During an ECG, up to 12 sticky pads

(electrodes) will be attached to your chest and limbs. These are connected to a
monitor that records the electrical signals that make your heartbeat.

Changes in the normal ECG pattern occur in numerous cardiac abnormalities,

including cardiac rhythm disturbances, inadequate coronary artery blood flow, and
electrolyte (sodium, potassium, calcium etc.) disturbances.

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ECG Holter Monitor

A Holter monitor is portable electrocardiography device for cardiac monitoring

(monitoring of the electrical activity of the cardiovascular system) for at least 24 to 72
hours. It is also, sometimes, called ambulatory electrocardiography.

This test is usually performed after an electrocardiogram (ECG). If you have signs or
symptoms of a heart problem, such as an irregular heartbeat (arrhythmia) or
unexplained fainting, an ECG may be suggested. ECG is a brief, non-invasive test
that uses electrodes taped to your chest to check your heart's rhythm. However,
sometimes it doesn't
detect any irregularities
in your heart rhythm.
These can be detected
by a Holter monitor
since it's a continuous
test to record your
heart’s rate and rhythm
for 24 hours. It can be
worn while performing
your normal daily
routine.

This device has electrodes and electrical leads exactly like a regular ECG. A typical
Holter monitor has 3 to 8 electrodes attached to your body. A 12 lead Holter system
is also available when precise ECG signal information is required to analyse the exact
nature and origin of the rhythm signal. It has no significant risks.

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Echocardiogram

An echocardiogram or echo is
an ultrasound of the heart. It is one of
the most widely used test in the
diagnosis, management, and follow-
up of patients with any suspected or
known heart diseases. It uses
standard 2-D, 3-D, and Doppler
ultrasound (used to visualize
abnormal communication in the
heart, leaking of blood through
valves (valvular regurgitation), and
estimate how well the valves open) to
create images of the heart.

It provides helpful information

including:
• Size and shape of the heart
• Location and extent of tissue
damage
• Calculation of cardiac output (volume of blood being pumped by the heart per unit
time)
• Ejection fraction (volumetric fraction of blood ejected from the heart with each
contraction)
• Diastolic function (how well the heart relaxes).

Echocardiography helps in detecting cardiomyopathies (chronic disease of the heart

muscle), assessing wall motion abnormality in patients with suspected cardiac
disease and reaching an early diagnosis of myocardial infarction (heart attack).

Its biggest advantage is that it is not invasive (does not involve breaking the skin or
entering body cavities) and has no known risks or side effects.

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Electroencephalography (EEG)
An EEG is a test that detects
electrical activity in the brain
using small, metal discs
(electrodes) attached to the
scalp. Brain cells
communicate via electrical
impulses and are active all
the time, even in sleep. This
activity can be seen as wavy
lines on an EEG recording.

An EEG can determine changes in brain activity that are used in diagnosing and
treating:
• Epilepsy
• Seizure disorder
• Brain tumour
• Brain damage from head injury
• Brain dysfunction (encephalopathy)
• Inflammation of the brain (encephalitis)
• Stroke
• Sleep disorders
• Brain death in a persistent coma

During the procedure, electrodes are attached to the scalp. The electrodes are
connected with wires to an instrument that amplifies the brain waves and records
them on a computer equipment. The patient is asked to relax, but at various times,
they might be asked to perform simple tasks like reading, calculating etc. Body
motions are captured by a video camera, in a routine video recording, while
the EEG records the brain waves. This combined recording helps diagnose and treat
any condition. An EEG typically takes up to 60 minutes.

EEGs are safe and painless.

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Electromyography (EMG)

Electromyography (EMG) is a
diagnostic procedure to assess
the health of muscles and the
nerve cells that control them
(motor neurons). Motor
neurons transmit electrical
signals that cause muscles to
contract. An EMG uses tiny
devices called electrodes to
translate these signals into
graphs, sounds or numerical
values that are then
interpreted by a specialist.

A nerve conduction study, part of an EMG, uses electrode stickers (surface

electrodes) to measure the speed and strength of signals traveling between two or
more points.
When the study is underway, the surface electrodes will at times transmit a tiny
electrical current that may feel as a twinge or spasm.

