A

TECHNICAL REPORT

ON

STUDENTS' INDUSTRIAL WORK EXPERIENCE SCHEME

(SIWES)

UNDERTAKEN AT

BIO-MEDEQUIP COMPANY

8B, DIPO AWOLESI, MAGODO GRA, LAGOS STATE, NIGERIA

PREPARED BY

ADEKANYE ENIOLA OPEYEMI

BIM/19/3017

SUBMITTED TO

THE DEPARTMENT OF BIOMEDICAL TECHNOLOGY,

SCHOOL OF BASIC MEDICAL SCIENCES,

FEDERAL UNIVERSITY OF TECHNOLOGY AKURE, ONDO STATE.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD

OF BACHELOR OF TECHNOLOGY (B.TECH.) IN BIOMEDICAL TECHNOLOGY

FEBRUARY, 2024

i
 CERTIFICATION

This is to certify that ADEKANYE ENIOLA OPEYEMI with the matriculation number

BIM/19/3017 of the department of BIOMEDICAL TECHNOLOGY, FEDERAL UNIVERSITY

OF TECHNOLOGY AKURE, compiled this report based on his 21 weeks Students’ Industrial

Work Experience Scheme (SIWES) undertaken at university of medical science teaching

hospital, Laje, Ondo State.

……………………………….. ……………………………….

Name of Student Signature and Date

……………………………….. ……………………………….

SIWES Supervisor Signature and Date

……………………………….. …..…………………………….

Head of Department Signature and Date

ii
 DEDICATION

This report is dedicated to God Almighty for His sustaining power and grace bestowed on me

during my training period, to Him be all the glory.

iii
 ACKNOWLEDGEMENT

ACKNOWLEDGEMENT
My utmost thanks go to God Almighty for making the four months industrial training program a
success for me. I am grateful to the Bio Med-Equip Team for providing access to essential data
and technical assistance. Their support significantly contributed to the comprehensive analysis
presented in this report, for motivation, daring challenges, the knowledge impacted and their
supports during my stay, without them, this report would not be complete.
I also extend my heartfelt gratitude to my lecturer, for their word of encouragement, advice,
mentorship all-around support. My appreciation also goes to my boss Doctor (Mr) Godswill
Marshall and my trainer at biomedical department, Engr. (Mr) Egbedokun, Engr. (Miss) Obibi,
Eng. (Mr) Samuel and other members of staff at Bio Med- Equip Tech Group.
I sincerely appreciate my parents Mr. and Mrs. Adekanye for their moral and financial support
and cooperation at all times. Also, to my siblings, for their motivation morally, financially,
academically, and spiritually towards the success of this program.
Finally, I would like to express my sincere gratitude to my seniors and friends for their
invaluable guidance and expertise throughout this project. Their insights on some research topic
were crucial in shaping the report's direction.

CONTENTS
CERTIFICATION...........................................................................................................................ii

DEDICATION...............................................................................................................................iii

ACKNOWLEDGEMENT..............................................................................................................iv

1 INTRODUCTION...................................................................................................................1

1.1 BACKGROUND..............................................................................................................1

1.2 SCOPE OF SIWES...........................................................................................................2

1.3 BODIES INVOLVED IN THE MANAGEMENT OF SIWES........................................3

1.4 AIM AND OBJECTIVES OF SIWES..............................................................................4

1.4.1 AIM OF SIWES........................................................................................................4

1.4.2 OBJECTIVES OF SIWES.........................................................................................4

1.5 OBJECTIVES OF SIWES REPORT................................................................................5

2 ORGANIZATION PROFILE..................................................................................................6

2.1 INTRODUCTION............................................................................................................6

iv
 2.2 VISION STATEMENT....................................................................................................7

2.3 ORGANIZATION CHART..............................................................................................8

2.4 DEPARTMENTS WITHIN THE COMPANY................................................................8

3 EXPERIENCE GAINED AT BIO-MEDEQUIP..................................................................10

3.1 TECHNICAL EXPERIENCE.........................................................................................10

3.2 EQUIPMENT AND DEVICES USED IN BIO-MEDEQUIP COMPANY..................11

3.2.1 ULTRASOUND MACHINE...................................................................................11

3.2.2 THE COLONOSCOPE...........................................................................................27

3.2.3 LENSMETER..........................................................................................................31

3.2.4 INFUSION PUMP...................................................................................................35

3.2.5 SYRINGE PUMP....................................................................................................39

3.2.6 ECG MACHINE......................................................................................................41

3.2.7 PACEMAKER.........................................................................................................45

3.2.8 PATIENT MONITOR.............................................................................................49

4 CONCLUSION......................................................................................................................68

4.1 RECOMMENDATIONS................................................................................................68

REFERENCES

v
 ABSTRACT

This report details my six-month industrial training experience at Bio-medequip Company,

situated at 8b, Dipo Awolesi, Magodo GRA, Lagos State. The focus of my training was on

equipment safety, problem-solving, repairs, and maintenance across all sections of the

organization, encompassing various medical devices such as ultrasound machines, lens meters,

infusion pumps, patient monitors, ECG machines, pacemakers, and more. I gained hands-on

experience and theoretical understanding of troubleshooting equipment issues.

Throughout the training period, I developed practical skills in diagnosing problems, maintaining,

repairing, replacing, and installing mechanical components of medical equipment. This report

delves into the technical expertise and practical insights acquired during the training,

emphasizing the significance of the program in equipping students with the necessary technical

knowledge for success in the real world.

vi
 CHAPTER ONE

1 INTRODUCTION

1.1 BACKGROUND

As an integral component of the approved academic standards within Nigerian universities, the

introduction of the Students' Industrial Work Experience Scheme (SIWES) addressed a pressing

concern among industrialists. They were apprehensive about the insufficient practical

background studies that graduates from higher institutions possessed, hindering their readiness

for employment in industries.

Observations and past experiences clearly indicated that theoretical knowledge alone is

insufficient to adequately prepare individuals for the professional world. The realization that

knowledge may dissipate without practical application through training underscored the

interdependence of education and training in contemporary society. The imperative for students

to amalgamate theoretical understanding with practical skills to yield high-quality results

prompted the establishment of SIWES, whose significance cannot be overstated.

SIWES serves as a crucial avenue for students to not only acquire practical skills but also gain

exposure to large-scale industrial production, translating theoretical concepts learned in

classrooms into real-world applications. This program is bestowed with the responsibility of

shaping and equipping students for life beyond the confines of higher institutions. It stands as a

mandatory requirement for undergraduates, serving as a vital prerequisite for the conferment of a

degree upon successful completion of their academic programs.

The inception of the Student Industrial Work Experience Scheme (SIWES) dates back to the

1973/1974 academic session, established by the Industrial Training Fund (ITF). This initiative

1
was established with the primary goal of providing tertiary institution students with practical

exposure to industrial work aligned with their respective fields of study. The intention was to

equip them with technical knowledge before the conclusion of their academic programs.

The overarching objective of SIWES is to immerse students in real-world industrial

environments, fostering the development of occupational competencies. The ultimate aim is to

empower these students to make meaningful contributions to national economic and

technological advancements upon their graduation from their respective institutions.

Participation in the Students Industrial Work Experience Scheme (SIWES) yields significant

advantages for conscientious students. The foremost benefit lies in the acquisition of valuable

skills and competencies. The skills obtained during this program are not ephemeral; rather, they

become enduring assets for participants throughout their lives. These competencies, deeply

ingrained through training, prove invaluable when individuals are called upon to execute tasks or

fulfill job responsibilities. The scheme thus plays a pivotal role in ensuring that graduates are

well-prepared and capable contributors to the economic and technological progress of the nation.

1.2 SCOPE OF SIWES

The duration of the Student Industrial Work Experience Scheme (SIWES) varies among

educational institutions, with specific guidelines for different levels and types of programs.

1. In universities, industrial training typically takes place at the conclusion of the 200, 300,

or 400 level of a degree program and lasts for a period of 3 to 6 months. It serves as a

practical component to enhance students' academic learning.

2
 2. The governing decree for SIWES does not prescribe a fixed timeframe for its

implementation but rather allows flexibility in its execution. Each university has the

autonomy to incorporate the program into its academic calendar, specifying when

students will undertake the scheme. It is imperative, however, that the stipulated duration

of training is adhered to during this period.

3. For Polytechnics, i’m

4. l, and Colleges of Technology, the SIWES program typically occurs at the conclusion of

the 1st year of a 2-year ND program, spanning a minimum of 4 months. This hands-on

experience aims to bridge the gap between theoretical knowledge and practical

application.

5. In Colleges of Education, the SIWES program is usually scheduled at the conclusion of

the 2nd year of the 3-year NCE program, lasting for 4 months. This strategic timing

ensures that students in teacher education programs gain valuable practical insights

before entering the workforce.

1.3 BODIES INVOLVED IN THE MANAGEMENT OF SIWES

The bodies involved are: The Federal Government, Industrial Training Fund (ITF). Other

supervising agents are: National University Commission (NUC), National Board for Technical

Education (NBTE) and National Council for Colleges of Education (NCE).

The functions of these agencies above include among others to:

 Ensure adequate funding of the scheme.

