Engineering Equipment Used in ICU Department - Essay Example

Engineering Equipments Used in ICU Department Student’s Name: Institutional Affiliation: Instructor’s Name: Course: Date: Table of Contents Introduction 4 Discussion 4 Pacemakers 6 Figure 1: Pacemaker fitting machine 6 Types of pacemakers 7 Transcutaneous 7 Wearable 7 Implantable 8 How pacemakers work 8 How pacemakers are fitted 9 Living with the Pacemaker and their Effects 9 Other equipments used with Pacemakers 10 Turning off the pacemaker 11 Tube feeding equipment 11 How they are fitted 12 Types of feeding tubes 12 Nasogastric Tube 12 Gastrostomy 12 Gastric tube 13 Gastrojejunal tube 13 How they work 14 Medical uses 15 Children 15 Dementia 15 Effects on the Body 15 Monitoring system, Physiologic 17 Components 17 Sensor 17 Translating component 17 Display devices 18 How it works 19 What they do 20 Application 20 Blood and glucose monitoring 20 Psychiatrist 21 Epilepsy monitoring 21 Toxic monitoring 22 How they affect the Body 23 Conclusion 24 References 26 Introduction This essay aims at discussing the type of medical engineering equipments used in intensive care unit (ICU) department by critically analyzing on how the equipments function, how they are operated and the kind of assistance the equipments offer during medication. The equipments discussed in this essay also offer similar degree of care in other departments such as in the neurosurgical and cardiothoracic departments (ESQUINAS, 2011). There are other several engineering equipments found in ICU such as patient monitoring machines and pacemakers. However, this essay only focuses on three main equipments. The pacemakers, the tube feeding and the physiological monitoring machines will be discussed as the main engineering equipments used in intensive care unit. Intensive care can be defined as the services offered to a patient by a team of doctors and nurses in a more detailed observation than can be done in an ordinary ward especially those who show potential recoverable conditions. Patients with specific conditions are normally taken care of in the ICU department in that this department is designed to handle patients with severe injuries and those that have conditions that call for constant monitoring. Discussion Most of the clinical and service professionals use technical equipments developed by engineers in healthcare and most of them manage the equipments. The technical skills needed to operate the equipment are normally offered by the manufactures through training and supervision. Some of the healthcare equipments are managed for a while by technicians before being handed offer (ESQUINAS, 2011). The main professions where medical devices are very prominent include but not limited to radiologists, anesthetists and intensive care units as well as the engineering support staffs that support them. Societies headed by the relevant ministries of government keep the hospitals up to date with new and emerging technological and device developments and their associated clinical, safety and legal implications (DYRO, 2004). The technical team also normally provides assistance with device procurement by providing for example, standard specification forms for use when tendering for up to date equipments. Societies are also known to provide advice on the planning and installation of engineering equipments in the specialized areas and a good example is the European intensive care society that provides and publish the minimum requirements for intensive care units (JOBB, 2012). The governments set u to date engineering equipments in intensive areas of medicine such as those devoted to clinical engineering and medical physics and intensive care medicine as well as those involved with surgeons, intensivists, radiographers and radiologists (JOBB, 2012). The concerned specialists are normally interested with the nature and performance of their equipments and the way in which they are used. The management team is not only the providers of the medical engineering equipments but the medical physicists play a major role in the specification, procurement and testing of the emerging monitoring machines (ESQUINAS, 2011). They are also concerned with those machines that use ionizing and non ionizing radiations. The interconnections of systems are also dealt with the engineers as well as safety and risk management with the use of physiological signal. The clinical engineers normally involve and educate the other members from the other professional groups in engineering equipment issue as they work alongside them to deliver services to patients (VLAD & CIUPA, 2014). The three main Engineering Equipments to be discussed The three common equipments discussed in this essay are the pacemakers, the tube feeding machine and the physiological monitoring machines (VLAD & CIUPA, 2014). All these three equipments are very essential engineering equipments used in ICU department to save the lives of the patients at risk. Some of these equipments work together while others can work independently (ESQUINAS, 2011). The physiological monitoring machines for instance are used to monitor patients with all complications and hence, it works with the other two equipments concurrently. For feeding to be accurate, the monitoring machines should give alert and hence one can say the engineering equipments used in intensive care units are interdependent (DYRO, 2004). Pacemakers Figure 1: