Defibrillator Technical Training
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![Page 1: Defibrillator Technical Training](https://reader034.fdocuments.us/reader034/viewer/2022042516/559426941a28ab34768b47a0/html5/thumbnails/1.jpg)
DEFIBRILLATOR MACHINE BAsic TECHNICAL TRAINING
By: Armando Darino Ngojo
Senior Biomedical Engr.
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Contents
Aims & Objectives
Introduction
Principle
Anatomy and Physiology
Application
Types
Operation
Safety
Maintenance
Troubleshooting
PPM
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Aims
To provide basic
understanding about
the Defibrillator Machine
To perform and understand the basic technical troubleshooting steps and PPM tasks
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Objectives
- as a result of completing this module, the biomedical technician /
engineer should be able to:
understand the concept of the Defibrillator including its
applications
perform and identify basic problems, errors and basic
troubleshooting solutions.
Perform PPM tasks
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History
1899 Prevost and Batelli first introduced the concept of electrical
fibrillation after noticing that large voltages applied across the
animal's heart could convert ventricular fibrillation into a
sinus rhythm.
1933
1950s
1956
Hooker, Kouwenhoven and Langworthy published an account
of successful alternating current (AC) internal animal
defibrillation
Kouwenhoven was able to defibrillate dogs by applying the
electrodes to the chest wall, that was the external electric
defibrillator.
Zoll defibrillated a human subject in the same manner .
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History
1960s
1970s
Edmark and Lown et al found that direct current (DC) or pulse
defibrillators were more effective and produced fewer side
effects than AC defibrillator. The DC pulse waveform was
further improved.
Experimental internal and external devices were designed to
automatically detect ventricular fibrillation.
1980s
Present
times
The first automatic internal defibrillator was implanted in
human
A lot of improvements were introduced to the defibrillator with
the aim of improving the survival rate of the cardiac arrested
patient
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What is Defibrillator
- A device that reverses the Fibrillation of the heart.
Fibrillation causes the heart to stop pumping
blood, leading to brain damage.
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Defibrillation
Defibrillation is a process in which an electronic device
sends an electric shock to the heart to stop an extremely
rapid, irregular heartbeat, and restore the normal heart
rhythm.
It is a common treatment for life threatening cardiac
dysrhythmia, ventricular fibrillation, and pulse less
ventricular tachycardia.
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Principle
A high voltage electric current is applied to
the Heart muscle either directly (Internal
Defibrillator) through the open chest or
indirectly (External Defibrillator) through the
chest wall to terminate Ventricular Fibrillation.
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Physiology of Defibrillation
If enough current is delivered to the heart then a
majority of Ventricular cells will be depolarized
A critical mass of cells should be simultaneously
depolarized to achieve defibrillation
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Bio Electric Signal
Polarization
Potassium ions pumped in
Sodium ions pumped out
Depolarization
Potassium ions pumped out
Sodium ions pumped in
Repolarization
Potassium ions pumped in
Sodium ions pumped out NGOJO
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Anatomy - Heart
Located between the lungs in the
middle of chest, behind and slightly
to the left of breastbone (sternum)
Size of ones fist and shaped like a
cone.
An average heart pumps 2.4
ounces (70 milliliters) per
heartbeat. An average heartbeat is
72 beats per minute. Therefore an
average heart pumps 1.3 gallons (5
Liters) per minute.
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Cont…
Heart is divided into four chambers
Right Atrium
Left Atrium
Right Ventricle
Left Ventricle
A wall of muscle called as a 'Septum', separates all chambers of heart.
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ECG tracingElectrical pattern
Normal Cardiac Conduction
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Normal ECG tracing
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NGOJO
whenABNORMALITIEShappen….
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1. Ventricular Fibrillation
Ventricular Fibrillation is a very fast, irregular
heart rhythm in the lower heart chambers
(ventricles). During VF the heart quivers and
pumps little or no blood to the body.