 Establish SIWES and accredit SIWES unit in the approved institutions.

3
  Formulate policies and guideline for participating bodies and institutions as well as

appointing SIWES coordinators and supporting staff.

 Supervise students at their places of attachment and sign their log-book and IT forms.

 Vet and process student’s log-book and forward same to ITF Area office.

1.4 AIM AND OBJECTIVES OF SIWES

1.4.1 AIM OF SIWES

The primary objective of the Students Industrial Work Experience Scheme (SIWES) is to create

a conducive atmosphere for the hands-on application of theoretical concepts within authentic

work settings. Additionally, it seeks to facilitate the practical confirmation of theoretical

principles acquired during academic studies. This program is designed to bridge the gap between

classroom learning and real-world work experiences, allowing students to gain practical insights

and establish a tangible connection between theory and application.

1.4.2 OBJECTIVES OF SIWES

The objectives of the Students Industrial Work Experience Scheme are:

 Preparing students for real-world industrial work situations following graduation

 Exposing students to advanced work methods and techniques, especially those involving

equipment and machinery not accessible in their academic institutions

 Providing a platform for students in higher learning institutions to actively acquire

industrial skills relevant to their fields of study

4
  Facilitating a smooth transition from academia to professional practice, enhancing

students' networking opportunities for potential job placements

 Offering real-world opportunities for students to apply theoretical knowledge, bridging

the gap between classroom learning and practical application

 Actively involving and strengthening employers' engagement throughout the educational

process, aligning academic curricula with industry demands and preparing students for

employment in diverse sectors, including industry and commerce

1.5 OBJECTIVES OF SIWES REPORT

This document is crafted with the intention of:

 Providing a detailed overview of the tasks accomplished and knowledge gained

throughout the internship duration.

 Clarifying the obstacles faced in the undertaken projects and presenting the solutions

devised to overcome them.

 Offering a comprehensive technical report on the executed work and the activities carried

out within the organization.

 Serving as tangible evidence of my active participation in the training.

 Offering suggestions for enhancing the internship program, involving all concerned

stakeholders.

5
6
 CHAPTER TWO

2 ORGANIZATION PROFILE

2.1 INTRODUCTION

Bio-Medequip is located at 8b Dipo Awolesi Magodo GRA phase 2, Lagos. Bio-Medequip

Group was founded in 2022. It stands as the premier destination for biomedical engineering

services and medical equipment sales. With a commitment to excellence and innovation, the

company operates through its three subsidiary corporations - ICEW Medicals, Bio-Medequip

Tech, and MMW Biomedical Engineering.

A. ICEW Medicals: As a leading supplier of medical equipment and devices, ICEW Medicals

plays a pivotal role in ensuring healthcare providers across Nigeria have access to a wide array of

cutting-edge products. The company prides itself on delivering quality equipment that aligns

with the latest advancements in medical technology.

B. Bio-Medequip Tech: Specializing in healthcare technology, Bio-Medequip Tech offers a

spectrum of services, ranging from facility planning to the installation and maintenance of

medical equipment. The company's expertise lies in seamlessly integrating technology into

healthcare settings, optimizing operational efficiency.

C. MMW Biomedical Engineering: MMW Biomedical Engineering is at the forefront of

providing engineering solutions for the healthcare industry. From the design and development of

medical devices to comprehensive testing, the company ensures that healthcare institutions

receive tailor-made solutions. Beyond this, MMW engages in community development projects,

such as building medical technologies in schools and fabricating low-cost equipment for primary

healthcare, demonstrating a commitment to social responsibility.

7
Bio-Medequip Group's commitment to excellence is evident through its team of over 50

indigenous engineers in Nigeria. This dedicated group works tirelessly to ensure that medical

equipment runs at optimal performance and adheres to stringent safety standards. Customized

solutions are offered to accommodate the unique needs of each healthcare provider, emphasizing

the company's client-centric approach.

2.2 VISION STATEMENT

At Bio-Medequip Group, the amalgamation of medical technology and innovation defines our

core vision. We are dedicated to providing comprehensive solutions to healthcare providers and

enthusiasts alike, ensuring the highest standards of excellence in the field of biomedical

engineering. Our mission is to be the trusted partner for all medical technology needs, from

equipment sales to engineering solutions.

Figure 2.1 Bio-medequip Group Logo

8
2.3 ORGANIZATION CHART

Figure 2.2 Organogram of Bio-medequip group.

2.4 DEPARTMENTS WITHIN THE COMPANY

1. Engineering department

The engineering department is involved in the design, development, and sales of cutting-edge

medical equipment. Comprising skilled engineers and experts, this department is dedicated to

ensuring the innovation and quality of products. They collaborate closely with the sales team

to understand market needs, contributing valuable insights that shape the features and

specifications of medical equipment.

This department also includes the repair department. Staffed by highly trained technicians,

this department is committed to swiftly addressing any technical issues that may arise with

9
our medical equipment. Their expertise spans diagnostics, repairs, and troubleshooting,

ensuring that our customers experience minimal downtime and receive optimal performance

from the products.

2. Sales Department

The sales department is tasked with identifying new business opportunities through the

development of targeted marketing strategies. The sales team is adept at understanding the

intricate specifications and functionalities of the medical equipment, enabling them to

effectively communicate the value proposition to potential clients.

10
 CHAPTER THREE

3 EXPERIENCE GAINED AT BIO-MEDEQUIP

3.1 TECHNICAL EXPERIENCE

During my industrial training as a Biomedical Technology student in Bio-medequip Company, I

gained practical experience in the maintenance and repair of biomedical equipment.

During my training, a significant focus was placed on acquiring the necessary skills to conduct

regular maintenance on a variety of biomedical devices. I gained hands-on experience in the

upkeep of diverse machines such as ultrasound machines, colonoscopes, lens meters, infusion

pumps, ECG machines, pacemakers, and patient monitors. This involved tasks such as inspecting

and cleaning equipment, replacing malfunctioning parts, and troubleshooting operational issues.

I learned how to execute routine maintenance procedures, including activities like cleaning,

lubricating, and calibrating equipment. Additionally, I learned how to conduct periodic checks to

ensure the proper functionality of the equipment. Throughout the training, I observed and

actively participated in tasks such as changing batteries, adjusting equipment settings, and

inspecting cables and connectors for signs of wear and tear.

Technical exposure during the industrial training has provided me with the expertise and

knowledge essential for maintaining and repairing biomedical equipment within a clinical

environment. I have acquired the skills to effectively work with various types of equipment,

diagnose and rectify faults, and perform routine maintenance to guarantee optimal functioning of

the equipment.

11
Figure 3.1 Picture depicting me at the office

3.2 EQUIPMENT AND DEVICES USED IN BIO-MEDEQUIP COMPANY

3.2.1 ULTRASOUND MACHINE

Ultrasound, or ultrasonography, is a highly flexible and extensively applied medical imaging

method that has transformed the healthcare sector. By utilizing high-frequency sound waves, it

produces images of the body's internal structures, providing a safe and non-intrusive method for

observing and identifying different medical conditions. (Department of Health & Human

Services)

12
3.2.1.1 PRINCIPLE OF ULTRASOUND

Ultrasound imaging operates on the fundamental principle of transmitting high-frequency sound

waves, known as ultrasound, using a specialized device called a transducer. This device serves

the dual role of emitting and receiving these sound waves. Upon emission, the ultrasound waves

travel through the body's tissues and organs. When encountering various structures within the

body, certain waves are reflected back to the transducer, while others persist in their journey. The

transducer captures the echoes returning from the body and transforms them into images, which

are then displayed on a screen for visualization. (Waldman, 1982)

13
Figure 3.2 An Ultrasound machine

3.2.1.2 TRANSDUCERS

The ultrasound system heavily relies on the transducer, a vital element whose configuration

changes based on the examination type and imaging depth. Comprising piezoelectric crystals

responsible for emitting and receiving sound waves, the transducer can generate diverse

ultrasound images by modifying the frequency and shape of these crystals. This manipulation

results in images of different detail levels and penetration depths. (Phenix et al., 2014)

14
3.2.1.3 TYPES OF ULTRASOUND:

 2D Ultrasound (Two-dimensional Ultrasound):

B-mode ultrasound, or 2D ultrasound, generates black-and-white two-dimensional

images by emitting a single ultrasound beam to create cross-sectional views; widely

utilized in obstetrics and gynecology for pregnancy monitoring, it is also applied across

various medical disciplines to diagnose organ conditions, detect abnormalities, and

visualize anatomical structures.

 3D Ultrasound (Three-dimensional Ultrasound):

Utilizing multiple ultrasound beams from different angles, 3D ultrasound surpasses the

constraints of 2D, generating a detailed three-dimensional image for enhanced

visualization in obstetrics, organ assessment, and identification of abnormalities,

ultimately providing a more comprehensive representation of complex structures.

 4D Ultrasound (Four-dimensional Ultrasound):

Principally known as "real-time 3D ultrasound," 4D ultrasound enhances 3D imaging by

introducing motion, capturing a continuous sequence of dynamic 3D images. Its

applications span from monitoring fetal development in obstetrics, providing real-time

views for expecting parents, to dynamic assessments of various structures and organs in

different fields.

