Medical Machines/Printable version

Medical Machines

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Autoclaves

Types of Autoclaves

Steris Rennaisance 3011 autoclave.

Boiler, chamber, control system.

Switches

Main switch on wall; do not touch; Standby/Power switch on console; user operated. Cycle selector buttons on console; user operated.

Gauges snd Sensors

Sight glass showing water level and Bourdon gauge showing pressure in the boiler of the Steris 3011.

Boiler, chamber, jacket.

Valves

Hi/Low, steam, flush.

States of the Machine

Off: [main switch on wall]. Standby: power to computer but boiler is cold; [console switch]. Powered: boiler at full temperature and pressure; [console switch]. Running: cycle under control of computer; [started by console button].

Operating Procedure

Mark log. Switch from "Standby" to "Power". In approximately 20 minutes the boiler pressure should increase to ~60 psi. If you have not marked the log, do that while waiting. Flush boiler at 10-15 psi after about 10 minutes warmup. Load. A liquid should always be in a stainless steel tub. Close and seal door. Note double hinge. Choose one of the four cycles. Flash is a rapid cycle for solid material only. The Liquid cycle has long heating and cooling gradients. Check parameters. Check parameters. Check parameters. Adjust if necessary. Check Hi/Low valve. Change if necessary.

1.LIQUID STER=45m TEMP=250 F Valve=LOW

3.WASTE STER=40m TEMP=270 F DRY=20m Valve=HIGH

2.FLASH STER=5m TEMP=270 F DRY=1m Valve=HIGH

4.GRAVITY STER=30m TEMP=250 F DRY=15m Valve=LOW

Start cycle. Wait. A tone will signal completion of the cycle. Respect any instruction on the display when opening the door. Unload. Restore parameters. Record any abnormal observation in log.

Safety Precautions

Opening the flush valve when the boiler is hot can cause a small burn from a water droplet or from a leak at the sight glass. Use a glove. A sealed bottle can explode. Do not heat an enclosed fluid. Use the Liquid cycle when appropriate.

Abnormal Conditions

Operating with no record in log; ask user to update log. Alarm; press reset. If chamber fails to cool, shut off steam supply. Correct the problem and start cycle again. Door mechanism is stuck; press center hub in. Door will not open; look for loose screw on lower edge of the outer cover of the door. Door will not close; look for loose screw on lower edge of the outer cover of the door. Leakage of steam; report to Jen or Peter. Water splashing out of settling tank, probably from flushing at too high a pressure; skip the flush when pressure exceeds 20 psi.

Maintenance Procedures

Tightening and Replacement of Sight Glass Gaskets

A sight glass and peripheral components. The meniscus is at the water level in the boiler. The glass is 16 mm diameter. A white backdrop has been inserted for clarity. The pressure gauge is deliberately tilted to the left to allow clearance for maintenance of the sight glass and valves.

The sight glass is connected to the boiler through a valve at upper and lower ends. The glass is sealed into the valve by compression of a rubber gasket in the annular space between the glass and the valve body. Compression is by action of a large nut pressing against a compression ring bearing on the end of the gasket.

With time and thermal cycling a compression nut can gradually loosen. Also, the rubber gasket will gradually harden and deteriorate. Either of these factors can result in leakage of water between the sight glass and valve. In routine inspection and if leakage is detected, the compression nuts should be checked for tightness. Torque required to seal the gasket is relatively small; similar to tightening a garden hose onto a faucet. In some configurations the nut can be tightened with a gloved hand. A pair of water pump pliers can be used. If necessary a wrench such as an Armstrong 28-048 Thin Pattern Pump Wrench can apply enough torque in close quarters. Care must be taken to avoid over-tightening. The inexperienced operator can follow an iterative procedure of tightening and testing until a seal is achieved. The gasket should be compressed sufficiently to seal but not to extrude it into a gap between the glass and the valve body. Test by running the boiler as in a normal cycle of use.

When leakage occurs and can not be stopped by moderate tightening of compression nuts, the gaskets should be replaced following this procedure.