Consciousness is lost in seconds. If not treated
immediately, VF will cause sudden cardiac arrest
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Occlusion of the
coronary artery leads
to ischemia.
Ischemia leads to
infarct which causes
interruption of normal
cardiac conduction
Infarct = VF/VT
Cardiac Arrest
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Ventricular Fibrillation Ventricular Tachycardia
SAMPLE SHOCKABLE RHYTHMS
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2. Atrial Fibrillation
Atrial Fibrillation is a very fast, irregular heart
rhythm in the upper heart chambers. During AF,
the waveform is almost similar to normal
waveform but for the loss of 'P' waveform.
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AF treatment:
For Atrial fibrillation, the
shock should be avoided
to be delivered in the T
period otherwise it will
lead to Ventricular
Fibrillation
This is achieved by
Synchronous mode
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Application
Emergency department
Anesthesiology
Cardiology
Operation theatre
Intensive care areas
Ambulance services NGOJO
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Types:
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1. Manual
Clinical expertise is needed to interpret the
heart rhythm and decide whether to charge the
defibrillator and deliver the shock to patient.
Energy selection and delivery is given to the
patient manually.
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2. Automatic
These defibrillators are small, safe, simple
and lightweight with two pads that can be
applied to the patient. The defibrillator guides
the operator step-by-step through a
programmed protocol. It records and analyses
the rhythm and instructs the user to deliver the
shock using clear voice prompts, reinforced by
displayed messages.
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3. External
External Defibrillator is the device which
delivers the high energy shock to patients
Heart externally on patient's chest by using a
Defibrillator Paddle. The maximum energy
deliver to the patient is about 360 Joules in
Monophasic & 200 Joules in Biphasic
Defibrillator.
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4. Internal
Internal defibrillator consist of sterilized internal
Handle/Paddle through which shock is delivered
directly to the heart.
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5. AED
Automatic External Defibrillator
AED can be classified as either fully automatic or semiautomatic. In fully automatic models disposable paddles are kept connected to the patient whilst the AED analyzes the ECG rhythm , decides and determines whether a defibrillation counter-shock is needed. Then the device automatically charges and discharges.
Semi Automatic AED analyze the patient's ECG and notify the operator when defibrillation is indicated. The operator then activates defibrillator and discharge.
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AED
Semi Automatic Fully Automatic
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6. ICD
Implantable Cardioverter Defibrillator
If it detects an abnormally fast heart rhythm, it either electrically paces the heart very fast or delivers a small electrical shock to the heart to convert the heart rhythm back to normal. The rapid pacing is not felt by the patient but the electrical shock, if used, is felt as a strong jolt in the chest. The ICD is used to treat life-threatening heart rhythms that lead to sudden death.
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ICD
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7. Pacemaker
A pacemaker is an electronic stimulator that
produces periodic electric stimulation to the
heart
It is classified into two types:
Internal Pacemaker
External Pacemaker
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Internal Pacemaker
Battery operated device
that is implanted inside the
patient’s body to pace the
Heart
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External Pacemaker
This is used to pace the
heart temporally. It may
use leads or electrodes
for the stimulation
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What is Joule?
It is the unit of energy delivered by the
Defibrillator
It means - “The energy released in one second
by a current of one ampere through a resistance
of one ohm”
Also called as watt-second
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– intrinsic characteristics of patient
– patient’s disease
– duration of arrhythmia
– patient’s age
– type of arrhythmia (more energy required for
VF)
– type of the machine used
- The delivered energy is in the range of 50-
360 joules and depends on:
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Operating Principle
Monophasic Defibrillator
Bi- Phasic Defibrillator
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Monophasic Defibrillator
Delivers its current in one forward direction
(positive)
Requires higher escalating energy levels (200-
300J) to convert VF/ pulse-less VT
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Bi Phasic Defibrillator
The Biphasic waveform type defibrillator delivers
the current in one direction during the first phase
and in opposite direction during the second
phase.