Pacemaker fitting machine A devise called a pacemaker is used in a situation whereby there is heart failure or when the heart of the patient is not beating well. This equipment produces electrical current that helps the heart to beat as well as stimulate it in circumstances where there is slow or heart failure (JOBB, 2012). The pacemakers can be implanted into the skin of the patient especially when it is only required for some few hours. They can also insert through the central venous if it has to stay for some few weeks or can implanted under the skin of the chest wall in case it has to be permanent. Types of pacemakers Transcutaneous This is an external pacemaker that was developed in 1950 by Canadian engineer called john Hopps (VLAD & CIUPA, 2014). The vacuum tube technology was used to develop this machine that provided transcutaneous pacing of the heart. The entire process was very painful to the patient and was also very risky in that it was using alternating current from the socket and hence could easily electrocute the patent (ESQUINAS, 2011). Later own, the machine was improved by inserting a rechargeable battery and hence this has been workable to date. It was through such engineering efforts that physicians managed to develop cardiac pace-making. Wearable Engineer Bakken developed an external wearable pacing machine that was used electrodes to pass its currents through the skin to the heart. The heart rate depends with the output voltage from the transistorized pacemaker. This type of pacemaker is very useful in intensive care units because it can easily be connected hence; it is used in emergency cases (DYRO, 2004). Implantable This type of pacemaker is commonly used with patients on permanent basis or over a long period of time. The electrode is inserted through the patient’s basilica vein. Research indicates that patients implanted with this kind of pacemakers can live their full lives unless affected by other ailments. The traditional pacemakers have been improved and currently, the pacemaker is small equipment like a pill and can be inserted through the leg (JOBB, 2012). How pacemakers work The human heart has a natural pacemaker called the sinus node. The sinus node normally sends an electrical like impulse to the brain for the heart to beat (JOBB, 2012). Whenever there is a failure of the sinus node due to illness or malfunctioning, the pacemaker artificially takes the role of the sinus node for the heart to beat hence balancing the blood pressure. A heartbeat is produced when the pacemakers sent electric impulses from the brain to stimulate the heart to contract and produce a heartbeat (JAFFRAY, 2015). The pacemakers normally work on demand that’s to say when they are required to do so. The pacemakers are automatic in that they work when the heart is irregular, too slow or too fast. There is what is called the fixed rates in some cases whereby the pacemakers send out impulses all the time (VLAD & CIUPA, 2014). Research indicates that the pacemakers can never give the heart an electric shock as perceived by other people. How pacemakers are fitted The pacemaker is inserted into the body with the local anesthesia and sedation hence, the patients normally feel sleepy. The patient is then required to stay overnight in the hospital so that the pacemaker is thoroughly checked before the patient is released (ESQUINAS, 2011). Once they are fitted, it will try to follow the trial rhythm of the heart by detecting the R wave. Living with the Pacemaker and their Effects The heartbeat rate should be recorded under the instructions of the doctor until it is checked after some months (VLAD & CIUPA, 2014). The battery life of the pacemaker should last for up to a period of eight years or longer. Surgery is required to replace the battery when it is on the low mode and hence medication must be taken as directed by the physician (DYRO, 2004). Research indicates that some household microwaves as well as light shop equipments and electric appliances cannot affect an inserted pacemaker. The use of television and microwave ovens as well as cell phones cannot affect the pacemakers (JOBB, 2012). Some side effects that can be experienced by individuals fitted with the pacemaker include difficulty in breathing, weight increase, feeling dizzy and at times fainting. However, it is normal for a patient fitted with a pacemaker to feel tired a few days after the fitting. Some of the medical equipments may affect the mode of operation of the pacemakers and hence, the doctor must be informed when carrying out other medical activities. The people surrounding an individual fitted with the pacemaker should also be aware so that they can offer assistance when needed. Other equipments used with Pacemakers The other common equipment used with pacemaker is the cardiovascular machine. This equipment uses electricity to restore an abnormal heart rate into a normal rhythm. The cardiac circle is controlled through a synchronized cardio-version by application of specific electric current. The cardiac arrest can therefore be stopped through this application of therapeutic electric current which gives a normal pace the pulses. The synchronized electrical cardio-version is achieved through the use of two electrode pads that contain metallic plate lined with a conductive gel (DYRO, 2004). The patient is made to lie vertically on the bed and then one pad is placed on the back and the