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EquipmentPacket:PatientMonitoringUMDNS#:12636DateofCreation:December7,2015Creator:CompliedbyCassandraStancoforEngineeringWorldHealth(EWH)EquipmentPacketContents:Thisisamulti-partpacketthatcontainsinformationabouttheoperation,maintenance,andrepairofpatientmonitoringsystems.Thisincludesgeneralphysiologicalmonitors,bloodpressuremonitors,oxygenmonitors,respiratorymonitors,andtemperaturemonitors.PartI:ExternalFromthePacket:1. AnIntroductiontoRespirationandApneaMonitors:PowerPointPartII:IncludedinthisPacket:SectionA:PatientMonitors(General)1. OperationandUse:a. BriefIntroductiontoPatientMonitoring(p.4)b. DetailedOverviewofPatientMonitoring(p.5-9)c. BriefIntroductiontoBedsideMonitors(p.10)d. BriefIntroductiontoPhysiologicMonitoringSystems(p.11)2. DiagramsandSchematics:a. Figure1:WHOSpecificationforPhysiologicalMonitor(p.13-16)3. PreventativeMaintenance:a. PreventativeMaintenanceforPhysiologicalMonitoringEquipment(p.18-19)b. MonitoringSystemsPreventativeMaintenanceTable(p.20)4. TroubleshootingandRepair:a. MonitoringSystemsTroubleshootingTable(p.22)SectionB:BloodPressureMonitorsa. BriefIntroductiontoPatientMonitoring(p.25)b. BloodPressureMonitor(Manual)PreventativeMaintenance(p.26-29)c. BloodPressureMonitor(Manual)TroubleshootingFlowchart(p.30-34)SectionC:OxygenMonitorsa. OperationandUseofOxygenMonitors(p.37-41)b. PreventativeMaintenanceforOxygenMonitors(p.42-43)SectionD:RespiratoryMonitorsa. BriefIntroductiontoApneaMonitors(p.46)b. OperationandUseofRespiratoryMonitors(p.47-48)c. RespiratoryMonitorPreventativeMaintenance(p.49)d. RespiratoryMonitorTroubleshootingFlowchart(p.50-53)SectionE:TemperatureMonitorsa. IntroductiontoHumanBodyTemperature(p.56-61)b. OperationandUseofTemperatureMonitors(p.62-68)c. TemperatureMonitorPreventativeMaintenance(p.69)SectionF:ResourcesforMoreInformationa. ResourcesforMoreInformation(p.72)b. Bibliography(p.73-74)




*****SECTION*A:*Patient*Monitoring*(General)* *




**1.*Operation*and*Use*of*Patient*Monitors****Featured*in*this*Section:** *Strengthening'Specialised'Clinical'Services'in'the'Pacific.'User(Care(of(Medical(Equipment:(A(first(line(maintenance(guide(for(end(users.'(2015).'''WHO.'“Monitor,'Bedside,'Electroencephalography.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.'''WHO.'“Monitor,'Physiologic.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.''' Wikipedia.'“Monitoring'(Medical).”'Wikipedia,(p.(1H6.'Retrieved'from:''https://en.wikipedia.org/wiki/Monitoring_(medicine)'*********




User Care of Medical Equipment – First line maintenance for end users


21


Chapter 4.5 Electronic Diagnostic/Monitoring Equipment


Function
There are many items of equipment in a hospital that use electronics for operation. The maintenance of


such equipment is a task for specialised and trained staff. However, regular inspection and cleaning will help
such equipment last for a long time and deliver safe function. These are tasks that the equipment user can carry
out and should be done regularly, as laid out on the checklists on the next pages.



The types of equipment that might be included in this category are for instance audiometers, blood gas


analyzers, cardiac monitors, cardiotocographs (CTGs), cryoprobes, defibrillators, infusion pumps and
stimulators. .




How it works
The electrical section of the machine that is most important for safety, and also is the most likely to give


problems, is the power supply. See chapter 8 on electrical safety for the background to this. The power supply
converts the voltage to a lower, stable value to make the equipment work and also protects the patient from the
mains voltage. Any damage to the power supply, or any liquid spilled near it, is very serious indeed. The user
care checklist therefore majors on checking the cables, fuses and power connectors. If a device uses low voltage
batteries, it is safer to use. In this case, the user should take care that the batteries are removed if the equipment
will not be used for longer than one month, as chemical spillage can occur. Rechargeable batteries must be kept
topped up with charge.










External power supply mounted in cable


Items of electromedical equipment, with
internal power supplies.





/QPKVQTKPI OGFKEKPG


%JTQMBZ EFWJDF PG B NFEJDBM NPOJUPS BT VTFE JO BOFTUIFTJB


+P OGFKEKPG monitoring KU VJG QDUGTXCVKQP QH C FKUGCUG
EQPFKVKQP QT QPG QT UGXGTCN OGFKECN RCTCOGVGTU QXGT VKOG
+V ECP DG RGTHQTOGF D[ EQPVKPWQWUN[ OGCUWTKPI EGTVCKP
RCTCOGVGTU D[ WUKPI Cmedical monitor HQT GZCORNG D[
EQPVKPWQWUN[ OGCUWTKPI XKVCN UKIPU D[ C DGFUKFG OQPKVQT
CPFQT D[ TGRGCVGFN[ RGTHQTOKPI OGFKECN VGUVU UWEJ CU
DNQQF INWEQUG OQPKVQTKPI YKVJ C INWEQUG OGVGT KP RGQRNG
YKVJ FKCDGVGU OGNNKVWU
6TCPUOKVVKPI FCVC HTQO C OQPKVQT VQ C FKUVCPV OQPKVQTKPI
UVCVKQP KU MPQYP CU VGNGOGVT[ QT DKQVGNGOGVT[


1 Classification by target parame-
ter


/QPKVQTKPI ECP DG ENCUUKិGF D[ VJG VCTIGV QH KPVGTGUV KP
ENWFKPI


• Cardiacmonitoring YJKEJ IGPGTCNN[ TGHGTU VQ EQP
VKPWQWU GNGEVTQECTFKQITCRJ[ YKVJ CUUGUUOGPV QH VJG
RCVKGPVU EQPFKVKQP TGNCVKXG VQ VJGKT ECTFKCE TJ[VJO
# UOCNN OQPKVQT YQTP D[ CP CODWNCVQT[ RCVKGPV HQT
VJKU RWTRQUG KU MPQYP CU C *QNVGT OQPKVQT %CTFKCE


OQPKVQTKPI ECP CNUQ KPXQNXG ECTFKCE QWVRWV OQPKVQT
KPI XKC CP KPXCUKXG 5YCP)CP\ ECVJGVGT


• Hemodynamic monitoring YJKEJ OQPKVQTU VJG
DNQQF RTGUUWTG CPF DNQQF ីQY YKVJKP VJG EKTEWNCVQT[
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UKXGN[ VJTQWIJ CP KPUGTVGF DNQQF RTGUUWTG VTCPUFWEGT
CUUGODN[ QT PQPKPXCUKXGN[ YKVJ CP KPីCVCDNG DNQQF
RTGUUWTG EWា


• Respiratory monitoring UWEJ CU


• 2WNUG QZKOGVT[ YJKEJ KPXQNXGU OGCUWTGOGPV
QH VJG UCVWTCVGF RGTEGPVCIG QH QZ[IGP KP VJG
DNQQF TGHGTTGF VQ CU 5R1 CPF OGCUWTGF D[
CP KPHTCTGF ិPIGT EWា


• %CRPQITCRJ[ YJKEJ KPXQNXGU %12 OGCUWTG
OGPVU TGHGTTGF VQ CU 'V%1 QT GPFVKFCN
ECTDQP FKQZKFG EQPEGPVTCVKQP 6JG TGURKTC
VQT[ TCVG OQPKVQTGF CU UWEJ KU ECNNGF #944
QT CKTYC[ TGURKTCVQT[ TCVG


• 4GURKTCVQT[ TCVG OQPKVQTKPI VJTQWIJ C VJQ
TCEKE VTCPUFWEGT DGNV CP '%) EJCPPGN QT XKC
ECRPQITCRJ[


• Neurological monitoring UWEJ CU QH KPVTCETCPKCN
RTGUUWTG #NUQ VJGTG CTG URGEKCN RCVKGPV OQP
KVQTU YJKEJ KPEQTRQTCVG VJG OQPKVQTKPI QH DTCKP
YCXGU GNGEVTQGPEGRJCNQITCRJ[ ICU CPGUVJGVKE EQP
EGPVTCVKQPU DKURGEVTCN KPFGZ $+5 GVE 6JG[ CTG
WUWCNN[ KPEQTRQTCVGF KPVQ CPGUVJGUKC OCEJKPGU +P
PGWTQUWTIGT[ KPVGPUKXG ECTG WPKVU DTCKP '') OQP
KVQTU JCXG C NCTIGT OWNVKEJCPPGN ECRCDKNKV[ CPF ECP
OQPKVQT QVJGT RJ[UKQNQIKECN GXGPVU CU YGNN


• Blood glucose monitoring


• Childbirth monitoring


• Body temperature monitoring VJTQWIJ CP
CFJGUKXG RCF EQPVCKPKPI C VJGTOQGNGEVTKE VTCPU
FWEGT


1.1 Vital parameters


/QPKVQTKPI QH XKVCN RCTCOGVGTU ECP KPENWFG UGXGTCN QH VJG
QPGU OGPVKQPGF CDQXG CPF OQUV EQOOQPN[ KPENWFG CV
NGCUV DNQQF RTGUUWTG CPF JGCTV TCVG CPF RTGHGTCDN[ CNUQ
RWNUG QZKOGVT[ CPF TGURKTCVQT[ TCVG /WNVKOQFCN OQP
KVQTU VJCV UKOWNVCPGQWUN[ OGCUWTG CPF FKURNC[ VJG TGNG
XCPV XKVCN RCTCOGVGTU CTG EQOOQPN[ KPVGITCVGF KPVQ VJG





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"O BOFTUIFUJD NBDIJOF XJUI JOUFHSBUFE TZTUFNT GPS NPOJUPSJOH PG
TFWFSBM WJUBM QBSBNFUFST JODMVEJOH CMPPE QSFTTVSF BOE IFBSU SBUF


DGFUKFG OQPKVQTU KP ETKVKECN ECTG WPKVU CPF VJG CPGUVJGVKE
OCEJKPGU KP QRGTCVKPI TQQOU 6JGUG CNNQY HQT EQPVKPWQWU
OQPKVQTKPI QH C RCVKGPV YKVJ OGFKECN UVCា DGKPI EQPVKP
WQWUN[ KPHQTOGF QH VJG EJCPIGU KP IGPGTCN EQPFKVKQP QH C
RCVKGPV 5QOG OQPKVQTU ECP GXGP YCTP QH RGPFKPI HCVCN
ECTFKCE EQPFKVKQPU DGHQTG XKUKDNG UKIPU CTG PQVKEGCDNG VQ
ENKPKECN UVCា UWEJ CU CVTKCN ិDTKNNCVKQP QT RTGOCVWTG XGP
VTKEWNCT EQPVTCEVKQP 28%


2 Medical monitor


# NFEJDBM NPOJUPS QT QIZTJPMPHJDBM NPOJUPS KU C OGFKECN
FGXKEG WUGF HQT OQPKVQTKPI +V ECP EQPUKUV QH QPG QT OQTG
UGPUQTU RTQEGUUKPI EQORQPGPVU FKURNC[ FGXKEGU YJKEJ
CTG UQOGVKOGU KP VJGOUGNXGU ECNNGF ནOQPKVQTUཔ CU YGNN
CU EQOOWPKECVKQP NKPMU HQT FKURNC[KPI QT TGEQTFKPI VJG
TGUWNVU GNUGYJGTG VJTQWIJ C OQPKVQTKPI PGVYQTM


2.1 Components


2.1.1 Sensor


5GPUQTU QH OGFKECN OQPKVQTU KPENWFG DKQUGPUQTU CPF OG
EJCPKECN UGPUQTU


2.1.2 Translating component


6JG VTCPUNCVKPI EQORQPGPV QH OGFKECN OQPKVQTU KU TG
URQPUKDNG HQT EQPXGTVKPI VJG UKIPCNU HTQO VJG UGPUQTU VQ C


HQTOCV VJCV ECP DG UJQYP QP VJG FKURNC[ FGXKEG QT VTCPU
HGTTGF VQ CP GZVGTPCN FKURNC[ QT TGEQTFKPI FGXKEG


2.1.3 Display device


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.'& QT .%& UETGGP CU FCVC EJCPPGNU CNQPI VJG VKOG CZKU
6JG[OC[ DG CEEQORCPKGF D[ PWOGTKECN TGCFQWVU QH EQO
RWVGF RCTCOGVGTU QP VJG QTKIKPCN FCVC UWEJ CU OCZKOWO
OKPKOWO CPF CXGTCIG XCNWGU RWNUG CPF TGURKTCVQT[ HTG
SWGPEKGU CPF UQ QP
$GUKFGU VJG VTCEKPIU QH RJ[UKQNQIKECN RCTCOGVGTU CNQPI
VKOG : CZKU FKIKVCN OGFKECN FKURNC[U JCXG CWVQOCVGF
PWOGTKE TGCFQWVU QH VJG RGCM CPFQT CXGTCIG RCTCOGVGTU
FKURNC[GF QP VJG UETGGP
/QFGTP OGFKECN FKURNC[ FGXKEGU EQOOQPN[ WUG FKIKVCN
UKIPCN RTQEGUUKPI &52 YJKEJ JCU VJG CFXCPVCIGU QH
OKPKCVWTK\CVKQP RQTVCDKNKV[ CPFOWNVKRCTCOGVGT FKURNC[U
VJCV ECP VTCEM OCP[ FKាGTGPV XKVCN UKIPU CV QPEG
1NF CPCNQI RCVKGPV FKURNC[U KP EQPVTCUV YGTG DCUGF QP
QUEKNNQUEQRGU CPF JCF QPG EJCPPGN QPN[ WUWCNN[ TGUGTXGF
HQT GNGEVTQECTFKQITCRJKE OQPKVQTKPI '%) 6JGTGHQTG
OGFKECN OQPKVQTU VGPFGF VQ DG JKIJN[ URGEKCNK\GF 1PG
OQPKVQT YQWNF VTCEM C RCVKGPVཐU DNQQF RTGUUWTG YJKNG CP
QVJGT YQWNF OGCUWTG RWNUG QZKOGVT[ CPQVJGT VJG '%)
.CVGT CPCNQI OQFGNU JCF C UGEQPF QT VJKTF EJCPPGN FKU
RNC[GF KP VJG UCOG UETGGP WUWCNN[ VQ OQPKVQT TGURKTCVKQP
OQXGOGPVU CPF DNQQF RTGUUWTG 6JGUG OCEJKPGU YGTG
YKFGN[ WUGF CPF UCXGF OCP[ NKXGU DWV VJG[ JCF UGXGTCN TG
UVTKEVKQPU KPENWFKPI UGPUKVKXKV[ VQ GNGEVTKECN KPVGTHGTGPEG
DCUG NGXGN ីWEVWCVKQPU CPF CDUGPEG QH PWOGTKE TGCFQWVU
CPF CNCTOU


2.1.4 Communication links


5GXGTCN OQFGNU QHOWNVKRCTCOGVGT OQPKVQTU CTG PGVYQTM
CDNG KG VJG[ ECP UGPF VJGKT QWVRWV VQ C EGPVTCN +%7OQP
KVQTKPI UVCVKQP YJGTG C UKPING UVCា OGODGT ECP QDUGTXG
CPF TGURQPF VQ UGXGTCN DGFUKFG OQPKVQTU UKOWNVCPGQWUN[
#ODWNCVQT[ VGNGOGVT[ ECP CNUQ DG CEJKGXGF D[ RQTVCDNG
DCVVGT[QRGTCVGF OQFGNU YJKEJ CTG ECTTKGF D[ VJG RCVKGPV
CPF YJKEJ VTCPUOKV VJGKT FCVC XKC C YKTGNGUU FCVC EQPPGE
VKQP
&KIKVCN OQPKVQTKPI JCU ETGCVGF VJG RQUUKDKNKV[ YJKEJ
KU DGKPI HWNN[ FGXGNQRGF QH KPVGITCVKPI VJG RJ[UKQNQIK
ECN FCVC HTQO VJG RCVKGPV OQPKVQTKPI PGVYQTMU KPVQ VJG
GOGTIKPI JQURKVCN GNGEVTQPKE JGCNVJ TGEQTF CPF FKIKVCN
EJCTVKPI U[UVGOU WUKPI CRRTQRTKCVG JGCNVJ ECTG UVCPFCTFU
YJKEJ JCXG DGGP FGXGNQRGF HQT VJKU RWTRQUG D[ QTICPK\C
VKQPU UWEJ CU +''' CPF*. 6JKU PGYGTOGVJQF QH EJCTV
KPI RCVKGPV FCVC TGFWEGU VJG NKMGNKJQQF QH JWOCP FQEW
OGPVCVKQP GTTQT CPF YKNN GXGPVWCNN[ TGFWEG QXGTCNN RCRGT
EQPUWORVKQP +P CFFKVKQP CWVQOCVGF '%) KPVGTRTGVC
VKQP KPEQTRQTCVGU FKCIPQUVKE EQFGU CWVQOCVKECNN[ KPVQ VJG
EJCTVU /GFKECN OQPKVQTཐU GODGFFGF UQHVYCTG ECP VCMG




3&'&3&/$&4


(JWFO *NBHJOH $BQTVMF FOEPTDPQZ


QH OQPKVQTKPI OGFKEKPG UQNWVKQPU CTG PQV CXCKNCDNG VQFC[
KP EQPXGPVKQPCN OGFKEKPG


5IF 1"4$"- %ZOBNJD $POUPVS 5POPNFUFS " NPOJUPS GPS EF
UFDUJPO PG JODSFBTFE JOUSBPDVMBS QSFTTVSF


Blood glucose monitoring +P XKXQ DNQQF INWEQUG OQP
KVQTKPI FGXKEGU ECP VTCPUOKV FCVC VQ C EQORWVGT VJCV
ECP CUUKUV YKVJ FCKN[ NKHG UWIIGUVKQPU HQT NKHGUV[NG QT
PWVTKVKQP CPF YKVJ VJG RJ[UKEKCP ECP OCMG UWIIGU
VKQPU HQT HWTVJGT UVWF[ KP RGQRNG YJQ CTG CV TKUM CPF
JGNR RTGXGPV FKCDGVGU OGNNKVWU V[RG =?