 Doppler Ultrasound:

Doppler ultrasound, based on the Doppler Effect, gauges alterations in ultrasound wave

frequency when interacting with moving blood cells, enabling assessment of blood flow

in blood vessels; its applications span cardiology for heart and major blood vessel

evaluation, as well as vascular medicine for diagnosing conditions like deep vein

thrombosis and arterial blockages.

15
  Color Doppler Ultrasound:

Color Doppler, based on Doppler ultrasound, utilizes color-coded images to represent

various velocities of blood flow, providing visualization of both the direction and speed

of blood flow within vessels, and finds applications in cardiology for detecting abnormal

blood flow patterns in heart valves, as well as in vascular medicine for assessing blood

flow in arteries and veins.

3.2.1.4 APPLICATIONS:

Ultrasound, also known as ultrasonography, finds extensive application in diverse medical

domains such as obstetrics and gynecology (for pregnancy monitoring), cardiology (to evaluate

heart function), and radiology (for imaging the abdomen and musculoskeletal system). Its

versatility, non-invasive characteristics, real-time imaging abilities, and safety render it an

indispensable asset in the field of healthcare.

1. Obstetrics and Gynecology:

 Monitoring Pregnancy: Ultrasound is extensively utilized to observe fetal growth, track

the development of the fetus, and assess the well-being of both the mother and baby. It

can identify abnormalities, determine gestational age, and evaluate the condition of the

placenta.

 Gynecological Exams: It is employed to inspect the female reproductive system, diagnose

issues like ovarian cysts or uterine fibroids, and assess fertility problems.

16
2. Cardiology:

 Echocardiography: Ultrasound is crucial for evaluating the structure and function of the

heart. It aids in visualizing the heart's chambers, valves, and blood flow, playing an

essential role in diagnosing and monitoring heart conditions such as heart disease and

congenital heart defects.

3. Abdominal Imaging:

 Liver and Gallbladder: Ultrasound is utilized to evaluate conditions of the liver and

gallbladder, including liver cirrhosis, hepatitis, and the presence of gallstones.

 Kidneys: It is used to visualize the kidneys, identify kidney stones or tumors, and assess

kidney function.

 Pancreas and Spleen: Ultrasound assists in evaluating pancreatic disorders and

abnormalities in the spleen.

 Gastrointestinal Tract: It can be applied to diagnose conditions in the digestive system,

such as appendicitis and bowel obstructions.

4. Emergency Medicine:

 Trauma Assessment: In emergency situations, ultrasound is employed for swift

assessments, such as identifying internal bleeding, evaluating abdominal injuries, and

diagnosing conditions that necessitate immediate attention.

5. Musculoskeletal Medicine:

 Tendon and Muscle Injuries: Ultrasound aids in diagnosing and guiding treatments for

tendon and muscle injuries, including tears and inflammation.

17
 Joint Injections: It is used to guide injections into joints for therapeutic purposes.

6. Breast Imaging:

 Breast Ultrasound: It complements mammography and is utilized to further investigate

breast abnormalities, determine whether a lump is solid or fluid-filled, and assist in breast

cancer diagnosis.

7. Vascular Medicine:

 Doppler Ultrasound: This specialized ultrasound form measures blood flow within blood

vessels. It is employed to detect blockages, assess blood vessel health, and diagnose

conditions like deep vein thrombosis (DVT) and peripheral artery disease (PAD).

8. Procedural Guidance:

 Needle Aspirations and Biopsies: Ultrasound guides the precise placement of a needle for

fluid aspiration or tissue biopsy, ensuring accuracy and minimizing risks.

 Catheter Insertions: It assists in guiding catheters during various medical procedures,

such as central venous catheter insertions and regional anesthesia.

9. Urology:

 Renal Ultrasound: It is crucial in diagnosing and monitoring kidney conditions, including

kidney stones, tumors, and cysts.

 Prostate Imaging: Ultrasound can be used to guide prostate biopsies and assess the health

of the prostate gland.

18
 10. Ophthalmology:

 Ocular Ultrasound: It aids in assessing the eye's structures, especially when other

methods are less effective due to eye trauma or opacity.

3.2.1.5 ADVANTAGES

1. Non-Invasive:

Ultrasound stands out for its non-invasive character, avoiding the use of ionizing radiation and

ensuring a secure option for patients, including pregnant women and children.

2. Real-Time Imaging:

Providing instant imaging, ultrasound enables healthcare professionals to observe dynamic

processes within the body in real-time, offering valuable insights into organ function, blood flow,

and fetal development during pregnancy.

3. Safety:

The utilization of high-frequency sound waves in ultrasound is deemed safe with no identified

long-term side effects, permitting repeated examinations without the concerns associated with

radiation exposure.

4. Versatility:

As a highly adaptable tool, ultrasound finds applications in various medical specialties, including

obstetrics, cardiology, radiology, emergency medicine, and more, facilitating imaging of a

diverse array of anatomical structures.

19
5. Cost-Effective:

Ultrasound, generally more economical than alternative imaging methods like MRI or CT scans,

emerges as a financially accessible option for diverse healthcare settings and patients.

6. Dynamic Imaging:

With the ability to capture moving images, ultrasound is well-suited for visualizing organ and

structural functions, such as the dynamic motions of the heart, blood flow, and musculoskeletal

movements.

7. Portability:

Modern ultrasound machines come in various sizes, including portable and handheld devices.

This portability facilitates point-of-care ultrasound (POCUS) in emergencies, remote areas, and

underserved locations.

8. Guided Procedures:

Ultrasound serves as a guidance tool for various medical procedures, including biopsies, needle

aspirations, and catheter placements, ensuring precision and minimizing associated risks.

9. Accessible for Monitoring:

Ultrasound supports continuous monitoring of patients in critical care settings, aiding healthcare

providers in assessing real-time changes and facilitating prompt interventions.

11. Pediatric and Neonatal Imaging:

20
With its safety and non-invasive attributes, ultrasound proves particularly suitable for imaging

pediatric and neonatal patients, enabling diagnosis and monitoring without exposing them to

radiation.

12. Fetal Imaging:

As the standard imaging tool for monitoring fetal development during pregnancy, ultrasound

allows for early detection of potential issues, assisting healthcare providers in managing

pregnancies effectively.

13. Immediate Results:

Ultrasound generates instant images, providing healthcare professionals with immediate

interpretations crucial for making timely decisions, especially in emergency cases.

14. Routine Screening:

Ultrasound is routinely employed in various health screenings, such as abdominal and thyroid

ultrasounds, facilitating the detection and monitoring of common health issues and conditions.

3.2.1.6 LIMITATIONS

Ultrasound, while serving as a valuable medical imaging technique, has specific limitations and

constraints that warrant consideration in clinical practice.

1. Restricted Penetration:

Ultrasound faces challenges in effectively penetrating bone or air-filled structures,

complicating the visualization of deep structures in areas with substantial bone or gas, like the

skull or lungs.

2. Operator-Dependent:

21
 The quality of ultrasound images heavily relies on the operator's skill and experience,

potentially impacting diagnostic accuracy when handled by inexperienced operators.

3. Image Quality Challenges in Obesity:

Ultrasound may yield suboptimal images in obese patients due to increased tissue depth and

the necessity for sound waves to traverse additional layers of fat.

4. Limited to Surface Structures:

Primarily suited for examining surface structures, ultrasound proves less effective for imaging

deep tissues, making it less ideal for assessing internal structures.

5. Constraints in Imaging Bones and Gas:

Obtaining detailed images of bones and gas-filled structures, such as the lungs and bowel,

poses difficulties, limiting its applicability in certain diagnostic scenarios.

6. Reduced Soft Tissue Contrast:

Ultrasound may offer less detailed soft tissue contrast compared to modalities like MRI or CT

scans, presenting challenges in distinguishing certain soft tissue abnormalities.

7. Inability to Equally Visualize All Organs:

Certain organs, like the pancreas deep within the abdomen, pose challenges for comprehensive

assessment using ultrasound alone.

8. Real-Time Imaging Limitation:

While real-time imaging is a strength, it may not be ideal for capturing static images for

detailed anatomical analysis or specific research applications.

22
9. Operator Fatigue:

Prolonged ultrasound examinations can strain operators physically, potentially compromising

image quality as the examination progresses.

10. Limited Microscopic Detail Visualization:

Unlike microscopy or advanced imaging methods, ultrasound cannot visualize microscopic

structures or cellular details.

11. Patient-Related Factors:

Patient factors, including movement, obesity, or the presence of surgical implants or dressings

in the scanning area, can impact the quality of ultrasound images.

3.2.1.7 INSTALLATION PROCEDURE:

The installation process for an ultrasound machine may vary based on the machine's type and

model. However, the following is a general overview of the installation steps:

Site Preparation:

 Select an appropriate location for the ultrasound machine, considering factors such as

patient accessibility, electrical outlets, and adherence to safety and regulatory standards

for medical equipment.

Electrical Requirements:

 Confirm the availability of necessary electrical connections (voltage, phase, and current)

required to power the ultrasound machine.