Biphasic waveform shocks of 200 J are safe,
equivalent or higher efficiency than damped
sinusoidal waveform shocks of 360 J.
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Generation of bi-phasic waveform
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Waveform Comparison
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Operation
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Defibrillator: Normal and Synchronous Mode
Monitor
Recorder
Pacemaker
NIBP
SPO2
CO2
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1. Manual Defibrillation
Switch 'ON' the Machine
Wait for initialisation and self test
Make sure it is not in SYNC Mode
Apply gel to the paddles
Place them properly on the chestNGOJO
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Cont…
Select 'ENERGY' to be delivered( energy in Joules)
Press 'CHARGE' button
Wait for Charging to complete. This is usually denoted
by a continuous /long beep sound.
Apply pressure to the paddles ( 12 Kg of pressure)
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Cont…
Make sure all the personnel are away from the
patient
Press both 'DISCHARGE' button simultaneously
Observe patient and monitor ECG
If required, defibrillate again
When finished, turn off and clean the paddles
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2. Synchronization Mode
Wait for initialization and self test.
Connect ECG leads to get a tall R wave
Select 'SYNC / CARDIOVERSION' mode..
Check for sync marker on the QRS waveform.
If possible sedate the patient and maintain
airway
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Cont…
Apply gel on the paddles and place it properly on chest
Select 'ENERGY' to be delivered( energy in Joules)
Press 'CHARGE' button
Wait for the Charge to be completed. This is usually denoted by a continuous /long beep sound.
Press both 'DISCHARGE' button simultaneously and hold till energy is delivered.
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Cont…
Check patient condition and Heart rhythm.
If required, defibrillate again.
Monitor the patient for few hours.
Switch off and clean the paddles
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3. Internal Defibrillation
Connect the Internal Paddles to the machine
Place one paddle over the apex of the left
ventricles and the other over the base of the
right ventricles
Switch on the machine
Select Energy
Charge and Discharge
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What are the types of Paddles?
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Paddle Placement
There are two notable methods of paddle
placement recommended by AHA
Anterior- Anterior
Anterior-Posterior
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Paddle Placement
Anterior- Anterior
Place one paddle near the
second or the third right
sternal border and the
other on the cardiac apex.
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Paddle Placement
Anterior-Posterior
- One paddle on
sternum and the other
on the left infra-
scapular region
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Important Factors: 1.Time
Early defibrillation allows more success or the longer period of VF, the less success of defibrillation.
Early initiation of CPR improves the success rate
> 8 mins neurological damage sets in
> 10 mins survival probability becomes very low
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2. Energy Level
AHA Recommendation for Adults
First shock 200 j
Second shock 200 j to 300 j
Third and above shocks 360 j
AHA Recommendation For Paeds
First shock 2 joules per Kg
Subsequent shock double the energy
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3. Paddle Size
Adult paddles should be 8 to 13 cm in
diameter
Child paddles should be 4.5 cm in
diameter
Infants use Anterior Posterior position
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4. Skin To Paddle Interface
Use the right gel
Too little gel increases possibility of burn
Too much gel causes electric current to arc from one electrode to another
If disposable paddles are used check the expire date
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Block Diagram of a typical Defibrillator machine
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Power Supply
Step up transformers used to convert 240
VAC to 5000 VAC
This is converted to DC by rectifier
In battery mode the DC is converted to AC
by inverter
This AC is amplified and then again rectified
to DC.NGOJO
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Capacitor Most important part
of Defibrillator
Stores large energy
which can be
discharged in a short
burst
Unit of measurement
is Farad NGOJO
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Inductor
Coils of wire that produce
a magnetic field when
current flow through them
Used to prolong the
duration of current flow
Unit of measurement is
HenryNGOJO
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Safety
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Safety - General
The Defibrillator generates High voltage. It must
be operated by trained, professional and
qualified personnel only.