Stress monitoring $KQ UGPUQTU OC[ RTQXKFG YCTPKPIU
YJGP UVTGUU NGXGNU UKIPU CTG TKUKPI DGHQTG JWOCP ECP
PQVKEG KV CPF RTQXKFG CNGTVU CPF UWIIGUVKQPU=?


Serotonin biosensor (WVWTG UGTQVQPKP DKQUGPUQTU OC[
CUUKUV YKVJ OQQF FKUQTFGTU CPF FGRTGUUKQP=?


Continuous blood test based nutrition +P VJG ិGNF QH
GXKFGPEGDCUGF PWVTKVKQP C NCDQPCEJKR KORNCPV
VJCV ECP TWP DNQQF VGUVU OC[ RTQXKFG C EQPVKP
WQWU TGUWNVU CPF C EQWORWVGT ECP RTQXKFG PWVTKVCKQP
UWIIGUVKQPU QT CNGTVU


Psychiatrist-on-a-chip +P ENKPKECN DTCKP UEKGPEGU FTWI
FGNKXGT[ CPF KP XKXQ $KQ/'/5 DCUGF DKQUGPUQTU
OC[ CUUKUV YKVJ RTGXGPVKPI CPF GCTN[ VTGCVOGPV QH
OGPVCN FKUQTFGTU


Epilepsy monitoring +P GRKNGRU[ PGZV IGPGTCVKQPU QH
NQPIVGTO XKFGQ'') OQPKVQTKPI OC[ RTGFKEV
GRKNGRVKE UGK\WTG CPF RTGXGPV VJGO YKVJ EJCPIGU QH
FCKN[ NKHG CEVKXKV[ NKMG UNGGR UVTGUU PWVTKVKQP CPF
OQQF OCPCIGOGPV=?


Toxicity monitoring 5OCTV DKQUGPUQTU OC[ FGVGEV VQZKE
OCVGTKCNU UWEJ OGTEWT[ CPF NGCF CPF RTQXKFG
CNGTVU=?


5 See also


• /GFKECN GSWKROGPV


• /GFKECN VGUV


• 0CPQGNGEVTQOGEJCPKECN U[UVGO 0'/5


• (WPEVKQPCN OGFKEKPG


6 References


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VJQT $TQPC 4QDGTVU %QR[TKIJVGF


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XKGYEQO


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=? 5VTGUU OQPKVQTKPI WUKPI C FKUVTKDWVGF YKTGNGUU KPVGNNKIGPV
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FG $KQNQIKG




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7 Further reading


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.FEJDJOF BOE 5IFSBQFVUJDT $POUFNQPSBSZ $BSEJPM
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9KNNKCO 9 *C[ ,T +5$0


• .FEJDBM /BOPUFDIOPMPHZ BOE /BOPNFEJDJOF 1FS
TQFDUJWFT JO /BOPUFDIOPMPHZ *CTT[ ( 6KDDCNU
+5$0


8 External links


• .POJUPSJOH NFEJDJOF JOUBLF JO UIF OFUXPSLFE IPNF
5IF J$BCJ/&5 TPMVUJPO +''' :RNQTG +UUWG &CVG
,CP (GD RR ཊ


• 1FSTPOBM .FEJDBM .POJUPSJOH %FWJDFT 6JG 7PKXGT
UKV[ QH /CT[NCPF




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9 Text and image sources, contributors, and licenses


9.1 Text
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,WPCKF UKRTC CPF #PQP[OQWU


9.2 Images
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• File:Maquet_Flow-I_anesthesia_machine.jpg 4PVSDF JVVRUWRNQCFYKMKOGFKCQTIYKMKRGFKCEQOOQPU/CSWGVA(NQY+A
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EEG monitors are used for observing and diagnosing a variety
of neurologic conditions, including epilepsy, related convulsive
disorders, and brain death. They can also be used to evaluate
psychiatric disorders and differentiate among various psychiatric
and neurologic conditions. In addition, electroencephalographic
studies with EEG monitors can assist in localizing tumors or
lesions on or near the surface of the brain.


Product description
EEG monitors use electrodes placed on a patient’s scalp to
measure, amplify, display in graphic form, and record the weak
electrical signals generated by the brain. They continuously
display processed EEG signals in graphic form over a period
of time so that waveform and pattern changes can be readily
detected. EEG monitors use computers to analyze and generate
large amounts of electroencephalographic data (as in Fourier
analysis), which are processed and displayed in various formats.
Many systems can produce and display certain types of EPs
or event-related potentials, a specific type of EEG signal that
occurs in response to a periodically applied external stimulus.


Principles oJ operation
Low-amplitude (microvolt range) EPs believed to be generated
by large numbers of nerve cells known as pyramidal cells, which
are located in the outer layer (cortex) of the brain, polarize
and depolarize in response to various stimuli, creating the EEG
waveform. These fluctuating electrical potentials are detected
by electrodes placed on the scalp and are displayed and/or
recorded on the EEG. Each EEG channel amplifies a signal from
a pair of electrodes, and these amplified signals can be printed
on a chart recorder and/or displayed on a monitor.


3peratinK steps
Scalp electrodes are usually affixed by a technician with a conductive
adhesive or paste. Cup, or disk, electrodes are affixed to the scalp
with a special adhesive called collodion or with a conductive paste.
Regardless of the electrode-placement procedure used, patients
usually lie down, remain awake, and keep their eyes closed during an
EEG recording; however, sleep EEG recordings (polysomnography)
are also common. The set of electrode pairs that the technician
selects for recording is called a montage.


6eported problems
The most common problem is improper electrode application.
Avoiding this problem requires use of proper technique during skin
preparation and electrode attachment, in addition to positioning
the electrodes in the correct system configurations. Poor electrode
contact with the scalp can distort the results of EEG recordings.
A recurring difficulty with electroencephalography is the failure of
EEG monitors to filter out artifacts, which can result in an incorrect
signal interpretation or inability to analyze the EEG signal.


9se and maintenance
User(s): Neurologists, neurosurgeons, or
other physicians, EEG technicians, sleep lab
technicians, nurses, anesthesiologists, OR
technicians,


Maintenance: Biomedical or clinical engineer/
technician, medical staff, manufacturer/
servicer


Training: Initial training by manufacturer,
operator’s manuals, user’s guide


EnZironment oJ use
Settings of use: ICUs, OR, sleep lab, EEG lab,
neurology clinics


Requirements: Uninterruptible power source,
battery backup, good lead/cable connections,
conductive gel


Product specifications
Approx. dimensions (mm): 350 x 50 x 390


Approx. weight (kg): 8


Consumables: Electrodes, conductive gel


Price range (USD): 1,750 - 113,000


Typical product life time (years): 8-10


Shelf life (consumables): NA


8]pes and Zariations
Computer laptop, mobile console, or monitor


1onitor &edWide )lectroencepLaloKrapL]
UMDNS GMDN
12602 Monitors, Bedside, Electroencephalography 38736 Electroencephalographic monitoring system,


portable


Other common names:
Cerebral function monitors; EEG recorders; electroencephalographs; monitors, bedside, electroencephalography,
spectral




http://www.who.int/medical_devices/en/index.html
© Copyright ECRI Institute 2011 (not including the GMDN code and device name).


Reproduced with Permission from ECRI Institute’s Healthcare Product Comparison System.


© Copyright GMDN Agency 2011. GMDN codes and device names are reproduced with permission from the GMDN Agency.


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Health problem addressed
Continuous monitoring is a valuable tool that helps provide
additional information to the medical and nursing staff about
the physiologic condition of the patient. Using this information,
the clinical staff can better evaluate a patient’s condition and
make appropriate treatment decisions.


Product description
These systems usually include a central station monitor that
receives, consolidates, and displays the information and a set of
monitors that are deployed near the patient (bedside monitors)
to provide the required data from each patient (ECG, respiratory
rate, noninvasive blood pressure (NIBP) and invasive blood
pressure (IBP) (systolic, diastolic, and mean), body temperature,
(SpO2), mixed venous oxygenation (SvO2), cardiac output,
(ETCO2), intracranial pressure, and airway gas concentrations).


Principles of operation
Physiologic monitors can be confi gured, modular, or both.
Confi gured monitors have all their capabilities already built-
in. Modular systems feature individual modules for each
monitoring parameter or group of parameters; these modules
can be used in any combination with each bedside monitor or
be interchanged from monitor to monitor. Some devices have
the capabilities of both modular and confi gured systems. Many
physiologic monitoring systems include a central station capable
of displaying ECG waveforms and other information from any
bedside within the system, and many are equipped with alarms
that are coordinated with those at the bedside monitor.


Operating steps
Once patients are attached to the appropriate monitoring
electrodes/pads, the cables are connected to the physiologic
monitor. Then the monitor allows patients’ physiologic
parameters to be continuously monitored so that changes can be
identifi ed and, if necessary, treated. The monitored parameters
can be seen at the bedside and (if desired) shared with a central
station. System suppliers offer different monitoring options to
meet a variety of applications (such as critical care, the operating
room, or transport).


Reported problems
Poor electrode preparation and attachment are most commonly
reported. Cables and lead wires should be periodically inspected
for breaks and cracks. Loss of patient alarms, misleading alarms,
and parameter errors have been the causes of most monitor
recalls. Even monitors that are functioning reliably cannot
substitute for frequent direct observation. Many devices
produce frequent “false alarms” which can lead to alarm fatigue
and missed critical events.


Use and maintenance
User(s): Physicians, nurses, other medical staff


Maintenance: Biomedical or clinical engineer/
technician, medical staff, manufacturer/
servicer


Training: Initial training by manufacturer,
operator’s manuals, user’s guide


Environment of use
Settings of use: Hospital, inter- and intra-
hospital transport; mostly in intermediate
care/step down units and in general medical
and surgical areas


Requirements: Uninterruptible power source,
battery backup, good lead/pad/cable
connections


Product specifi cations
Approx. dimensions (mm): 375 x 275 x 238


Approx. weight (kg): 10


Consumables: Batteries, cables, sensors/
electrodes, cuffs


Price range (USD): 3,000 - 50,000


Typical product life time (years): 7-10


Shelf life (consumables): NA


Types and variations
Bedside mounted, pole mounted, wall
mounted, transport, handle


Monitoring System, Physiologic
UMDNS GMDN
12636 Monitoring Systems, Physiologic 33586


36872
35569


Physiologic monitoring system, single-patient
Transportable physiologic monitoring system
Neonatal physiologic monitoring system


Other common names:
Operating room (OR) monitors, acute care monitoring systems, vital signs monitors, neonatal monitors, physiologic
monitors; Single-patient monitoring system and related equipment; Measuring/monitoring system, biophenomena;
Monitoring, bedside unit; Single patient monitoring system; Monitor, patient transport; Physiologic monitoring system,
acute care, battery-powered; physiologic monitoring system, neonatal




***2.**Diagrams*and*Schematics*of*Patient*Monitors'***Featured*in*this*Section:**** 'WHO.'“Physiological'Monitor.”'From'the'publication:'“WHO'Technical'Specifications'for'61'Medical'Devices.'WHO.'Retrieved'from:'http://www.who.int/medical_devices/management_use/mde_tech_spec/en/'* *




WHO_TS_61_MDs_web.xlsx 43


1


i Version No. 1ii Date of initial version 6/13/12iii Date of last modification 6/18/14iv Date of publicationv Completed / submitted by WHO working group1 WHO Category / Code (under development)2 Generic name Physiological monitor3 Specific type or variation (optional) single-patient, bedside4 GMDN name Single-patient physiologic monitoring system5 GMDN code 335866 GMDN category 02 Anaesthetic and respiratory devices , 04 Electro mechanical medical devices 7 UMDNS name Monitors, Bedside, Physiologic 8 UMDNS code 20-1709 UNSPS code (optional)10 Alternative name/s (optional) Single-patient monitoring system and related equipment; Physiologic monitoring system; Monitoring, bedside unit; Physiologic monitoring system, acute care; Single patient monitoring system11 Alternative code/s (optional) S 41036; MS 12636; S 36528; S 12647; S 3437712 Keywords (optional) Monitors, Bedside, Physiologic13 GMDN/UMDNS definition (optional)
An assembly of devices designed for continuous assessment of several vital physiologic parameters (e.g., ECG, blood pressure, heart rate, temperature, cardiac output, apnoea, and respiratory/anaesthetic gas concentrations) of one patient. It typically includes a central station monitor that receives, consolidates, and displays the information, and a bedside patient monitor; it often includes portable radio transmitters, receivers, and antennas (telemetry systems) to allow monitoring of an ambulatory patient. The system is used to evaluate and observe trends in a compromised or unstable patient in intensive or general healthcare settings.14 Clinical or other purpose 15 Level of use (if relevant) District hospital, Provincial hospital, Specialized hospital16 Clinical department/ward(if relevant) Intensive care unit, Inpatiant ward17 Ov rview of functional requirements Continuous display on screen of patient ECG, respiration and heart rates, invasive / non-invasive blood pressure, body temperature and SpO2Display to be digital of all active parameters and trace display of at least three selectable parametersUnwanted parameters can be deselected from displayAllows display of single, 3 lead ECG or simultaneous display of at least 3 waves selected from up to 12 pointsOperator can set audiovisual alarm levels for low or high levels of each parameter independentlyOperates from mains voltage or from internal rechargeable batteryECG patient connectors that are sterilisable and reusable are preferred, though reusable cables that attach to disposable connection patches are also acceptableHard copy printout of traces will not be required


MEDICAL DEVICE SPECIFICATION(Including information on the following where relevant/appropriate, but not limited to)
NAME, CATEGORY AND CODING


PURPOSE OF USE


TECHNICAL CHARACTERISTICS




WHO_TS_61_MDs_web.xlsx 43


2


18 Detailed requirements *Multichannel (up to 12 leads) ECG measurement and selectable display; an extra option for simple five lead connection would be preferred.*Heart rate measurement range to be at least 30 to 250 bpm, with accuracy better than ± 5 bpm and minimum gradation 1 bpm*SpO2 measurement range at least 70 to 99 %, with accuracy better than ± 3% and minimum gradation 1%*Blood pressure monitoring range at least 30 to 300 mmHg, minimum gradation 1 mmHg*Internal pump for cuff inflation for non-invasive blood pressure measurement, with over pressure protection*Temperature probe to be reusable, external skin contact type*Temperature range at least 30 to 40 deg C, minimum gradation 0.1 deg C*Respiration rate measurement range at least 0 to 100 bpm, minimum gradation 1 bpm*Alarm override and temporary silence facility to be included * Automatic and programmable memory.* Storage of at least 24 hours of continuous monitoring data.* Trace signal velocity of at least 25mm/sec.* LCD or TFT screen with:a) analog shape signals and numerical values visualization;b) settable limits for the measured variables;c) not less than 14” wide.* At least 5 simultaneous curves visualization.* Protections of all the functions against defibrillator discharges and electrosurgical units.* Pace-maker detection.* All the cables, sensors and connectors needed for full monitor functionality are to be included in the bid.19 Displayed parameters Trend display of each parameter over at least previous 24 hours to be selectable20 User adjustable settings User operated 1mV ECG test marker function requiredAlarm override and temporary silence facility to be included Audiovisual alarms required: high and low levels for each parameter (operator variable settings), sensor / wire / probe disconnected, low battery21 Components(if relevant) Case is to be hard and splashproofDisplay must allow easy viewing in all ambient light levelsSupplied in protective case for clean storage and safe transportWired patient cable connections will be preferred above wireless connection Cable connectors to be designed so as fit correct socket only22 Mobility, portability(if relevant)23 Raw Materials(if relevant) N/A24 Electrical, water and/or gas supply (if relevant) Power input to be ************* fitted with ********** compatible mains plugBattery powered, silenceable alarm for power failure Internal, replaceable, rechargeable battery allows operation for at least one hour in the event of power failureBattery charger to be integral to mains power supply, and to charge battery during mains power operation of unitVoltage corrector / stabilizer / UPS to allow operation at ± 30% of local rated voltage and one hour operation in the event of mains power failureElectrical protection by resettable circuit breakers in both live and neutral supply linesMains supply cable to be at least 3m in lengthRechargeable battery back-up with:a) at least 1 hour of autonomy without electrical source;b) visual alarm in case of low battery;c) automatic shift from battery to line source and vice-versa;d) unit integrated battery charger.Charger electrical source requirements: Amperage: ______; Voltage: ______; Frequency: ______; Phases: ______.Protections against over-voltage and over-current line conditions.Compliance with ______ electrical standards and regulations.


