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Qadri Master Guid1e,

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BIOMEDICS
(SPECIALLY FOR NURSING STUDENTS)

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Ruhaan Publication Urdu Bazar Karachi

r QADRI ACADEMY OF NURSING MA~IR KARACH~
subject: Blomedics By: Sir: Sarwar Qadr1

DEFlNITION
nd cardiac
Intensive care unit (ICU) equ ipment includes patient monitoring, respiratory a
• ment emergency resuscitation devices, and other life support equipment
suppo rt , pain manage ,
· d f t· t h are seriously inJ·ured , have a critical or life-threatening illness,
des1gne to care or pa 1en s w o
4
or have undergone a major surgical procedure, thereby requiring 2 -hour care and monitoring.

Life support and emergency resuscitative equipment

Intensive care equipment for life support and emergency resuscitation includes the following:
• ventilator (also called a respirator)-assi sts with or controls pulmonary ventilation in

p; tients ~ o cannot breathe on their own. Ventilators consist of a flexible breathing

circuit, gas supply, heating/humidification mechanism, monitors, and alarms. They are

microprocessor-controlled and programmable, and regulate the volume, pressure, and

flow of patient respiration. Ventilator monitors and alarms may interface with a cen tral

monitoring system or information system.

• ..!.!Jfu_sio_o_ _pump-device that delivers fluids intravenously or epidurally through a

catheter. Infusion pumps employ automatic, programmable pumping mechanisms to

deliver continuous anesthesia, drugs, and blood infusions to the patient. The pump is
hung on an intravenous pole placed next to the patient's bed .

• Crash cart-also called a resuscitation or code cart. This is a portable cart containing

emergency resuscitation equipment for patients who are "coding." That is, their vital

signs are in a dangerous range. The emergency equipment includes a defibrillator,

airway intubation devices, a resuscitation bag/mask, and medication box. Crash carts are

strategically located in the ICU for immediate availability for when a patient experiences
cardiorespiratory failure.

• lntraaortic balloon pump-a device that helps reduce the heart's workload and helps

blood flow to the coronary arteries for patients with unstable angina, myoca~dia l

infarction (heart attack), or patients awaiting organ transplants. lntraaortic balloon

pumps use a balloon placed in the patient's aorta . Th e b a11oon 1s • h. d of a
on t e en
catheter that is connected to the pump's console , wh·1c h d'1sp 1ays heart rate, press ure,

and electrocardiogram (ECG) readings . The patient's ECG is used to time t he inflation
and deflation of the balloon.

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 QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Blomedlcs By: Sir: Sarwar Qadri

Diagnostic equipment
Th e use of diagnostic equipment is also required in the ICU. JiQ obile x-r~ uoits are used for

bedside radiography, particularly of the chest. Mobile x-ray units use a battery-operated

-
generator that powers an x-ray tube. Handheld, portable clinical laborato ry deyices, or point-of-
.-
care.

Patient monitoring equipment

Patient monitoring equipment includes the following :

• Acute care physiologic monitoring system-comprehensive patient monitoring systems

that can be configured to continuously measure and display a number of parameters via

electrodes and sensors that are connected to the patient. These may include the
electrical act ivity of the heart via an EKG, respiration rate (breathing), blood pressure,

body temperature, cardiac output, and amount of oxygen and carbon dioxide in the
blood. Each patient bed in an ICU has a physiologic monitor that measure these body

activit ies. All monitors are networked to a central nurses' station.

• e oximeter-mon itors the arterial hemoglobin oxygen saturation (oxygen level) of

Puls_
the patient's blood with a sensor clipped over the finger or toe.

• lntracranial pressure monitor-measures the pressure of fluid in the brain in patients

with head trauma or other conditions affecting the brain (such as tumors, edema, or
hemorrhage) . These devices warn of elevated pressure and record or display pressure
trends. lntracranial pressure monitoring may be a capability included in a physiologic

monitor.

Ae_nea monitor-continuously mon itors breathing via electrodes or sensors placed on the
patient. An apnea monitor detects cessation of breathing in infants and adults at risk of
respiratory failure, d isplays respiration parameters, and triggers an alarm if a certain amount of
t ime passes without a patient's breath being detected . Apnea monitoring may be a capability
inciuded in a physiologic monitor.

