Capnography: Clinical Aspects - Assignment Example

Question 1 First: What is capnography? The technology of capnography has developed due to its vital role in anesthesia or for patients under intensive care in wards or transit in ambulances. Capnography equipment detects how much carbon dioxide is contained in a patient’s breath in comparison to other gases. As the amount of carbon dioxide fluctuates, physicians and surgeons are able to identify any abnormal condition in a patient. It is an invasive, rapid approach to identifying a patient’s condition in a continuous manner making it easy to detect danger early enough for an intervention to work (Gravenstein et al., 2004). Option One: Main stream versus side stream capnometers So much study has been conducted on whether mainstream or side stream equipment is the best for use in capnometry. In the use of side stream, there is a tendency to read erroneous results due to the likelihood of reducing the concentration of carbon dioxide due to dilution. Since main stream capnometers do not allow diversion, there is a high likelihood that their value for PaCO2 is more accurate (Chan, 2008). Either of these can e obtained from several manufacturers like Dr. Grobel, UV-Electronik GmbH on http://www.uv-groebel.com/ , or GenTech, analytical instrument sales, services, parts and training on http://www.gentechscientific.com Options Two: The use of spectrometry (generically) or spectrophotometry techniques Another alternative is the use of devices with capability of showing the contents of components in a sample drawn from a patient. Spectrophotometers are more advanced since they combine both colored light production and ability to measure light intensity. It’s capable of measuring certain component’s composition in a sample by measurement of amount of light absorbed since different components in a human being have diverse abilities in absorbing light. There are several manufacturers for spectrophotometers. It is better to obtain them from manufacturing institutions like Cairo University, faculty of Engineering, chemical engineering department. Other manufacturers include Angstrom Advanced Inc who can be contacted on email-sales@angstrom-advanced.com or through their website- http://www.angstrom-advanced.com. You can also find new or used Spectrophotometer at MED WOW, your global Medical Equipment Platform. Contact them through the link http://www.medwow.com Question 2 List two manufactures of defibrillators, not suppliers. 1. Beijing M & B electronic Instruments Co., Ltd; No. 27, Yongwang Rd., Beijing Bioengineering And Medicine Industrial Base, Huangcun Town, Daxing District, Beijing, China (Mainland); http://www.mbelec.com 2. Nortic Instrument (Nanjing) Limited; phone 86-25-86280922,13813862615; Address No.10 Wangying, Luying, Yanjiang Industry Development District, Nanjing, China; website link http://www.avantisca.com List two manufacturers of NIBP devices, not suppliers. 1. Philips Medical Systems; manufacturer of patient monitoring and medical devices. Address: Medical Devices Business Review, Progressive Media Group, John Carpenter House John Carpenter Street, London. Phone +44 (0) 20 7936 6898, Email: jsharp@industryreview.com 2. CASMED-OEM MAXINIBP, Contact info toll free number/code is 800.227.4414. List two multi parameter patient monitor manufacturers, not supplies 1. ATICO Medical Pvt. Ltd: Phone number India  +(91)-8376808154 Website: http://www.aticomedical.com/hospital-laboratory-instruments.html 2. Meditech Equipent Co., Ltd.; Address Nanjing Road No.100, Qingdao, Shandong Province, P. R. China; Phone 86-532-85832673  81705331; Email: meditech4u@hotmail.com; website http://www.meditech.com.cn List two thermometers manufactures, not suppliers 1. Shanghai Ruicare Medical Device Co., Ltd. Address: Rm.B091, No.1 Building, No.5500 Yuanjiang Road, Minhang District, Shanghai, Phone: 86-577-88256807, website: http://www.ruicare.com 2. S Brannan & Sons Ltd, Tel: +44 (0) 1946 816 600; Email: sales@brannan.co.uk. website: www.brannanshop.co.uk Question 3 WRO 1: The repair work should be done since it is part of maintenance without which the hospital risks damage of facilities due to wear and tear. An appropriate site within the hospital be provided where all services provided in this area and all goods stored here to be moved for safe keeping until the renovation works are over. Moreover, the properties of the items being moved should also be considered and proper equipment used for their transit. WRO 2: This is a very appropriate safety request due to nature of hospital where some of the equipment or apparatus used could be pure metallic with a likelihood of shock when they are powered on an unearthed extension. The equipment being used might lack a three prong input and this might pose a challenge. A three prong option should be sought in order not to risk patients and staff. Safety is first and a safe option must be provided. A new equipment can be ordered to replace the one already available, or earth cable provision be made on the equipment through some engineering. The most affordable safe option, which can easily be available to ensure hospital services are not affected, should be given priority. WRO 3: Electrical safety is a basic requirement in creating safe sanitariums. The testing devices used in hospital especially those which must deliver electrical energy to patients must be manufactured up to high standards. At no single tingle should a test from one instrument be relied upon. A hospital should have several testing devices so that the disadvantages on one can be countered by the advantages of the other. It would be good to use devices with multiple parameters. The current and voltage output should be key parameters in such devices. At no time should any naked cables be allowed on such devices. Any faulty device must be discarded unless upon repair the hospital is assured of its normal functionalities as before. Testing must always be done by approved people no matter the knowledge and understanding of the physician or technician in need of such devices. Some of the devices which a hospital should have to ensure electrical safety include insulation monitors, insulation fault location systems, and