During a needle EMG, a needle electrode, inserted directly into a muscle records the
electrical activity in that muscle. During this process, assessment of spontaneous
electrical activity takes place, when the muscle is at rest (activity that isn't present in
healthy muscle tissue) and the degree of activity when the muscle is slightly
contracted.

EMG is a low-risk procedure. However, there's a small risk of:

• Bleeding
• Infection
• Nerve injury
• Lung collapse (pneumothorax)

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Gastroscope

A gastroscope is a flexible tube that

has a small light and a video camera
attached to the end of it. The images
from the video camera are sent to a
screen. The tube can be used to take
tissue samples by inserting
instruments such as small pincers. It
can also be used to suck out air and
fluids. Gastroscopy may be done
because of ulcers, stomach-ache,
vomiting, recent stomach surgery
etc.

The procedure generally lasts for about 5-10 minutes. A small tube or a protective
ring is put between the teeth so that the mouth stays open. The gastroscope is first
swallowed so that it can enter into the oesophagus (food pipe). Then it is slowly
pushed into your stomach and down to the entrance of your duodenum.

Using the video images, the food pipe and stomach lining is examined to determine
the problem. If necessary, a tissue sample is taken. Bleeding, unusually narrow
passages, and certain medical conditions can be treated directly during the
procedure.

Risks include:
• Sore/numb throat
• Bleeding and injury to organs
• Reaction to sedative causing breathing and cardiovascular problems
• Perforation (tearing) of lining of oesophagus, stomach etc.

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Heart-Lung Machine
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes
over the function of the heart and lungs during surgery, maintaining the circulation
of blood and the oxygen content of the patient's body. It is also known as a heart-
lung machine. Its components include pumps, oxygenators, temperature regulators,
and filters.

It's commonly used in

operations involving the
heart. In many
operations, the heart is
arrested (stopped)
because of the difficulty
of operating on a
beating heart. CPB is
required to provide a
bloodless field to
increase visibility. The
machine pumps blood
and an oxygenator
allows RBCs to pick up oxygen, and release carbon dioxide.

The surgeon places a cannula (a tube that is inserted into the body for delivery or
removal of fluid) in a major vein to withdraw blood from the body, which is then
filtered, and oxygenated before it is returned to the body by a mechanical pump. A
cannula is also used to return oxygenated blood and is inserted in a major artery.

The risks of heart and lung bypass include:

• Blood clots and bleeding
• Nerve injury
• Kidney injury
• Decreased lung and/or heart function.

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High-Frequency Chest Wall Oscillation (HFCWO)

High-frequency chest wall oscillation (also called The Vest) involves an inflatable
vest, to be worn around the chest, that is attached to a machine. The machine
mechanically performs chest physical therapy by vibrating at a high frequency. The
vest vibrates the chest to loosen and thin mucus. Every five minutes, the machine is
stopped to cough or huff.

The machine is made up of

2 pieces, an air-pulse
generator and an inflatable
vest that is connected to the
generator by hoses. The
generator sends air through
the hoses, which causes the
vest to inflate and deflate
rapidly, as much as 20 times
per second. This creates
pressure on the chest. The
vibrations separate mucus
from the airway walls and
help move it up into the
large airways. Sessions last
for about 20 to 30 minutes.

HFCWO devices are often used as a treatment for cystic fibrosis and bronchiectasis.
Studies show that HFCWO improved pulmonary function and quality of life in
patients. Despite this, several other clinical trials of the Vest are currently ongoing.

HFCWO is a safe treatment, especially for trauma patients with lung and chest wall
injuries.

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Oxygen concentrator

An oxygen concentrator is a medical device

that concentrates the oxygen from a gas
supply by selectively removing nitrogen to
supply an oxygen-enriched gas stream.

Oxygen concentrators filter surrounding air,

compressing it to the required density and
then delivering purified oxygen into a
pulse-dose delivery system or continuous
stream system to the patient. Compressing
air as the cooling mechanism also keeps the
concentrator from becoming overheated. It’s
also equipped with special filters and sieve
beds which help remove nitrogen from the
air to ensure delivery of completely purified
oxygen. The levels of oxygen concentration and delivery settings can be adjusted
using the electronic user interface. The oxygen is inhaled through the nasal cannula
or a mask.