Jt RS-21, Commercial Lane, Green Park City, Near Qua idabad, Ma in Nat iona l Highway, Ka rach i, Sindh, Pa kist an . PAGE s
I. 03 31 · 2 350149 \ . 021 -35002032 @ www.qadriacademy.co m O Qadri Academy of Nursing Malir Karachi
r QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Biomedlcs By: Sir: Sarwar Qadri

Monitors

Patients in intensive care are constantly monitored to track th eir co nd ition and alert staff to
changes. This monitoring routinely includes measurement of: . .
■ Heart rate and heart electrical • Pressure in the veins (CVP)
't racing (ECG) • ~ rine output
• Temperature
• Oxygen levels in the blood
■ All the flui ds, food and drugs.
• • Blood pressure

Lines
These are plastic catheters or tubes sometimes referred to as 'drips' or 'lines' and are inserted
by the doctors and nurses into the patient's blood vessels . These lines help to give fluids and
medications, are used in monitoring blood pressure, and for taking blood samples for regular
investigations. Common lines inserted in ICU are:

Arterial line
A very thin tube is inserted into one of the patient's arteries (usually in the arm) to allow direct
measurement of the blood pressure and to measure the concentration of oxygen and carbo n
dioxide in the blood.

Central line
A thin tube is inserted into a big vein usually in the neck, shoulder or groin to measure the
pressure, take blood samples and to give concentrated medications and fluids.Dialysis line or
Vascath These line are similar to central lines and are inserted into a big vein. However there
are bigger in diameter enabling to attach to a kidney machine in order to perform the job of the
kidneys.

PICC lines f e,t'f/2 a/j' / W

I

'?5 v,/e_ ,I, C~J

.,..--

{fa/~ -
These Imes are inserted 1n one of the veins in the upper arm and are long enough to reach the
big veins close to the heart. They have the advantage of having less chance of infection, thereby
could be used for long duration of time.

How are lines inserted?

All lines inserted are done by doctors or nurses ex · d . . I
. . . . . penence m doing the procedure. Loca
anaesthetic will be Injected into the site to numb th b
. e area efore performing the procedure to
ensure patient comfort. Sometimes a strong painkille · h b . . . II
lines are inserted in the safest manner. r m1g t e given through a venous hne. A

Complications do occur although these are rare Th

• f ct· · e common one are bleeding bruising and
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Qadri Academy of Nursing Malir Karachi
 QADRI ACADEMY OF NURSING MALIR KARACHI
SUbject: llomedlcs By: Sir: Sarwar Qadrl

Breathing tubes
. This is
Some of the patients in the intensive care will need support with their breathing
two types of
achieved by passing a plastic breathing tube into the windpipe . There are
breathing tubes:
mouth or rarely
Endotracheal (ET) tube This is a plastic tube placed through the patient's
to keep them
through the nose into the windpipe (trachea). Most patients will need sedation
comfortable while this breathing tube is in place.

PEG tube
the skin on the
A PEG (Percutaneous Endoscopic Gastrostomy) tube is inserted through
if the patient need long standing
abdomen leading into the stomach. These tubes are inserted
The procedure is
feeding, or they are a high risk of aspirated food contents into the lung.
you with further
technically challenging and the surgeon performi ng the procedure will update
informati on .

Urinary catheter
urine. This is
A urinary catheter is a flexible tube that is inserted into the bladder to drain
toilet normally . In
essential to drain the bladder of urine while the patient is unable to use the
addition to t his,
it is essential to check the amount of urine produced by the patient to ensure that the kidneys
/ '
are functioni ng alright. c!.-. z!_;) v
The tube is inserted by a doctor or a nurs~ the ur~thra until it reaches the bladder and a
a risk of urinary
balloon is inflated to keep the tube within the bladder. Urinary catheter carry
tract
to prevent such
infection (UTI) in the urethra, bladder or the kidneys. Care will be taken
infections, however this might need treating with antibiotics.

7
Karach i, Sindh, Pa ki 5t an . PAGE
~ RS-ll, Comme rcial Lane, Green Park City, Nea r Quaidabad, Ma in National Highway,
~ 0331-2350149 \,. 021. 3500203 2 @ www.qad riacade my.com O Qadri Acade my of Nursing Mali r Karachi
 ~
RI ACADEMY OF NURSING MALIR KARACHI
QAD Subject: Biomedics ·s
By: Sir: arwar Qd"
a r1

PROCEDURES
MECHANICAL VENTILATION

What is mechanical ventilation?

Mechanical ventilation is a form of artificial respiration th at uses a brea th ing machine
(ventilator) to assist patients with their breathing.

What are the benefits?

Mechanical ventilation is used when the lungs are not functioning properly. This breathing
support may be used to help get enough oxygen to the body and to remove carbon dioxide.
Sometimes ICU patients need support from a ventilator because they are not awake enough or
strong enough to breath safely on their own._

What are the risks?

Patients who require a breathing machine are at increased risk to develop infections of the
lungs, called pneumonia. Occasionally, patients may develop a collapsed lung from the pressure
used to push the air into the lungs. Both of these complications require treatment.