medical IT systems (Cadick, 2006). Question 4 The accompanying protocol on how the equipment is meant to function is necessary. In addition the safety features on the equipment should also be indicated especially how easy it is to control in case it malfunctions. Finally an equipment should come with instructions warranty and service indicating after how long it is due for servicing and where in case there is no local service provider. Question 5 These devices help physicians to know both the pulse rate and oxygen saturation in arterial blood. These two are vital signs in a patient upon which medical decision is made. Using an appropriate device is so beneficial and very critical since any error can lead to loss of life. They can be applied in patients who have problems in their respiratory systems like asthmatic patients, those diagnosed with chronic obstructive airway diseases, acute respiratory problems, and chronic obstructive pulmonary disease. This device is also useful among patients with serious heart problems for self monitoring. It is also used to guard against hypoxia among people climbing mountains or those residing in high attitudes. This is also important for athletes who need to train at high altitudes (Moyle, 1998). Question 6 Stain gauges are the main sensing element in so many apparatus used for various purposes including hospital. They use foil which is mounted on a backing substance. The way the foil changes when it is triggered by stress helps to define the cause of the stress. When purchasing a strain gauge, you must know clearly what it is going to be used for since they come in various designs like mechanical and hydraulic. After purchase ensure you have been given necessary accessories which must accompany the gauges. The material used in the manufacture should be specified. Ensure you are given installation instructions and contacts of individuals well trained and certified in bonding of strain gauges (Olson, 2008). Question 7 Cerebral Oximetry This is a method that depends on light penetration below the skin in order to determine how much oxygen is in blood flowing in the brain. It uses rays almost equal to infra red which are able to reach below the skull. Light is channeled to the skull, and after penetration, photons are reflected back to the oximeter. The sensing of photons provides an accurate amount of oxygen in the brain. This method is advantageous in that it is noninvasive as other methods used in measuring oxygen concentration in patients who have undergone surgery. Moreover, it is rapid and decreases patient stay in the hospital before the tests can be done on him. Unlike pulse Oximetry, cerebral Oximetry is designed in such a manner that two photo detectors are used. This allows more light penetration below the skull. Arterial blood and venous blood due to their differences in oxygen concentration absorb light differently. This is principle used in both cerebral and pulse Oximetry (Newman et al., 2001). Question 8 The hospital has decided to purchase new NIBP devices. The responsibility of choosing which model has fallen to you. While researching available models you have come across several options and you must decide which options to select before you can recommend a product. The following list represents these options. For each option discuss the possible choices, the functionality of the choice (how it works), its pros and cons and then make a choice recommendation for each option. You will need cited sources to support your decision and your definition of each choice. Option one: Auscultatory, Oscillometric, or Doppler methods of measurement Oscillometry is preferred for use on infants since it doesn’t allow distortions on observer variation. It can be done without disturbing an infant and it can display pulse rate at the same time. Korotk of sound on which Ausculatory measures are dependent are hard to obtain in infants. These two take less time compared to the Doppler method. Depending on who the patient or client is, an appropriate method is selected. Doppler is the last option in BP measurement (Andrea, 2005). Options Two: Continuous, or stepped cuff deflation Pressure can be measured once after the cuff is inflated continuously or inflation can be step by step, and at each step the pressure measured. Slow deflation increases accuracy in detecting blood pressure of a patient. These are manual methods of measuring blood pressure (Lawrence et al., 2007). Option Three: Is motion artifact detection necessary It is important such artifacts are detected since they are disturbing and can easily confuse accurate detection of ECG signal. In cases where they cannot be stopped it is important that their values are known and taken into consideration in the final reading (Jorg et al., 2008). References Andrea, D. S. (2005). Basic Principles of Noninvasive Blood Pressure Measurement in Infants. Advanced Neonatal Care, 5 (5), 252 – 261. Cadick, J. (2006). Electrical Safety Handbook 3e. London: McGraw Hill. Chan, K. L., Chan, M.T. V., & Gin, T. (2008). Mainstream vs. Side stream capnometry for Prediction of Arterial Carbon Dioxide Tension during Supine Craniotomy. Anaesthesia, 58 (2), 149 -155. Gravenstein, J. S. et al. (2004). Capnography: Clinical Aspects: Carbon Dioxide over time and volume. London: Cambridge University Press. Jorg, O., Malte, K., Luciana, J., Michal, H., Ulrich, G., & Wilhelm, S. (2008). Reliable Motion Artifact Detection for ECG Monitoring Systems with Dry Electrodes. 30th Annual International IEEE EMBS Conference. Retrieved from https://www2.lirmm.fr/lirmm/interne/BIBLI/CDROM/ROB/2008/EMBC_2008/PDFs/Pa pers/04290765.pdf  Lawrence, T. H., Sai, K., Bruce, A. F., & Richard, M. (2007). Method of Controlling Blood Pressure Cuff Deflation. General Electric Company, 11, 272-290. Moyle, J. (1998). Principles and practice series: Pulse Oximetry. New York: John Wiley. Newman, M. F., Kirchner, J. L., Philips, B., Gaver, V., & Grocott, H. (2001). Longitudinal Assessment of Neurocognitve Function after Coronary-Artery Bypass Surgery. The New England Journal of Medicine, 344, 395-402. Olson, S. P. (2008). Patterned Piezoresistive Silicon Strain gauge devices for use in low power applications. London: ProQuest. Read More