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LAPAROSCOPE

Laparoscopy is a type of surgical procedure in which a small cut is made through the navel (tummy button) through which a viewing tube (laparoscope) is inserted. The video image of the liver, stomach, intestines, gallbladder, spleen, peritoneum, and pelvic organs can be viewed on a monitor after insertion of a telescope into the abdomen. Other small cuts can be made to insert instruments to perform procedures (keyhole surgery). Manipulation and biopsy of the viscera is also possible through additional ports. Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination of intra abdominal organs in order to detect pathology.

LAPAROSCOPIC INSTRUMENT

This is kind of special surgical tools that the surgeon uses to work on the patient. These tools allow the surgeon to move, cut, and stitch organs during the operation. The laparoscopic instrument used during the previous activity is much different from the instrument used during a real surgical procedure. The instrument is assemble with other components to aid Surgeon see clear pictures of image of an internal organs of human system.

LAPAROSCOPE OPERATIVE PROCEDURE

Laparoscopy is a surgical procedure performed in the hospital under general anaesthesia. Before starting the procedure the bladder is emptied with a small catheter and the skin of the abdomen cleaned.

After the patient is given anaesthesia a hollow needle is inserted into the abdomen through a small cut through the navel (tummy button), and carbon dioxide gas pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs the monitor. The laparoscope is then inserted through this cut to look at the internal organs on the video monitor. Usually one or two additional small cuts are made along the ‘bikini line’ to insert other instruments which are used to lift the tubes and ovaries for examination or to perform surgical procedures.

USES OF LAPAROSCOPE

Laparoscopy can be carried out to diagnose certain conditions or to perform certain types of operations which include:
Sterilization.
Pelvic pain
Ectopic pregnancy.
Infertility.
Endometriosis.
Hysterectomy
Ovarian cysts.
Adhesiolysis.
Fibroids.

COMPONENT OF LAPAROSCOPIC

Camera Head
Coupler
Camera Head Cable
Camera Processor
Video Monitor
Light Box
Light Cord
Rotation Knob
Cord Connection
Trigger+ Handle
Scissor Insert

ADVANTAGES OF LAPAROSCOPY

Small incision
Minimal pain
Attenuated stress response
Earlier return to ambulation
Reduced hospital stay
Fast recovery
Reduced blood loss

DISADVANTAGES OF LAPAROSCOPY

Injury to blood vessels
Surgical burns
Excess CO2 gas in the abdomen
Longer surgeries

PREVENTATIVE MAINTENANCE OF LAPAROSCOPIC INSTRUMENT

1. Poor Insufflation:

The possible cause be as result of Empty CO2 tank, Accessory port stopcock(s) not properly adjusted Leak in sealing cap or stopcock Excessive suctioning, loose connection of insufflator tubing at source or at port, Hasson stay sutures loose Tubing disconnection from insufflators or Flow rate set too low.

Check and change the CO2 tank if it’s empty. Inspect all accessory ports. Open or close stopcock(s) as needed. Change cap or cannula and Allow time to reinsufflate. Re-tighten all lose connections, Replace or secure sutures. Connect tubing And Adjust flow rate.

2. Excessive pressure required for insufflations (initial or subsequent)

The problem may be as a result of Veress needle or cannula tip not in free peritoneal cavity. Occlusion of tubing (kinking, table joints, etc.), Port stopcock turned off, Patient is “light” Cannula tip not in peritoneal space.

Reinsert needle or cannula. Inspect full length of tubing. Replace with proper size as necessary. Fully open stopcock, Give more muscle relaxant, Advance cannula under visual control.

3. Inadequate lighting (partial/complete loss):

The cause can be as result of loose connection at source or scope Light is on “manual-minimum”,Bulb is burned out, Fiber optics are damaged, Monitor brightness turned down Room brightness floods monitors.
Adjust connector, Go to “automatic” Replace bulb Replace light cable Readjust setting Dim room lights

4. Lighting too bright.

This may be due to Light is on “manual-maximum” “Boost“ on light source is activated or Monitor brightness turned up.