1. Shut down the boiler and lock out the main switch or steam supply.
2. Collect tools and two spare gaskets.
3. Open door or panel for good access.
4. Provide good lighting. If necessary connect a temporary lamp.
5. Check the sight glass, valves and peripheral plumbing are cool enough to avoid a burn.
6. Don heavy work gloves; essential for protection in case the glass is broken. Thin rubber gloves are not adequate. Find thick gloves with a grippy rubber coating. Leather gloves will not hold the glass well.
7. Remove the guard rods protecting the sight glass by lifting them out.
8. Open flush valve and allow water to drain to lower end of sight glass. A tray can be placed under the sight glass to catch spilt water.
9. Back off compression nuts and release compression rings from rubber gaskets.
10. By tying with a cord, fasten the compression nuts and ring near the top of the glass to prevent interference with further work.
11. Move the lower gasket upward until it is free of the annular space. An appropriate tool is essential. A heavy O-ring tool is one possibility. Care and patience must be exercised to avoid touching the glass with a metal tool. In normal circumstances, there is no justification for breaking the glass. If difficulty is encountered, find a more appropriate tool. If the rubber is hardened, it may come out in pieces.
12. Release the cord so that the compression nuts and rings rest at the lower end of the sight glass.
13. Move the upper gasket downward until it is free of the annular space.
14. The glass should then be loose in the annular space of the upper and lower valves. Hold the compression nuts and rings, lift the glass up, tilt the bottom end out clear of the lower valve and lower the glass clear of the upper valve.
15. Slide the old gaskets off of the glass and push new ones on.
16. Reassemble by inverting the preceding disassembly procedure.
17. Fit the glass with nuts and rings into the valves.
18. Slide the rings into the annular spaces. The glass must be approximately centered between the two valves. If the glass is displaced too far up or down a gap between the end of the glass and valve will allow extrusion of the gasket.
19. For each valve, slide the compression ring against the gasket, engage thread of nut and begin tightening. Take care to avoid displacing the glass too far up or down as mentioned in the preceding step.
20. Tighten the nuts to achieve a seal. Too loose is better than too tight for an initial test.
21. Restore electrical power or steam supply and energize the boiler while watching for leakage.
22. If leakage occurs, lock out power or steam again and adjust glass and compression nuts.
23. Repeat the preceding two steps until a reliable seal is achieved.
24. Power down boiler, replace covers and put tools away.
25. Monitor use through more than one cycle to be sure no leak develops.

External References

CDC: Disinfection and Sterilization

See Also

Sterilization
Autoclave

Pneumatic Tourniquets

Applications

In surgery on a limb, an automatic tourniquet can be used to temporarily restrict blood flow. This can be useful in treatment of trauma and in procedures where unrestricted bleeding would make work difficult or impossible.

Zimmer Automatic Tourniquet System, A.T.S. 2000. Tubes of a cuff are connected to the "Main" channel. Tabs of instruction cards are visible above the connectors.

Centrifuges

A centrifuge used for toxicology research.

A centrifuge can separate components of a fluid by density. They are often used in medicine for tasks such as bloodwork.

Crash Carts

• 
  A crash cart at the John D. Dingell VA Medical Center in Detroit, Michigan.
• 
  A crash cart made in Waterloo, Ontario, Canada.

Purpose

A crash cart can provide timely and mobile access to equipment, instruments, materials and pharmaceuticals needed for care of a patient in critical distress. Survival of a patient can depend upon the rapid availability of something in the cart.

Contents

Typically, a cart is stocked by an assigned staff member in coordination with a pharmacist and a stores department at the site where the cart is used. Contents are reviewed against a checklist on a fixed schedule and items are replaced after use. Contents accord to site practice. The list here is an example and not authoritative.

An adjustable IV pole and brackets holding an arrest board are on the back of the cart.

Top Drawer

Waterloo Crash Cart Top Drawer

• Laryngoscope
• Intubation (Magill) forceps
• Suction tubes
• Oxygen masks

Middle Drawer

Waterloo Crash Cart Middle Drawer

• Disposable endotracheal tubes

Bottom Drawer

Waterloo Crash Cart Bottom Drawer

• Disposable syringes
• Dressings
• Adhesive tapes
• Disposable gloves

Cubby

Waterloo Crash Cart Cubby

• Portable suction machine
• Needle disposal box
• Sphygmomanometer

Microtomes

Cambridge Instruments GmbH, Reichert-Jung Biocut 2030

Cambridge Instruments, Reichert-Jung Microcut 2030 microtome. The handwheel on the left provides rapid traversal of the specimen relative to the knife.

Instructions for Reassembly

For disassembly, begin at the bottom of the page and read upwards.

Torque at which lever rotates on micrometer screw

The end of the micrometer screw from the Cambridge Instruments Biocut 2030 microtome. An M3x12 screw in the cross hole to engage a 0.5" socket on a torque wrench.

Measuring the torque at which friction between lever and micrometer screw is overcome and relative rotation occurs. Torque wrench in left hand. Lever held with right forefinger.

Torque at which nut rotates in the cylinder

Hook and 800 g weight used to check the adjustment of the Belleville washers holding the micrometer nut within the cylinder.