UTILITY REQUIREMENTS
PHYSICAL/CHEMICAL CHARACTERISTICS




WHO_TS_61_MDs_web.xlsx 43


3


25 Accessories (if relevant) 12 lead ECG cable5 lead ECG cable (if option offered)100 sets of ECG connection electrodes (if disposable type)5 sets of ECG connection electrodes (if reusable type)5 tubes electrode gel (if required)Two reusable SpO2 probes each for adult and paediatric useBlood pressure – invasive: one sensor for each channel offered; non-invasive: two each paediatric and adult size reusable cuffsTwo external skin temperature probes1 reusable respiratory sensor and connector set.26 Sterilization process for accessories (if relevant)27 Consumables / reagents (if relevant)28 Spare parts (if relevant) Two sets of spare fuses (if non-resettable fuses used)29 Other components (if relevant)30 Sterility status on delivery (if relevant) N/A31 Shelf life (if relevant) N/A32 Transportation and storage (if relevant) N/A33 Labelling (if relevant) N/A34 Context-dependent requirements Capable of being stored continuously in ambient temperature of 0 to 50 deg C and relative humidity of 15 to 90%.Capable of operating continuously in ambient temperature of 10 to 40 deg C and relative humidity of 15 to 90%.
35 Pre-installation requirements(if relevant)36 Requirements for commissioning (if relevant) Supplier to perform installation, safety and operation checks before handoverLocal clinical staff to affirm completion of installation37 Training of user/s (if relevant) Training of users in operation and basic maintenance shall be providedAdvanced maintenance tasks required shall be documented38 User care(if relevant) The case is to be cleanable with alcohol or chlorine wipesUnit layout to enable easy cleaning and sterilization of all surfaces
39 Warranty40 Maintenance tasks41 Type of service contract 42 Spare parts availability post-warranty43 Software / Hardware upgrade availability44 Documentation requirements User and maintenance manuals to be supplied in ************** language.Certificate of calibration and inspection to be provided.List to be provided of equipment and procedures required for local calibration and routine maintenanceList to be provided of important spares and accessories, with their part numbers and cost.Contact details of manufacturer, supplier and local service agent to be provided45 Estimated Life Span 7 years46 Risk Classification Class B (GHTF Rule 10);Class II (USA); Class I (EU, Japan, Canada and Australia)47 Regulatory Approval / Certification Must be FDA, CE or UL approved product.


DOCUMENTATION
DECOMMISSIONINGSAFETY AND STANDARDS


ACCESSORIES, CONSUMABLES, SPARE PARTS, OTHER COMPONENTS


PACKAGING
ENVIRONMENTAL REQUIREMENTS
TRAINING, INSTALLATION AND UTILISATION


WARRANTY AND MAINTENANCE




WHO_TS_61_MDs_web.xlsx 43


4


48 International standards ISO 13485:2003 Medical devices -- Quality management systems -- Requirements for regulatory purposes (Australia, Canada and EU)ISO 14971:2007 Medical devices -- Application of risk management to medical devices IEC 60601-1:2012 Medical electrical equipment - Part 1: General requirements for basic safety and essential performanceIEC 60601-1-1:2000 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systemsIEC 60601-1-2:2007 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests IEC 60601-1-8 :2012 (Part 1-8: General requirements for basic safety and essential performance - Collateral Standard: General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems)IEC 60601-2-49:2011 (Part 2-49: Particular requirements for the basic safety and essential performance of multifunction patient monitoring equipment)Optional:IEC 60601-2-23:2011 (Part 2-23: Particular requirements for the basic safety and essential performance of transcutaneous partial pressure monitoring equipment)IEC 60601-2-26:2012 (Part 2-26: Particular requirements for the basic safety and essential performance of electroencephalographs) IEC 60601-2-27:2011 (Part 2-27: Particular requirements for the basic safety and essential performance of electrocardiographic monitoring equipment)IEC 60601-2-34:2011 (Part 2-34: Particular requirements for the basic safety and essential performance of invasive blood pressure monitoring equipment)IEC 60601-2-40:1998 (Part 2-40: Particular requirements for the safety of electromyographs and evoked response equipment)IEC 60601-2-47:2012 (Part 2-47: Particular requirements for the basic safety and essential performance of ambulatory electrocardiographic systems)IEC 80601-2-30:2009 (Part 2-30: Particular requirements for the basic safety and essential performance of automated non-invasive sphygmomanometers)ISO 80601-2-55:2011 (Part 2-55: Particular requirements for the basic safety and essential performance of respiratory gas monitors)ISO 80601-2-61:2011 (Part 2-61: Particular requirements for basic safety and essential performance of pulse oximeter equipment)
49 Reginal / Local Standards AAMI/ANSI EC38:2007 (Part 2-47: Particular requirements for the safety, including essential performance, of ambulatory electrocardiographic systems) IEEE Std 11073-10406-2011 (Health informatics - Personal health device communication Part 10406: Device specialization - Basic electrocardiograph) EN 12470-4:2000 Clinical thermometersPerformance of electrical thermometers for continuous measurement JIS T 1115:2005 Non-invasive Automated Sphygmomanometers JIS T 3323:2008 Pressure transducers50 Regulations US regulations 21 CFR part 820 21CFR section 870.2300 monitor,physiological,patient(without arrhythmia detection or alarms) JP regulations MHLW Ordinance No.169 33586002 Multiparameter monitor




*3.**Preventative*Maintenance*and*Safety*of*Patient*Monitors'***Featured*in*this*Section:**Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Patient'Monitors.'EWH.'2012.''(Strengthening'Specialised'Clinical'Services'in'the'Pacific.'User(Care(of(Medical(Equipment:(A(first(line(maintenance(guide(for(end(users.'(2015).'**** *




Preventative)Maintenance)for)Physiological)Monitoring)Equipment)) Monitor,)Physiological)1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Push#test#button#and#clear#error#codes.###8.##Verify#the#accuracy#of#all#parameters#using#simulators.##9.##Verify#correct#operation#of#the#overview#and#record#functions.#10.#Clean#air#filter#as#necessary.###11.#Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###12.#Verify#correct#operation#of#unit#in#all#functional#modalities.#13.#Clean#exterior#of#unit#including#all#accessories,#cables,#controls#and#displays.###Monitor,)Physiological,)Neonatal)1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Inspect#patient#cable#and#connectors#for#mechanical#or#electrical#damage.##8.##Verify#correct#detenting#and#lead#shorting#of#lead#selector#switch.##9.##Verify#vertical#gain#and#calibration#pulse.#Inspect#monitor/diagnostic#switch.###10.#Verify#correct#operation#of#temperature#monitor.###11.#Verify#common#mode#rejection#and#check#ECG#mode#operation.##12.#Verify#correct#brightness#and#focus#of#trace.###13.#Verify#correct#operation#of#displays#and#correct#response#times.##




14.#Verify#correct#operation#of#freeze#and#cascade#controls#if#applicable.##15.#Verify#accuracy#of#heart#rate#meter#at#3#points#for#±3%#accuracy.#16.#Verify#operation#of#high#and#low#alarms#for#correct#trigger#and#response#time.###17.#Cycle#alarms#and#verify#correct#operation#of#audio#and#visual#indicators.##18.#Verify#operation#of#all#recorder#drive#speeds#to#be#within#±3%#accuracy.###19.#Verify#correct#dampening#and#temperature#of#writing#and#marker#stylus.##20.#Use#standard#pulse#to#check#sensitivity#and#decay#(frequency#response).#21.#Inspect#condition#of#drive#and#idler#rollers.#Clean#off#wax#buildVup.###22.#Verify#correct#signal#response.#Check#at#lower,#mid#and#upper#positions.###23.#Verify#timing#markers.#Check#data#printer#and#print#head.###24.#Verify#correct#operation#of#apnea#alarm#delay,#alarm#reset#&#reVarming#after#reset.#25.#Verify#accuracy#of#pressure#section,#displays,#alarms,#etc.#26.#Verify#accuracy#of#temperature#section.###27.#Inspect#recorder#drive#belts#and#chains#for#damage#and#verify#correct#adjustment.###28.#Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###29.#Verify#correct#operation#of#unit#in#all#functional#modalities.#30.#Clean#exterior#of#unit#including#all#accessories,#cables,#controls#and#displays.### )




User Care of Medical Equipment – First line maintenance for end users


23


User Care Checklist – Electronic Diagnostic/Monitoring Equipment


Daily

Cleaning



9 Wipe dust off exterior

9 Remove any tape, gel, paper or foreign body from equipment




Visual checks



9 Check all fittings and accessories are mounted correctly

9 Check there are no cracks in covers or liquid spillages




Function
checks



9 If in use that day, run a brief function check before clinic



9 Cover equipment after checks




Weekly

Cleaning



9 Unplug, clean outside with damp cloth and dry off

9 Clean any filters or covers as directed by user manual




Visual checks



9 Check all screws and parts are fitted tightly

9 Check mains plug screws are tight

9 Check mains cable has no bare wire and is not damaged



Function
checks



9 Check any paper, oil, batteries etc. required are sufficient

9 Check all switches operate correctly





Every six months
Biomedical Technician check required




** 4.**Troubleshooting*and*Repair*of*Patient*Monitors'****Featured*in*this*Section:*** * Strengthening'Specialised'Clinical'Services'in'the'Pacific.'User(Care(of(Medical(Equipment:(A(first(line(maintenance(guide(for(end(users.'(2015).'* *********** *




User Care of Medical Equipment – First line maintenance for end users


22


Troubleshooting – Electronic Diagnostic/Monitoring Equipment


Fault Possible Cause Solution


1.



Equipment is not running



No power from mains socket







Electrical cable fault





Check power switch is on.
Replace fuse with correct voltage
and current rating if blown.
Check mains power is present at
socket using equipment known to
be working. Contact electrician
for rewiring if power not present.

Try cable on another piece of
equipment. Contact electrician
for repair if required.



2.



Fuse keeps blowing



Power supply or cable fault



Refer to electrician



3.



Equipment not fully operational



Part malfunction



Check controls for correct
positioning and operation
(refer to user manual)

Check all bulbs, heaters and
connectors for function. Repair
or replace if necessary.

Check patient connection, using
gel, pads or straps as directed in
user manual.



4.



Signals erratic or large



Reference connection loose


Wire broken inside cable (due to
bending or crushing)

Dirt build up on electrodes or
contacts



Check reference connection for
good contact

Replace with spare cable


Clean as instructed in the user
manual



5.



Electrical shocks



Wiring fault



Refer to electrician




***''''' SECTION*B:*Blood*Pressure*Monitors*** *




*5.*Operation,*Use,*and*Maintenance*of*Blood*Pressure*Monitors***Featured*in*this*Section:*** Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Blood'Pressure'Monitor'Preventative'Maintenance.”'From'the'publication:''Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Blood'Pressure'Monitor'Troubleshooting'Flowchart.”'From'the'publication:'Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''WHO.'“Blood'Pressure'Monitor.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.'




http://www.who.int/medical_devices/en/index.html
© Copyright ECRI Institute 2011 (not including the GMDN code and device name).


Reproduced with Permission from ECRI Institute’s Healthcare Product Comparison System.


© Copyright GMDN Agency 2011. GMDN codes and device names are reproduced with permission from the GMDN Agency.


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Health problem addressed
NIBP is an essential indicator of physiologic condition. As one of
the most frequently used diagnostic tests, it indicates changes
in blood volume, the pumping effi ciency of the heart, and the
resistance of the peripheral vasculature. Vital signs monitors are
used to measure basic physiologic parameters so that clinicians
can be informed of changes in a patient’s condition. Depending
on their confi guration, these units can measure and display
numerical data for NIBP, oxygen saturation, and temperature.


Product description
Automatic electronic sphygmomanometers noninvasively
measure and display a patient’s arterial blood pressure. The main
unit includes controls and a display; it also includes appropriate
attached cuffs, probes, and sensors that make possible sequential
and/or simultaneous measurements of the parameters. Some of
the NIBP monitors can be used as vital sign monitors with the
real-time measuring and display of two or more of the vital signs.
These monitors typically consist of portable or mobile electronic
units. The monitor may be connected to the line and/or powered
by internal batteries. Many devices may also perform continuous
monitoring during transportation or at the bedside. Vital signs
physiologic monitors are intended mainly for periodic automated
measuring of the parameters of one or more patients.


Principles of operation
Automatic electronic sphygmomanometers (NIBP monitors)
measure by the use of sound and detection of blood sound
turbulence (Korotkoff sounds). A microphone positioned against an
artery compressed by the device cuff detects the Korotkoff sounds,
enabling the unit to directly determine systolic and diastolic values
blood pressure values. NIBP is usually measured using cuffs and
either auscultatory or oscillometric techniques. The measurement
of temperature is typically accomplished using an intraoral sensor,
and SpO2 is determined using pulse oximetry sensors. These
monitors typically consist of portable or mobile electronic units
that facilitate movement from one location to other; the monitor
may be connected to the line and/or powered by internal batteries.


Operating steps
The cuffs, probes, and sensors are attached to the patient, and
then the monitor will begin taking intermittent or continuous
measurements as selected by the clinician. The devices may
remain at a patient’s bedside or can be transported by a caregiver
for vital signs spot checking throughout a care area. Alarms (e.g.,
for high blood pressure or low oxygen saturation) can typically
be set by caregivers and can be manually temporarily silenced.


Reported problems
Problems associated with monitors are often user-related.
Poor cuff placement or sensor preparation and attachment
are most commonly reported. Cables and lead wires should
be periodically inspected for breaks and cracks. Automatic


electronic sphygmomanometry and pulse
oximeters may have the inability to effectively
monitor patients with certain conditions (e.g.,
tremors, convulsions, abnormal heart rhythms,
low blood pressure)


Use and maintenance
User(s): Physicians, nurses, other medical staff


Maintenance: Biomedical or clinical engineer/
technician, medical staff, manufacturer/
servicer


Training: Initial training by manufacturer,
operator’s manuals, user’s guide


Environment of use
Settings of use: Hospital (all areas),
ambulatory surgery centers


Requirements: Battery, uninterruptible power
source, appropriate cuffs/sensors


Product specifi cations
Approx. dimensions (mm): 100 x 150 x 200


Approx. weight (kg): 3


Consumables: Batteries, cables, sensors/
electrodes, cuffs


Price range (USD): 580 - 4,500


Typical product life time (years): 10


Shelf life (consumables): NA


Types and variations
Roll stand, portable, pole or bed mounts


Blood pressure monitor
UMDNS GMDN
18325
18326
25209


Sphygmomanometers, Electronic, Automatic,
Auscultatory
Sphygmomanometers, Electronic, Automatic,
Oscillometric
Monitors, Physiologic, Vital Signs


16173 Automatic-infl ation electronic
sphygmomanometer, non-portable


Other common names:
Vital signs monitoring units; noninvasive blood pressure (NIBP) monitors; auscultatory sphygmomanometers;
oscillometric sphygmomanometers; oscillotonometers, spot check monitors; spot checking; Recorder,
sphygmomanometer, automatic




Equipment*Blood*Pressure*Monitor*Preventative*Maintenance***How$To:$Dissemble$a$Mercury$Manometer$
• Remove&the&cuff&and&tubing&from&the&mercury&apparatus&
• Open&the&mercury&column&lever,&and&tilt&the&apparatus&back&to&allow&any&mercury&in&the&column&to& run&into&the&reservoir&
• Remove&the&tank&cover&(usually&using&a&screwdriver)&
• Remove&all&mercury&from&the&tank&using&a&syringe&
• Pour&mercury&into&a&clearly&labeled&container,&following&proper&protocol&
• Remove&cover&over&the&rise&tube&(usually&using&a&screwdriver)&
• Take&out&the&rise&tube& How$To:$Clean$Mercury$
• Roll&a&sheet&of&paper&into&a&funnel&
• The&pointed&end&should&have&a&tiny&hole&
• Put&the&funnel&in&a&bottle&
• Pour&the&mercury&into&the&funnel&and&let&pass&through&






How$To:$Take$Blood$Pressure$ 1.&Prepare&the&patient.&o Sitting&down& o Arm&unobstructed& o Ask&about&blood&pressure&history& 2. Wrap&the&cuff&around&the&upper&arm&with&leads&facing&the&brachial&artery.&




Should&be&about&level&with&&the&heart.&Be&sure&that&it&is&the&proper&cuff&size&for&the&patient’s&arm.&&&
3. Put&on&stethoscope.&Listen&to&the&brachial&artery&very&close&to&the&cuff.&&&
4. Ensure&that&the&knob&is&turned&completely&clockwise.&&&
5. Pump&the&cuff&to&a&high&pressure&(for&adults:&160P180&mmHg,&for&children:&140&mmHg)&&&
6. Carefully&turn&the&knob&counterclockwise&to&release&the&pressure&in&the&cuff&at&a&slow&rate.&&&
7. Look&at&the&pressure&on&the&dial&while&listening&to&the&heartbeat&through&the&stethoscope.&&&
8. Obtain&and&record&the&blood&pressure.&&&o Systolic:&the&pressure&at&which&you&start&to&hear&the&heart&beat&o Diastolic:&the&pressure&at&which&you&stop&hearing&the&heart&beat& Examples&of&ranges&for&healthy&blood&pressures:&




Age$ BP$(Systolic/$Diastolic)$
Child,&<6&months& 90P105/70&
Child,&6&months&to&7&years& 105P117/70&


Adult&


120/80&




How$To:$Mercury;Handling$Protocol$
• When&exposed&to&air,&mercury&vaporizes&and&is&extremely&poisonous&
• Always&handle&mercury&while&wearing&rubber&gloves&
• Work&with&mercury&outside&or&in&a&wellPventilated&area&
• Recover&mercury&with&a&large&syringe&
• When&storing&mercury,&add&some&water&to&prevent&evaporation&
• Always&have&an&airtight&cover&on&a&mercury&container&
• Wash&skin&thoroughly&if&it&comes&into&contact&with&mercury&




Blood%Pressure%Monitor%(Manual)%Flowchart:%


!