23
  Install dedicated electrical circuits to prevent power fluctuations or interruptions.

Room Setup:

 Organize the room with the ultrasound machine, examination table, and any additional

equipment, such as chairs, storage, or workstations.

Mounting and Positioning:

 Securely install the ultrasound machine at the proper height and angle for optimal

imaging results, especially if it's wall-mounted or ceiling-mounted.

 Position the patient examination table to allow for proper patient positioning and access.

Calibration and Testing:

 Biomedical engineers or technicians will calibrate the ultrasound machine to ensure

precise and high-quality imaging.

 Conduct test scans using phantoms or test subjects to validate the machine's functionality.

Networking and Connectivity:

 Configure the ultrasound machine with network capabilities to connect to the hospital's

network for data storage and sharing.

 Ensure compatibility with the hospital's Picture Archiving and Communication System

(PACS) or Radiology Information System (RIS).

Training:

 Provide training to healthcare professionals operating the ultrasound machine, covering

controls, image acquisition, and patient positioning.

24
Documentation:

 Maintain detailed records of the installation process, calibration, and any technical

specifications.

Quality Assurance:

 Implement a quality assurance program to routinely test and maintain the machine's

performance.

Compliance and Regulation:

 Ensure compliance with local, national, and international regulations and standards

related to medical equipment installation and operation.

Ongoing Support:

 Establish a support system for maintenance and troubleshooting, including regular

servicing and software updates.

3.2.1.8 ULTRASOUND ERROR CODES:

Error codes within ultrasound systems serve to signal potential issues, malfunctions, or

abnormalities encountered during the imaging process. These codes play a crucial role in aiding

operators and technicians in swiftly identifying problems and efficiently troubleshooting them.

While the specific error codes may vary across ultrasound machine manufacturers and models,

here is a compilation of commonly encountered error codes in ultrasound systems:

25
 No Signal Detected (Error Code: E001): This code indicates that the ultrasound machine

is not receiving the anticipated signal from the transducer, potentially stemming from a

connection problem.

 Overheating (Error Code: E002): An overheating error may manifest when the system's

temperature surpasses safe levels, leading to a temporary pause in imaging until the

system cools down.

 Transducer Malfunction (Error Code: E003): This code denotes an issue with the

transducer, encompassing problems with the cable, crystal elements, or connectors.

 Calibration Error (Error Code: E004): Calibration errors can impact measurement

accuracy and image quality, signaling a potential need for recalibration.

 Power Supply Issue (Error Code: E005): Power supply errors may arise from voltage

fluctuations, power surges, or a faulty power source.

 Acoustic Feedback (Error Code: E006): Acoustic feedback occurs when transmitted

sound waves reflect back to the transducer, causing interference. Rectifying this error

may involve repositioning the transducer.

 Image Processing Error (Error Code: E007): Errors in the image processing unit can lead

to this code, affecting image quality and diagnostic precision.

 Data Storage Error (Error Code: E008): Errors related to data storage can hinder the

ultrasound system from correctly saving images and patient data.

 Peripheral Device Connectivity Issue (Error Code: E009): This code points to challenges

with peripheral devices like printers, external hard drives, or network connections.

26
  System Software Error (Error Code: E010): Software-related errors can result in system

instability and incorrect image rendering, necessitating software updates or system

reconfiguration.

 Transducer Cable Issue (Error Code: E011): Specific to the transducer cable, this error

may be triggered by cable damage or disconnection.

 Interference (Error Code: E012): Interference errors arise from external factors such as

electromagnetic interference or improper grounding, impacting image quality.

 System Boot Failure (Error Code: E013): This error appears when the ultrasound system

encounters difficulties during startup or initialization.

 Signal Loss (Error Code: E014): Signal loss errors occur when the signal strength drops

below a certain threshold, affecting image quality.

 Voltage Fluctuation (Error Code: E015): Variations in voltage can influence system

stability, potentially requiring voltage regulation solutions. In the event of encountering

an error code, referring to the manufacturer's documentation is crucial.

3.2.1.9 ULTRASOUND MACHINE MAINTENANCE

The ultrasound maintenance kit serves as a comprehensive resource for the regular care and

upkeep of ultrasound equipment. Comprising various tools and supplies, its contents may differ

based on the manufacturer and ultrasound machine model. Among the common items found in

these kits are soft, lint-free cloths for cleaning transducers and surfaces, specialized cleaning

solutions for transducer surfaces, and brushes for hard-to-reach areas.

In addition, the kit typically includes ultrasound gel to ensure optimal acoustic contact, printer

paper or digital recording media for machines with built-in printers, and disposable covers for

27
transducers and probes to maintain hygiene during examinations. Essential cable inspection tools

are included for examining cables, connectors, and transducer cables for potential damage.

Calibration tools, such as calibration phantoms or test objects, are provided for fine-tuning the

machine. User manuals, maintenance guides, and documentation specific to the ultrasound

machine are also part of the kit. Disinfectant wipes or solutions are included for sanitizing high-

touch areas like the control panel and keyboard.

Labeling and marking materials, such as labels and markers, facilitate the documentation of

maintenance and calibration dates. Depending on the machine, spare parts like fuses,

replacement buttons, or other components may be included. To ensure organized storage, a

sturdy container or case is often part of the maintenance kit.

3.2.2 THE COLONOSCOPE

A colonoscope is a vital medical instrument used in the field of gastrointestinal endoscopy. This

slender, flexible tube with a light and camera at its tip is designed to examine the interior of the

colon, providing valuable diagnostic and therapeutic capabilities.

The colonoscope is introduced through the rectum, allowing the endoscopist to navigate through

the entire length of the colon. The camera captures images, which are transmitted to an external

monitor for real-time visualization. The flexibility of the tube, controlled by the endoscopist,

enables precise maneuvering and thorough examination of the colon's mucosa. (Waye &

Thomas-Gibson, 2018)

28
Figure 3.3 A colonoscope

3.2.2.1 COMPONENTS OF A COLONOSCOPE

 Insertion Tube: The insertion tube is a flexible, elongated portion of the colonoscope

that is introduced into the patient's colon. Its flexibility allows for navigation through the

twists and turns of the colon, providing access to the entire length.

 Light Source: A built-in light source illuminates the colon's interior, ensuring clear

visibility for the endoscopist. This feature is critical for identifying abnormalities, lesions,

and other pathologies during the examination.

 Camera: The colonoscope is equipped with a high-resolution camera at its tip. This

camera captures real-time images of the colon's lining, providing detailed visuals for

29
 diagnostic purposes. Advances in camera technology have significantly improved image

quality, aiding in the detection of subtle abnormalities.

 Channels: Colonoscopes typically have multiple channels within the insertion tube.

These channels serve various functions, such as insufflation (introduction of air to expand

the colon), suction for removing fluids, and the passage of therapeutic instruments for

interventions like polyp removal.

3.2.2.2 DIAGNOSTIC PROCEDURES

Colonoscopes are primarily employed for the diagnosis of various gastrointestinal conditions,

including colorectal cancer, inflammatory bowel diseases, and polyps. The ability to visualize

the colon's lining allows for early detection and accurate diagnosis. In addition to diagnosis,

colonoscopes enable therapeutic interventions. Polypectomy, the removal of polyps, is a

common procedure performed during colonoscopy. Other interventions include biopsy collection

for histological examination and the control of bleeding through the application of hemostatic

measures.

3.2.2.3 TROUBLESHOOTING A COLONOSCOPE

Issue Description:

1. The colonoscope is not achieving complete upward angulation.

Troubleshooting steps:

1. Visual inspection:

We inspected the distal end, insertion tube, and bending section for any visible

damage or obstruction.

30
 2. We checked the colonoscope light source and camera for any visible damage or

debris.

No visible damage found.

3. Bending section Function Test:

We operated the colonoscope’s bending section to check if it is moving smoothly and

without any abnormal resistance.

We noticed that there was some stiffness during the upward angulation.

4. Lubrication: We applied appropriate grease to improve angulation.

We noticed the screws were washed.

Figure 3.4 Picture depicting me working on a colonoscope

2. Poor Image Quality:

Possible Causes:

31
  Dirty or damaged lens

 Inadequate lighting

 Camera malfunction

Troubleshooting:

 Clean and inspect the lens before each procedure.

 Ensure proper illumination by checking the light source.

 Test and calibrate the camera for optimal performance.

3. Difficult Scope Insertion:

Possible Causes:

 Inadequate lubrication

 Bowel loop formation

 Patient-related factors (e.g., anatomy, spasms)

Troubleshooting:

 Adequately lubricate the insertion tube.

 Carefully navigate through bowel loops, adjusting the scope's flexibility.

32
3.2.3 LENS METER

A lens meter, also known as a lensometer or foci meter, is an essential instrument in the field of

optics and optometry. It is widely used to measure the power of spectacle lenses, ensuring

accurate prescription for individuals with refractive errors. The lens meter operates on the

principle of measuring the focal length and power of a lens. It utilizes a target, such as a

crosshair or a target chart, which is reflected from the lens surface. By adjusting the lens meter’s

controls, the operator aligns the reflected image with the target, allowing for the determination of

lens power. (Musa & Zeppieri, 2024)

33
Figure 3.5 A lensmeter

3.2.3.1 COMPONENTS OF A LENSMETER

Eyepiece: The eyepiece is where the operator observes the target and the image reflected from

the lens. It often includes a diopter scale for additional adjustments.