INTUBATION
What is an intubation?
The most common use of this term in the ICU refers to placing a breathing tube into a patient's
windpipe (endotracheal intubation).

What are the benefits?

Endotracheal intubation is necessary if the patient requires mechanical ventilation. Patients in a
coma may require intubation to protect their lungs from aspiration (secretions going into the
lungs}. Other patients may require help getting enough oxygen into their bloodstream.

What are the risks?

In critically ill patients, placing the tube can be difficult, and may result in dangerous alterations
in breathing or blood pressure. The mouth, teeth, and upper airway can be damaged while the
tube is being placed, as can the vocal cords. This occurs very rarely.

CENTRAL VENOUS CATHETERIZATION

What is a central venous catheter?
A central venous catheter is a special IV line that is inserted · t - • h b d They
in o a 1arge vein in t e o y.
can be inserted into the shoulder, neck, or groin.

What are the benefits?

These special IVs are used when the patient needs a rel · bl IV h
. . . la e t at can last many days, or
needs special med1cat1ons that cannot be given through th .
e smaller arm veins.

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In ' .
1
-
QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Blomedlcs By: Sir: Sarwar Qadri

What are the risks?

Bleeding and infection are the main complications associated with central catheters, although
they are rare. A collapsed lung is a very rare complication, if this occurs a tube may be required
to re-expand the lung.

WHAT IS CARDIOPULMONARY RESUSCITATION (CPR)?

CPR is the combination of life saving measures performed to restart lung and heart function in a
patient who has stopped breathing and/or whose heart has stopped beating. This is called a
cardiac arrest. Measures may include pushing down on the chest (chest compressions),
attempting to restore the heart rhythm to normal (with an electric shock), administration of
medications and artificial respiration using a face mask or breathing tube.

What are the benefits?

In the event of cardiac arrest, the patient is likely to die. If the problem that caused the cardiac
arrest can be identified and fixed, successful CPR is the only chance for survival. Unfortunately
CPR is not often successful.

What are the risks?

Most patients who suffer cardiac arrest will die even if they receive CPR. Some patients may
survive but will suffer serious injury to the brain and other organs from lack of blood flow. A
minority of patients will survive without injury.

ARTERIAL LINES
What is an arterial line?
An arterial line is a catheter that is inserted into a artery, as opposed to a vein (as is the case for

IVs). They may be inserted into the wrist or groin.

What are the benefits?

The arterial line provides a way to constantly measure a patient's blood pressure and may be
essential to treat the patient safely. Arterial lines may be useful in patients with very high or low
blood pressures. The arterial line also provides access for fr~quent blood sampling, as blood can
be withdrawn from the patient through the catheter .
What are the risks?
The major complications associated with the arterial line are bleeding and infection. On very
rare occasions the catheter may injury the artery it is inserted into.

Chest tubes
What is a chest tube?
nd
A che st tube is a hollow tube placed between the ribs into the small space between lung a
th e cheS t wall (called the pleural space) . The chest tube provides a way to drain air, blood, or

infection f rom t h e pleural space .

RS-21 Co . . h Karachi Sindh, Pakistan . PAGE 2

• mmercia l Lane, Green Park City, Near Quaidabad, Ma in National Hig way, '
0331-23 50149 t
@ www .qadriacademy.com
O Qadri Academy of Nursing Malir Karachi
-.,. 02 1-35002032
 ~ QADRI ACADEMY OF NURSING MALIR KARACHI
~ subject, Biomedlcs By, ''" , • ..,., Qad,I

What are the benefits?

th
A chest tube is used when the patient has air or fluid in the pleural space at needs to be
nd th e lung, or to re-
removed. Often this is necessary to drain blood or infection from arou
expand a collapsed lung.

What are the risks?

The potential complications associated with the use of a chest tube include bl~eding, infection
and poor positioning of the tube itself. After placing a chest tube the doctor will check a chest x-
ray to assure that the tube is in the correct position.

TRACHEOSTOMY
What is a tracheostomy tube?
A tracheostomy tube is a small tube placed directly into a patient's windpipe through the neck.
It replaces the breathing tube that is inserted through the mouth. The surgical procedure of
inserting a tracheostomy tube is called a tracheotomy.

What are the benefits?

A tracheostomy tube may be needed for ICU patients requiring long-term mechanical
ventilation. The decision to perform a tracheostomy on a particular patient depends upon the
circumstances surrounding that patient and most often follows use of breathing tube inserted
through the mouth .

What are the risks?

The potential complications associated with the insertion of a tracheostomy tube are bleeding
and infection, although both are rare.