Description+#! Text%Box! Comments!
1! Begin:!Manual!Blood!Pressure!Cuff! Testing!and!maintenance!is!advised!when!the!manual!cuff!fails!to!give!out!a!complete!or!accurate!blood!pressure.!
2! Does!the!cuff!have!a!mercury!manometer?! There!are!two!types!of!manual!blood!pressure!cuffs,!one!with!a!mercury!manometer!and!an!aneroid!sphygmomanometer!with!just!a!small!pressure!dial.!
3! Is!mercury!leaking!from!the!apparatus?! If!there!is!any!mercury!escaping!the!reservoir,!proceed!with!extreme!caution!and%follow%mercury>handling%protocols.%See!BTA!skills!for!Leaking!and!Blockages.!
4! Disassemble!apparatus!and!check!gaskets,!filters,!and!tubing!for!leaks.!Replace!as!needed.! Disassemble!the!apparatus!(follow!protocol!below).Assess!each!part!for!any!leaks!and!cracks.!Replace!or!repair!faulty!parts!as!necessary.!See!BTA!skills!on!Plumbing!and!Mechanical.!5! Is!any!black!powder!present?! The!black!powder!is!oxidized!mercury!and!needs!to!be!removed.!


6! Disassemble!and!clean!specific!parts!accordingly.!


Disassemble!the!apparatus!(follow!protocol!below)!If!oxide!is!in!rise!tube!and!mercury!tank:!RUsing!a!stiff!wire,!push!a!small!piece!of!cotton!or!gauze!through!the!rise!tube!several!times!RGently!tap!mercury!tank!(with!opening!facing!downwards)!onto!tray!to!make!sure!all!mercury!has!been!removed!RWash!tube!and!tank!in!a!detergent!and!water!solution!RDry!thoroughly!RClean!mercury!using!protocol!below!




7! Is!the!mercury!level!at!zero!when!no!pressure!is!in!the!cuff?! Meter!should!be!at!zero!when!no!pressure!is!applied.!
8! Add/remove!mercury!to!column!as!needed.! Follow%mercury>handling%protocol.!Any!added!mercury!can!be!taken!from!another!existing!meter!that!doesn’t!work!correctly!or!isn’t!in!use.!
9! Begin!pumping!air!into!meter.!Ensure!that!the!mercury!column!lever!is!open.!


If!possible,!disassemble!tubing,!and!attach!the!bulb!and!its!tubing!to!the!meter!so!that!the!cuff!is!not!involved!in!meter!testing.!Be!sure!that!the!mercury!column!lever!is!open,!or!else!no!mercury!will!come!up!the!rise!tube.!
10! Does!the!pressure!level!lower!over!time?! The!mercury!level!will!fall!if!there!are!any!cracks!or!leaks.!
11! Check!for!any!leaks!in!meter!or!between!connections.! Use!BTA!skills!on!Leaking!and!Seals!to!assess!for!cracks!or!leaks.!
12! Does!the!pressure!level!rise!over!time?! Leather!seal!and!washer!may!be!cracked/broken.!
13! Investigate!leather!seal!and!washer.!Replace!as!needed.! Use!BTA!skills!to!assess!for!cracks!or!leaks.!Leather!seal!and!washer!will!usually!need!to!be!replaced.!See!BTA!skills!on!Leaking,!Seals!and!Connections.!
14! Do!bubbles!appear!in!mercury!column?! Small!air!pockets!will!form!if!not!enough!mercury!is!in!the!tank.!
15! Add!mercury!to!column!as!needed.! Follow%mercury>handling%protocol.!Any!added!mercury!can!be!taken!from!another!existing!meter!that!doesn’t!work!correctly!or!isn’t!in!use.!16! Reattach!cuff!to!mercury!meter.! Reassemble!cuff!to!meter!if!the!apparatus!was!dissembled!in!step!9.!




17! Before!applying!pressure!in!the!cuff,!is!the!needle!at!zero?! Needle!in!the!dial!should!be!at!zero!when!no!pressure!is!applied.!
18! Open!meter!and!manually!twist!the!needle!to!zero.! Screw!off!dial!cover!and!use!a!screwdriver!to!loosen!or!remove!needle.!Reassemble!once!needle!is!back!at!zero.!
19! Can!air!be!pumped!into!the!cuff?! Try!putting!cuff!around!your!arm!or!a!bottle!before!pumping!air.!Is!there!difficultly!in!pushing!air!into!the!cuff?!Does!it!deflate!immediately?!!
20! Check!the!valve.!Ensure!that!the!knob!is!turned!completely!clockwise.! Valve!must!be!turned!completely!clockwise!to!inflate!the!cuff.!
21! Clean!filter!between!the!bulb,!valve,!and!cuff!connection.! Remove!the!valve!from!the!bulb!and!cuff!tubing.!Use!a!screwdriver!to!scrape!out!any!dirt!in!valve!connection,!or!see!BTA!skills!on!Blockages!Reassemble!bulb,!valve,!and!cuff!tubing.!
22! Check!the!bulb.!Replace!if!necessary.! Is!the!bulb!able!to!pump!air?!Are!there!any!holes!or!leakage!in!the!bulb?!Repair!with!silicon!if!possible.!Bulbs!will!typically!need!to!be!replaced.!See!BTA!skills!on!Seals!and!Leaking.!
23! Pump!air!to!a!particular!pressure!and!hold!for!at!least!10!seconds.! Pump!air!to!a!pressure!of!approximately!180!mmHg!for!a!human!arm.!
24! Does!the!pressure!drop!significantly?! If!the!pressure!drops!more!than!5!mmHg!in!10!seconds,!there!is!probably!a!leak.!
25! Test!for!leaks!in!tubing!and!between!connections.! Use!BTA!skills!for!cracks!or!leaks.!26! Release!the!air!from!cuff.! Turn!knob!completely!counterclockwise.!
27! Is!air!being!released!from!the!cuff?! You!will!hear!air!being!released!from!the!valve,!and!the!cuff!should!deflate!with!no!difficulty.!




28! Check!the!valve.!Ensure!that!the!knob!is!turned!completely!counterclockwise.! Valve!must!be!turned!completely!clockwise!to!deflate!the!cuff.!
29! Clean!filter!between!the!bulb!and!cuff!connection.! Remove!the!valve!from!the!bulb!and!cuff!tubing.!Use!a!screwdriver!to!scrape!out!any!dirt!in!valve!connection,!or!see!BTA!skills!on!Blockages.!Reassemble!bulb,!valve,!and!cuff!tubing.!
30! Test!for!accuracy!and!calibrate!if!necessary.! Use!BTA!skills!on!Calibration!to!calibrate!sphygmometer.!31! BP!cuff!is!working!properly.! Return!apparatus!to!appropriate!clinical!staff.!!




****SECTION*C:*Oxygen*Monitors*




**6.*Operation,*Use,*and*Maintenance*of*Oxygen*Monitors***Featured*in*this*Section:* ''Developing'World'Healthcare'Technology'Laboratory.'“Oxygen'Monitors.”'From'the'Publication:'“Biomedical'Technicians'Training'Program,'Session'3'v2,'Special'Topics:'Cardiac'Equipment.”'Engineering(World(Health,'March'1,'2011,'p.'1H161.'*Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Oxygen'Monitors.'EWH.'2012.(




š›‰en ‘nit‘r• 




Oxygen Monitors

An oxygen monitor displays oxygen concentrations from zero to 100 percent. It produces
audible and visual alarms to indicate:


„ That the displayed value is greater than or less than operator selected high O2
or low O2 alarm limits.


„ that the sensor is disconnected or defective
„ that the batteries require replacement



The monitor uses a galvanic sensor that produces a current proportional to the oxygen
concentration (partial pressure) at its sensing surface. The sensor does not require special
attention and can be replaced without tools.

CAUTION: The oxygen monitor contains electronic components that are susceptible to
damage by electrostatic discharge. Always work at a static control workstation. Handle
the circuit board by its nonconductive edges and use an anti-static container for transport.
Before servicing the monitor, properly ground yourself (and any tool you are using) by
wearing a static control wrist strap to discharge accumulated static charges.

Troubleshooting procedures

The best troubleshooting tool is a thorough understanding of what the monitor does and
how it does it. Refer to the Operation and Maintenance Manual to learn what the monitor
does.

Let the symptoms be your guide. If only a single function is not working, concentrate on
the block(s) schematic that controls the function. If several symptoms are present, locate
a block that serves multiple functions (such as power supply or hybrid). The following
section will guide you in troubleshooting the suspected block.


Functional Description

Refer to the block diagram for an overview of the various systems that make up the
oxygen monitor’s circuitry. The position of each block, relative to the hybrid, is in the
location of the circuitry as it appears on the overall schematic.


A. The POWER SUPPLY boosts the relatively low voltage produced by three
“C” cells (4.5 volts nominal) and regulates it to the 9.5 volts (V+) required by
the circuitry throughout the monitor.



B. The BATTERY/POWER SUPPLY TEST circuit continuously monitors the


voltage produced by the batteries. When the battery voltage falls to a design-
determined threshold the battery check circuitry signals the HYBRID to
generate a first level, low battery alarm that is a flashing LOW BATT


110




š›‰en ‘nit‘r• 




message on the display. When the battery voltage falls further to a second
threshold the HYBRID shuts down the operation of the monitor and generates
a high level alarm: the display reading is set to zero, an oscillating two0tone
alarm sounds, and the alarm indicator (along with the LOW BATT message)
flashes.



C. The CRYSTAL OSCILLATOR produces a clock signal that controls the logic


processes within the hybrid.






































Oxygen monitor


111




š›‰en ‘nit‘r• 




D. The hybrid chip contains an analog-to-digital converter (A/D). The AUTO-
ZERO AND A/D CONVERTER COMPONENTS, which could not be
integrated on the chip, complete the function of the A/D converter.



E. The EXTERNAL CONTROL represents the switches that “tell” the HYBRID


what function to implement: Such as BATT TEST (Ɓ), CIRCUIT TEST, and
SILENCE.



F. The hybrid chip monitors the LIMIT SET block to determine for which values


of % O2 to generate the HIGH O2 or LOW O2 alarms. The HYBRID also
monitors these switches for LOW O2 set to “Less than 18” and High O2 set to
“zero”.






































Block Diagram – Oxygen monitor


112




š›‰en ‘nit‘r• 





G. The REFERENCE SET circuitry generates a calibrated voltage that the
HYBRID interprets as 100% O2.

H. The oxygen sensor produces a current that is proportional to the oxygen


concentration at its sensing surface. The SENSOR CALIBRATION AND
CURRENT-TO-VOLTAGE CONVERSION circuit converts this current to a
calibrated voltage which the HYBRID interprets as a corresponding percent of
oxygen.



I. The calibrated sensor voltage is buffered and scaled by the ANALOG


OUTPUT circuitry. A 20% O2 dislay results in a 200 mV output at the rear
housing connector for remote monitoring (10 mV per % O2).




J. The hybrid chip interprets all the inputs from the functional sections discussed


so far and sends appropriate signals to the DISPLAY section to generte the
displays corresponding to the input conditions. The display is a liquid crystal
type (LCD) that includes seven-segment disgits and formed messages.



K. In addition to controlling the display, the HYBRID produces outputs to


DRIVE the backlights, the audible alarm, and the alarm indicator (LED).



L. Two input lines to the hybrid chip are used by MANUFACTURING to


facilitate production testing.

M. As previously noted, the HYBRID is the central component in the oxygen


monitor system. The other functional blocks either input signals to the
HYBRID or receive processed signals from it to drive the display, the
messages, and the visual and audible alarms.




















113




š›‰en ‘nit‘r• 





























Hybrid section


The Hybrid Section provides A/D conversion of the external sensor signal,
display/annunciator drive, and all digital timing and control functions associated with the
instrument. The hybrid circuit consists of an ICL 7126 A/D converter chip, a custom
gate-array CMOS chip, four ceramic chip capacitors, 20 thick-film resistors, and all
associated screened interconnects.


114




Preventative)Maintenance)for)Oxygen,)Carbon)Dioxide,)and)Blood)Gas)Monitors))Monitor,)Oxygen)1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Inspect#sensor#and#cable#assembly.#Inspect#alarms#and#batteries.##8.##Verify#calibration#using#21%#and#100%#standards.###9.##Inspect#sensing#element#(membrane,#gel,#fuel#cell,#etc.).#Replace#per#mfr.#specs.###10.#Verify#correct#operation#of#alarms#and#remote#signaling#systems#if#present.###11.#Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###12.#Verify#correct#operation#of#unit#in#all#functional#modalities.#13.#Clean#exterior#of#unit#including#all#accessories,#cables,#controls#and#displays.## Monitor,)Carbon)Dioxide)1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Verify#that#the#unit’s#power#passes#on#auto#test.##8.##Using#sensor#simulator#box,#check#operation#and#calibration#of#unit.#9.##Verify#calibration,#referring#to#service#manual#as#required.###10.#Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###11.#Verify#correct#operation#of#unit#in#all#functional#modalities.#12.#Clean#exterior#of#unit#including#all#accessories,#cables,#controls#and#displays.#




Monitor,)Blood)Gas,)CarbonFDioxide)1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Verify#calibration#using#correct#controls#and#standards.#8.##Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###9.##Verify#correct#operation#of#unit#in#all#functional#modalities.#10.#Clean#exterior#of#unit#including#all#accessories,#cables,#controls#and#displays.##




****SECTION*D:*Respiratory*Monitors** *




*7.*Operation,*Use,*and*Maintenance*of*Respiratory*Monitors***Featured*in*this*Section:* Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Respiratory'Monitor'Preventative'Maintenance.”'From'the'publication:''Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'*Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Respiratory'Monitor'Troubleshooting'Flowchart.”'From'the'publication:'Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'*Malkin,'Robert.'Medical(Instrumentation(in(the(Developing(World.'Engineering'World'Health,'2006.'' WHO,'“Apnea'Monitor.”'WHO.'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.'




http://www.who.int/medical_devices/en/index.html
© Copyright ECRI Institute 2011 (not including the GMDN code and device name).


Reproduced with Permission from ECRI Institute’s Healthcare Product Comparison System.


© Copyright GMDN Agency 2011. GMDN codes and device names are reproduced with permission from the GMDN Agency.


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n Health problem addressed


Apnea monitors detect the cessation of breathing (apnea) in
infants and adults who are at risk of respiratory failure and
alert the parent or attendant to the condition. Some prolonged
respiratory pauses result in low oxygen concentration levels in
the body, which can lead to irreversible brain damage and, if
prolonged, death.


Product description
The components of apnea monitors depend specifi cally on
the type. However, in general they are composed of a set of
sensors which obtain the information of different physiological
parameters. This information is passed to a micro computer
system, which analyses the sensors’ information and determines
if apnea is occurring.


Principles of operation
Monitors that use impedance pneumography detect small
changes in electrical impedance as air enters and leaves the
lungs and as the blood volume changes in the thoracic cavity.
Mattress-type motion sensors typically monitor changes in the
capacitance or resistance of a mattress transducer. Pneumatic
abdominal sensors also detect breaths as changes in pressure.
More direct methods of respiration detection monitor the airfl ow
into and out of the lungs; these include thermistors, proximal
airway pressure sensors, and carbon dioxide (CO2) sensors.


Operating steps
The apnea monitor is attached to the patient using appropriate
sensor for the measurement technique (e.g., mattress motion
sensor, pneumatic abdominal sensors, thermistors, proximal
airway pressure sensors, carbon dioxide (CO2) sensors, cannula).
Once connected, as the patient breathes, the unit monitors
different body parameters. If an alarm sounds, the operator
must attend the patient immediately.


Reported problems
Apnea monitors may fail to alarm during an episode because
they sense artifact (artifacts include vibrations, heart activity,
patient movement). Electromagnetic emissions from electronic
devices (other electronics or equipment) can also cause
interference, possibly leading to false breath and heartbeat
detection. Impedance pneumographs are more subject to
cardiovascular artifact. Misinterpreting impedance changes
because of heartbeats perceived as breaths frequent when
instrument sensitivity is not adjusted.


Use and maintenance
User(s): Nurse, medical staff, home care
providers


Maintenance: Biomedical or clinical engineer/
technician, medical staff, manufacturer/
servicer


Training: Initial training by manufacturer,
operator’s manuals, user’s guide


Environment of use
Settings of use: Hospital, home, ambulatory
care center, nursery


Requirements: Uninterruptible power source,
battery backup


Product specifi cations
Approx. dimensions (mm): 150 x 120 x 120


Approx. weight (kg): 0.75


Consumables: Batteries, cables, electrodes/
sensors


Price range (USD): 200 - 5,000


Typical product life time (years): 8


Shelf life (consumables): NA


Types and variations
Stand-alone, modular


Apnea Monitors
UMDNS GMDN
12575 Monitors, Bedside, Respiration, Apnea 35194 Respiratory apnoea monitoring system


Other common names:
Cardiorespiratory monitors; Monitor, recording, apnoea




Equipment found in the OR, ICU and ER


Page 50


2.13 Respiration Rate Meter or Apnea Monitor


2.13.1 Clinical Use and Principles of Operation


Apnea is defined as the cessation of respiratory air flow. The air may have ceased to flow
because the patient has stopped trying to breathe (central or diaphragmatic apnea) or because
the airway is blocked (obstructive apnea). The two types of apnea are clinically treated quite
differently. Obstructive apnea is typically caused by chocking on food or another object.
Episodes of central apnea are somewhat common in children and often disappear as the child
develops. However, in severe cases, neonates and babies can be kept on apnea monitors for up
to one year. When Sudden Infant Death Syndrome (SIDS) is feared, the physician may prescribe
continuous apnea monitoring.


An apnea monitor is a device used to monitor a patient’s respiration rhythm and often cardiac
activity and oxygen saturation. Most monitors will attempt to distinguish between central and
obstructive apnea, sounding an alarm if either is prolonged. Most monitors run on both batteries
and line power.