Target and Target Chart: The target, typically a crosshair or target chart, provides a reference for

aligning the lens and determining its power. The target chart may include various markings for

astigmatism and other lens characteristics.

Lens Holder: The lens holder is a platform where the lens to be measured is placed. It is

adjustable to accommodate different types and sizes of lenses.

Power Drum: The power drum is a rotating wheel that allows precise adjustments to measure the

lens power. It is graduated with diopter values, aiding in accurate power readings.

3.2.3.2 OPERATING A LENSMETER

Placing the Lens: The lens under examination is positioned in the lens holder. Care should be

taken to ensure the lens is centered and stable.

Aligning the Target: Using the controls, the operator aligns the reflected image of the target with

the actual target. This ensures accurate measurement of the lens power.

Reading the Power: Once the alignment is achieved, the operator reads the power value directly

from the power drum. This reading represents the spherical power of the lens.

Checking for Astigmatism: Additional markings on the target chart help identify and measure

astigmatism. The operator notes any deviations from the horizontal and vertical axes. (Cordero,

2016)

34
3.2.3.3 TROUBLESHOOTING A LENSMETER

1. Inaccurate Readings:

 Possible Causes: Dirt or smudges on the lens or eyepiece, misalignment of the target,

or calibration errors.

 Troubleshooting Steps: Clean the lens and eyepiece thoroughly, ensure proper

alignment of the lens, and check for calibration accuracy. Recalibrate the lensmeter if

necessary.

2. Blurry or Distorted Image:

 Possible Causes: Dirty or scratched target chart, misalignment of the lens, or optical

system issues.

 Troubleshooting Steps: Clean or replace the target chart, ensure the lens is correctly

aligned, and inspect the optical components for damage.

3. Eyepiece Diopter Scale Issues:

 Possible Causes: Misalignment of the eyepiece, damage to the diopter scale, or

internal mechanical problems.

 Troubleshooting Steps: Realign the eyepiece, inspect the diopter scale for damage,

and check internal components for any visible issues.

4. Lens Holder Instability:

35
  Possible Causes: Loose or damaged lens holder components, worn-out parts, or

improper adjustment.

 Troubleshooting Steps: Tighten or replace any loose or damaged parts, lubricate

moving components, and ensure proper adjustment of the lens holder. Regular

maintenance can prevent instability issues.

5. Power Drum Resistance:

 Possible Causes: Jammed or misaligned power drum, lack of lubrication, or worn-out

internal components.

 Troubleshooting Steps: Gently realign or unjam the power drum, lubricate moving

parts, and inspect for any signs of wear or damage.

6. Inconsistent Astigmatism Readings:

 Possible Causes: Misalignment of the lens, calibration errors, or issues with the

astigmatism marking on the target chart.

 Troubleshooting Steps: Ensure proper alignment of the lens, recalibrate the lensmeter,

and check the astigmatism markings on the target chart for accuracy.

3.2.4 INFUSION PUMP

Infusion pumps are essential medical devices designed to deliver fluids, such as medications,

nutrients, or blood, into a patient's circulatory system in a controlled and precise manner. These

devices play a crucial role in various medical settings, including hospitals, clinics, and home

care.

36
Infusion pumps operate on the principle of controlled and regulated fluid administration. The

device typically consists of a pump mechanism, a reservoir for the fluid, and a set of tubing with

a specialized administration set. The pump regulates the flow rate, allowing healthcare

professionals to administer fluids at a predetermined rate, ensuring accurate dosing and

minimizing the risk of over- or under-infusion. ("Infusion pump integration," 2013)

Figure 3.6 An Infusion pump

3.2.4.1 TYPES OF INFUSION PUMPS

There are several types of infusion pumps, each designed for specific applications. The common

types include volumetric pumps, syringe pumps, and ambulatory pumps. Volumetric pumps are

37
suitable for large-volume infusions, syringe pumps for precise small-volume injections, and

ambulatory pumps for portable and continuous infusion over an extended period.

3.2.4.2 KEY COMPONENTS OF INFUSION PUMPS

1. Pump Mechanism: This is the core component responsible for driving the fluid through the

tubing and into the patient's body. It can be peristaltic or piston-driven, with each having its

advantages and applications.

2. Reservoir: The reservoir holds the fluid to be infused. It can be a bag, bottle, or syringe,

depending on the pump type and the volume of the substance being administered.

3. Administration Set: The tubing and connectors form the administration set, linking the

reservoir to the patient. It includes features such as a drip chamber to visualize the flow and

various safety mechanisms to prevent accidental disconnection.

3.2.4.3 TROUBLESHOOTING AN INFUSION PUMP

Flow Rate Discrepancies:

 Possible Causes: Occluded tubing, air bubbles, or mechanical malfunctions.

 Troubleshooting Steps: Check for kinks in the tubing, inspect the infusion site for

potential obstructions, and verify the pump's calibration. Clear any air bubbles from the

tubing.

38
Figure 3.7 Repairing an infusion pump

2. Alarms and Error Messages:

 Possible Causes: Low battery, disconnection, or a malfunction in the pump.

 Troubleshooting Steps: Ensure the pump is properly connected to a power source or has

sufficient battery charge. Inspect the tubing for any disconnections or blockages. If error

messages persist, consult the device's manual for specific codes and recommended

actions.
39
3. Leakages:

 Possible Causes: Damaged tubing, loose connections, or a malfunctioning pump.

 Troubleshooting Steps: Visually inspect the tubing for cracks or leaks. Tighten

connections and replace damaged tubing if necessary. If leakage persists, consult the

manufacturer's guidelines for further troubleshooting.

4. Inaccurate Dosing:

 Possible Causes: Pump calibration issues, incorrect administration set, or mechanical

failures.

 Troubleshooting Steps: Verify the pump's calibration against a known standard. Confirm

that the correct administration set is in use. If issues persist, the pump may require

recalibration or maintenance by qualified technicians.

5. Unusual Noises:

 Possible Causes: Mechanical issues, foreign objects in the pump, or worn-out

components.

 Troubleshooting Steps: Listen for any unusual sounds and inspect the pump for foreign

objects. If the noise persists, consult the device manual for guidance on disassembly and

further examination.

3.2.5 SYRINGE PUMP

A syringe pump is a critical medical device employed in various biomedical applications,

offering precise and controlled delivery of fluids. This sophisticated instrument plays a crucial

40
role in fields such as drug administration, research, and clinical settings, providing accurate

dispensation of fluids at predetermined rates. (Wadham, 1986)

Figure 3.8 A Syringe pump

The syringe pump operates based on the principle of positive displacement, where the syringe

plunger is moved incrementally to deliver a specific volume of fluid. The motor, controlled by

the programmed settings, drives the plunger, and the flow rate is determined by factors such as

syringe size, motor speed, and the pump's design. This mechanism ensures precise and

reproducible fluid delivery.

3.2.5.1 COMPONENTS OF A SYRINGE PUMP

The primary parts include a syringe, a motor or stepper motor, a controller, and a user interface.

The syringe holds the fluid to be dispensed, while the motor facilitates the controlled movement

of the syringe plunger. The controller ensures accurate and consistent flow rates, while the user

interface allows for easy programming and monitoring.

41
3.2.5.2 ADVANTAGES OF SYRINGE PUMPS

One of the key advantages of syringe pumps is their ability to deliver fluids at very low flow

rates, making them suitable for applications requiring high precision. The controlled and

consistent delivery offered by syringe pumps minimizes the risk of over- or under-dosing in

medical treatments and research experiments. Additionally, their compact and portable design

enhances their versatility in various settings.

3.2.5.3 CHALLENGES AND CONSIDERATIONS

While syringe pumps are highly beneficial, certain challenges need to be considered. These

include the potential for mechanical failure, the need for periodic calibration to maintain

accuracy, and the importance of selecting the appropriate syringe size for optimal performance.

Additionally, the viscosity of the fluid being dispensed can influence the pump's efficiency,

requiring careful consideration in certain applications.

3.2.6 ECG MACHINE

Electrocardiogram (ECG) machines are essential medical devices used in the field of cardiology

to record and analyze the electrical activity of the heart over a specific period. This non-invasive

tool plays a crucial role in diagnosing various cardiac conditions, making it an indispensable

asset for healthcare professionals, especially in emergency situations. (Chan, 2014)

3.2.6.1 COMPONENTS OF AN ECG MACHINE

Electrodes: The ECG machine consists of electrodes that are strategically placed on the patient's

skin. These electrodes detect the electrical signals generated by the heart and transmit them to the

machine for analysis. Standard electrode placements include on the limbs and chest.

42
Leads: Leads are configurations of electrodes that record the electrical activity from specific

angles. Twelve-lead ECGs, for example, provide a comprehensive view of the heart's electrical

function by utilizing 10 electrodes in different combinations.

Cables and Wires: Connecting the electrodes to the ECG machine are cables and wires that

ensure the accurate transmission of electrical signals. The quality of these components is crucial

for obtaining clear and reliable readings.