Go to “automatic” deactivate “boost” And Readjust setting

5. No picture display on monitor

This may be that Camera control or other components (V.C.R., printer, light source, monitor)
Are not “on”, or Cable connector between camera control unit and monitors not attached properly or Cable between monitors not connected Input select button on monitor doesn’t match “video in” choice

Make sure all power sources are plugged in and turned on. Cable should run from “video out” on camera control unit to “video in” on primary monitor. Use compatible cables for camera unit and light Source. Cable should run from “video out” on primary monitor to “video in” on secondary monitor, Assure matching selections.

6. Poor quality fogging/haze picture:

The problem may occur when there is Condensation on lens from cold scope entering warm abdomen Condensation on scope eyepiece, camera lens, coupler lens.

Gently wipe lens on viscera; use anti-fog solution, or warm water Detach camera from scope (or camera from coupler), inspect and clean lens as needed.

7. Flickering, Electrical interference:

May be there is a moisture in camera cable connecting plug or Poor cable shielding or Insecure connection of video cable between monitors.

Use suction or compressed air to dry out moisture (don’t use cotton tip applicators on muti-pronged plug. Also move electrosurgical unit to different circuit or away from video equipment and reattach video cable at each monitor.

8 Blurring distortion image:
There is Cracked on the lens, or internal moisture content, Incorrect focus too grainy

Adjust camera focus ring Inspect scope/camera, replace if needed, Adjust enhancement and/or grain settings for units with this option

9. Poor or Inadequate suction/irrigation:
This can occur if there is Occlusion of tubing (blood clot). Occlusion of valves in suction/irrigator
Device, not attached to wall suction, Irrigation fluid container not pressurized.

Inspect full length of tubing. If necessary, detach from instrument and flush tubing with sterile saline. Detach tubing, flush device with sterile saline. Inspect and secure suction & wall source connector. Inspect compressed gas source, connector, pressure dial setting.

10. Absent or “weak” cauterization:
If the Patient is not grounded properly or there is no Connection between electro-surgical unit and instrument loose or Foot pedal or hand switch not connected to electrosurgical unit or wrong output selected or Connected to the wrong socket on the electrosurgical unit. Instrument insulation failure outside of surgeon’s view.

Make sure there is adequate grounding pad contact. Inspect both connecting points, correct output choice, Check that cable is attached to endoscopic socket, and also Use new instrument and inspect insulation.

By
Ibrahim S Usman
Biomedical Technician
461 Nigerian Air force Hospital
Kaduna Nigeria
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Anesthesia Machines
➖➖➖➖➖➖➖➖➖➖➖
Purpose
• Anesthesia units dispense a mixture of gases and vapors and vary the proportions to control a patient’s level of consciousness and/or analgesia during surgical procedures.

Functions
• Provide oxygen (O2) to the patient.
• Blend gas mixtures that can include (besides O2) an anesthetic vapor, nitrous oxide (N2O), other medical gases, and air.
• Facilitate spontaneous, controlled, or assisted ventilation with these gas mixtures.
• Reduce, if not eliminate, anesthesia-related risks to the patient and clinical staff.

Anesthesia delivery
• The patient is anesthetized by inspiring a mixture of O2, the vapor of a volatile liquid halogenated hydrocarbon anesthetic, and, if necessary, N2O and other gases.
• Because normal breathing is routinely depressed by anesthetic agents and by muscle relaxants administered in conjunction with them, respiratory assistance — either with an automatic ventilator or by manual compression of the reservoir bag — is usually necessary to deliver the breathing gas to the patient.

Principles of operation
• An anesthesia system comprises four basic subsystems:
– a gas supply and control circuit;
– a breathing and ventilation circuit;
– a scavenging system;
– a set of system function and breathing circuit monitors (e.g., inspired O2 concentration, breathing circuit integrity).

Safe practice of anesthesia
• Anesthesia machines incorporate a number of alarms that indicate:
– levels and variations of several physiologic variables and parameters associated with cardiopulmonary function; and/or
– gas and agent concentrations in breathed-gas mixtures.

Safe practice of anesthesia
• Anesthesia machines must monitor:
– O2 concentration;
– airway pressure; and either
– the volume of expired gas (Vexp); or
– the concentration of expired CO2 (capnography).
• Stand-alone monitors may be used to track other essential variables:
– electrocardiogram;
– SpO2;
– blood pressure (invasive / non-invasive);
– temperature.