Transthoracic Electrical Impedance


The most popular type of apnea monitoring is based on transthoracic electrical impedance. To
use this device, electrodes are placed in the 5th intercostal space on each side of the neonate. A
signal of 55kHz at 2 to 3 mV is injected into the electrodes and the impedance of the chest is
measured. As the chest expands during inspiration, the impedance increases. During expiration,
the impedance decreases. Simultaneously, the impedance electrodes are used to monitor the
ECG.


It is possible for the monitor to read a false positive (presence of breathing when there is none)
because it can be fooled by muscle movement. False negatives can occur if the chest motion is
slight or in the presence of excessive electrical noise. Despite the popularity of this monitor, it is
not effective at distinguishing between obstructive and central apnea.


Pneumatic Abdominal Sensor


Unlike the transthoracic apnea monitor, the abdominal monitor measures the motion of the
abdomen. However, the impedance of the abdomen does not tend to change, as the cavity is
not filled with air. Therefore, the abdominal sensor operates by detecting the increased
circumference of the abdomen, typically with a linear variable displacement transducer (LVDT) or
other displacement transducer.


This stand-alone apnea monitor would
be unusual to find in the developing
world. Most apnea monitors are
respiration rate meters incorporated
into a vital signs monitor.




Medical Instruments in the Developing World Malkin


Page 51


Thermistors and Pressure Sensors


Neither the thoracic nor the abdominal apnea monitor can distinguish between central and
obstructive apnea. Currently, only the thermistor and proximal airway pressure sensing apnea
monitors can make this distinction. Neither is likely to be found in the developing world. A
thermistor monitor measures the temperature of the air entering or exciting the nostrils. A
proximal airway pressure sensor measures the change in pressure at the mouth and nose.


2.13.2 Common Problems


The most frequent source of error is caused by false alarms. The worst case is when an apnea
monitor fails to alarm during apnea because it senses artifact and interprets it as respiration
(false negative). Artifacts include vibration from equipment, interference from the ECG, and
patient movement. Electrical impedance monitors are the most prone to this type of error.


A false positive (when the alarm sounds unnecessarily) is often caused by infant movement that
loosens an electrode or sensor. Also, a false positive alarm may sound when the child is
breathing normally but too shallowly for the monitor to detect.


For any false alarms first consider user error. The alarm limits may be set inappropriately. They
can be confusing to program, and may need to be changed as the patient matures. Never
change a limit without consulting with the physician.


The next most likely cause of false alarms is the electrodes. The electrodes may not be placed
correctly (across the chest). Or, the sensor is in a belt, the belt may be too loose. Ask a nurse
to help with tightening the belt, as an excessively tight belt can lead to complications.


If the electrodes are placed correctly, they may be dirty or old. Try rinsing them in isopropyl
alcohol, then water. Electrode belts can be gently cleaned with soap and water. Be careful to
rinse off all soap residue and hang to dry before applying to the patient’s skin. Also, check to see
if the skin is dirty. The child may have lotion or powder on the skin under the electrodes. You
can clean the child’s skin with soap and water. In some cases, electrode paste can be used, and
may improve the measurements.


2.13.3 Suggested Minimal Testing


Apnea monitors are easily tested on yourself. Hold your breath to trigger an alarm. If the alarm
doesn’t sound when you are breathing normally and does sound when you hold your breath, the
apnea monitor is ready to release to the floor. If the machine is a respiration rate meter, check
to see that the rate matches what you measure when you count breaths with a watch. If the
apnea monitor includes ECG, be sure to check your heart rate against the machines rate. The
rates should be very close (within 5 beats per minute).




Respiratory+Monitor+Preventative+Maintenance+
Preventative)Maintenance)


• Keep$belt$devoid$of$dirt$and$debris.$Clean$regularly$with$soap$and$water$• Clean$electrodes$after$each$use$• Check$all$cords$for$defects$and$replace$as$needed$Regularly+check+device7measured+respiratory+rate+with+a+manual+measurement+
+$)




Respiratory+Monitor+Repair+and+Troubleshooting+


!




Description+#! Text+Box! Comments!
1! Start:!Respiratory!Monitor!troubleshooting!!! Begin!diagnostic!process!for!a!work!order!for!Respiratory!Monitor.!
2! Is!the!respiratory!monitor!free!of!any!external!damage/defects?! Inspect!respiratory!monitor!for!external!cracks,!broken!switch!etc.!
3! Identify!and!replace!damaged!switches,!indicators.! Refer!BTA!skill!set!on!Switches!and!Lighting/Indicators!to!identify!and!replace!damaged!switches!and!indicators.!
4! Clean!casing,!electrodes!using!Alcohol!and!then!water.! Examine!casing,!electrodes!and!cables!for!dirt!and!contamination.!Refer!BTA!skill!set!on!Cleaning!to!clean!the!respiratory!monitor.!
5! Does!the!respiratory!monitor!power!on!from!ac!power!line?! Power!the!device!from!ac!line!and!turn!it!on.!
6! Identify!and!replace!blown!fuse.! Refer!BTA!skill!set!on!Fuse!to!identify!and!replace!blown!fuse.!
7! Inspect!and!fix!broken!wires!or!bad!connections!inside!the!respiratory!monitor.! Inspect!wires!and!connections!from!power!supply!circuit!board!to!other!boards!using!multimeter.!Refer!BTA!skill!set!on!Connections!for!identifying!and!fixing!broken!wires!and!bad!connections.!
8! Inspect!AC!adapter!cable!for!cuts,!broken!wires!and!replace!if!necessary.! Refer!BTA!skill!set!on!Connections!and!Connectors!for!identifying!and!replacing!damaged!cables.!
9! Troubleshoot!power!supply.! Most!respiratory!monitors!can!power!on!from!battery!and!ac!power!mains.!
10! Does!the!respiratory!monitor!power!on!with!battery!(if!this!option!is!available)?! Disconnect!respiratory!monitor!from!ac!power!line.!Turn!the!device!on.!If!respiratory!monitor!fails!to!power!on!then!battery!is!fully!depleted!or!damaged.!
11! Recharge!battery!if!applicable!or!replace!it.! Refer!BTA!skill!set!on!Batteries!to!replace!and!identify!damaged!batteries.!
12! Troubleshoot!charging!circuit!if!battery!doesn't!or!charges!very!slowly.! Refer!BTA!skill!set!on!Transformer!and!Regulators!to!troubleshoot!charging!circuit.!
13! Hold!breath!for!few!seconds.!!!!!!!!!!!!!! Place!electrodes/belt!as!required!and!turn!the!device!on.!Hold!breath!for!few!seconds.!




14! Does!the!alarm!trigger?! All!respiratory!and!apnea!monitors!are!designed!to!detect!and!trigger!an!alarm!when!there!is!a!breathing!pause!for!a!period!of!time.!15! Are!the!alarm!limits!properly!set?! Alarm!limits!can!be!modified!by!the!user.!16! Correct!the!alarm!limits.!!! Refer!device!manual!for!correcting!alarm!limits.!
17! Does!the!device!use!impedance!method!to!measure!respiratory!rate?!


There!are!two!types!of!respiratory!monitors!commonly!found!in!the!developing!world.!Transthoracic+electrical+impedance!makes!use!of!electrodes.!Pneumatic+abdominal!type!makes!use!of!a!belt.!
18! Are!the!electrodes!free!of!damage,!dirt?! Electrodes!should!be!clean!and!dry.!Inspect!the!electrode!cables!and!connectors!for!cuts!and!broken!wires.!
19! Clean!electrodes!using!alcohol!and!then!water.!Replace!damaged!electrodes.!! Refer!BTA!skill!set!on!Connections!and!Connectors!for!identifying!and!replacing!damaged!cables.!
20! Were!the!electrodes!placed!correctly!on!the!chest!during!testing?! User!error!is!one!of!the!main!reasons!for!false!alarms.!
21! Ensure!proper!placement!of!electrodes!in!the!5th!intercostal!space!on!each!side.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! The!5th!intercostal!space!is!between!the!5th!and!6th!ribs.!
22! Troubleshoot!internal!circuitry.!!! Improper!functioning!of!internal!circuitry!is!a!common!reason!for!the!failure!of!transthoracic!impedance!type!respiratory!monitor.!See!BTA!skills!on!Electrical!Simple.!23! Go!back!to!step!13.! Restart!calibration!process.!
24! Is!the!belt!free!of!damage,!dirt?! Belts!should!be!clean!and!dry.!Inspect!the!cables!and!connectors!for!cuts!and!broken!wires.!
25! Clean!belt!using!soap!and!then!water.!Replace!damaged!belts.!! Refer!BTA!skill!set!on!Connections!and!Connectors!for!identifying!and!replacing!damaged!cables.!
26! Was!the!belt!tightly!placed!around!the!abdomen!during!testing?! User!error!is!one!of!the!main!reasons!for!false!alarms.!27! Ensure!proper!placement!of!belt!around!abdomen.!! Excessively!tight!belt!can!lead!to!complications.!
28! Troubleshoot!displacement!sensor.! Improper!functioning!of!displacement!sensor!(LVDT!or!strain!gauge)!is!a!common!reason!for!the!failure!of!pneumatic!abdominal!sensor!type!




respiratory!monitor.!
29! Does!the!respiratory!monitor!display!respiratory!rate!value?! Apnea!monitors!are!provided!with!only!the!alarm!feature.!But!respiratory!monitors!have!the!alarm!feature!and!can!also!display!the!respiratory!rate!value.!
30! Measure!respiratory!rate!manually!using!a!stop!watch.!!!!!!!!!!!!!! Manually!count!the!number!of!breaths!for!a!period!of!20s!using!stopwatch.!Multiply!result!by!3.!
31! Does!the!measured!respiratory!rate!matches!with!the!value!displayed!on!the!Respiratory!Monitor?! Improper!functioning!of!internal!circuitry!or!damaged!electrodes/belts!if!there!is!a!mismatch!between!the!measured!respiratory!rate!and!the!rate!displayed!on!the!Respiratory!Monitor.!
32! Perform!preventive!maintenance!on!Respiratory!monitor.!Return!device!to!clinical!personnel.!!!


Respiratory!Monitor!is!working!properly.!Perform!preventive!maintenance!before!returning!the!device!to!clinical!personnel.!!!
+!)




****SECTION*E:*Temperature*Monitors** *




*7.*Operation,*Use,*and*Maintenance*of*Temperature*Monitors****Featured*in*this*Section:*** Developing'World'Healthcare'Technology'Laboratory.'“Temperature'Monitors.”'From'the'Publication:'“Biomedical'Technicians'Training'Program,'Session'3'v2,'Special'Topics:'Cardiac'Equipment.”'Engineering(World(Health,'March'1,'2011,'p.'1H161.'*Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Temperature'Monitors.'EWH.'2012.(((Wikipedia.'“Human'Body'Temperature.”'Wikipedia,(p.(1H6.'Retrieved'from:''https://en.wikipedia.org/wiki/Human_body_temperature'**




*WOCP DQF[ VGORGTCVWTG


ནཔ TGFKTGEVU JGTG (QT QVJGT WUGU UGG FKUCO
DKIWCVKQP


Normal human body temperature CNUQ MPQYP CU nor-
mothermia QT euthermia FGRGPFU WRQP VJG RNCEG KP VJG
DQF[ CV YJKEJ VJG OGCUWTGOGPV KU OCFG VJG VKOG QH FC[
CU YGNN CU VJG CEVKXKV[ NGXGN QH VJG RGTUQP 0GXGTVJGNGUU
EQOOQPN[ OGPVKQPGF V[RKECN XCNWGU CTG
1TCN WPFGT VJG VQPIWG r q% r q(=?


+PVGTPCN TGEVCN XCIKPCN q% q(=?


&KាGTGPV RCTVU QH VJG DQF[ JCXG FKាGTGPV VGORGTCVWTGU
4GEVCN CPF XCIKPCN OGCUWTGOGPVU VCMGP FKTGEVN[ KPUKFG
VJG DQF[ ECXKV[ CTG V[RKECNN[ UNKIJVN[ JKIJGT VJCP QTCN
OGCUWTGOGPVU CPF QTCN OGCUWTGOGPVU CTG UQOGYJCV
JKIJGT VJCP UMKP OGCUWTGOGPVU 1VJGT RNCEGU UWEJ CU
WPFGT VJG CTO QT KP VJG GCT RTQFWEG FKាGTGPV V[RKECN
VGORGTCVWTGU=? #NVJQWIJ UQOG RGQRNG VJKPM QH VJGUG CX
GTCIGU CU TGRTGUGPVKPI VJG PQTOCN QT KFGCN VGORGTCVWTG
C YKFG TCPIG QH VGORGTCVWTGU JCU DGGP HQWPF KP JGCNVJ[
RGQRNG=?


6JG DQF[ VGORGTCVWTG QH C JGCNVJ[ RGTUQP XCTKGU FWTKPI
VJG FC[ D[ CDQWV q% q( YKVJ NQYGT VGORGTC
VWTGU KP VJG OQTPKPI CPF JKIJGT VGORGTCVWTGU KP VJG NCVG
CHVGTPQQP CPF GXGPKPI CU VJG DQF[ཐU PGGFU CPF CEVKXK
VKGU EJCPIG=? 1VJGT EKTEWOUVCPEGU CNUQ CាGEV VJG DQF[ཐU
VGORGTCVWTG 6JG EQTG DQF[ VGORGTCVWTG QH CP KPFKXKF
WCN VGPFU VQ JCXG VJG NQYGUV XCNWG KP VJG UGEQPF JCNH QH VJG
UNGGR E[ENG VJG NQYGUV RQKPV ECNNGF VJG PCFKT KU QPG QH VJG
RTKOCT[ OCTMGTU HQT EKTECFKCP TJ[VJOU 6JG DQF[ VGO
RGTCVWTG CNUQ EJCPIGU YJGP C RGTUQP KU JWPIT[ UNGGR[
UKEM QT EQNF


1 Methods of measurement


6CMKPI C RGTUQPཐU VGORGTCVWTG KU CP KPKVKCN RCTV QH C HWNN
ENKPKECN GZCOKPCVKQP 6JGTG CTG XCTKQWU V[RGU QH OGFKECN
VJGTOQOGVGTU CU YGNN CU UKVGU WUGF HQT OGCUWTGOGPV KP
ENWFKPI


• +P VJG CPWU TGEVCN VGORGTCVWTG


• +P VJG OQWVJ QTCN VGORGTCVWTG


• 7PFGT VJG CTO CZKNNCT[ VGORGTCVWTG


• +P VJG GCT V[ORCPKE VGORGTCVWTG


• +P VJG XCIKPC XCIKPCN VGORGTCVWTG


" NFEJDBM UIFSNPNFUFS TIPXJOH B UFNQFSBUVSF SFBEJOH PG
p$


• +P VJG DNCFFGT


• 1P VJG UMKP QH VJG HQTGJGCF QXGT VJG VGORQTCN CTVGT[


2 Variations


%JVSOBM WBSJBUJPO JO CPEZ UFNQFSBUVSF SBOHJOH GSPN BCPVU
p$ GSPN BN UP QN BOE GBMMJOH UP BCPVU p$ GSPN
BN UP BN


6GORGTCVWTG EQPVTQN VJGTOQTGIWNCVKQP KU RCTV QH C
JQOGQUVCVKE OGEJCPKUO VJCV MGGRU VJG QTICPKUO CV QR
VKOWO QRGTCVKPI VGORGTCVWTG CU KV CាGEVU VJG TCVG QH
EJGOKECN TGCEVKQPU +P JWOCPU VJG CXGTCIG KPVGTPCN VGO
RGTCVWTG KU q% q( VJQWIJ KV XCTKGU COQPI KPFK
XKFWCNU *QYGXGT PQ RGTUQP CNYC[U JCU GZCEVN[ VJG UCOG
VGORGTCVWTG CV GXGT[ OQOGPV QH VJG FC[ 6GORGTCVWTGU
E[ENG TGIWNCTN[ WR CPF FQYP VJTQWIJ VJG FC[ CU EQPVTQNNGF
D[ VJG RGTUQPཐU EKTECFKCP TJ[VJO 6JG NQYGUV VGORGTC
VWTG QEEWTU CDQWV VYQ JQWTU DGHQTG VJG RGTUQP PQTOCNN[
YCMGU WR #FFKVKQPCNN[ VGORGTCVWTGU EJCPIG CEEQTFKPI
VQ CEVKXKVKGU CPF GZVGTPCN HCEVQTU=?





7"3*"5*0/4


+P CFFKVKQP VQ XCT[KPI VJTQWIJQWV VJG FC[ PQTOCN DQF[
VGORGTCVWTG OC[ CNUQ FKាGT CU OWEJ CU q% q(
HTQO QPG FC[ VQ VJG PGZV UQ VJCV VJG JKIJGUV QT NQYGUV
VGORGTCVWTGU QP QPG FC[ YKNN PQV CNYC[U GZCEVN[ OCVEJ
VJG JKIJGUV QT NQYGUV VGORGTCVWTGU QP VJG PGZV FC[
0QTOCN JWOCP DQF[ VGORGTCVWTG XCTKGU UNKIJVN[ HTQO
RGTUQP VQ RGTUQP CPF D[ VJG VKOG QH FC[ %QPUGSWGPVN[
GCEJ V[RG QH OGCUWTGOGPV JCU C TCPIG QH PQTOCN VGORGT
CVWTGU 6JG TCPIG HQT PQTOCN JWOCP DQF[ VGORGTCVWTGU
VCMGP QTCNN[ KU r q% r q(=? 6JKU OGCPU
VJCV CP[ QTCN VGORGTCVWTG DGVYGGP CPF q%
CPF q( KU NKMGN[ VQ DG PQTOCN
6JG PQTOCN JWOCP DQF[ VGORGTCVWTG KU QHVGP UVCVGF CU
ཊ q% ཊ q(=? +P CFWNVU C TGXKGY QH
VJG NKVGTCVWTG JCU HQWPF C YKFGT TCPIG QH ཊ q%
ཊ q( HQT PQTOCN VGORGTCVWTGU FGRGPFKPI QP
VJG IGPFGT CPF NQECVKQP OGCUWTGF=?