other on the chest simultaneously. A machine that functions with electrodes is then connected with the cables and then it displays on the screen the heartbeat rate which in turn is monitored by the physiological machine. The reversion shock is therefore released by the electric current which in turn is responded by the R waves in the pacemaker (ESQUINAS, 2011). The automatic timing of the waves is checked by the physiological machine and hence, the shock is prevented during a critical stage. When the patient becomes conscious in intensive care unit, there are some drugs that are used to assist sedate the patient making the procedure more supportable. The shock is normally maintained on the unconscious patients provided they are confirmed to be arrhythmia. The drug therapy is maintained together with the cardio-version until the patient recovers his/her normal sinus rhythm (VLAD & CIUPA, 2014). The procedure is maintained in simple cases and the pacemakers might be used in case the shock process fails and the patient repeats high or lower heartbeat rate. Turning off the pacemaker Some patients can be very sick to extend they request for turning off the pacemaker for them to rest. The group of heartbeat society in United States agrees that it is ethical and legal for the patient to request for turning off. The law indicates that the procedure is the same with that of removal of the feeding tubes. A patient normally has a right to refuse treatment under certain conditions in some countries (DYRO, 2004). However, some physicians refuse to remove such critical equipments from sick patients but the law allows refer to a willing physician (JOBB, 2012). Cardiac devices can support lives but some patients believe that it’s more painful to prolong hopeless lives like those brought in by severe strokes. Tube feeding equipment Figure 2: Tube feeding In most cases, very sick patients admitted in the ICU might not be capable of consuming food through the mouth or they might not even be able to consume the needed calories to heal. Food is very essential in the body of any being, and hence an individual must eat for him/her to survive. Those who are not able to eat due to sickness are feed with the tube inserted into their mouth or nose down into their small intestines or the stomach through tube feeding (JAFFRAY, 2015). The tube feeds can also be used to supply food directly into the blood stream in cases where the stomach of the patient is not functioning well. Prolonged illness cannot be stopped if the patient is not supplied with the required calorie to fight the infection. How they are fitted Types of feeding tubes Nasogastric Tube This type of feeding tube is passed through the nostril passing the esophagus down to the stomach. This is the most common feeding tube used in intensive care units because they are developed for shorter purposes. Those who call for more permanent tubes are fitted with gastric tubes (DYRO, 2004). This normally happens to patients who do not recover quickly in case they are in intensive care units. This type of feeding tube does not require surgery because they are placed for temporary basis. Gastrostomy This type of feeding tube is inserted through the abdomen into the stomach. This type is permanent and is not normally used in intensive care unit compared with the other tubes that are used temporarily on emergency basis. This tube contains a very powerful light source and hence can be visualized outside the patient’s abdomen (VLAD & CIUPA, 2014). Gastric tube This tube unlike the other tubes is best used for drainage. This is common with patients who have blockages in their small intestines. Accumulation of acids inside the stomach may result in constant vomiting hence; engineers have developed gastric drainage tubes to assist patients facing such complexities (VLAD & CIUPA, 2014). Gastrojejunal tube This is a type of feeding tube that combines devices to access both the stomach and the middle small intestines. A tube is placed inside the stomach and then a narrow one extends to the jejunum. This tube is commonly used with patients with high gastric motility. It makes it possible for the stomach to be drained while feeding takes place in the small intestines. The process of insertion of this tube is somehow different from the other tubes because it requires radiologist (ESQUINAS, 2011). The tube can cause complications when the longer part gets out of the small intestines and enters the stomach. To insert the endoscope, the doctor uses anesthetic to relieve the pain. The patient is made to lie on their back. The physician then inserts the endoscope in the mouth of the patient down the esophagus into the stomach (JOBB, 2012). The use of camera to guide the doctor to ensure that the tube follows the stomach lining is the other use of engineering equipment in tube feeding. The camera also helps the doctor to observe the stomach so that he/she make small incision in the patients’ abdomen (VLAD & CIUPA, 2014). The next step is to insert the feeding tube through the opening with the guide of the computer. Once the tube is secure, the doctor normally places the sterile dressing around the site to avoid any form of contamination (DYRO, 2004). The wound can have small fluids such as pus or blood and hence there is drainage of such fluids. In most cases, the entire process lasts for an hour or less. The feeding tubes inserted in ICU are normally