FEEDING TUBES
What is a feeding tube?
Due to illness or injury, some ICU patients cannot eat in the usual fashion. Therefore, nutrition
is often given to patients through feeding tubes or intravenously. Where possible, the preferred
way to provide nutrition to ICU patients is through the feeding tube, which can be inserted into
the nose, mouth, or directly into the stomach though the skin .

What are the benefits?

Adequate nutrition is essential to the healing process . In patients who cannot eat normally, a
feeding tube is the best way to receive nutrition.

What are the risks?

In general, the risks are very low. The feeding tube may become displaced, or the process of
feeding may result in electrolyte imbalances. Insertion of the feeding tube can cause bleeding or
infection, although this is rare. The doctor, dietician, pharmacist, and nursing staff will closely
monitor patients receiving feedings.

~ RS-21, Commercial Lane, Green Park City, Near Quaidabad, Main National Highway, Karachi, Sindh, Pakistan . PAGE 10
~ 0331-2350149 \ . 02 1-35002032 @www.qadriacademy.com O Qad ri Academy of Nursing M.ilir Karachi
 QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Blomedlcs By: Sir: Sarwar Qadri

ECHOCARDIOGRAPHY
leaky valves, looks for any clots
This is a scan of the heart to look how it is functio ning) identify
·in the hea rt, and to guide treatm ent plans for the patient .
und device. A probe is placed on
E chocardiography uses the same princip le as any other ultraso
the echocardiograms done in the
the patient 's chest to obtain images of the heart. Most of
Sometimes, more detailed images
intensive care unit are painless with no risk to the patient .
on the patient 's chest. In such
need to be acquired which can't be done by a probe placed
s oesophagus (food pipe). This
circumstances, the probe has to be introdu ced into the patient
will be done under sedation or
procedure is called as Transoesophageal Echocardiogram and
under general anaesthesia.

injury or tear in the oesophagus

The procedure is usually safe. Occasionally there is a risk of an
and an operati on might be needed.

Brain Stem Evoked Response Equipment

stem with painless sound waves
Auditor y brain stem responses evoked by stimula ting the brain
and a machin e is used to test
4ising headph ones. These sou~d waves are received by the brain,
whethe r the brain stem has received the signals.
t is though t to be an import ant
The quality of the brain stem's functio ning in a comatose patien
highly specialized equipm ent is not
indicat or of the degree and location of brain injury. This
available in all hospitals. Click Here To Return To List

Catheter
from, or introdu cing fluids into, a
A flexible plastic tube of varying sizes for withdra wing fluids
r. Click Here To Return To List
cavity of the body. Frequently used to drain the urinary bladde

Central Venous (CVP) Line

the venous blood pressure (the
A very thin tube which is inserted into a vein to measure
inserte d into veins in either the
pressure of the blood as it returns to the heart). CVP lines are
side of the neck. The CVP line is
arm or the chest just below the shoulder, or occasionally on the
connected to a monito r. Click Here To Return To List

Electrocardiogram (ECG/EKG)
on the patient 's chest to monito r
The recording made by small, round electro de pads located
uses routine ly in the intensive
heart rate and rhythm . These are connected to a monito r and
care unit. Click Here To Return To List

Endotracheal Tube (E.T. Tube)

patient 's nose or mouth. ft passes
A tube that serves as an artificia l airway inserted throug h the
ng. To do this, it must also pass
down the throat and into the air passages to help breathi
as long as the endotracheal t~be
~h~ough the vocal chords. The patient will be unable to speak
. Click Here To Return To Li st
•sin place. It is this tube that connects the respira tor to the patient

~ RS-21, Commerc ial Lane, Green Park City, Near Quaidaba d, Main
National Highway, Karachi, Sindh, Pakistan . PAGE 11

~ 033 1-23~0149 I 02 1- 35002032 @ .

www.qadn academy.c om
0 Qadri Academy of Nursing Malir Karachi
-._
 QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Biomeclics By: Sir: Sarwar Qadri

Eye Tape
Tape used to close the patient's eyes. It is important that the eyes be kept moist. We do this
naturally when we bl ink our eyes . This reflex is lost in the patient who is unresponsive but has
open eyes . To protect the eyes and to prevent them from drying out, eye drops may be put into
the eyes and eye tapes may be used to close them .

Foley Catheter
This is a tube (catheter) inserted into the urinary bladder for drainage of urine. This helps to
monitor the patient's fluid status and kidney function. The urine drains through the tube into a
plastic bag hanging low by the foot of the bed. Click Here To Return To List

GI Tube
A tube inserted through a surgical opening into the stomach. It is used to introduce liquids,
food , or medication into the stomach when the patient is unable to take these substances by
mouth . Click Here To Return To List

lntracranial Pressure (ICP) Monitor

A mon itoring device to determine the pressure within the brain . It consists of a small tube
(catheter) attached to the patient's skull by either a ventriculostomy, subarachnoid bolt or
screw and is then connected to a transducer, which registers the pressure.