2.1 Natural rhythms


$QF[ VGORGTCVWTG PQTOCNN[ ីWEVWCVGU QXGT VJG FC[ YKVJ
VJG NQYGUV NGXGNU CTQWPF CO CPF VJG JKIJGUV KP VJG
NCVG CHVGTPQQP DGVYGGP CPF RO CUUWOKPI
VJG RGTUQP UNGGRU CV PKIJV CPF UVC[U CYCMG FWTKPI VJG
FC[=?=? 6JGTGHQTG CP QTCN VGORGTCVWTG QH q%
q( YQWNF UVTKEVN[ URGCMKPI DG C PQTOCN JGCNVJ[ VGORGT
CVWTG KP VJG CHVGTPQQP DWV PQV KP VJG GCTN[ OQTPKPI=? #P
KPFKXKFWCNཐU DQF[ VGORGTCVWTG V[RKECNN[ EJCPIGU D[ CDQWV
q% q( DGVYGGP KVU JKIJGUV CPF NQYGUV RQKPVU GCEJ
FC[=?=?


$QF[ VGORGTCVWTG KU UGPUKVKXG VQ OCP[ JQTOQPGU UQ
YQOGP JCXG C VGORGTCVWTG TJ[VJO VJCV XCTKGU YKVJ
VJG OGPUVTWCN E[ENG ECNNGF C DJSDBNFOTBM TJ[VJO=? #
YQOCPཐU DCUCN DQF[ VGORGTCVWTG TKUGU UJCTRN[ CHVGT QXW
NCVKQP CU GUVTQIGP RTQFWEVKQP FGETGCUGU CPF RTQIGUVGTQPG
KPETGCUGU (GTVKNKV[ CYCTGPGUU RTQITCOU WUG VJKU RTG
FKEVCDNG EJCPIG VQ KFGPVKH[ YJGP C YQOCP ECP DGEQOG
RTGIPCPV &WTKPI VJG NWVGCN RJCUG QH VJG OGPUVTWCN E[ENG
DQVJ VJG NQYGUV CPF VJG CXGTCIG VGORGTCVWTGU CTG UNKIJVN[
JKIJGT VJCP FWTKPI QVJGT RCTVU QH VJG E[ENG *QYGXGT
VJG COQWPV VJCV VJG VGORGTCVWTG TKUGU FWTKPI GCEJ FC[ KU
UNKIJVN[ NQYGT VJCP V[RKECN UQ VJG JKIJGUV VGORGTCVWTG QH
VJG FC[ KU PQV XGT[ OWEJ JKIJGT VJCP WUWCN=? *QTOQPCN
EQPVTCEGRVKXGU DQVJ UWRRTGUU VJG EKTECOGPUCN TJ[VJO CPF
TCKUG VJG V[RKECN DQF[ VGORGTCVWTG D[ CDQWV q%
q(=?


6GORGTCVWTG CNUQ XCTKGU YKVJ VJG EJCPIG QH UGCUQPU
FWTKPI GCEJ [GCT 6JKU RCVVGTP KU ECNNGF C DJSDBOOVBM
TJ[VJO=? 5VWFKGU QH UGCUQPCN XCTKCVKQPU JCXG RTQFWEGF
KPEQPUKUVGPV TGUWNVU 2GQRNG NKXKPI KP FKាGTGPV ENKOCVGU
OC[ JCXG FKាGTGPV UGCUQPCN RCVVGTPU
+PETGCUGF RJ[UKECN ិVPGUU KPETGCUGU VJG COQWPV QH FCKN[
XCTKCVKQP KP VGORGTCVWTG=?


9KVJ KPETGCUGF CIG DQVJ CXGTCIG DQF[ VGORGTCVWTG CPF
VJG COQWPV QH FCKN[ XCTKCDKNKV[ KP VJG DQF[ VGORGTCVWTG


VGPF VQ FGETGCUG=? 'NFGTN[ RCVKGPVU OC[ JCXG C FG
ETGCUGF CDKNKV[ VQ IGPGTCVG DQF[ JGCV FWTKPI C HGXGT UQ
GXGP C UQOGYJCV GNGXCVGF VGORGTCVWTG ECP KPFKECVG C UG
TKQWU WPFGTN[KPI ECWUG KP IGTKCVTKEU


2.2 Measurement methods


&KាGTGPV OGVJQFU WUGF HQT OGCUWTKPI VGORGTCVWTG RTQ
FWEG FKាGTGPV TGUWNVU 6JG VGORGTCVWTG TGCFKPI FGRGPFU
QP YJKEJ RCTV QH VJG DQF[ KU DGKPI OGCUWTGF 6JG V[RK
ECN FC[VKOG VGORGTCVWTGU COQPI JGCNVJ[ CFWNVU CTG CU HQN
NQYU


• 6GORGTCVWTG KP VJG CPWU TGEVWOTGEVCN XCIKPC QT
KP VJG GCT QVKE KU CDQWV q% q(=?


• 6GORGTCVWTG KP VJG OQWVJ QTCN KU CDQWV q%
q(=?


• 6GORGTCVWTG WPFGT VJG CTO CZKNNCT[ KU CDQWV
q% q(=?


)GPGTCNN[ QTCN TGEVCN IWV CPF EQTG DQF[ VGORGTCVWTGU
CNVJQWIJ UNKIJVN[ FKាGTGPV CTG YGNNEQTTGNCVGF YKVJ QTCN
VGORGTCVWTG DGKPI VJG NQYGUV QH VJG HQWT 1TCN VGORGTC
VWTGU CTG IGPGTCNN[ CDQWV q% q( NQYGT VJCP TGEVCN
VGORGTCVWTGU=?


1TCN VGORGTCVWTGU CTG KPីWGPEGF D[ FTKPMKPI EJGYKPI
UOQMKPI CPF DTGCVJKPI YKVJ VJG OQWVJ QRGP %QNF
FTKPMU QT HQQF TGFWEG QTCN VGORGTCVWTGU JQV FTKPMU JQV
HQQF EJGYKPI CPF UOQMKPI TCKUG QTCN VGORGTCVWTGU=?


#ZKNNCT[ CTORKV V[ORCPKE GCT CPF QVJGT UMKPDCUGF
VGORGTCVWTGU EQTTGNCVG TGNCVKXGN[ RQQTN[ YKVJ EQTG DQF[
VGORGTCVWTG=? 6[ORCPKEOGCUWTGOGPVU TWP JKIJGT VJCP
TGEVCN CPF EQTG DQF[ OGCUWTGOGPVU CPF CZKNNCT[ VGORGT
CVWTGU TWP NQYGT=? 6JG DQF[ WUGU VJG UMKP CU C VQQN VQ KP
ETGCUG QT FGETGCUG EQTG DQF[ VGORGTCVWTG YJKEJ CាGEVU
VJG VGORGTCVWTG QH VJG UMKP 5MKPDCUGF VGORGTCVWTGU CTG
OQTG XCTKCDNG VJCP QVJGT OGCUWTGOGPV UKVGU=? 6JG RGCM
FCKN[ VGORGTCVWTG HQT CZKNNCT[ OGCUWTGOGPVU NCIU CDQWV
VJTGG JQWTU DGJKPF VJG TGUV QH VJG DQF[=? 5MKP VGORGT
CVWTGU CTG CNUQ OQTG KPីWGPEGF D[ QWVUKFG HCEVQTU UWEJ
CU ENQVJKPI CPF CKT VGORGTCVWTG
'CEJ OGCUWTGOGPV OGVJQF CNUQ JCU FKាGTGPV PQTOCN
TCPIGU FGRGPFKPI QP UGZ


2.3 Variations due to outside factors


/CP[ QWVUKFG HCEVQTU CាGEV VJG OGCUWTGF VGORGTCVWTG CU
YGNN ན0QTOCNཔ XCNWGU CTG IGPGTCNN[ IKXGP HQT CP QVJGT
YKUG JGCNVJ[ PQPHCUVKPI CFWNV FTGUUGF EQOHQTVCDN[ KP
FQQTU KP C TQQO VJCV KU MGRV CV C PQTOCN TQQO VGORGTC
VWTG VQ q% VQ q( FWTKPI VJG OQTPKPI
DWV PQV UJQTVN[ CHVGT CTKUKPI HTQO UNGGR (WTVJGTOQTG
HQT QTCN VGORGTCVWTGU VJG UWDLGEV OWUV PQV JCXG GCVGP
FTWPM QT UOQMGF CP[VJKPI KP CV NGCUV VJG RTGXKQWU ិHVGGP




)ZQFSUIFSNJB


VQ VYGPV[ OKPWVGU CU VJG VGORGTCVWTG QH VJG HQQF FTKPM
QT UOQMG ECP FTCOCVKECNN[ CាGEV VJG TGCFKPI
6GORGTCVWTG KU KPETGCUGF CHVGT GCVKPI QT FTKPMKPI CP[
VJKPI YKVJ ECNQTKGU %CNQTKE TGUVTKEVKQP CU HQT C YGKIJV
NQUU FKGV FGETGCUGU QXGTCNN DQF[ VGORGTCVWTG=? &TKPM
KPI CNEQJQN FGETGCUGU VJG COQWPV QH FCKN[ EJCPIG UNKIJVN[
NQYGTKPI FC[VKOG VGORGTCVWTGU CPF PQVKEGCDN[ TCKUKPI
PKIJVVKOG VGORGTCVWTGU=?


'ZGTEKUG TCKUGU DQF[ VGORGTCVWTGU +P CFWNVU C PQVKEGCDNG
KPETGCUG WUWCNN[ TGSWKTGU UVTGPWQWU GZGTEKUG QT GZGTEKUG
UWUVCKPGF QXGT C UKIPKិECPV VKOG %JKNFTGP FGXGNQR JKIJGT
VGORGTCVWTGU YKVJ OKNFGT CEVKXKVKGU NKMG RNC[KPI
2U[EJQNQIKECN HCEVQTU CNUQ KPីWGPEG DQF[ VGORGTCVWTG C
XGT[ GZEKVGF RGTUQP QHVGP JCU CP GNGXCVGF VGORGTCVWTG
9GCTKPI OQTG ENQVJKPI UNQYU FCKN[ VGORGTCVWTG EJCPIGU
CPF TCKUGU DQF[ VGORGTCVWTG=? 5KOKNCTN[ UNGGRKPI YKVJ
CP GNGEVTKE DNCPMGV TCKUGU VJG DQF[ VGORGTCVWTG CV PKIJV=?


5NGGR FKUVWTDCPEGU CNUQ CាGEV VGORGTCVWTGU 0QTOCNN[
DQF[ VGORGTCVWTG FTQRU UKIPKិECPVN[ CV C RGTUQPཐU PQT
OCN DGFVKOG CPF VJTQWIJQWV VJG PKIJV 5JQTVVGTO UNGGR
FGRTKXCVKQP RTQFWEGU C JKIJGT VGORGTCVWTG CV PKIJV VJCP
PQTOCN DWV NQPIVGTO UNGGR FGRTKXCVKQP CRRGCTU VQ TG
FWEG VGORGTCVWTGU=? +PUQOPKC CPF RQQT UNGGR SWCNKV[
CTG CUUQEKCVGF YKVJ UOCNNGT CPF NCVGT FTQRU KP DQF[
VGORGTCVWTG=? 5KOKNCTN[ YCMKPI WR WPWUWCNN[ GCTN[
UNGGRKPI KP LGV NCI CPF EJCPIGU VQ UJKHV YQTM UEJGFWNGU
OC[ CាGEV DQF[ VGORGTCVWTG=?


3 Specific temperature concepts


3.1 Fever


/CKP CTVKENG (GXGT


# VGORGTCVWTG UGVRQKPV KU VJG NGXGN CV YJKEJ VJG DQF[ CV
VGORVU VQ OCKPVCKP KVU VGORGTCVWTG 9JGP VJG UGVRQKPV KU
TCKUGF VJG TGUWNV KU C HGXGT /QUV HGXGTU CTG ECWUGF D[
KPHGEVKQWU FKUGCUG CPF ECP DG NQYGTGF KH FGUKTGF YKVJ
CPVKR[TGVKE OGFKECVKQPU
#P GCTN[ OQTPKPI VGORGTCVWTG JKIJGT VJCP q%
q( QT C NCVG CHVGTPQQP VGORGTCVWTG JKIJGT VJCP q%
q( KU PQTOCNN[ EQPUKFGTGF C HGXGT CUUWOKPI VJCV
VJG VGORGTCVWTG KU GNGXCVGF FWG VQ C EJCPIG KP VJG J[
RQVJCNCOWUཐU UGVRQKPV=? .QYGT VJTGUJQNFU CTG UQOGVKOGU
CRRTQRTKCVG HQT GNFGTN[ RGQRNG=? 6JG PQTOCN FCKN[ VGO
RGTCVWTG XCTKCVKQP KU V[RKECNN[ q% q( DWV ECP
DG ITGCVGT COQPI RGQRNG TGEQXGTKPI HTQO C HGXGT=?


#P QTICPKUO CV QRVKOWO VGORGTCVWTG KU EQPUKFGTGF
BGFCSJMF QT BQZSFYJD OGCPKPI ནYKVJQWV HGXGTཔ +H VGORGTC
VWTG KU TCKUGF DWV VJG UGVRQKPV KU PQV TCKUGF VJGP VJG TGUWNV
KU J[RGTVJGTOKC


3.2 Hyperthermia


/CKP CTVKENG *[RGTVJGTOKC


*[RGTVJGTOKC QEEWTU YJGP VJG DQF[ RTQFWEGU QT CDUQTDU
OQTG JGCV VJCP KV ECP FKUUKRCVG +V KU WUWCNN[ ECWUGF
D[ RTQNQPIGF GZRQUWTG VQ JKIJ VGORGTCVWTGU 6JG JGCV
TGIWNCVKPI OGEJCPKUOU QH VJG DQF[ GXGPVWCNN[ DGEQOG
QXGTYJGNOGF CPF WPCDNG VQ FGCN GាGEVKXGN[ YKVJ VJG JGCV
ECWUKPI VJG DQF[ VGORGTCVWTG VQ ENKOD WPEQPVTQNNCDN[
*[RGTVJGTOKC CV QT CDQXG CDQWV q% q( KU C NKHG
VJTGCVGPKPI OGFKECN GOGTIGPE[ VJCV TGSWKTGU KOOGFKCVG
VTGCVOGPV %QOOQP U[ORVQOU KPENWFG JGCFCEJG EQPHW
UKQP CPF HCVKIWG +H UYGCVKPI JCU TGUWNVGF KP FGJ[FTCVKQP
VJGP VJG CាGEVGF RGTUQP OC[ JCXG FT[ TGF UMKP
+P C OGFKECN UGVVKPI OKNF J[RGTVJGTOKC KU EQOOQPN[
ECNNGF IFBU FYIBVTUJPO QT IFBU QSPTUSBUJPO UGXGTG J[RGT
VJGTOKC KU ECNNGF IFBU TUSPLF *GCV UVTQMG OC[ EQOG
QP UWFFGPN[ DWV KV WUWCNN[ HQNNQYU VJG WPVTGCVGF OKNFGT
UVCIGU 6TGCVOGPV KPXQNXGU EQQNKPI CPF TGJ[FTCVKPI VJG
DQF[ HGXGTTGFWEKPI FTWIU CTG WUGNGUU HQT VJKU EQPFKVKQP
6JKU OC[ DG FQPG VJTQWIJ OQXKPI QWV QH FKTGEV UWPNKIJV
VQ C EQQNGT CPF UJCFGF GPXKTQPOGPV FTKPMKPI YCVGT TG
OQXKPI ENQVJKPI VJCV OKIJV MGGR JGCV ENQUG VQ VJG DQF[
QT UKVVKPI KP HTQPV QH C HCP $CVJKPI KP VGRKF QT EQQN YCVGT
QT GXGP LWUV YCUJKPI VJG HCEG CPF QVJGT GZRQUGF CTGCU QH
VJG UMKP ECP DG JGNRHWN
9KVJ HGXGT VJG DQF[ཐU EQTG VGORGTCVWTG TKUGU VQ C JKIJGT
VGORGTCVWTG VJTQWIJ VJG CEVKQP QH VJG RCTV QH VJG DTCKP
VJCV EQPVTQNU VJG DQF[ VGORGTCVWTG YKVJ J[RGTVJGTOKC
VJG DQF[ VGORGTCVWTG KU TCKUGF YKVJQWV VJG EQPUGPV QH VJG
JGCV EQPVTQN EGPVGTU


3.3 Hypothermia


/CKP CTVKENG *[RQVJGTOKC


+P J[RQVJGTOKC DQF[ VGORGTCVWTG FTQRU DGNQY VJCV TG
SWKTGF HQT PQTOCN OGVCDQNKUO CPF DQFKN[ HWPEVKQPU +P
JWOCPU VJKU KU WUWCNN[ FWG VQ GZEGUUKXG GZRQUWTG VQ EQNF
CKT QT YCVGT DWV KV ECP DG FGNKDGTCVGN[ KPFWEGF CU C OGFK
ECN VTGCVOGPV 5[ORVQOU WUWCNN[ CRRGCT YJGP VJG DQF[ཐU
EQTG VGORGTCVWTG FTQRU D[ ཊ q% ཊ q( DGNQY
PQTOCN VGORGTCVWTG