temporary because in most cases, they are used to feed patients who cannot be able to eat due to the condition they are because of injuries or other short-term effects. How they work The medicine used during insertions can make the patient drowsy and hence should have enough time to relax. In most cases, the abdomen normally heals after a week (JOBB, 2012). If the tubes are supposed to be permanent, the doctor normally gives the patients the instructions on how to use them. The tube needs a lot of care because it is directed into the sensitive part of the body and any abnormality can lead to serious injuries (ESQUINAS, 2011). Soluble foods calculated by the doctor are put in the container thus dripping slowly into the stomach to give out the required calories to the critically ill patients at ICU. The nurse or the caregiver is required to do drainage regularly around the tube to avoid any form of infections. People who have been fitted with the feeding tubes argue that there is some feeling of pain though not persistent. The pain is felt around the place of incision for a day or two before the place goes back to normal state. Medical uses There are various circumstances in which the need of tube feeding becomes compulsory. The most common circumstance that calls for tube feeding includes cancer patients that are unable to swallow food, children, anatomical, digestive disorders and post-surgical abnormalities. Children Children born in intensive care units due to various reasons such as death of the mother during birth are normally fed with tubes. The premature births commonly carried out in intensive care units are also what calls for tube feeing of the infant (DYRO, 2004). Some children only use the tubes until they eat for themselves while others use it permanently if they are born with complications mentioned above. Dementia Some of the patients who cannot eat through their mouths because of dementia can be fed by tubes. Research indicates that patients who are assisted to eat on their own instead of tube feeding have a longer life expectancy (VLAD & CIUPA, 2014). Effects on the Body If the place around the tube is not kept dry and clean, there might be infections or irritations. Tetanus can take advantage of this to cause death if general drainage and cleanliness is not observed. This however, happens with those fittings done and the patient is released to go home. Cases of infection are very minimal at the ICU because of close monitoring by the care givers. It has been found through research that tube feeding do not increase the life expectancy. Patents with tube feeds are also prone to aspiration pneumonia. The pressure ulcers are also associated with feeding tubes for those patients who use it for a long time (VLAD & CIUPA, 2014). The patients with feeding tubes are also known to be distressed because of the physical restraints. Human interaction is very essential and hence, palliative care should be encouraged whenever the patient is fitted with the feeding tube. The gastric contents contained in food can be leaked into the abdomen causing a very dangerous disease called peritonitis. This complication can cause sudden death if not closely monitored and prevented (JOBB, 2012). The tubes undergo wear and tear and hence have to be changed. Changing the tubes results in pain and distress to the patient and is also associated with a lot of risks. Children who use the feeding tubes for a long period of time are reported to lack appetite. The patients also are malnourished compared to those who eat themselves. Patients can also have regular gagging, nausea, vomiting and retching. For children, this can result in growth retardation and dependency (DYRO, 2004). For this reason, there will be poor development that can lead to poor school performance in children and students as well as poor intellectual ability. The immune system can be affected by limited nutrient intake and in children this can lead to wasting (VLAD & CIUPA, 2014). Secondary diseases can take advantage of the malnutrition caused by tube feeding making patients to be susceptible to illness hence high chances of death. Research also indicates that there are risks associated with the procedure of insertion although the cases are nor rampant. The most common risks include trouble breathing and the sickness from the prescription. Whenever the surgery is involved, there are risks of excessive bleeding and infections such as tetanus infection even with the unexpected minor procedures like feeding tube placing (ESQUINAS, 2011). There are also reported cases of reflux especially with those patients who lie flat while the tube feedings are running. If the tube moves out of place, the patient can experience some complications that include malnutrition. The place must be washed with soap and water though should be rinsed with tap water to remove all the soap. Monitoring system, Physiologic Components Sensor The physiological monitoring machines have some sensors that include biosensors that monitor the body of the patients in the intensive care unit and the mechanical sensors that monitor other machines within the parameters (VLAD & CIUPA, 2014). Translating component This component is used to convert signals from the sensor mode to a more understandable language that can easily be interpreted by the caregivers. From the sensors, the translating component can also send information into the recording devices