Never use defibrillator with improper grounding
or electrical leak socket.
Keep away the Defibrillator from any x-ray,
Ultrasonic or other electronic instruments.
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Cont…
Check the patient lead wire, cable and paddles for any damage or mishandling, otherwise replace the same immediately.
Recommend using proper size and placement of recording paper.
Clean the print head regularly for clear printout
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Safety - Monitoring
Use only the specified patient cable as recommended by manufacturer.
Place the patient cable in proper winding position or hang on to patient cable arm attached with Defibrillator trolley
Use good ECG electrodes to monitor ECG waveform.
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Cont…
Don't use damaged patient cable.
Confirm there is no ECG waveform because
of electrical interference or defective patient
cable. This may misinterpreted as QRS in
synchronize mode.
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Safety - Defibrillation
Excessive Gels can cause arcing of the current along the chest wall
Malfunction of permanent pacemakers can result from placing defibrillator pads or paddles near the pacemaker
Defibrillation in the absence of an ECG rhythm (ie, 'blind defibrillation') to be avoided
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Cont…
A shock can be accidentally delivered to other rescuers
The initial three shocks should be delivered in sequence, without interruption for CPR, medication administration, or pulse checks.
If transthoracic impedance is high, a low energy shock (< 100 J) may fail to generate enough current to achieve successful defibrillation.
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Cont…
Alcohol should never be used as conducting material for paddles because serious burns can result.
Never discharge the Defibrillator in Air to check its performance
Never discharge with paddles shorted
Always clean the paddles after useNGOJO
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Maintenance - Cleaning
For Exterior surface of defibrillator and battery /battery well or compartment
Isopropyl alcohol(70% in water)
Mild soap and water
Chlorine bleach (3% in water)
While cleaning take care that solution should not go inside the defibrillator. Use soft cloth for cleaning display, to prevent scratching.
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Maintenance - Cleaning
For Paddles, pads, Electrodes & cables
Disposable pads & monitoring Electrodes do not require cleaning.The paddles, paddle cable and patient cable, may cleaned with
Alcohol free hand soap
Chlorine bleach solution 10%in water
Isopropyl Alcohol
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Maintenance - Cleaning
Internal Paddles / Cables
Internal Paddle Handle/ Cable / Electrodes can
be cleaned ultrasonically, autoclave or steam
sterilized but follow the manufacturer's
instruction for sterilization procedure
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The paddles used in the procedure should not be
placed:-
• on a woman's breasts
• over an internal pacemaker patients.
Before the paddle is used, a gel must be applied
to the patient's skin
PRECAUTIONS
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• Skin burns from the defibrillator paddles are
the most common complication of defibrillation.
• Other risks include injury to the heart muscle,
abnormal heart rhythms, and blood clots.
RISKS IN DEFIBRILLATION
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• Attach the external and internal paddles if the monitor
reads, "No paddles."
• Check to ensure that the leads are securely attached if
the monitor reads, "No leads.“
• Connect the unit to AC power if the message reads,
"Low battery."
• Verify that the Energy Select control settings are correct
if the defibrillator does not charge.
TROUBLESHOOTIN
G
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• Change the electrodes and make sure that the
electrodes adapter cable is properly connected
if you receive a message of "PACER
FAILURE." Restart the pacer.
• Close the recorder door and the paper roll if
the monitor message reads, "Check recorder”.
TROUBLESHOOTING
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PPM (Planned Preventive Maintenance)
Qualitative Task
PPM Task
Quantitative Task
Electrical Safety Test
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Test tool: Defibrillator Analyzer
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Defibrillator Analyzer
Basic Functions
Measures output energy
Measures cardioversion delay time
Measures output of pacemakers
Simulates range of ECG waveforms
Provides clinical training
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Practical Training
and
Assessment
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Questions!!!
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THA
NK
YOUNGOJO