Measuring the torque at which the Belleville washers allow the micrometer nut to rotate relative to the cylinder.

Adjustment of threaded disk

Adjustment of the threaded disk compressing Belleville washers against the micrometer nut in the cylinder.

Installing micrometer spindle in nut

Threading the micrometer spindle of the Biocut 2030 into the nut in the cylinder.

Barrel and cylinder

The barrel of the Biocut 2030 microtome with cylinder and link block.

Replacing the gear wheel on the cylinder.

Guide pin orienting cylinder and barrel in sliding block

Removal and replacement of the pin.

The guide pin, spring, bolt and setscrew.

Oxygen Concentrators

More information pending.

Suction Machines

Applications

In surgery, suction is used to remove blood, saliva, other biological material and foreign detritus from an anatomical passage or from a working field. A suction-irrigator can simultaneously perfuse and collect a saline solution where washing is required.

Suction is indispensable to clear the airway of blood, mucous, vomitus or other obstructing material. Consequently, suction machines can be found in emergency rooms, ambulances, patient wards and cafeterias.

A central vacuum pump connected to a building-wide network of suction plumbing is termed a "house vacuum". This is an efficient alternative to multiple small machines distributed throughout the building. Nevertheless the individual machines are necessary for mobile use and for backup during failure of a house vacuum.

Fluid Flow Path

Inlet accessory

⟶

Suction tube

⟶

Collection vessel

⟶

Liquid blocking device

⟶

Vacuum gage

⟶

Vacuum regulator

⟶

Vacuum pump

⟶

Exhaust filter

Classes of Machines

Bedside and Emergency

The contemporary Gomco 4040 Aspirator. Typical of machines used at the bedside and in an emergency room or cafeteria.

Surgical

The Gyrus ACMI Berkeley VC-10 machine marketed for gynecological surgery. A pneumatic foot operated actuator is connected.

Portable

A Laerdal portable suction machine with battery and power cord.

Components

Inlet Accessories

A disposable sterile curette made of clear plastic. Typically connected to a suction line and used in surgical procedures.

A suction catheter, 16 French by 53 cm, made of moderately soft and flexible plastic.

Collection Vessels

A Laerdal 1 litre collection vessel. Two are visible atop the Gyrus ACMI machine illustrated above.

Limiting Devices

A pump will tolerate a gas phase well and a liquid phase poorly. The limiting device has the function of allowing air and vapor to pass while blocking liquid from reaching the pump. The limiting device is essential to protect the pump.

Overflow Valves

A common implementation of an overflow valve is a spherical element similar to a ping-pong ball which will block the suction channel when elevated. The ball is buoyant and is elevated by increasing level of liquid. Such a valve is below the lid of the Laerdal collection vessel. The ball is immediately above the blue dyed water. The valve must be cleaned thoroughly along with other surfaces in the vessel when it is emptied and cleaned.

Inlet Filters

Another means of blocking liquid is to pass the flow through a textile filter. The dry filter passes the gas phase. Surface tension of a liquid phase prevents flow through the textile. Therefore the filter blocks liquid flow. A contaminated and blocked filter must be discarded and replaced.

Vacuum Gages

The rear or mechanical side of the vacuum gauge of a Gomco 3020 aspirator.

Vacuum Regulators

The vacuum regulator valve used in several Gomco aspirators, dismantled. A simple plastic needle valve which reduces the vacuum by admitting atmospheric air through an opening in the top of the body of the valve. The opening is too small to be visible in this photo.

Operation

Bedside and Emergency

Application of suction to clear the upper airway. The outside diameter of the suction tube is 16 Fr = 5.3 mm. The suction release port is above the thumb and finger of the right hand of the operator. Suction is applied by restricting or blocking the port with the thumb.

.

Surgical

Low volume oral suction as used by a dental hygienist or dental surgeon.

High volume suction, right, with a pneumatic dental drill, left.

Contributors

These people have donated information and materials, and assisted with photography.
A.M. Carbungco, Biomedical Engineering, UBC Hospital.
F. Keong, Biomedical Engineering, UBC Hospital.
C. Linden, Biomedical Engineering, Vancouver General Hospital.
J. Burgoyne, The Marshall Clinic, Vancouver, BC.
J. Fox, Biomedical Engineering, Vancouver General Hospital.
J. Lapointe, MD, Radiology, retired, Vancouver General Hospital.
J. Tai, Department of Pathology and Laboratory Medicine, UBC.
M. Bulloch.
M. Murphy, Biomedical Engineering, UBC Hospital.
P. Odermatt, KBNF.