on the display (DYRO, 2004). It is at this point that the nurses keep the record for the patients in that can be retrieved within a very short time to follow up the changes in the patient’s body for example the level of calcium and the sugar levels. Display devices Once the data have been translated, they can now be displayed overtime on the LCD or CRT screens along the expected time frame. The computed numerical such as average, minimum and maximum value of the blood level, respiratory frequencies and the heartbeat rate are displayed. The digital medical displays have an ability to display numeric readouts continuously on the screen (ESQUINAS, 2011). The modern medical displays from the physiological machines have an advantage of tracking essential signs at once. They are also very portable and can multitask within a given parameter unlike the old displays that used oscilloscopes and would only interpret information from one channel. This is to say one physiologic machine would track the patient’s blood pressure while the other would measure the breathing system (JOBB, 2012). The discovery of computer improved the monitoring systems in intensive care units. Figure 3: Blood analysis care device (Source: Courtesy of Philips medical system.) How it works Critically ill patients in intensive care unit requires close monitoring through measurement of various patient parameters such as respiratory rate, hearth beat rate and rhythm, calorie content, blood pressure and many other parameters. Physiological data in the ICU are therefore collected by the electronic monitors that are computerized and hence, information on the patient parameters is timely and accurate (JAFFRAY, 2015). The management team monitoring critically ill persons use information from the monitoring machines to make decisions on matters such as when to do therapeutic interventions. Life support devices are controlled by the patient monitor by showing data on the connected life supporters on top of making alerts to the caregivers on any potential life threatening events (VLAD & CIUPA, 2014). Computers are very essential in giving the caregivers such as doctors and nurse the collection, storage, display and interpretation of clinical data as well as in the process of making therapeutic recommendations (ESQUINAS, 2011). They are also important in that they are used as alarms in the intensive care unit where small errors may lead to lose of life. The monitoring system with the help of a computer not only gives clinical data such as blood pressure but they also give information from bedside instruments. They do also integrate data from other many sources outside the ICU (JOBB, 2012). What they do There are two types of physiologic monitors such as the configured, modular or both. The configured once have build in operations unlike the modular systems which only feature individual modules for specific monitoring parameter. The modular can be used to monitor specific bedsides although they can also be interchanged from monitor to monitor. The new models have abilities of both configured and modular thus can act once (DYRO, 2004). The monitoring systems can act as a central station that can display range of factors including the waveforms. They give alerts within the configured bedsides hence simple to monitor more than one bedside by one caregiver. Application Blood and glucose monitoring Diabetes type one and type two are deadly diseases which if not monitored closely can cause death. Millions of people have diabetes in the world. Diabetes is a disease that is caused by glucose imbalance in the blood (VLAD & CIUPA, 2014). The vivo blood physiological machine can transmit data to a computer that can assist on when and how to inject glucose to the blood as well as the kind of nutrition to be used. Stress monitoring Electrical engineers have also developed bio sensors that can read and interpret giving warning when the stress level rose up before a patient notices it. The bio sensors can provide both alerts and suggestions on what to do to return to normal. Nutrition and constant blood test The blood tests are carried out by the monitoring machine and can give alerts as well as nutritional suggestions continuously hen a patient is at the intensive care unit. This is managed through a lab chip implant that runs nonstop within the parameters (ESQUINAS, 2011). Psychiatrist There are clinics that specializes in vivo drug delivery. This monitor can assists caregivers in intensive care units to detect and prevent early mental disorders. A patient can develop other complications in intensive care unit due to nutrients imbalance and other factors and hence, these sensors are very essential (DYRO, 2004). Epilepsy monitoring Epilepsy can be controlled by some activities such as mood management, good sleep and nutrition. This can only be managed when the patient is aware of the condition. This can be attained by long-term video monitoring that can predict epileptic seizure (VLAD & CIUPA, 2014). Toxic monitoring Engineers have also designed some biosensors capable of detecting toxic components like mercury and lead. Such elements are very dangerous in that can cause death and hence, the monitors can provide alerts. Figure 5: Shows a nurse at ICU Bedside. Within the figure, there are IV pump, patient ventilators and computer terminals (Source: Courtesy of Philips medical system.) Life saving therapy are correctly