An oxygen concentrator may be required in:

• Acute respiratory conditions like asthma, pneumonia, Respiratory Distress
Syndrome (RDS) etc.
• Chronic respiratory conditions like Chronic Obstructive Pulmonary Disease
(COPD), Cystic Fibrosis, Sleep Apnoea etc.

Risks include:
• Air trapped in oesophagus
• Auditory hallucinations
• Dry mouth
• Fatigue
• Rhinitis (nasal inflammation)

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Pacemaker
A pacemaker is a small device that's placed in the chest to help control/treat
arrhythmias (abnormal heart rhythms). It uses electrical pulses to prompt the heart to
beat at a normal rate.

Types of pacemakers:
• Single chamber
pacemaker usually carries
electrical impulses to the
right ventricle (lower
chamber of the heart).
• Dual chamber pacemaker
carries electrical impulses to
the right ventricle and the
right atrium (upper
chamber of the heart).
• Biventricular pacemaker
stimulates both the ventricles to make the heart beat more efficiently for people with
heart failure.

An implanted electronic pacemaker mimics the action of a natural electrical system

and comprises two parts:
• Pulse generator: It is a small metal container that houses a battery and the electrical
circuitry that regulates the rate of electrical pulses sent to your heart.
• Leads (electrodes): These are one to three flexible, insulated wires that are each
placed in chambers of your heart and deliver the electrical pulses to adjust your heart
rate.

Risks include:
• Infection
• Allergic reaction
• Swelling, bruising or bleeding
• Damage to blood vessels
• Collapsed lung

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Polysomnography
Polysomnography (sleep study) is a test used to diagnose sleep disorders. It records
brain waves, oxygen level in blood, heart rate and breathing patterns, snoring and
other noises as well as eye and body movements and position.

Polysomnography may be
done to check:
• Sleep apnoea or sleep-related
breathing disorder (fitful
breathing during sleep)
• Periodic limb movement
disorder (involuntary flexing
and extending of legs while
sleeping)
• Narcolepsy (daytime
drowsiness and sudden attacks
of sleep)
• REM sleep behaviour
disorder (acting out of dreams)
• Unusual behaviours during
sleep
• Unexplained chronic
insomnia (consistent trouble
falling or staying asleep)

For a polysomnography, patient arrives at the sleep center in the evening and stays
overnight. The sleeping area has a low-light video camera and audio system for
patient monitoring. Sensors are placed on the scalp, temples, chest and legs. These
are connected by (long) wires to a computer. A clip is placed to monitor blood
oxygen level. Positive airway pressure (PAP) machine may be tried to deliver a
stream of air to enhance breathing.

Polysomnography is a non-invasive, safe test.

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Positive Expiratory Pressure Device

Positive Expiratory Pressure

(PEP) is breathing against
resistance. It consists of cycles of
breathing through a mask or a
mouthpiece device, followed by
the forced expiration technique
and coughing. For low pressure
PEP therapy, optimal pressure is
10-20cm H2O, whereas high-
pressure PEP ranges from 26-
102cm H2O.

In PEP, a person breathes through

a mask or a handheld
mouthpiece. PEP devices allow
air to flow freely when breathed
in, but not when breathed out. Air
must be breathed out (almost 4
times) harder against the
resistance. This helps air get behind the mucus and move it from lung and airway
walls. It also holds the airways open, keeping them from closing and helps maintain
a homogenous expiratory airflow. It promotes collateral ventilation (when alveoli are
ventilated through channels that bypass normal airways) allowing pressure to build
up. It also increases the tidal volume and functional residual capacity (FRC)
temporarily.

PEP therapy may be applied through:

• Face mask with a one-way valve to which expiratory resistors are attached.
• Mouthpiece with holes of different diameters that act as resistors.

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Prosthetic heart valves

An artificial heart valve is a one-

way valve implanted into the
heart of a patient to replace a
dysfunctional valve. Valves are
actual flaps that are located on
each end of the two ventricles
(lower chambers of heart). Their
main purpose is to keep blood
flowing in one direction
through the heart, and from the
heart into the major blood
vessels.

Heart valves can malfunction

for a variety of reasons, which
can impede the flow of blood
through the valve (stenosis)
and/or let blood flow
backwards through the valve
(regurgitation). Both processes put strain on the heart and may lead to serious
problems, including heart failure and thus, require valve replacement.