Figure 3.9 An ECG machine

3.2.6.2 FUNCTIONS OF AN ECG MACHINE

Signal Amplification: The ECG machine amplifies the weak electrical signals generated by the

heart to produce a readable and interpretable waveform. This amplification is essential to

enhance the machine's sensitivity and detect subtle abnormalities.

Data Processing and Display: ECG machines are equipped with sophisticated algorithms for

processing the incoming electrical signals. The processed data is then displayed on a screen as a

43
series of waves representing the electrical activity of the heart. These waveforms typically

include the P wave, QRS complex, and T wave.

Printing and Recording: ECG machines often have built-in printers to generate hard copies of

the recorded data. This printout, known as an electrocardiogram, serves as a visual record for

healthcare professionals to analyze and interpret.

3.2.6.3 TROUBLESHOOTING AN ECG MACHINE

1. Poor Signal Quality:

Issue: Inadequate signal quality can result in distorted waveforms, making interpretation

challenging.

Troubleshooting:

- Ensure proper electrode placement and skin preparation.

- Check for damaged or worn-out cables and replace if necessary.

- Verify the integrity of the electrodes and their connections.

2. Electrode Offsets or Artifacts:

Issue: Artifacts such as muscle interference or electrode offsets can distort the ECG signal.

Troubleshooting:

- Check for loose electrode connections and reattach if needed.

- Evaluate patient positioning and muscle activity.

44
 - Replace faulty electrodes and ensure they adhere properly.

3. Baseline Drift:

Issue: Baseline drift, a slow shift of the baseline, can obscure important details of the ECG.

Troubleshooting:

- Inspect the electrode-skin interface for impedances.

- Verify the proper functioning of the ECG machine's filters.

- Check for interference from nearby electronic devices and relocate if necessary.

4. Electrical Interference:

Issue: External electrical interference can lead to noise in the ECG signal.

Troubleshooting:

- Identify and eliminate potential sources of interference in the environment.

- Use shielded cables to reduce susceptibility to external electrical noise.

- Ensure proper grounding of the ECG machine and related equipment.

5. Printer Issues:

Issue: Problems with the printer may result in incomplete printouts or artifacts on the ECG

strip.
45
 Troubleshooting:

- Inspect the printer for paper jams and ensure an adequate supply of paper.

- Clean the printer head to maintain print quality.

- Verify that the printer settings are configured correctly.

3.2.7 PACEMAKER

A pacemaker is a medical device that plays a crucial role in managing and regulating heart

rhythms. It is commonly used to treat various cardiac arrhythmias, ensuring that the heart

maintains a steady and appropriate rhythm. This electronic device consists of a generator and

leads, which are thin, insulated wires that connect the generator to the heart. (Toogood, 2007)

Figure 3.10 A Pacemaker

46
3.2.7.1 COMPONENTS OF A PACEMAKER

Generator: The generator is the main unit of the pacemaker and contains the power source and

circuitry. Typically, it is implanted under the skin near the collarbone. Modern generators are

small, lightweight, and powered by lithium batteries, providing a long lifespan for the

pacemaker.

Leads: Leads are insulated wires that transmit electrical impulses from the generator to the heart

and vice versa. These wires are threaded through blood vessels and positioned in specific areas

of the heart. The leads detect the heart's natural electrical activity and deliver electrical stimuli

when necessary.

3.2.7.2 TYPES OF PACEMAKERS

1. Single-Chamber Pacemakers: In this type, only one lead is connected to either the atrium

(upper chamber) or ventricle (lower chamber) of the heart. Single-chamber pacemakers

are suitable for patients with specific arrhythmias affecting either the atrium or ventricle.

2. Dual-Chamber Pacemakers: Dual-chamber pacemakers have two leads, allowing them to

regulate both the atrium and ventricle independently. This helps to synchronize the

timing between the upper and lower chambers, mimicking the natural heart rhythm more

closely.

3. Biventricular Pacemakers (CRT-P): These pacemakers are designed for individuals with

heart failure and ventricular dyssynchrony. Biventricular pacing involves stimulating

both ventricles simultaneously, promoting more efficient pumping of blood and

improving heart function. (Mulpuru et al., 2017)

47
3.2.7.3 FUNCTIONALITY OF PACEMAKERS

Pacemakers continuously monitor the heart's electrical activity. When irregularities are

detected, the device delivers electrical impulses to restore a normal rhythm. This ensures that the

heart maintains an appropriate rate and prevents bradycardia (slow heart rate) or other

arrhythmias.

3.2.7.4 IMPLANTATION PROCEDURE

The implantation of a pacemaker is a surgical procedure performed by a cardiac

electrophysiologist. The generator is usually placed beneath the skin, while the leads are

carefully threaded through veins into the heart. X-ray guidance is often used to ensure accurate

lead placement.

3.2.7.5 MONITORING AND PROGRAMMING

After implantation, pacemakers are periodically checked and adjusted to meet the patient's

specific needs. Follow-up appointments involve non-invasive testing to assess the device's

function, battery life, and the overall condition of the patient.

3.2.7.6 TROUBLESHOOTING A PACEMAKER

1. Battery Issues:

Symptoms: Sudden cessation of pacing, loss of telemetry.

48
Troubleshooting: Check battery status through remote monitoring or in-person interrogation. If

the battery is low, plan for elective device replacement.

2. Lead Issues:

Symptoms: Loss of capture, high pacing thresholds.

Troubleshooting: Perform lead impedance and threshold checks during device interrogation. X-

rays may be necessary to assess lead integrity and placement.

3. Sensing Issues:

Symptoms: Inaccurate sensing, oversensing or undersensing.

Troubleshooting: Evaluate lead integrity, reposition leads if necessary, and adjust sensing

parameters during device programming. Confirm proper electrode contact with the myocardium.

4. Programming Errors:

Symptoms: Inappropriate pacing rate, mode switch errors.

Troubleshooting: Review and correct programming settings using a programmer. Confirm proper

mode, rate, and sensitivity settings. Address any programming discrepancies.

5. Electromagnetic Interference (EMI):

Symptoms: Erratic device behavior in the presence of electronic devices.

Troubleshooting: Identify and eliminate potential sources of EMI. Educate the patient on

avoiding devices that may interfere with the pacemaker. Reassess device function after removing

potential sources of interference.

6. Infection at the Implant Site:

49
Symptoms: Localized pain, swelling, or erythema at the implant site.

Troubleshooting: Assess the implant site for signs of infection. Administer appropriate

antibiotics if necessary. In severe cases, device removal may be considered.

7. Pacemaker-Mediated Tachycardia (PMT):

Symptoms: Rapid heart rate due to interaction between atrial and ventricular pacing.

Troubleshooting: Adjust pacing parameters to minimize the risk of PMT. Consider

reprogramming the device to optimize AV delays and avoid unnecessary pacing.

8. Lead Dislodgment:

Symptoms: Sudden increase in pacing thresholds, loss of capture.

Troubleshooting: Perform lead impedance checks and assess lead positioning through

fluoroscopy or other imaging modalities. If dislodgment is confirmed, reposition or replace the

lead.

3.2.8 PATIENT MONITOR

A patient monitor is an electronic medical device comprising monitoring sensors, processing

components, and a screen display, commonly referred to as a "monitor." This device records and

provides medical professionals with crucial information such as a patient's vital signs (body

temperature, blood pressure, pulse rate, and respiratory rate) or activity measurements of various

body organs, including ECG monitors, anesthesia monitors, and EKG monitors. Multi-parameter

patient monitors play a vital role in patient care across various settings such as doctors' offices,

outpatient facilities, hospital operating rooms, critical care facilities, and during emergency

50
medical services and non-emergency ambulance transport. They are also essential for bedside

vital sign measurements in low-acuity post-anesthetic care and during sleep studies, catering to

adults, pediatrics, and neonates. (Simpson, 1962)

Figure 3.11 A patient monitor

Current hospital patient monitoring systems involve hardwiring sensors to bedside monitors or

PCs, limiting patient mobility and requiring manual monitoring by paramedical assistants. This

approach is error-prone and poses risks in case of human error. The proposed system introduces

a Mobile multi-patient monitoring system that continuously monitors patient health. The

51
acquired data is transmitted to a centralized microcontroller using Wireless Sensor Networks.

Each patient monitor system is equipped with a low-power, small-sized Bluetooth transceiver

designed for efficient data transfer over a distance of about 10 m. This makes Wireless Sensor

Networks ideal for remote patient monitoring.

To enhance accuracy and efficiency, a real-time patient monitoring system based on Wireless

Sensor Networks and a centralized microcontroller is integrated with a Bluetooth module. This

system automatically logs vital patient parameters for easy access, with the data accessible to

doctors through mobile devices for added convenience.