applied depending with the information given out by the monitoring machine hence, the monitoring machines are the most important engineering equipments used in ICU departments. Computers are commonly used in most intensive care units in hospitals to report, store and organize data. Unlike the previous years, large data can be stored and coded by the computers as well as giving alerts on time to monitor critically ill patients. The planning of the critically ill persons also largely depend with the monitoring machines thus it acts as a decision making tool in the ICU department (JAFFRAY, 2015). The severity of the critically ill patients is also determined by the monitoring machines hence classification purpose of the patient depends with the interpretations of the monitoring machines. Both radiology and laboratory departments depend with the information from the monitoring systems in that the data are integrated and correlated to make decisions on the next course of action (ESQUINAS, 2011). The cost effectiveness and clinical effectiveness of the ICU outcomes are also analyzed by the physiological monitoring machine. How they affect the Body The monitoring machines have got no reported cases of effects on human body. However, poor electrode preparation and attachment are among reported cases of monitoring machine failures (VLAD & CIUPA, 2014). Breaks and cracks on wires should be inspected regularly to avoid misinterpretation of the information in that the people dealt with are those that are critically ill (DYRO, 2004). The loss of patient alarms might lead to mismanagement and hence loss of lives as well as parameter errors. Some critical events can be missed in case the machines fail to give alarm. Conclusion In conclusion, there are several engineering equipments used in the ICU departments in the hospitals. There is clear indication that the ICU activities cannot be easy without engineering equipments. Research indicates that there is a bright future in hospitals due to computerized technologies that are taking shape in various departments. The pacemakers have enabled people with heart problems to survive even with the slow heartbeat rates. Today million of people around the world live with the pacemakers. Some of the people live with them permanently while others use pacemakers for a while till their heartbeats return to the normal base. Physiological monitoring system has saved millions of lives by monitoring the patient’s state so that the caregivers can be alerted on patient’s conditions. Without the monitoring system, the work of the clinicians would be very complicated and some lives could be lost when technical changes in ICU takes place without the knowledge of the nurses or doctors. The ambulatory telemetry transmitters have also assisted doctors to receive information of the critically ill people in ICU thus enabling them to give the required attention in time. The data recorded by the physiological machines have reduced the number of caregivers needed to work in the ICU at a time. The level of accuracy of these machines is also higher compared to the old systems where the nurses used to record the information manually. This is to say the engineering equipments used in intensive care units have made work easier. Tube feeding has also save millions of lives in ICU. Most of the patients admitted in the ICU cannot be able to eat food. Without the required calorie, the patients cannot easily heal because of malnutrition. It is through the use of this engineering equipment that people have been able to be feed till they recover and eat through the mouth. The use of engineering equipments in intensive care unit has more advantages compared with the disadvantages. The effects they have on human body are very minimal like in the case of use of tube feeding; the only disadvantage is the infections associated with the fitting. Without the use of engineering equipments, some surgeries and technical medication such as pacemaker fitting cannot be possible. Some areas though have to be improved to minimize the challenges that come with the use of engineering equipments in the intensive care unit department. Accurate machines should be developed in future to minimize the errors with the help of the computers. There is also need of risk management for a proper life cycle of the medical information technology network. This is to say, without engineering, the work at intensive care unit can be very difficult or even impossible during this digital error. References ESQUINAS, A. M. (2011). Humidification in intensive care medicine: physiological basis, equipment, and applications. Berlin, Springer. DYRO, J. F. (2004). Clinical engineering handbook. Amsterdam: Elsevier Academic Press. JAFFRAY, D. A. (2015). World Congress on Medical Physics and Biomedical Engineering, June 7-12, 2015, Toronto, Canada. http://public.eblib.com/choice/publicfullrecord.aspx?p=3563243. JOBB,G .Y . (2012). 5th European Conference of the International Federation for Medical and Biological Engineering: 1418 September 2011, Budapest, Hungary. Berlin, Heidelberg, Springer-Verlag Berlin Heidelberg. http://dx.doi.org/10.1007/978-3-642-23508-5. VLAD, S., & CIUPA, R. V. (2014). International Conference on Advancements of Medicine and Health Care through Technology: 5th-7th June 2014, Cluj-Napoca, Romania : MEDITECH 2014. http://public.eblib.com/choice/publicfullrecord.aspx?p=1731171. Read More