3.4 Basal body temperature


/CKP CTVKENG $CUCN DQF[ VGORGTCVWTG


$CUCN DQF[ VGORGTCVWTG KU VJG NQYGUV VGORGTCVWTG CV
VCKPGF D[ VJG DQF[ FWTKPI TGUV WUWCNN[ FWTKPI UNGGR +V KU
IGPGTCNN[ OGCUWTGF KOOGFKCVGN[ CHVGT CYCMGPKPI CPF DG
HQTG CP[ RJ[UKECN CEVKXKV[ JCU DGGP WPFGTVCMGP CNVJQWIJ
VJG VGORGTCVWTG OGCUWTGF CV VJCV VKOG KU UQOGYJCV JKIJGT




)6."/ 5&.1&3"563& 7"3*"5*0/ &''&$54


VJCP VJG VTWG DCUCN DQF[ VGORGTCVWTG +P YQOGP VGORGT
CVWTG FKាGTU CV XCTKQWU RQKPVU KP VJG OGPUVTWCN E[ENG CPF
VJKU ECP DG WUGF KP VJG NQPIVGTO VQ VTCEM QXWNCVKQP DQVJ
HQT VJG RWTRQUG QH CKFKPI EQPEGRVKQP QT CXQKFKPI RTGI
PCPE[ 6JKU RTQEGUU KU ECNNGF HGTVKNKV[ CYCTGPGUU


3.5 Core temperature


%QTG VGORGTCVWTG CNUQ ECNNGF EQTG DQF[ VGORGTCVWTG KU
VJG QRGTCVKPI VGORGTCVWTG QH CP QTICPKUO URGEKិECNN[ KP
FGGR UVTWEVWTGU QH VJG DQF[ UWEJ CU VJG NKXGT KP EQORCT
KUQP VQ VGORGTCVWTGU QH RGTKRJGTCN VKUUWGU %QTG VGORGT
CVWTG KU PQTOCNN[ OCKPVCKPGF YKVJKP C PCTTQY TCPIG UQ
VJCV GUUGPVKCN GP\[OCVKE TGCEVKQPU ECP QEEWT 5KIPKិECPV
EQTG VGORGTCVWTG GNGXCVKQP J[RGTVJGTOKC QT FGRTGUUKQP
J[RQVJGTOKC VJCV KU RTQNQPIGF HQT OQTG VJCP C DTKGH RG
TKQF QH VKOG KU KPEQORCVKDNG YKVJ JWOCP NKHG
6GORGTCVWTG GZCOKPCVKQP KP VJG TGEVWO KU VJG VTCFKVKQPCN
IQNF UVCPFCTFOGCUWTGOGPV WUGF VQ GUVKOCVG EQTG VGORGT
CVWTG QTCN VGORGTCVWTG KU CាGEVGF D[ JQV QT EQNF FTKPMU
CPF OQWVJDTGCVJKPI 4GEVCN VGORGTCVWTG KU GZRGEVGF
VQ DG CRRTQZKOCVGN[ QPG (CJTGPJGKV FGITGG JKIJGT VJCP
CP QTCN VGORGTCVWTG VCMGP QP VJG UCOG RGTUQP CV VJG
UCOG VKOG 'CT VJGTOQOGVGTU OGCUWTG GCTFTWO VGORGT
CVWTG WUKPI KPHTCTGF UGPUQTU 6JG DNQQF UWRRN[ VQ VJG
V[ORCPKE OGODTCPG KU UJCTGF YKVJ VJG DTCKP *QYGXGT
VJKU OGVJQF QH OGCUWTKPI DQF[ VGORGTCVWTG KU PQV CU CE
EWTCVG CU TGEVCN OGCUWTGOGPV CPF JCU C NQY UGPUKVKXKV[
HQT HGXGTU OKUUKPI VJTGG QT HQWT QWV QH GXGT[ VGP HGXGTU
KP EJKNFTGP=? 'CT VGORGTCVWTG OGCUWTGOGPV OC[ DG CE
EGRVCDNG HQT QDUGTXKPI VTGPFU KP DQF[ VGORGTCVWTG DWV KU
NGUU WUGHWN KP EQPUKUVGPVN[ KFGPVKH[KPI HGXGTU
7PVKN TGEGPVN[ FKTGEV OGCUWTGOGPV QH EQTG DQF[ VGORGT
CVWTG TGSWKTGF UWTIKECN KPUGTVKQP QH C RTQDG UQ C XCTK
GV[ QH KPFKTGEV OGVJQFU JCXG EQOOQPN[ DGGP WUGF 6JG
TGEVCN QT XCIKPCN VGORGTCVWTG KU IGPGTCNN[ EQPUKFGTGF VQ
IKXG VJG OQUV CEEWTCVG CUUGUUOGPV QH EQTG DQF[ VGORGT
CVWTG RCTVKEWNCTN[ KP J[RQVJGTOKC +P VJG GCTN[ U
KPIGUVKDNG VJGTOKUVQTU KP ECRUWNG HQTO YGTG RTQFWEGF CN
NQYKPI VJG VGORGTCVWTG KPUKFG VJG FKIGUVKXG VTCEV VQ DG
VTCPUOKVVGF VQ CP GZVGTPCN TGEGKXGT QPG UVWF[ HQWPF VJCV
VJGUG YGTG EQORCTCDNG KP CEEWTCE[ VQ TGEVCN VGORGTCVWTG
OGCUWTGOGPV=?


4 Human temperature variation
effects


4.1 Hot


• q% q( QT OQTG ཊ #NOQUV EGTVCKPN[ FGCVJ
YKNN QEEWT JQYGXGT RGQRNG JCXG DGGP MPQYP VQ UWT
XKXG WR VQ q% q(=?


• q% q( ཊ 0QTOCNN[ FGCVJ QT VJGTG OC[ DG
UGTKQWU DTCKP FCOCIG EQPVKPWQWU EQPXWNUKQPU CPF


UJQEM %CTFKQTGURKTCVQT[ EQNNCRUG YKNN NKMGN[ QEEWT


• q% q( ཊ 5WDLGEV OC[ VWTP RCNG QT TGOCKP
ីWUJGF CPF TGF 6JG[ OC[ DGEQOG EQOCVQUG DG KP
UGXGTG FGNKTKWO XQOKVKPI CPF EQPXWNUKQPU ECP QE
EWT $NQQF RTGUUWTG OC[ DG JKIJ QT NQY CPF JGCTV
TCVG YKNN DG XGT[ HCUV


• q% q( ཊ /GFKECN GOGTIGPE[ ཊ (CKPV
KPI XQOKVKPI UGXGTG JGCFCEJG FK\\KPGUU EQPHW
UKQP JCNNWEKPCVKQPU FGNKTKWO CPF FTQYUKPGUU ECP QE
EWT 6JGTG OC[ CNUQ DG RCNRKVCVKQPU CPF DTGCVJNGUU
PGUU


• q% q( ཊ (CKPVKPI FGJ[FTCVKQP YGCMPGUU
XQOKVKPI JGCFCEJG CPF FK\\KPGUU OC[ QEEWT CU YGNN
CU RTQHWUG UYGCVKPI 5VCTVU VQ DG NKHGVJTGCVGPKPI


• q% q( ཊ 5GXGTG UYGCVKPI ីWUJGF CPF TGF
(CUV JGCTV TCVG CPF DTGCVJNGUUPGUU 6JGTG OC[ DG GZ
JCWUVKQP CEEQORCP[KPI VJKU %JKNFTGP CPF RGQRNG
YKVJ GRKNGRU[ OC[ DG XGT[ NKMGN[ VQ IGV EQPXWNUKQPU
CV VJKU RQKPV


• q% q( ཊ VJKU KU ENCUUGF CU J[RGTVJGTOKC KH
PQV ECWUGF D[ C HGXGT (GGNKPI JQV UYGCVKPI HGGNKPI
VJKTUV[ HGGNKPI XGT[ WPEQOHQTVCDNG UNKIJVN[ JWPIT[
+H VJKU KU ECWUGF D[ HGXGT VJGTG OC[ CNUQ DG EJKNNU


4.2 Normal


• q% q( ཊ 0QTOCN KPVGTPCN DQF[ VGORGTCVWTG
YJKEJ XCTKGU DGVYGGP CDQWV ཊ q% ཊ
q(


4.3 Cold


• q% q( ཊ (GGNKPI EQNF OKNF VQ OQFGTCVG UJKX
GTKPI DQF[ VGORGTCVWTG OC[ FTQR VJKU NQY FWTKPI
UNGGR /C[ DG C PQTOCN DQF[ VGORGTCVWTG


• q% q( ཊ *[RQVJGTOKC KU NGUU VJCP
q% q( ཊ +PVGPUG UJKXGTKPI PWODPGUU CPF
DNWKUJITC[PGUU QH VJG UMKP 6JGTG KU VJG RQUUKDKNKV[
QH JGCTV KTTKVCDKNKV[


• q% q( ཊ 5GXGTG UJKXGTKPI NQUU QH OQXG
OGPV QH ិPIGTU DNWGPGUU CPF EQPHWUKQP 5QOG DG
JCXKQWTCN EJCPIGU OC[ VCMG RNCEG


• q% q( ཊ /QFGTCVG VQ UGXGTG EQPHWUKQP
UNGGRKPGUU FGRTGUUGF TGីGZGU RTQITGUUKXG NQUU QH
UJKXGTKPI UNQY JGCTV DGCV UJCNNQY DTGCVJKPI 5JKX
GTKPI OC[ UVQR 5WDLGEV OC[ DG WPTGURQPUKXG VQ EGT
VCKP UVKOWNK


• q% q( ཊ /GFKECN GOGTIGPE[ *CNNWEKPC
VKQPU FGNKTKWO EQORNGVG EQPHWUKQP GZVTGOG UNGGRK
PGUU VJCV KU RTQITGUUKXGN[ DGEQOKPI EQOCVQUG 5JKX
GTKPI KU CDUGPV UWDLGEV OC[ GXGP VJKPM VJG[ CTG JQV
4GីGZ OC[ DG CDUGPV QT XGT[ UNKIJV




• q% q( ཊ %QOCVQUG XGT[ TCTGN[ EQPUEKQWU
0Q QT UNKIJV TGីGZGU 8GT[ UJCNNQY DTGCVJKPI CPF
UNQY JGCTV TCVG 2QUUKDKNKV[ QH UGTKQWU JGCTV TJ[VJO
RTQDNGOU


• q% q( ཊ 5GXGTG JGCTV TJ[VJO FKUVWTDCPEGU
CTG NKMGN[ CPF DTGCVJKPI OC[ UVQR CV CP[ VKOG 2C
VKGPV OC[ CRRGCT VQ DG FGCF


• ཊ q% ཊ q( QT NGUU ཊ &GCVJ WUWCNN[ QEEWTU
FWG VQ KTTGIWNCT JGCTV DGCV QT TGURKTCVQT[ CTTGUV JQY
GXGT UQOG RCVKGPVU JCXG DGGP MPQYP VQ UWTXKXG YKVJ
DQF[ VGORGTCVWTGU CU NQY CU q% q(=?


5 References


=? /CTZ ,QJP 3PTFOࣙT FNFSHFODZ NFEJDJOF DPODFQUT
BOE DMJOJDBM QSBDUJDF /QUD['NUGXKGT R +5$0


=? -CTCMKVUQU & -CTCDKPKU # 5GRVGODGT ན*[
RQVJGTOKC VJGTCR[ CHVGT VTCWOCVKE DTCKP KPLWT[ KP EJKN
FTGPཔ / &OHM + .FE 359 ཊ
FQK0',/E 2/+&


=? #ZGNTQF ;- &KTKPIGT /0 /C[ ན6GORGTCVWTG
OCPCIGOGPV KP CEWVG PGWTQNQIKE FKUQTFGTUཔ /FVSPM $MJO
26 ཊ ZK FQKLPEN
2/+&


=? .CWRNCPF -$ ,WN[ ན(GXGT KP VJG ETKVKECNN[ KNN
OGFKECN RCVKGPVཔ $SJU $BSF .FE 37 5WRRN
5ཊ FQK%%/DGCC 2/+&


=? .BOTPOࣙT 5SPQJDBM %JTFBTFT &YQFSU $POTVMU 5CWPFGTU
R +5$0


=? 6TCWVPGT $9 %CXKPGUU #% )GTNCEJGT )4 &GOONGT )
/CEKCU %) ,WN[ ན2TQURGEVKXG GXCNWCVKQP QH VJG
TKUM QH UGTKQWU DCEVGTKCN KPHGEVKQP KP EJKNFTGP YJQ RTGUGPV
VQ VJG GOGTIGPE[ FGRCTVOGPV YKVJ J[RGTR[TGZKC VGORGT
CVWTG QH FGITGGU ( QT JKIJGT 1FEJBUSJDT 118
ཊ FQKRGFU 2/%
2/+&


=? GF &CP . .QPIQ 'FU QH RTGXKQWU GFU 64 *CTTKUQP
)BSSJTPOࣙT QSJODJQMFT PG JOUFSOBM NFEJDJOF VJ
GF 0GY ;QTM /E)TCY*KNN R +5$0


=? -GNN[ )5 /CTEJ ན$QF[ VGORGTCVWTG XCTKCDKNKV[
2CTV OCUMKPI KPីWGPEGU QH DQF[ VGORGTCVWTG XCTK
CDKNKV[ CPF C TGXKGY QH DQF[ VGORGTCVWTG XCTKCDKNKV[ KP FKU
GCUGཔ "MUFSO .FE 3FW 12 ཊ 2/+&


=? /CEMQYKCM 2 # 5 5 9CUUGTOCP / / .GXKPG
ན# ETKVKECN CRRTCKUCN QH FGITGGU ( VJG
WRRGT NKOKV QH VJG PQTOCN DQF[ VGORGTCVWTG CPF QVJGT
NGICEKGU QH %CTN 4GKPJQNF #WIWUV 9WPFGTNKEJཔ +"."
268 ཊ FQKLCOC
2/+& 4GVTKGXGF


=? -CTCMKVUQU & -CTCDKPKU # 5GRVGODGT ན*[
RQVJGTOKC VJGTCR[ CHVGT VTCWOCVKE DTCKP KPLWT[ KP EJKN
FTGPཔ / &OHM + .FE 359 ཊ
FQK0',/E 2/+&


=? 5WPF.GXCPFGT / (QTUDGTI % 9CJTGP .- ,WPG
ན0QTOCN QTCN TGEVCN V[ORCPKE CPF CZKNNCT[ DQF[ VGO
RGTCVWTG KP CFWNV OGP CPF YQOGP C U[UVGOCVKE NKV
GTCVWTG TGXKGYཔ 4DBOE + $BSJOH 4DJ 16 ཊ
FQKLZ 2/+&


=? -GNN[ ) &GEGODGT ན$QF[ VGORGTCVWTG XCTKCDKNKV[
2CTV C TGXKGY QH VJG JKUVQT[ QH DQF[ VGORGTCVWTG CPF
KVU XCTKCDKNKV[ FWG VQ UKVG UGNGEVKQP DKQNQIKECN TJ[VJOU ិV
PGUU CPF CIKPIཔ "MUFSO .FE 3FW 11 ཊ 2/+&


=? 5WPF.GXCPFGT / (QTUDGTI % 9CJTGP .-
ན0QTOCN QTCN TGEVCN V[ORCPKE CPF CZKNNCT[ DQF[ VGO
RGTCVWTG KP CFWNV OGP CPF YQOGP C U[UVGOCVKE NKV
GTCVWTG TGXKGYཔ 4DBOE + $BSJOH 4DJ 16 ཊ
FQKLZ 2/+&


=? 'NGTV )NGPP ན6GORGTCVWTG QH C *GCNVJ[ *WOCP
$QF[ 6GORGTCVWTG 5IF 1IZTJDT 'BDUCPPL 4GVTKGXGF


=? &QFF 54 .CPECUVGT )# %TCKI ,8 5O[VJ 4.
9KNNKCOUQP 24 #RTKN ན+P C U[UVGOCVKE TGXKGY
KPHTCTGF GCT VJGTOQOGVT[ HQT HGXGT FKCIPQUKU KP EJKNFTGP
ិPFU RQQT UGPUKVKXKV[པ + $MJO &QJEFNJPM 59 ཊ
FQKLLENKPGRK 2/+&


=? ,' /E-GP\KG &9 1UIQQF 8CNKFCVKQP QH C PGY
VGNGOGVTKE EQTG VGORGTCVWTG OQPKVQT ,QWTPCN QH
6JGTOCN $KQNQI[ 8QNWOG +UUWGU ཊ 1EVQDGTཊ
&GEGODGT 2CIGU ཊ +550 FQK
LLVJGTDKQ


=? &YDFSQU )VNBOT #PEZ &YUSFNFT )WKPPGUU 9QTNF
4GEQTFU 4GVTKGXGF 1EVQDGT




5&95 "/% *."(& 4063$&4 $0/53*#65034 "/% -*$&/4&4


6 Text and image sources, contributors, and licenses


6.1 Text
• Human body temperature 4PVSDF JVVRUGPYKMKRGFKCQTIYKMK*WOCPADQF[AVGORGTCVWTG!QNFKF $POUSJCVUPST 'F 2QQT
,FRKRG %KRJGTIQVJ *2# (WTT[MGH 1OGICVTQP 4QDDQV *CG$ *C[PG 5VWCTV%JGUJKTG +YKNEQZ 6JQTYCNF /KMG 4QUQHV &KUEQURKPUVGT
4KEJ (CTODTQWIJ (NQTKCP $NCUEJMG $QDQ (QQDC\ 'N QUQ ,LTQP ,CMGY 4KCPC )GPG 0[ICCTF (CNEQTKCP /KPFOCVTKZ $GPDGUV
$NCKUG('ICP )TCJCO ,QUJ 2CTTKU 4LYKNOUK ,CMG 9CTVGPDGTI ,QCEJKOR )NGPP . %JQDQV $IYJKVG %JWPM[ 4KEG +PQJKTQ #FKECTNQ
1EJKYCT /KTCEWNQWUEJCQU 4GFIQNRG )GQាTG[NCPFKU #NNGPU 0GKN0 5OCEM$QV +PEPKU /TUK &GNNFQV &CXKF 9QQNNG[ 7PHQTIGVVCDNGKF
)KNNKCO &T DCD 5CFCFU 1EVCJGFTQP 5ETC[ 5OCNNDQPGU $TKCP6WPI %[DGTEQDTC #FG/KCOK )QDQPQDQ ,QTKUX5 +TQP)CTIQ[NG 0QCJ
5CN\OCP նծփ չխնսհ 'CUUKP 6JGMCRKN )GQTIG /KECJ&%QEJTCP 4WPPKPIQPDTCKPU %[FGDQV 0KEM 9KNUQP #NCKDQV 'RDT %QR
RGT-GVVNG +UJFCTKCP 5QDTGKTC /CTGM 'NGTV 1TGQ 2TKGUV ,QJP ,#P&DQV %ETTEETT 8Q#$QV ++ $GSWY 9JCVCO+FQKPI #FTKCP
, *WPVGT 0KMRCRCI ,FGNCPQ[ %JTKUHTQO*QWUVQP %RKTCN /KMCGN *¥IIUVT·O 5OKVV[ 7UGKIJV 5GTIKXUGP D[VGU 8QNMQX$QV 2JKNKR
6TWGOCP 6CXKZ .GEJCVLCWPG 4C[OQPFYKPP -KNOGTUCP #JOCF JCNCYCPK &QE ,COGU *FFXF 2NCPGV5VCT 8DQPF 5YUPQY *QTFC
NCPF %NWG$QV &GXKCVQT 4LF 'FWCTFQ 0KEGIW[GFE $NCPEJCTFD 'ZEKTKCN %TC\[%JGO)W[ <LYKIIKPU )GOKPK 8KEVGT
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Module VIC Equipment Troubleshooting Page 1 of 7
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International Aid – Medical Equipment Training Program


Temperature Monitor

The example used here is an IVAC TEMP-PLUS vital signs measurement system, Model
2000, consisting of the unit, a battery charger/storage base, and probe assembly.
Maintenance sections are written for personnel experienced in the analysis,
troubleshooting, and repair of analog and digital electronic equipment.