MAJOR COMPONENTS
• Gas Supply
• Pressure Regulators
• Flowmeters
• Vaporizers
• Safety Devices
• Breathing System

Breathing circuits used in continuous-flow systems

Circle systems – advantages:
– conserve a greater proportion of the anesthetic gases: ↓ cost;
– conserve body heat and moisture from the patient.
• T-piece systems – advantages:
– lower circuit compliance;
– easier circuit sterilization;
– less complex design requiring fewer valves and no CO2 absorber (although one can be used with it).
Note: T-piece systems are used most often in pediatric anesthesia.

• Lack of O2 delivered to the patient (Hypoxia):
– can result in brain damage or death.
• Administration of O2 in a concentration of 100%, even for a short duration, may be toxic:
– resorption atelectasis;
– particularly acute in neonatal anesthesia; can cause retrolental fibroplasia and bronchopulmonary dysplasia.

Flowmeters
N2O and O2 flow controls are interlocked so that the proportion of O2 to N2O can never fall below a minimum value (nominal 0.25) to produce a hypoxic breathing mixture.

Vaporizers
• Inhaled anesthetic agents, with the exception of N2O, exist as liquids at room temperature and sea-level ambient pressure.
• Vaporizers add a controlled amount of anesthetic vapor to the gas mixture.
• Types of vaporizers:
– variable bypass (conventional);
– heated blender;
– Measured flow;
– draw-over.

CO2 Absorbers
• soda lime
• barium hydroxide lime

O2 Monitor
• An O2 monitor located on the inspiratory
side of the breathing circuit analyzes gas sampled from the Y-piece of the patient’s breathing circuit and displays O2 concentration in volume percent.
• O2 monitors sound an alarm if the O2 concentration falls below the preset limit.

Adjustable Pressure Limiter (APL) Valve
• Pressure imposed on the patient’s lungs can cause serious lung damage.
• Either an APL valve or a valve in the ventilator allows excess gas to escape when a preset pressure is exceeded.
• Types:
– spring-loaded;
– needle.
• Many APL valves do not have calibrated markings: The anesthetist must adjust them empirically to give a desired peak inspired pressure.
• Circle systems and T-piece systems also include a pressure gauge for monitoring circuit pressure and setting the APL valve.

Scavenging System - Rationale
• Captures and exhausts waste gases to minimize the exposure of the operating room staff to occupational risks.
• Exposure to trace levels of anesthetic gases continually present in the operating room can cause adverse health effects in operating room personnel:
– increased incidence of spontaneous abortion;
– congenital anomalies in babies.
• Trace gas levels in the air may have a slight anesthetizing effect on the anesthetist and surgeon.

• Scavenging systems remove gas by a vacuum, a passive exhaust system, or both.
• Note: Inadequate evacuation of some scavenging systems can cause pressure to build up in the breathing circuit, with the potential for pneumothorax (air in the pleural cavity).

Vacuum (active):
– Vacuum scavengers use the suction from an operating room vacuum wall outlet or a dedicated vacuum system.
– To prevent positive or negative pressure in the vacuum system from affecting the pressure in the patient circuit, manifold-type vacuum scavengers use one or more positive or negative pressure-relief valves in an interface with the anesthesia system.
– Open-type vacuum scavengers have vacuum ports that are open to the atmosphere through some type of reservoir; such units do not require valves for pressure relief.

Passive exhaust system:
– Passive-exhaust scavengers can vent into a hospital ventilation system (if the system is the non-recirculating type) or, preferably, into a dedicated exhaust system.
– The slight pressure of the waste-gas discharge from the anesthesia machine forces gas through large bore tubing and into the disposal
system or directly into the atmosphere.

Preventive Maintenance
• Test apparatus and supplies:
– Lung simulator with adjustable compliance or ventilator tester
– Pressure gauge or meter with 2cm H2O resolution, from -20 to +120 cm H2O
– Various breathing circuit adapters
– Leakage current meter or electrical safety analyzer
– Ground resistance ohmmeter
– Additional items as required for specific manufacturers’ procedures

Preventive Maintenance
• Qualitative tests:
– Chassis/Housing
– Mount/Fasteners
– Casters/Brakes
– AC Plug
– Line Cord
– Strain Reliefs
– Circuit Breaker/
– Tubes/Hoses
– Cables
– Fittings/Connectors
– Filters
– Controls/Switches
– Fan
– Battery/Charger
– Indicators/Displays
– Alarms/Interlocks
– Labeling
– Accessories
– Bellows

