FiFteeNtH dAy Of aTTaChmEnT

What i really did for the whole morning? I spend close to 3 hours in checking the military anesthesia ventilator is working properly by using a pressure/volume/frequency analyser to see whether the value of the various variable such as volume delivered and frequency obtained is close to the desirable value that you set. When i saw the reading for the volume delivered is way off the desirable setpoint, i heard a "hissing" sound which indicates there is a leak somewhere in the machine. Curious of me went to ask Mr Sin what the problem that caused the leaking. He told me that the dump water valve, which connects the reservoir (a storage of compressed air during expiration) to the opening to release some oxygen, is not working. He roughly told me how it works by looking at the schematic just to give me a brief idea. For my better understanding, i read the user's manual to know about the device like what the compressor does and how the device able to produce the 21% of oxygen. We are only allowed to check the medical devices that are for military use.

Did a weekly routine which is delivered all the devices to their locations. I delivered the infusion pumps, transmitten suction unit and the monitor to ward 3, ward 7, ward 12 and ward 11. One of the infusion pump was from SICU but they lent to the ward 11 so had to go to these two locations to check with them.

There are two devices that was known as faulty by the nurses in ward 1 and 12. they are the sphygonomometer and ECG. For the sphygonomometer, we analysed the device in the ward but it was unable to turn on. Faz brought back the equipment back and asked me to find the causes so i checked the fuses and the power cord. Everything seems fine so i plug the same power cord into it and it was turned on. It started to function properly. For the ECG, the cause of unable to indicate the charging is the power cord as the LED lights up when we plug another device's power cord.

Last but not least, i took the gastroscope to the department for the repair as the tip of the scope is damaged.

Fourteenth DaY of AttaChMent

I was introduced to this ventilator, military anesthesia ventilator. The colour of device is a huge hint that it is for military use. The difference between oxylog 2000 and this ventilator is it only has two turning knobs which are for volume delivered and frequency whereas oxylog 2000 has knobs for the maximum pressure, tidal volume and frequency. Military anesthesia ventilator has a pressure relief valve to prevent the pressure from further building up after the maximum pressure, as it will cause bursting of the lungs if it reaches higher than the maximum pressure. Oxylog 2000 does not have this valve instead it allows the operator to select the maximum desirable pressure.

Faz brought back an endoscope which its insertion tip-elevator become faulty so I had to called the vendor, Olympus, to take back the device for repair and lend us a loaner as they only have this endoscope. However, the bad news was the vendor did not have this model to loan to us so in order for the staffs from the endoscopy department to use as soon as possible, we have to ask the user to get it repair once it arrived to the company.

A staff brought down to the department a monitor, propac, as they suspect that the device is faulty. After a while, I found out that the same problem arise again. The SpO2 sensor is faulty, as the infrared light did not light up when it was placed into the monitor. I used patient stimulator to see whether the ECG probes are faulty too but it turned out all right. The staffs usually bring down the whole machine down when they did not know where the problem is.

There was a commissioning of a laser device, Holmium Yag Laser (Dornier Medilas H20). It has the same function as lithotripter as it is to destroy kidney stones. However, the device is using laser while lithotripter is using shock wave and ultrasound to find the exact location of the stones. However, the commissioning failed again as the expected current supposed to be 16 A but the devices only generates 13 A which tends to draw to much current that end up shorting the electricity supply of the whole ward which causing a black out. This device is meant for the operation theatre so can you imagine what will happen if this device is used and halfway through the whole ward black out. It will be disastrous in a way. The laser device has a fiber that channels the laser to the desirable organ by puncturing two small holes at the region slightly below the hips and inserting the fiber through it. It is invasive. I asked the vendor which is better and he told me that the lithotripter is better than the laser as it uses ultrasound to locate the positioning of the stones. If there is more cases of kidney stones in hospitals such as Tan Tock Seng Hospital, the hospital will purchase the lithotripter because it has a higher demand. If not, they will use the laser device instead.

I went to diabetes centre which is the clinic A to continue with my research on diabetes type 2 patients with neuropathy. In the morning, the place seems packed with people regardless of their ages and the room that i was susppose to use for my research is being used by the nurses so i had to go back in the afternoon. I had result from a patient with neuropathy. i feel that it is quite difficult to find people who are diabetes type 2 with neuropathy.

thirteenth Day of AttAchMent

Started to learn how to call up the vendors to order the parts for devices. Initially, i had lots of butterflies in my stomach and nervous over a call to order parts. It is called quotation. I need to do quotation for a device's cable as the insulator seems to be broken and conductors were exposed. This caused the skillreporter for the manikin to be turned on for a while. Skill reporter is like a controller that indicates whether the participant is doing the correct way for CPR. I was introduced to this book, RS book, that shows the price list of various devices parts and test equipment and you are able to buy them by calling their number. The reason i was introduced is i am able to get the cable cheaper from the Laderal Medical which is the vendor for this device. However, after looking at the prices of the parts from RS, the price of individual parts are more expensive than the vendors so Mr Sin suggested that going to Sim Lim to buy the individual parts. I was wondering how come the cable seems to be in such a bad condition and Mr Sin told me that may be trolley went over the cable or pulling the cable instead of the connector to remove the skillreporter from the manikin. There may be one of the conductor broke in the cable to cause it malfunctioning.