Jejunostomy Tube (J Tube)

A type of feeding tube surgically inserted into the small intestine.

Leg Bag
A sma ll, thick _plastic b~g that ca~ be tied to the leg and collects urine. It is connected by tubin
to a catheter inserted into the urinary bladder. Click Here To Return To List g

Nasogastric Tube (NG Tube)

A tube that passes through the patient's nose and throat and ends in th • , .
tube allows for direct "tube feeding" to mainta·1n then t ·t · I e patients stomach. This
of stomach acids. Click Here To Return To List
u n 1ona status of the r t
pa ien or removal

Posey Vest/ Houdini Jacket

A vest worn to keep the patient stationary. This is for the patient's safety

Respirator/Ventilator
A machine that does the breathing work for th . patient It serv t d 1·
e unresponsive
the appropriate percentage of oxygen and at th . ·
.
the respirator. e appropriate rate The · · esI oh e 1ver
...
air in
· air 1s a so um1d1f1ed by

Shunt
A procedure to draw off excessive fluid in the b · A .
• · . • . ram. surg1ca lly-placed t b ·
ventricles which deposits fluids into eitner the abdo . . u e running from the
1
mma cavity, heart or large veins of the neck

RS-21, Commercial Lane, Green Park City, Near Quaidabad Main N t' .
' a ional Highway, Karachi, Sindh, Pakistan. PAGE 12
0331-2350149 \ . 02 1-35002032 @www.qadriacademy.com O Qadn.Academy of Nursing Malir Karachi
~-
 QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Blomedlcs Bv: Sir: Sarwar Qadri
I

"Space Boots" (Spenco Boots)

ankles of the
Padded su~port de~ices made of la~b's wool used to position the feet and
us for long . d
patient. Without this support and alignment, patients who are unconscio peno s
· · ·
1 · · f
may deve Iop def orm1t1es 1m1ting uture moveme nt

Subarachnoid Screw
through a
Also Subarachnoid Bolt. A device for measuring intracranial pressure which is screwed
hole in the skull and rests on the surface of the brain . Click Here To Return To List

Support Hose/TEDS
and thus
Anti-embolic stockings. Tight knee or thigh-high stockings that support the leg muscles
help prevent pooling of blood in veins of legs. Click Here To Return To List

Swan-Ganz Monitor
measure blood
A catheter (tube) similar to the Central Venous Pressure (CVP) Line. It is used to
of the lungs and
pressure and blood gas concentrations in the right side of the heart, in vessels
in the left side of the heart.

Tracheostomy Tube
ing access to
A tube inserted into a tempora ry surgical opening at the front of the throat provid
the trachea and windpipe to assist in breathing .

Traction
patient with
A weighted traction setup composed of pulleys and lines used in the care of the
te casts,
broken leg or spine . After repair of the fractures and application of the appropria
weights are used to keep the bones in alignmen t.

Transducer
rate and blood
A sensitive electronic device which detects bodily functions, such as heart
those functions to a monitor so that the can be
pressure, and transmits signa ls representing
observed.

Oxygen Cylinder with Stand

or after
Oygen cylinder is a instrume nt used to supply oygen to the patient during a surgery
.The oxygen is stored in this
surgery where patient suffers from inadequete oxygen supply
cylinder.

~ t:::::::::::::======~== ==================================== ===================~===i

. H1g. hway, Kar achi' Sindh, Pakistan . PAGE 13
G RS-21 • commerc1.al Lane, Green Park City, Near Quaidabad , Main National
6
~ 0331 -23 50149 \ . 021 -3~2032 @ www.qadriacademy.com O Qadri Academy of Nursing Malir Karachi
 QADRI ACADEMY OF NURSING MALIR KARACHI
Subject: Biomedics By: Sir: Sarwar Qadri

ECG - Monitor with Leads

Electro cardiogram is a diagonistic machine used to observe heart rate.With the Delta
multiparameter monitor, you can continuously monitor adult,pediatric and neonatal patients
both at_the bedside and on transport -- eliminating the need for separate transport monitors.
The main

ECG - Machine with Leads

The electrocardiogram (ECG ) is a diagnostic tool that is routinely used to assess the electrical
and muscular functions of the heart.it gives the full information about the heart beats consi sts
of 12 leads for acquistion and a rhythm lead as an optional.- it is used to analyse the heart rate
& rhythm of the heart.

Suction Apparatus
A Suction machine is an instrument that uses to principles of suction to remove substances,such
as mucus or blood or serum, from a body cavity. Most commanly a suction machine is used to
create a partial vacuum inside a body.