Although some dysfunctional valves can be treated with drugs or repaired, others
need to be replaced with an artificial valve. A valve-replacement (open-heart)
surgery has to be performed to replace native heart valves. The main types of
artificial heart valves are mechanical, bioprosthetic/tissue valves. Tissue valves are
usually made from animal tissue. Artificial valves usually last from 10-20 years.
Mechanical valves last longer than others (up to 30 years).

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Pulmonary function test (PFT)

Pulmonary function tests (PFTs) are non-invasive tests that show how well the lungs
are working.

PFTs may be needed:

• To detect allergies, infections,
chronic lung conditions, such as
asthma, bronchiectasis etc.
• If symptoms of lung problems are
seen
• To assess how well the lungs are
working before a surgery
Different types of PFTs include:
• Spirometry measures the amount
of air a person breathes in and out.
The patient is fitted with a
mouthpiece and a nose clip is worn
to prevent breathing air out through the nose and then asked to breathe into the
machine.
• Plethysmography test measures the volume of gas in the lungs (lung volume). The
patient sits/stands in a small booth and breathes into a mouthpiece. The pressure in
the booth is then measured to check lung volume.
• Diffusion capacity test evaluates how well the small air sacks inside the lungs
(alveoli) work. Certain gases such as oxygen or carbon dioxide are breathed in. The
machine detects when this gas is breathed out. This tests how well the lungs are able
to transfer gases.

Risks may include:

• Dizziness
• Shortness of breath
• Coughing
• Asthma attack

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Resectoscope

A resectoscope is a type of
endoscope used in
surgeries of the uterus,
prostate, bladder, or
urethra. The device is used
to extract tissue for biopsy,
remove growths, or
destroy diseased or
damaged tissue. It
includes a wide-angle
microscope to allow
complete visualization of
the surgical site and an
attached wire loop can be
activated to cauterize (burn) tissue, limiting bleeding and eliminating the need for
stitches.

It is mainly used in Transurethral Resection of the prostate (TURP) or sometimes, in

hysteroscopy.
TURP is a surgery used to treat urinary problems that are caused by an enlarged
prostate. A resectoscope is inserted through the tip of the penis and into the urethra.
This helps view and trim away excess prostate tissue that's blocking the urine flow.

Hysteroscopy is a procedure that helps look inside the uterus in order to diagnose
and treat causes of abnormal bleeding. This process usually uses a hysteroscope (a
thin, flexible, lightweight telescope) but a resectoscope can also be used. The
hysteroscope is inserted through the vagina and cervix into the uterus to view its
inside.

A resectoscope usually poses no risks.

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Respiratory Monitor
A respiratory monitor is a device which can be used in a hospital or in the home to
monitor respiration rate. Patches placed on the body measure respiration and heart
rate, transmitting real-time data along leads to a monitor which displays and logs
values for various time points.

The rate is usually measured

when a person is at rest and
simply involves counting the
number of breaths for one
minute by counting how
many times the chest rises.
Respiration rates may
increase with fever, illness,
and other medical conditions. The monitor also has an alarm which indicates when
values are dangerously low.

Respiratory monitoring can give us a lot of data such as:

1. Gas exchange
2. Respiratory Mechanics (measure of lung function through pressure, flow, volume
etc.)
3. Lung Volumes
4. Cardiopulmonary interactions (communication between heart and lungs)
5. Lung inflammation

Normal respiration rates for an adult person at rest range from 12 to 20 breaths per
minute. A respiration rate under 12 or over 25 breaths per minute while resting is
considered abnormal. Respiratory monitoring is non-invasive and has no significant
risks.

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Resuscitator

A resuscitator is a device
using pressure to inflate the
lungs of an unconscious
person who is not
breathing, in order to keep
them alive and oxygenated.
The bag can also be used to
give large breaths after
suctioning, a trach change
or when a ventilator circuit
is being changed.

There are three basic types:

• A manual version (bag valve mask) consisting of a mask and a hand-squeezed
plastic bulb using supplemental oxygen from a high-pressure tank (if needed).
• Expired Air or breath powered resuscitator.
• Oxygen powered resuscitator is driven by pressurized gas, delivered by a
regulator. It can be automatic or manual.