BLOCK DIAGRAM:

The block diagram of a personal medical kit utilizing Bluetooth is depicted in the following

illustration. This innovative device enables the measurement of slight fluctuations in normal

heart rate and body temperature. The collected data is transmitted to a microcontroller, where it

is compared against standard values for body temperature and heart rate. If any parameters

deviate from the norm, the results are sent to a doctor for prompt action, ensuring timely

treatment without unnecessary delays. The entire reporting process is facilitated through

Bluetooth technology. This heart rate monitoring and display system, incorporating Bluetooth

connectivity, serves as a portable and superior alternative to traditional stethoscopes with its

enhanced efficiency. The system combines a high-power LED-based heart rate monitor interface

with a Bluetooth module, enabling the transmission of patient heart rate information to a remote

location. The device functions on the principle that blood circulation, detectable by the LED,

corresponds to each heartbeat. The rate of blood circulation is then used to calculate the heart

52
beats per minute, and this information is communicated via Bluetooth to interfaced receivers. In

summary, the Bluetooth-based heart rate monitoring and display system offers a convenient and

effective solution, surpassing the limitations of outdated stethoscope models. (Liu et al., 2020)

Figure 3.12 Block diagram of patient monitoring system

Applications and Scope: The Patient Monitor is a versatile device designed to monitor vital

physiological indicators in both adult and pediatric patients. It offers real-time recording and

display of parameters, including ECG, heart rate, non-invasive blood pressure, functional oxygen

saturation, end-tidal CO2 concentration, respiration rate, body temperature, enabling a

comprehensive analysis of the patient's physiological status.

THE OVERALL STRUCTURE AND WORKING THEORIES

The patient monitor, which performs physiological parameter measurement through different

modules, is a product of module design. It consists of six modules: ECG module, NIBP module,

SpO2 module, CO2 module (optional) and the main unit.

53
1. The ECG module collects the heart rate, respiration waveforms through the ECG leads &

electrodes and collects the temperature data through the temperature probes as well.

2. The SpO2 module collects the data of pulse rate, pulse oxygen saturation (SpO2) and SpO2

volume waveform via the SpO2 probe.

3. The NIBP module collects the blood pressure data, including the diastolic, systolic and mean

arterialpressure through the NIBP cuff. The cuffs are designed for adult, infant and neonate

respectively, and the NIBP measurement has two modes: adult, infant and neonate.

4. The CO2 module collects the date of respiration rate, EtCO2, InsCO2 through the sampling

tube.

5. The main unit consists of main board, multi-function board, and the keyboard. The multi-

function board performs the data communication among the main board, ECG module, SpO2

module, NIBP module, and CO2. (Baronov et al., 2015)

3.2.8.1 HOW TO READ A PATIENT MONITOR

The data from the patient's body, transmitted by the connected sensors, is presented on the

patient monitor. The machine displays various parameters, including heart rate, blood pressure,

body temperature, and oxygen saturation. To understand the information shown on the display,

here's how you can interpret the numerical values:

Heart Rate: Typically, the resting heart rate of a healthy adult is between 60-100 beats per

minute.

Blood Pressure: Blood pressure numbers in the range 120/80 are considered to be normal.

54
Body Temperature: Temperature is reported in degrees Fahrenheit or degrees Celsius. It can be

anywhere from just under 98 degrees F to a little over 99.

Oxygen Saturation (SpO2): It is the measure of the amount of oxygen in the patient's blood.

The SpO2 is normally 95 or higher.

Respiratory Rate (RR): A resting adult typically breathes 12 to 16 times a minute. It is reported

in breaths per minute.

3.2.8.2 PARAMETERS OF PATIENT MONITOR

1. ECG, also known as electrocardiogram or EKG, is a diagnostic tool that captures the

electrical signals produced by the heart to identify various cardiac conditions. Electrodes

are positioned on the chest to record the heart's electrical activity, visualized as waves on

a monitor.

2. Body temperature is subject to variation based on factors such as gender, recent activity,

food and fluid intake, time of day, and, in women, the menstrual cycle stage. A healthy

adult typically maintains a body temperature ranging from 97.8°F (36.5°C) to 99°F

(37.2°C).

3. Respiratory rate, denoting the number of breaths taken per minute, is commonly

measured during rest. The count involves observing chest movements and may be

influenced by factors like exercise, fever, illness, and other medical conditions. While

assessing respiration, it's crucial to monitor for any breathing difficulties. The normal

respiratory rate for a resting adult ranges from 12 to 20 breaths per minute.

55
 4. Blood pressure gauges the force exerted on arteries during heartbeats (systolic pressure)

and at rest (diastolic pressure). Optimal blood pressure values for the systolic and

diastolic readings are 100 to 130 and 60 to 80, respectively.

5. Oxygen saturation indicates the percentage of oxygen in the blood, measured on a scale

up to 100. A typical reading is 95 or higher, and values below 90 may signify insufficient

oxygen supply to the body.

3.2.8.3 MAINTENANCE OF A PATIENT MONITOR

Inspect and clean the filter: It is crucial to examine the filter of your patient monitor regularly

as the accumulation of debris, dust, or other particles may lead to damage and significantly

reduce the monitor's lifespan. Regular weekly cleaning of the filter is essential to keep it free

from debris.

Clean the monitor surface: Wiping down the monitor on a weekly basis will further guarantee

the cleanliness of the equipment, preventing the ingress of dust or debris that could harm the

machine.

Examine the water traps: The water traps in the monitor require frequent checks and emptying,

especially after each surgical procedure. An excessively full water trap has the potential to

damage the patient monitor.

Calibrate according to the manufacturer’s guidelines: Calibration of your patient monitor is

crucial for its longevity. Engage a certified technician to perform the calibration following the

manufacturer’s specifications. To locate a certified technician, please refer to this link.

56
Schedule preventative maintenance: It is not only prudent but also essential to have preventive

maintenance conducted on your machine. This ensures that your equipment is in proper working

order and identifies any potential issues before they become problematic.

3.2.8.4 TROUBLESHOOTING PATIENT MONITORS

 Inspect the Patient Cable thoroughly for any evident damage, such as visible cracks or

folds where the wires may be compromised beneath the protective coating. Additionally,

ensure that your leads are compatible with the device you are utilizing.

 Examine the expiration date on the Electrodes in use. These electrodes have a limited

shelf life, and it's common for individual packages to be utilized within 7-10 days of

opening. The gel also has a designated use-by date, as it has the potential to harden over

time.

 Evaluate the Blood Pressure Cuff and Hose for any signs of leakage. Often hastily

wrapped and placed next to the monitor, these components may experience kinks in the

hose, leading to cracks or small tears in the cuff. A leaking cuff can result in inaccurate

readings.

 Confirm that the electrode clips are securely attached. A loose spring action will prevent

the clip from tightly clamping against the electrode, potentially affecting the accuracy of

measurements.

 Check the fit of SpO2 Sensors on the patient's finger. Improper fitting, whether too loose

or too tight, can yield inaccurate readings. Ensure that the tip of the finger is in direct

contact with the sensor. Be mindful that nail polish can interfere with accurate readings,

and cold fingers may not produce a reading at all.

57
3.2.8.5 EXTERNAL COMPONENTS OF A PATIENT MONITOR

Figure 3.13 Front panel of a Patient monitor

FRONT PANEL

1. Activate the monitor by pressing the power switch to turn it on or off.

2. The AC power indicator illuminates when the device is using mains power.

3. The built-in battery's DC power indicator lights up when the battery is in use. If both AC and

DC indicators are lit, it indicates the device is using mains power while recharging the battery.

58
4. Switch ECG monitoring circulation among Ⅰ, Ⅱ, and Ⅲ AVL, AVF, and V by clicking on the

ECG lead selection.

5. Use the alarm silence key to set or activate the system alarm. On the monitoring screen, press

"Alarm" to set the timer. The countdown begins, and an alarm sounds when the set time elapses.

Options for alarm silent time include 2, 5, 10, and 20 minutes. Do not alter the audible alarm or

decrease its volume to maintain patient safety.

6. Freeze the ECG waveform or ECG, SpO2, and RESP waveforms for S-T segment analysis by

pressing the freeze key, following the system settings.

7. Start or stop NIBP measuring by pressing the NIBP key.

8. Click on the print key to generate printouts of different waveforms based on the system's

current state.

9. Shift display modes by clicking the DISP key. Move between the main screen, list screen,

viewing screen, and seven leads on the same screen. Return to the main screen from other

screens.

10. The Navigation Knob serves as the primary operating key, allowing the selection of functions

or parameters. Press and release it to shift the screen and confirm functions or other operating

tips.

11. Alarm indicator

59
 Indicator Color Alarm Level Alarm Event

Red flashing High priority alarm Exceeding the limits, pulse stop

or suffocation

Orange flashing Medium priority alarm Leads and probe off, VE RONT

and SVE RONT

Orange light Low priority alarm Low priority alarm

Green light Normal None

Table 3.1 LED colors of the alarm indicator and their significance

60
LEFT AND RIGHT PANEL

Figure 3.14 Left and right panel of a patient monitor. (A); the left panel, (B); the right panel

Different ports are located in different positions of the monitor for operating conveniences. The

built-in printer is at the left panel, shown in Figure A. The cable and probe ports are at the right

panel, shown in Figure B

1. TEMP1, TEMP2: TEMP probe connector

2. NIBP: NIBP hose connector

3. SpO2: SpO2 probe connector

4. ECG/RESP: ECG cable connector

5. CO2: Cable connector of CO2 sensor module

61
6. The cover of battery compartment, open it to replace or insert the battery. The provided

standard battery is a piece of 12V and 2.3Ah rechargeable battery. (The back-up rechargeable

battery is optional, and the detailed type of the battery you can see the surface of it.)