Implantable cardioverter-defibrillator
An implantable cardioverter-defibrillator (ICD) is implanted to continually monitor a patient's
heart for bradycardia,ventricular tachycardia, and ventricular fibrillation. The device also
administers either shocks or paced beats.Some ICDs can provide biventricular pacing or
administer therapy for atrial fibrillation.
ICDs are generally indicated when drug therapy,surgery, or catheter ablation fails to prevent the
patient's dangerous arrhythmia.

An ICD system consists of a programmable pulse generator and one or more leadwires. The
pulse generator is a small battery-powered computer that monitors the heart's electrical signals
and delivers electrical therapy when an abnormal rhythm is identified.
It also stores information on the heart's activity before,during, and after an arrhythmia, along
with tracking which treatment was delivered and the outcome of that treatment.
Many devices also store electrograms (electrical tracings similar to electrocardiograms). With an
interrogation device,a practitioner can retrieve this information to evaluate ICD function and
battery status and to adjust ICD system settings

Jt RS· 21 , Commercial Lane, Green Park City, Near Quaidabad, Main National Highway, Karachi, Sindh, Pakistan . ~
~ •
0 33 1 23 50
149 \ . 02 1•35002032 @www.qadriacademy.com O Qadri Academy of Nursing Malir Karachi
-
QADRI ACADEMY OF NURSING MALIR KARACHI

I
' Subject : Biomedlcs By: Sir: Sarwar Qadri

Monito ring ICP (/ntrac ranial pressure )

lntraventricular cathet er monitoring

r ICP directly, the doctor inserts a small
In int ravent ricular cathet er monito ring, used to monito
ventricles throug h a burr hole. Althou gh
polyet hylene or silicone rubber cathet er into the lateral
the greatest risk of infecti on. This is
th is me thod is most accurate for measuring ICP, it carries
the only type of ICP monito ring that allows evaluation of
l fluid (CSF).
bra in compl iance and signific ant drainage of cerebrospina

Subarachnoid bolt monitoring

l bolt into the subarachnoid space
Subarachnoid bolt monito ring involves insertion of a specia
behind the hairline. Placing the bolt is
throug h a twist-d ril l burr hole in the front of the skull,
ally if a computed tomog raphy scan
easier than placing an intrave ntricul ar catheter, especi
les have collapsed . This type of ICP
reveals that the cerebr um has shifted or the ventric
damage because the bolt doesn 't
mon itoring carries less risk of infecti on and parenchymal
penetr ate the cerebr um .

Epidural or subdural sensor monitoring

space. For epidural monito ring, a fiber-
ICP can also be monito red from the epidural or subdural
a burr hole.
optic sensor is inserted int o the epidural space through
nable accuracy because ICP isn't being measured
Th is system's ma in drawback is its questio
directl y from a CSF-fi lled space. For subdural monitoring, a fiber-o ptic transd ucer-ti pped
cathet er is tunnel ed
the dura mater. The main drawback to
th rough a burr hole and is placed on brain tissue under
th is metho d is its
inab ility to drain CSF.

lntraparenchymal mon itoring

cathet er throug h a small subarachnoid
In intrapa renchy mal monito ring, the doctor inserts a
er a few centimeters into the brain's
bolt and, after punctu ating the dura, advances the cathet
white matte r. There's no need
metho d doesn 't provide direct access
to balance or ca librate the equipm ent after insertion. This
tissue pressure correlates well with
to CSF, but measurements are accurate because brain
be used to obtain ICP measu remen ts in
ventric ular pressures. lntrapa renchy mal monito ring may
patien ts with compressed
or dislocated ventricles.

Biphasic defibrillators
electri city t hat travels in one directi on
Monop hasic defibri llatrors delive r a single curren t of
t of electrical curren t is req ui red for
betwe en the two pads on the patien t's chest. A large amoun
effective monophasic defibri llation .
Biphasic defibri llat ors are now more popula r in hospitals.
llator.
Pad placem ent is the same as with the mono phasic defibri

ad, M ain National Highway, Karachi, Sindh, Pakistan .

~
~ RS- 21, Commercial Lane, Green Park City, Near Quaidab

~ 0331-2350149 \ . 02 1-3500203 2 @ www.qadriacademy. com O Qad ri Academy of Nursing Malir Kar achi
 QADRI ACADEMY OF NURSING MALIR KARACHI
Sub)ect: llomedlcs By: Sir: Sarwar Qadri

Blphaslc defibrillators (Conti nues.... )

The differen ce is that during biphasic defibrillation, th e electrical current discharged from th e
pads travel s in a posi tive direct ion fo r a specified duration and th en reverses and flows in a
negative direction fo r t he rema ining t ime of the electrica l discharge .