Steps to use a resuscitator:

1. Tubing from the bag is attached to the oxygen source (if needed).
2. The bag (and optional flex tube) is attached to the trach tube.
3. Breaths are given at a particular rate by gently squeezing the bag as the chest rises.
4. The bag is then removed from the trach tube.
5. The flow meter is then turned off if oxygen is used.

Possible complications include:

• Air inflating the stomach
• Lung injuries from over-stretching or over pressurization
• Gastric inflation that can lead to pneumonia

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Ureteroscope

Ureteroscopy is a procedure
to address kidney stones,
and involves the passage of
a small flexible telescope,
called a ureteroscope,
through the urethra and
bladder and up the ureter to
the point where the stone is
located. The procedure
usually lasts from 1-3 hours.

Ureteroscopy is done:
• If kidney stones are detected
• If polyp, tumour or abnormal tissue is suspected in urinary tract
• To remove a stone, polyp or tissue for testing (biopsy)

If the stone is small, it may be snared with a basket device (tiny wire basket that
grabs the stone and pulls it free from the ureter). If the stone is relatively large to the
ureter, the stone will need to be fragmented, which is usually accomplished with a
laser. Once the stone is broken into tiny pieces, these pieces are removed.

The passage of the ureteroscope may result in swelling in the ureter. Therefore, it
may be necessary to temporarily leave a small tube, (ureteral stent) inside the ureter
to ensure the drainage of urine.

Risks for this procedure include:

• Breathing problems
• Bleeding and blood clots
• Infection
• Injury of the ureter or kidney
• Narrowing or scarring of the ureter

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Ventilator
A ventilator (or respirator)
is a machine that moves
breathable air in and out
of the lungs, to deliver
breaths to a patient who is
physically unable to
breathe or breathing
insufficiently (respiratory
failure), or during surgery.

A mask or helmet is fitted

to get air from the
ventilator into the lungs.
Sometimes, a breathing tube may be needed. The endotracheal tube is inserted into
the windpipe through the mouth or nose (intubation). Rarely, a tube may need to be
placed through an opening in the neck (tracheostomy). The breathing tube connects
the body to the ventilator machine which uses pressure to blow oxygenated air into
the lungs.

Being on a ventilator while being conscious can be very uncomfortable since a person
can’t talk, eat, or move around while they’re connected to the ventilator machine.

A ventilator can be lifesaving. However, it can sometimes cause side effects like:
• Pneumonia or sinus infection
• Blood clots
• Lung damage
• Fluid build-up (pulmonary oedema)
• Muscle weakness
• Pneumothorax (air leaks out of the lungs)
• Vocal cord damage
• Atelectasis (lungs don't expand fully causing air sacs to collapse)

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Ventricular Assist Device (VAD)

A ventricular assist
device (VAD) is a
mechanical pump that's
used to support heart
function and blood flow in
people who have weakened
hearts. The device takes
blood from a ventricle
(lower chamber of the heart)
and helps pump it to the
body and vital organs.

A VAD includes a small tube that carries blood out of your heart into a pump;
another tube that carries blood from the pump to your blood vessels, and a power
source. The power source is connected to a control unit that monitors the VAD's
functions. The control unit gives warnings if the power is low or if it senses that the
device isn't working right.

The two basic types of VADs are a left ventricular assist device (LVAD) and a right
ventricular assist device (RVAD). If both types are used at the same time, they are
called a biventricular assist device (BIVAD). LVAD is the most frequently used type.

The procedure to implant a VAD often requires an open-heart surgery. Implanting

and using a VAD involves risks including:
• Bleeding and clotting
• Infection
• Device malfunction
• Heart failure
However, a VAD can be lifesaving if you have severe heart failure.

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About Author:

Heer Thosani

Student

Dwarkadas J. Sanghvi

College of Engineering (DJSCE),

Mumbai, Maharashtra

Biography:

Ms. Heer Thosani was born in Mumbai, Maharashtra in 2002. She is currently
pursuing her Bachelor of Technology (B. Tech) in Biomedical Engineering from
Dwarkadas J. Sanghvi College of Engineering, Mumbai and will graduate in the year
2023. She plans to pursue her Master’s degree from Germany.

She likes learning new things, especially related to technology. She developed an
interest in biomedical after learning about all the medical wonders that biomedical
engineers manufacture. She saw it as an opportunity to develop new technologies
and give back to the society. India’s healthcare sector has a long way to go and she
hopes that she can help improve it.

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