• Quantitative tests:
– Grounding resistance [≤0.5 Ω]
– Leakage current [≤300μA chassis]
– Modes and settings [±10% accuracy]
– Monitors and Alarms [±10% accuracy]
– Alarms tested:
• Airway pressure
• Tidal volume
• FIO2

• Others:
– Gas Supply
– Pneumatic lines (including air filters)
– Gas cylinders (and gauges and regulators, if so equipped)
– Patient Circuit

– Breathing circuit (including filters)
– Humidifiers
– Pressure-relief mechanism
– Absorber

+++++++++++++++++++++++++++
N Nenohwe.
BSc (hons) Applied Physics
National University of Science and Technology
Zimbabwe
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NABH Guidelines

Biomedical Equipment (calibration): NABH team accepted as per below.

Bp apparatus
Do 1 Bp apparatus calibration from NABL accreditation company and do all Bp apparatus in hospital and prepare certificate (in house report) do sticker as per the reference by calibrated one


Monitors, defibrillator, ECG, Ventilator, workstation: take validation / calibration certificates direct from company itself.


Diathermy’s, TCM, HEARTLUNG MACHINE, OT lights, OT tables, Laproscope equipments: pms report is enough from company with checklist or from biomedical in house pm report.

Syringe pumps, infusion pumps: take calibration certificate from belonging company

ICP monitor: need pms report only from company

Adult Weighing scales, nebulisers, physiotherapy eqt. : need pms in house report by biomedical
Wax both , Lab weighing scales , micro pippets, cetrifuge, water bath, oven, incubator, neonatal incubators, infant warmers, digital/manual thermometers of Refrigerator:
need to be done calibration from accreditation company(NABL/NABH)

Microtome, tissue processor: need pms report by biomedical is enough
All analysers, bio safety cabinet, laminar flow: need calibration certificate from same company accepted


Radiology Equipments: need to be done QA from registered AERB accreditation company
safety tools certificate submission to AERB is must n should need in biomedical as well as in radiology department it’s in online now in ELORA website .


Ultrasound, ECHO: state PNDT registration certificate from DMHO n pms report need
————————

Files Must and should be in Biomedical Engineering department.

Main asset list of all equipments department wise with asset number to the equipment with summary sheet.

Pms reports of all equipment as per the equipment
PMS schedule month wise file (year calendar) to be prepared

Installation reports of all equipment

IQ, PQ, OQ, for all analysers in lab equipment.


Biomedical Calls /complaints management register/logbook (start to till date)


BIOMEDICAL SOP files as per team number (if team 5 in Biomedical Department, sop files should prepare on every name)

Purchase order: releasing protocols and PO file Of Equipment and Spares

Equipment. Condemnation report file: minutes of meeting report n condemned equipment list to be filed by signing by condemnation committee
(Committee members:
1.GM-hospital/CHA(chief hospital administrator,
2.Manager-finance

CEO(optional)
Manager/HOD- biomedical
Medical superintendent
Prepared by: biomedical engr name
Approved by: Medical director /CEO )


AERB REGISTRATION certificates from AERB for all radiology EQT. File as well as state registration from DMHO.


Every year prenatal test not doing report should submit in DMHO office on Dr. personnel name whoever doing ultrasound and echo , letter on ₹ 50 stamp/bond paper ,which prepared by layer with Dr. sign , this photocopy should file in biomedical department after submission to DMHO. (answer by biomedical engineer n this letter submission done by biomedical as per new law in PNDT law in India since 2014)


Stock register (optional)


All equipment should be placed by cal/pms stickers with updated dates & every dept. having biomedical maintenance requisition book, slips of received and issued eqt after repair which should file in BMED.
This is my personnel experience and I succeed without NC’s for biomedical dept. from NABH TEAM in my period of job where I did in India.

———————————–

Author is Mr. Rajendra Prakash (10yrs experience in Biomedical, NABH & NABL)
Currently working in AFRICA, Abuja, Nigeria,
If any quires regarding this message most welcome to contact him via
What’s app no: +234-7010081024
Email: rpbme123@gmail.com
All The Best
©FORCE BIOMEDICAL

Work Together Develop Together

For reference purpose only
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