Automated external defibrillator

An automated external defibrillator (AED) has a card iac rhythm analysis system . The AED
interprets the patient' s cardiac rhythm and gives the operator step-by-step directions on how to
proceed if defibril lation is indicated . Most AEDs have a "quick-look" feature that allows
visua lization of the rhythm with the paddles before electrodes are connected .

Computer-assisted system
The AED is equipped with a microcomputer that senses and analyzes a patient' s heart rhythm at
the push of a button . It then audibly or visually prompts you to deliver a shock.
All models have the same basic functions but offer different operating options .For example, al l
AEDs commun icate directions by displaying messages on a screen,giving vo ice commands, or
both. Some AEDs simultaneously display a patient's heart rhythm.
All devices record your interactions w ith the patient during defibrillation, eith er on a cassette
tape or in a sol id-state memory module. Some AEDs have an integra l printer fo r im med iate
event documentation .S

Closed chest drainage systems

There are three types of chest tube drainage systems: a water seal-wet suction system, a water
seal-dry suction system, and a dry seal-dry suction system .

Water seal-wet suction system

A water seal-wet suction system is a disposable plastic drainage system that contains three
chambers. The drainage chamber is on the right and has three calibrated columns
that display the amount of drainage collected. When the first column f ills, drainage carries over
into the second and, when that fills, into the third. The water-seal chamber is located in the
center. The suction-control chamber on the left is filled with water to achieve various suction
levels. Rubber diaphragms are provided at the rear of the device to change the water level
or remove samples of drainage. A positive-pressure relief valve at the top of the wate r-se al
chamber vents excess pressure into the atmosphere, prevent ing pressure bu ildup .

~ RS-21, Commercial Lane, Green Pa rk City, Near Qu aidabad, Main National Highway, Ka rachi, Sind h, Pakist an . PAGE 16

~ 0331-2350149 \ . 02 1-35002032 @ www.qadriac.ademy.c.om O Qadri Acade my of Nursi ng Malir Karie.hi

 fl
IR KARACHI
QADRI ACADEMY OF NURSING MAL
Subject: Biomedlcs By: Sir: Sarwar Qadri

ventilator modes
ventilators and have various
itive-pressure ven tilat ors are categorized as volume or pressure
Pos
modes and options.
• Vol ume modes
datory ven tilat ion (CMV),
ven tilat ion (CV) or controlled man
Volume modes include con troll ed
inte rmit tent man dato ry
st-co ntro l (A/C) or assisted mandatory ven tilat ion (AMV), and
assi
(SIMV).
inte rmit tent man dato ry ven tilat ion
ventilation (IMV) or synchronized

CVo rCm V
ent.
or supplies all ven tilat ion for the pati
In the CV or CMV mode, the ven tilat
endexpiratory pressure
(VT), inspiratory time, and positive
The resp irato ry rate, tida l volu me
ate spontaneous breaths,
lly used when a pati ent can't initi
(PEEP) are preset. This mode is usua
lar disease, or chemically
a spinal cord injury or neuromuscu
such as when he's paralyzed from
king agents.
paralyzed with neu rom uscu lar bloc

A/C orA mV
the VT, inspiratory time ,
c respiratory rate is set along with
In the A/C or AMV mode, the basi
rate . The sensitivity is set so
to breathe faster than the preset
and PEEP, but the pati ent is able
ered , so that all breaths
spontaneous breath, a full VT is deliv
that when the pati ent initiates a
set rate. If the pati ent
by the pati ent or delivered at the
are the same VT, whe ther triggered to deliver breaths at the
and his driv e to brea the is negated, the ven tilat or continues
t ires
preset rate .

imV ors imV time, sensitivity, and PEEP.

et respiratory rate, VT, inspiratory
IMV and SIMV modes require pres
the man dato ry breaths, the
at a set rate and VT. In between
Man dato ry breaths are delivered
these spontaneous breaths
at his own rate and VT. The VT of
pati ent can brea the spontaneously
ity to generate negative
determined by the patient's abil
can vary because the brea t hs are
datory breaths with the
the ventilator synchronizes the man
pressure in his chest. Wit h SIMV,
pati ent' s own insp irations .

• Pressure modes pressurecontrolled ven tilat ion

sure support ventilation (PSV),
'• · Pressure modes include pres airway pressure release
rse ratio ventilat ion (PC/IRV), and
(PCV), pressure- con troll ed/i nve
ven tilat ion (APRV) .