The TEMP-PLUS is a portable, battery-powered instrument. The PULSE button, °F - °C,
and P-M switches on the underside of the instrument control its functions. They are used
to activate the pulse mode, convert the displayed temperature reading from Fahrenheit to
Celsius (and vice versa), and activate the predictive and monitor modes. The front of the
unit contains the probe storage well and the probe connector socket. The power cord
supplies 120 VAC or 220 VAC current to the battery charger/storage base.

Inside the unit the major components are a power switch, activated by the probe; a nickel-
cadmium battery pack; a coil used to recharge the battery pack; and three printed wiring
boards – the display, display driver, and logic boards. The display consists of a seven-
segment LED array.

The IVAC probe contains a heat-sensing thermistor in the tip of the stainless steel shaft.
The thermistor, a temperature-proportional resistor, is joined electrically and physically
to the thermometer through the probe connector and flexible extension cord attached to
the base of the probe shaft. Located at the base of the probe is an ejection button for easy
disposal of used probe covers. Oral probes are blue; rectal probes are red. The oral and
rectal probes are electronically identical.

The IVAC probe cover is a thin, plastic sheath with thermal characteristics carefully
selected to match the requirements of the unit. It covers the shaft of the thermometer
probe during temperature measurement to prevent cross-contamination or infection.

The IVAC battery charger/storage base is an AC operated, solid state device used to
recharge the unit battery. A coil positioned inside the unit inductively couples with a coil
inside the charger to provide the energy for battery charging without any physical
connections.

There are several operating modes for the system. The predictive mode is used under
ordinary clinical conditions because it provides the fastest way of taking a temperature
with the TEMP-PLUS system. In the monitor mode, the unit continuously measures the
patient’s temperature as it rises or falls. The pulse mode calculates the patient’s pulse rate
in beats per minute. The analog-to-digital mode is used for calibration of the TEMP-
PLUS unit by service and repair personnel.

Before operating the system, perform the functional checkout to establish that the system
is functioning properly (applies only to initial setup).


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Features, controls and indicators of the IVAC TEMP-PLUS system





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Table of Controls and Indicators

Control/ Indicator Function

°F - °C Switch Used to convert temperature readout on display to
Fahrenheit or Celsius scale. Can convert the
temperature scale before, during, or after a
temperature is taken.

PULSE button Used to actuate the pulse mode.

P-M Switch Used to change mode of TEMP-PLUS unit to
Predictive or monitor mode.

Charge Light LED illuminates on the display panel when battery
Is being recharged.

Audible Tone Sounds when computed temperature is


obtained in predictive mode, when pulse is
calculated, or when an error occurs.



Tissue Contact Indicator Short line rotates clockwise on right side
Of display panel when probe temperature is
Rising,

Display Panel Indicates temperature reading, pulse rates,


battery charging, and error messages on a
five-character LED display.



1. Ensure that the correct power connection (120 VAC or 220 VAC) is made to the


charger. Unless connected to a receptacle marked “Hospital Use” or “Hospital
Grade,” the reliability of the instrument ground cannot be assured. Always use a
three-wire grounded receptacle.



2. Properly seat the TEMP-PLUS unit on the battery charger. A small light will appear


on the display panel to indicate that the battery is charging. Allow an initial charge of
10 to 14 hours before using the system.



3. Insert the connector from the appropriate probe into the probe connector socket.


Insert the probe into the probe storage well in the front of the unit.

NOTE: The performance of the system is affected by the thermal characteristics of the
probe cover used.

NOTE” If the room temperature (and probe tip temperature) is higher than 34.4° C (94.0
°F) the unit may not be able to quickly determine the patient’s temperature. Instead, the
temperature indicated on the display will slowly rise until, after 3 to 5 minutes, the


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International Aid – Medical Equipment Training Program


patient’s temperature has been reached. (No audible toe will sound, and a flashing F or C
will appear in the place of the tissue contact indicator. If the instrument is not turned off
within approximately 6 minutes, the Err Ŀ message will appear.

Temperature Error Messages

The following error messages will be displayed during temperature measurement if:

ERR Ŀ – In the predictive mode, the TEMP-PLUS unit fails to obtain a temperature
within one minute after insertion or the probe tip temperature is still below the displayed
temperature (32.2L or 90.0L) 75 seconds after the unit is turned on.

ERR L – In the predictive mode, the TEMP-PLUS unit senses a loss of proper tissue
contact within the mouth for more than 35 seconds.

ERR H – The probe temperature exceeds 42.1° C or 107.9°F.

ERR O – There is an electronics error. If the error persists after resetting the TEMP-
PLUS unit, refer to the troubleshooting procedures.

If Lobat appears on the display, the battery is low and needs recharging.

Cleaning and Sterilizing

CAUTION: Do NOT autoclave or immerse the unit or the battery charger.

It is good practice to periodically clean the instrument surface by wiping it with a soft
cloth dampened with isopropyl alcohol (greater than 70% by weight), prepackaged
alcohol wipes, warm water, or a general nonstaining chemical disinfectant. Do not use
solvents or cleaning agents.

Standard ETO gas sterilization techniques can be used to sterilize the system provided the
maximum temperature does not exceed 58 C (135 F) and the relative humidity does not
exceed 60%. Aerate the system for 24 hours in free air or 8 hours in an aerator after
sterilizing. Test the system for proper operation following aeration.

Troubleshooting

This section describes descriptions of possible malfunctions or troubles that may be
encountered in operating the TEMP-PLUS or similar system. These troubles are based on
generally known or anticipated conditions that may occur. Referring to this section before
attempting to repair, replace, or service any components will save time and may avert
unnecessary effort. Refer to the service manual for your particular instrument.

The checkout and troubleshooting procedure may be used periodically as a preventive
maintenance measure.


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NOTE: Whe4n the unit detects an alarm condition, the appropriate message will flash
seven to ten times alternating with an audible tone before the instrument turns off.

Checkout and troubleshooting procedure

The following checkout and troubleshooting procedure should be performed routinely
every few months to confirm the proper functioning of the system. The mechanical and
electrical inspections locate any parts that may require calibration, repair, or replacement.

BASIC MECHANICAL AND ELECTRICAL INSPECTION
1. Charge the unit for approximately 15 minutes. Verify that the charge indicator light


illuminates.
2. Slide the P-M switch to P and the °F-°C switch to ° F. Place the probe tip on warm


tissue, such as behind the ear. Verify the display advances, reaching a final
temperature reading in about 30 seconds. Make sure the display flashes in alternation
with a beeping audible tone when the final temperature is obtained. (Note:
Temperature readings taken behind the ear are about 0.3 to 0.6°C [0.5 to 1.0°F] lower
than oral temperature readings.)


3. Without moving the probe, slide the °F-°C switch to °C before the instrument turns
off. Verify that the unit converts the temperature reading from Fahrenheit to Celsius.
Now slide the °F-°C switch back to °F and verify that the display changes to a
Fahrenheit reading.


4. Keeping the probe tip in the same location as in step B, slide the P-M switch to M.
verify that the temperature reading is now 0.3 – 0.4 °C (0.6-0.8 °F) lower than the
final temperature reading obtained in step B.


5. Depress the PULSE button. Verify that 888.888 is displayed, with the decimal point
flashing.


6. Release the PULSE button. Verify that inserting the probe into the storage well turns
off the unit.


7. Verify that depressing the PULSE button activates the pulse mode.
8. Verify that ERROR is displayed if the pulse measure is less than 20 beats per minute


or greater than 200 beats per minute.

Technical Troubleshooting Guide

Trouble Probable cause(s)

Unit is completely inoperative. Dead or defective battery.
Blown fuse.
Broken connections or switches,
Defective crystal.
Defect on logic board.

Pulse mode does not work Broken connection or defect in flexible


circuit.


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International Aid – Medical Equipment Training Program


Defective pulse switch.
Defect on logic board.

Temperature taking modes do not work. Defective probe.
Broken wire or wires.
Defective probe switch.
Defect on logic board.

Always turns off 2-3 seconds after Broken connection in flexible circuits
being turned on. Defective display driver.
Defect on logic board.

One digit missing: instrument may Broken flexible circuit to driver board
turn off if the center digit is missing. Broken flexible circuit to display board
Open transistors

Missing segment on one digits Defective LED

Same segment missing on all five Broken flexible circuit to display driver
digits; missing decimal point or display board
Open transistors on display driver board

Same segment of all digits always on; Short between traces on a circuit board.
one digit bright and jumbled, or decimal Short on display driver board.
point always on.

Instrument does not turn itself off. PULSE button is stuck.
Short circuit between traces on circuit board.
Defect on logic board.

Instrument displays Lobat when battery Defective battery.
is charged, or does not display Lobat Defect on logic board.
when charge is low. Defect on display driver board.

Battery discharges when instrument Defect on logic board.
is turned off. Defective battery.

Charge light does not illuminate. Defective charger; broken wire to coil or
open circuit in coil.
Short circuit on logic board.
Disconnection in flexible circuits between
display, display driver and logic boards.
Defective charge light.




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International Aid – Medical Equipment Training Program



Instrument does not read temperature Defective probe.
or immediately displays Err H. Break or short circuit in harness.
Defective probe connector socket.
Defect on logic board

Unit cannot be calibrated. Defect on logic board.

Err O occurs. Defect on logic board.

Instrument does not respond to one Defective flexible circuit.
Or both function switches (°F-°C, P-M) Defective switch.
Defect on display driver board.
Defect on logic board.

Instrument turns on with unusual Defect on logic board.
characters in display, with only decimal
point lit, or does not turn off unless probe
connector is unplugged.

No audible tone. Defective speaker
Defect on logic board


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Preventative)Maintenance)for)Temperature)Monitoring)Equipment))Monitor,)Temperature)(With)Probe))1.##Inspect#exterior#of#equipment#for#damage#or#missing#hardware.##2.##Inspect#the#power#cord,#strain#relief#and#plug/s#for#any#signs#of#damage.##3.##Turn#unit#off,#open#user#accessible#covers#and#inspect#unit#for#damage.#4.##Clean#unit#interior#components#and#exterior#with#vacuum#or#compressed#air.#5.##Inspect#interior#for#signs#of#corrosion#or#missing#hardware.#Repair#as#required.#6.##Inspect#electrical#components#for#signs#of#excessive#heat#or#deterioration.###7.##Verify#temperature#calibration#at#2#points.##8.##Verify#correct#operation#of#all#buttons,#controls,#displays#and/or#indicators.###9.##Verify#correct#operation#of#unit#in#all#functional#modalities.#




****SECTION*F:*Resources*for*More*Information** *




8.*Resources*for*More*Information****Featured*in*this*Section:****Developing'World'Healthcare'Technology'Laboratory.'“”ECG'Monitor:'How'to'Use.”'From'the'Publication:'“Biomedical'Technician'Assistant'(BTA)'Skills.”'DHT(Laboratory,(Duke(University:'2011.'''Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Blood'Pressure'Monitor'Packet.”'Engineering(World(Health,'2015.'''Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“ECG'Packet.”'Engineering(World(Health,'2015.''''Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Fetal'Doppler'and'Fetal'Monitor'Packet.”'Engineering(World(Health,'2015.'' * *




''Resources*for*More*Information:'*'**Internal*Resources*at*library.ewh.org:*For*More*Information*about*patient*monitoring,*please*see*these*resources*in*the*BMET*Library!*' 1. Blood*Pressure*Monitoring:'a. Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Blood'Pressure'Monitor'Packet.”'Engineering(World(Health,'2015.''2. ECG*(Electrocardiograms):'a. Developing'World'Healthcare'Technology'Laboratory.'“”ECG'Monitor:'How'to'Use.”'From'the'Publication:'“Biomedical'Technician'Assistant'(BTA)'Skills.”'DHT(Laboratory,(Duke(University:'2011.'b. Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“ECG'Packet.”'Engineering(World(Health,'2015.''3. Fetal*Monitoring:'a. Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Fetal'Doppler'and'Fetal'Monitor'Packet.”'Engineering(World(Health,'2015.''''********** **




Patient*Monitoring*Bibliography:*'' Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Blood'Pressure'Monitor'Preventative'Maintenance.”'From'the'publication:''Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Blood'Pressure'Monitor'Troubleshooting'Flowchart.”'From'the'publication:'Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Respiratory'Monitor'Preventative'Maintenance.”'From'the'publication:''Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''Cooper,'Justin'and'Alex'Dahinten'for'EWH.'“Respiratory'Monitor'Troubleshooting'Flowchart.”'From'the'publication:'Medical(Equipment(Troubleshooting(Flowchart(Handbook.'Durham,'NC:'Engineering'World'Health,'2013.'''Developing'World'Healthcare'Technology'Laboratory.'“”ECG'Monitor:'How'to'Use.”'From'the'Publication:'“Biomedical'Technician'Assistant'(BTA)'Skills.”'DHT(Laboratory,(Duke(University:'2011.'''Developing'World'Healthcare'Technology'Laboratory.'“Oxygen'Monitors.”'From'the'Publication:'“Biomedical'Technicians'Training'Program,'Session'3'v2,'Special'Topics:'Cardiac'Equipment.”'Engineering(World(Health,'March'1,'2011,'p.'1H161.'''Developing'World'Healthcare'Technology'Laboratory.'“Temperature'Monitors.”'From'the'Publication:'“Biomedical'Technicians'Training'Program,'Session'3'v2,'Special'Topics:'Cardiac'Equipment.”'Engineering(World(Health,'March'1,'2011,'p.'1H161.'''Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Patient'Monitors.'EWH.'2012.'((Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Oxygen'Monitors.'EWH.'2012.'((Engineering'World'Health.'“Preventative'Maintenance'Schedule'for'Temperature'Monitors.'EWH.'2012.'




(Malkin,'Robert.'Medical(Instrumentation(in(the(Developing(World.'Engineering'World'Health,'2006.''' 'Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Blood'Pressure'Monitor'Packet.”'Engineering(World(Health,'2015.'''Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“ECG'Packet.”'Engineering(World(Health,'2015.''''Stanco,'Cassandra'ed.'for'Engineering'World'Health.'“Fetal'Doppler'and'Fetal'Monitor'Packet.”'Engineering(World(Health,'2015.''''Strengthening'Specialised'Clinical'Services'in'the'Pacific.'User(Care(of(Medical(Equipment:(A(first(line(maintenance(guide(for(end(users.'(2015).'''WHO,'“Apnea'Monitor.”'WHO.'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.'''WHO.'“Blood'Pressure'Monitor.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.'''WHO.'“Monitor,'Bedside,'Electroencephalography.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.''' WHO.'“Monitor,'Physiologic.”'From'the'publication:'Core(Medical(Equipment.'Geneva,'Switzerland,'2011.''WHO.'“Physiological'Monitor.”'From'the'publication:'“WHO'Technical'Specifications'for'61'Medical'Devices.'WHO.'Retrieved'from:'http://www.who.int/medical_devices/management_use/mde_tech_spec/en/'''Wikipedia.'“Human'Body'Temperature.”'Wikipedia,(p.(1H6.'Retrieved'from:''https://en.wikipedia.org/wiki/Human_body_temperature'''Wikipedia.'“Monitoring'(Medical).”'Wikipedia,(p.(1H6.'Retrieved'from:''https://en.wikipedia.org/wiki/Monitoring_(medicine)''




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