Had vision Alignment which is a talk from a department every last wednesday of the month after my lunch. It is pretty interesting as it shows that jobs in hospitals available more than the people who applied job there so there is a higher demand of workforce in hospitals compared to the 1990s. It was a 40 minutes talk.

Went to MICU for checking the oxylog 2000 as the senior staff nurse felt that the devices need to be calibrated as the reading for the test check is more than the standard value which is 6+/-1 L/min. After 15 minutes, we found out that the value for the minute volume test in the checklist is like 5+/-1 which is different from the vendor's checklist for preventive maintenance so we called up to check. Mr Sin told Lee Chong that vendor's checklist is correct so we should trust it.

Went to Endoscopy department to return two endoscopes and loan an endoscope to them. i went with Lee Chong for commissioning a device in trial which is a dialysis machine which able to let the user know when it is the next preventive maintenance due and occlusion. A warmer is needed as to keep the blood warm to prevent the patient from having shock.

twelveth day of AttAchMent

I done a few preventive maintenance for the devices which are the transmitten suction unit and infusion pump ( i did the leakage current test while faz did the flow and occlusion test). I continued my preventive maintenance of the ventilator, oxylog 2000 by doing the transferring of data from the safety analyser and keying the results that i got from following the service manual. Now, i start to believe that service manuals are very important and helps in repair and maintaining the devices.

I got to try a portable ventilator, autovent 3000 from Allied Medical and see how it really works. It uses a different type of oxygen regulator and has a oxygen mask. The device can be used fo children and adult. It is mainly used for field event like Tsunami and events such as marathon and biathlon. As the marathon runners would often end up fainting and go unconsciousness after running too much that their body is unable to take it.

I went to see how endoscope really looks like as the workplace had two which returned by the vendor, olympus after preventive maintenance. It has a control that allow the user to go to the desirable region like stomach. When i was in the endoscopy department, i saw traces of blood in the tubing of the endoscope which it is pretty scary as i did not expect that it will hurt the organ's surface as it is going down to the desirable region.

I was given a task from Mr Sin that i have to troubleshoot a manikin which allows people to practise CPR and check whether the person is applying the right amount of compression and oxygen blow into the mouth by using LEDs indicator. It is like my first major task as i need to do soldering for the cable. i hope that i am able to do it well.

eleventh DaY of aTtachMent

While i was reading the service manuals of rehab device which helps to regulate blood circulation for resting or patients who are unable to walk, Mr Sin came and told me that i will be having a 2-day training course on 19th and 20th April with my colleague, Lee Chong at Tyco Healthcare. The training will be about the maintenance and repairing of the latest model of ventilator. He told me more about ventilators in order for me to have better understanding and idea of how ventilator works and different type of it before undergoing the training. Before trying out the transport ventilator, oxylog 2000 from Drager Medical, i had to deliver a injection device to the day surgery which was done with the maintenance and collected a infusion pump ST 503 from ward 4.

I initially thought that i just have to to the leakage current test but after a while, i realised that i also have to do the flow and occlusion test. Careless of me to forget about the 2 main important tests for the maintenance for the infusion pump. when i am about to test the device, the tubing clamp is unable to close so i went to separate the mechanical parts and adjust the metal rodto be in line with the screw. After a few minutes, another problem arised, clip that prevent the rod from slipping and the rod were bented so went to change them. i found out that the solution is able to leak into the device which caused some problem to the it. while i was trying the first test which is the occlusion test, i found out that the pump's occlusion sensor is not working so i told Lee Chong as i only allowed to do minor repair with my colleagues' supervision.

After spending about 2 hours doing it, i started trying out the ventilator and see how it actually works. i took me quite some time to figure out how to connect the tube, flow sensor and etc. An oxygen tank is required no matter whether you are doing a preventive maintenance or connect to the patient. for the test, we are using a patient "lung" which a elastic rubber which able to hold up to a capacity of 2 litre. I was afraid if i turn the knob to the maximum capacity of the device, will the rubber ballon burst? so Mr Sin reassured that it will not as the maximum capacity is 1.5 litre. i just found out that the breath rate increases, the duration for inspiration and expiration become shorter. it is quite similar to what i have learnt in school as the frequency of a signal increases, the period will be shorter. The flow sensor has 2 chambers which each has a opening for the tube to connect to the device and a flap in between the chambers. Before the machine is placed to the patient, the device will do a self test which is checking for any offset flow. The offset flow value is being determined by the direction and the angle of the flap. The flow of the air is also being determined by the pressure difference between the 2 chambers. The final flow value is being calculated by substrating the flow value that is being detected by the offset value if there is any offset. everything is being done automatically by the device. I tried out how to do a preventive maintenance of the ventilator with the guidelines from the service manual.

Before ending my work, i sent back a device back to ward 4.