, Pakistan . ~
Natio nal Highw ay, Karach i, Sindh
Park Cit y, Near Quaidabad, Main
~ RS-21, Comm erci al Lane, Green
@ www.qadriacadem y.com O Qadri Acade my of Nur sing Malir
Karachi
~ 0331 -2350 149 \ . 02 1-3500203 2
 QADRI ACADEMY OF NURSING MALIR KARACHI
SUb)ect: Blomedlcs By: Sir: Sarwar Qadri

psV
The PSV mode augments inspiration for a spontaneously breathing patient.
The inspiratory pressure level, PEEP , and sensitivity are preset.
When the patient initiates a breath, the breath is delivered at the preset pressure level and is
maintained throughout inspiration . The patient determines the VT, respiratory rate, and
inspiratory t ime.
pCV
In PCV mode, inspiratory pressure, inspiratory time, respiratory rate, and PEEP are preset. VT
varies with the patient' s airway pressure and compliance.

pC/iVR
PC/IVR combines pressure-limited ventilation with an inverse ratio of inspiration to expiration .
In this mode, the inspiratory pressure, respiratory rate, inspiratory time {1:1, 2:1, 3:1, or 4:1),
and PEEP are preset.
PCV and PC/IRV modes may be used in patients with acute respiratory distress syndrome
(ARDS).

ApRV
During APRV, a high continuous positive airway pressure (P high) is delivered for a long duration
(T high) and then falls to a lower pressure (P low) for a shorter duration (T low) . The transition
from P high to P low deflates the lungs and eliminates carbon dioxide. Conversely, the transition
from P low to P high inflates the lungs. Alveolar recruitment is maximized by the high
continuous positive airway pressure. Spontaneous breathing is allowed throughout the
ventilation cycle, which results in a decreased requirement for sedation and neuromuscular
blockade use.
APRV mode may be used in patients with acute lung injury or ARDS.

Shunt
A procedure to draw off excessive fluid in the brain . A surgically-placed tube running from the
ventricles which deposits fluids into either the abdominal cavity, heart or large veins of the
neck . .

--xx--

~ RS-21, Com mercial Lane, Green Park City, Near Qua ldabad, Main National Highway, Karachi, Sindh, Pakistan
. PAGE 18
i- 0331-23 50149 \ . 021-3S00203 2 @www.qadriacademy.com O Qadri Academy of Nursing Malir Karachi
 KARACHI
QAORI ACADEMY OF NURSING MALIR
Subject: Blomedlcs By: Sir: Sarw ar Qadri

Monitors ition and aler t staff to

tant ly mon itore d to track thei r cond
Patients in intensive care are cons
includes mea sure men t of:
changes . This mon itori ng rout inely
1. Heart rate and hea rt electrica
l tracing (ECG)
2. Oxygen levels in the bloo d
3. Blood pressure
4. Pressure in the veins (CVP)
5. Urine outp ut
6. Tem pera ture
7. All the fluids, food and drugs

. PAGE 19
Highw ay, Karachi, Sindh, Pakistan
City, Near Quaidabad, Main National
RS-21, Commercial Lane, Green Park
0331 -23501 49 \ . 021 -3500 203 2
@ www .qadriacademy.com 0 Qadr i Academy of Nursing Malir Kar
achi
 QADRI ACADEMY OF NURSING MALIR KA.RACHI
~ : lklffledks l y: Sir : Sarwar Qad rl

EQUIPMENT USED IN ICU

Endotracheal tube , distal cuff with pilot balloon ( blue ) and subglottic suction port ( yellow )

~--
C
,-#
,. a
_,,. ;
\

~. I. t d
·,

'
b \
\\ ' _,
_
f

Equipment needed for intubation: (a) suction, (b) Macintosh laryngoscope,

...
g
I

(c) endotracheal tubes of varying sizes, (d) bougie in case of difficult intubation,
(e) syringe to inflate cuff, (f) tape to secure tube, (g) alternative method of securing airway if
intubation fails,
e.g. laryngeal mask airway

~ RS -21 . Commercial lane. Green Parle City, Near Qua1dabad , Main Nationa l Highway, Karach i, Sind h, Pakistan . PAGE 20
~ 0331-23~149 \ . 021 -3500203 2 @ www.q~iiilcad~my.com O Qadr, Acildemy of Nur$lng Millir KilrilChi
 ,

11 QAORI ACADEMY OF NURSING MALIR KARACHI

Subject: Blomedlcs By: Sir: Sarwar Qadri

Gel pads in typical position before cardioversion

12 MHzprobe; ( b) 3.5- 5 MHz curvilinear probe

Commonly used ult rasound probes (a) Linear 7-

--The End -

way, Karach i, Sindh, Pa k1~tan P~

H'., / l, C.011,n ,t'ruol Lant>, <,rt't'll Par!, City, Near Qua1da bad, M ain National High

U.B J / J',<JJ 4'.I \ . U/ l J',OiJ/ U3/ @ www ~.dn•1.Jdl'my <0111