Note: Only the battery of same model with the standard battery can be used. Insert battery

properly, or else the improper insertion may damage the monitor.

Figure 3.15 Rear panel of a Patient monitor

REAR PANEL:

The following ports are at the rear panel of the monitor.

(1) Monitor: External display port

62
(2) NET: Serial communication port which is used to network with central monitoring system

(3) Equipotential grounding port

(4) Fuse 2T3. 15A: Fuse holders, fuse specification: T3. 15AL/250V Φ520mm.

(5) 100~240VAC: Power supply socket

(6) S/N: Serial Number

3.2.8.6 ADVANTAGES OF PATIENT MONITOR

1. Early Detection of Abnormalities: Patient monitors enable the early detection of

changes in vital signs such as heart rate, blood pressure, and oxygen saturation. Timely

identification of abnormalities allows healthcare providers to intervene promptly,

preventing potential complications and improving patient outcomes.

2. Continuous Monitoring: Unlike intermittent manual measurements, patient monitors

provide continuous and automated monitoring of vital signs. This continuous data stream

offers a comprehensive and dynamic view of a patient's physiological status, enhancing

the ability to detect subtle changes or trends over time.

3. Improved Patient Safety: Patient monitors play a crucial role in enhancing patient

safety by providing immediate alerts through audible alarms and visual indicators.

Healthcare providers can respond promptly to abnormal values or critical situations,

preventing adverse events and minimizing the risk of complications.

4. Efficient Resource Utilization: Continuous monitoring by patient monitors allows

healthcare providers to optimize resource utilization. Rather than conducting frequent

63
 manual assessments, staff can focus on other aspects of patient care, knowing that the

monitor will provide timely updates on vital signs.

5. Customizable Alarm Settings: Patient monitors offer customizable alarm settings,

allowing healthcare providers to tailor alerts based on individual patient needs and

specific clinical situations. This flexibility minimizes unnecessary alarms while ensuring

that critical events are promptly addressed.

6. Remote Monitoring Capabilities: Many modern patient monitors come equipped with

remote monitoring capabilities. This feature enables healthcare providers to access real-

time patient data from various locations, promoting timely decision-making and

facilitating collaborative care, especially in critical care or telemedicine settings.

7. Comprehensive Data Recording: Patient monitors record and store historical data,

providing a valuable resource for retrospective analysis and documentation. This

information can be crucial for assessing the effectiveness of interventions, tracking

patient progress, and informing long-term care plans.

8. Integration with Electronic Health Records (EHR): Patient monitors can seamlessly

integrate with electronic health record systems, ensuring the automatic transfer of vital

sign data into a patient's medical record. This integration enhances communication

between healthcare providers and promotes a more comprehensive approach to patient

care.

9. Enhanced Clinical Decision-Making: The real-time data provided by patient monitors

aids healthcare providers in making informed clinical decisions. Monitoring trends and

64
 changes in vital signs enables a proactive approach to patient management and facilitates

early intervention in response to evolving clinical conditions.

10. Versatility Across Healthcare Settings: Patient monitors are versatile and applicable

across various healthcare settings, including hospitals, clinics, ambulances, and home

care. Their adaptability makes them essential tools for monitoring patients in diverse

medical environments.

3.2.8.7 DISADVANTAGES

Cost:

Patient monitors can be expensive to acquire, install, and maintain. This cost factor may pose

challenges for healthcare facilities, especially those with limited budgets.

Training and Familiarity:

Effective use of patient monitors requires specialized training. Healthcare professionals need to

be familiar with the specific model and its features to interpret data accurately. Insufficient

training may lead to misinterpretation or underutilization of the device.

False Alarms:

Patient monitors are programmed to trigger alarms when certain parameters deviate from preset

thresholds. However, false alarms can occur due to artifacts, patient movement, or transient

conditions, leading to alarm fatigue among healthcare providers.

Dependency on Power Sources:

65
Patient monitors rely on a continuous and reliable power source. Power outages or disruptions

can compromise patient monitoring, emphasizing the need for backup power systems to ensure

uninterrupted functionality.

Size and Mobility:

Some patient monitors are bulky, limiting mobility for both patients and healthcare providers.

This can be a challenge in emergency situations or for patients requiring ambulation.

3.2.8.8 TROUBLESHOOTING A PATIENT MONITOR

1. No Power or Display Issues:

Issue: The monitor is not powering on or displaying information.

Troubleshooting Steps:

 Check the power source and ensure the power cable is securely connected.

 Verify the integrity of the power outlet and try an alternative outlet.

 Inspect for any visible damage to the power cable or monitor itself.

2. Abnormal Readings or Artifacts:

Issue: Inaccurate or erratic readings on the monitor.

Troubleshooting Steps:

 Examine sensor connections for looseness or damage.

 Replace damaged cables and ensure proper placement of sensors.

 Relocate the monitor away from potential sources of interference.

3. Alarms Activating Inappropriately:

66
Issue: Alarms are triggering without an actual patient issue.

Troubleshooting Steps:

 Review alarm settings and adjust thresholds if necessary.

 Inspect sensors for proper placement and functionality.

 Ensure the monitor is configured correctly for the patient's condition.

4. Noisy ECG or Waveform Distortions:

Issue: Distorted or unclear ECG or waveform readings.

Troubleshooting Steps:

 Reassess electrode placement for ECG.

 Replace damaged ECG cables.

 Verify the grounding of the monitor.

5. Intermittent Connectivity:

Issue: Wireless or network connectivity issues.

Troubleshooting Steps:

 Check for interference sources in the environment.

 Adjust wireless settings on the monitor.

 Ensure a stable network connection

67
 CHAPTER FOUR

4 CONCLUSION
In conclusion, the industrial training experience in repairing and troubleshooting medical

equipment has been a comprehensive and enriching journey, providing valuable insights into the

intricate world of healthcare technology. The hands-on exposure to a diverse range of devices,

including ultrasound machines, pacemakers, lensmeters, patient monitors, and ECG machines,

has significantly enhanced my technical expertise and problem-solving skills.

Throughout the training, I gained an in-depth understanding of the intricate mechanisms

underlying these medical instruments. The repair and troubleshooting processes involved in

restoring functionality to devices such as ultrasound machines, pacemakers, lensmeters, patient

monitors, and ECG machines required a meticulous approach, integrating theoretical knowledge

with practical application.

The significance of this industrial training program cannot be overstated, as it serves as a bridge

between academic knowledge and practical application. The acquired skills are not only relevant

for ensuring the seamless operation of healthcare devices but also contribute to the overall

improvement of patient care and safety.

4.1 RECOMMENDATIONS

Based on my experience during the course of my Industrial training at Bio-medequip, I will like

to make these recommendations:

The School of Basic Medical student could endeavor to make finding relevant placements

easier for students. The visitations by supervisors should be more frequent to properly assess the

quality of the placement centers.

68
 The Department should also have extensive communications to relevant biomedical

placement centers, to smoothen the process of IT placement.

69
REFERENCES

Baronov, D., McManus, M., Butler, E., Chung, D., & Almodovar, M. C. (2015). Next generation
patient monitor powered by in-silico physiology. Annu Int Conf IEEE Eng Med Biol Soc,
2015, 4447-4453.
Chan, A. (2014). Portable ECG machine. Hong Kong Med J, 20(2), 172.
Cordero, I. (2016). Understanding and caring for a lensmeter. Community Eye Health, 29(94),
37.
Infusion pump integration. (2013). Health Devices, 42(7), 210-221.
Department of Health & Human Services. (n.d.). Ultrasound scan. Better Health
Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ultrasound-
scan
Liu, Y., Liu, L., Wang, Z., & Wu, J. (2020). [Core Technology of Wearable Multi-parameter
Patient Monitor]. Zhongguo Yi Liao Qi Xie Za Zhi, 44(4), 307-310.
Mulpuru, S. K., Madhavan, M., McLeod, C. J., Cha, Y. M., & Friedman, P. A. (2017). Cardiac
Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series. J
Am Coll Cardiol, 69(2), 189-210.
Musa, M. J., & Zeppieri, M. (2024). Lensometry. In StatPearls. StatPearls Publishing

Copyright © 2024, StatPearls Publishing LLC.

Phenix, C. P., Togtema, M., Pichardo, S., Zehbe, I., & Curiel, L. (2014). High intensity focused
ultrasound technology, its scope and applications in therapy and drug delivery. J Pharm
Pharm Sci, 17(1), 136-153.
Simpson, D. C. (1962). A patient-monitor. Lancet, 2(7259), 759-760.
Toogood, G. (2007). Pacemaker therapies in cardiology. Aust Fam Physician, 36(7), 518-519,
521-514.
Wadham, P. (1986). Syringe pump design. Eng Med, 15(4), 171-174.
Waldman, W. J. (1982). Biological interactions of ultrasound. Radiol Technol, 54(2), 106-115.
Waye, J. D., & Thomas-Gibson, S. (2018). How I do colonoscopy. Gastrointest Endosc, 87(3),
621-624.

70