Microsoft Word - Troubleshooting Flowchart Handbook v6.docx

                                                                                                                                            Medical  Equipment  Troubleshooting  Flowchart  Handbook  Version  6  
Published  by:  Engineering  World  Health  


2013  


 




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Medical  Equipment  Troubleshooting  Flowchart  Handbook  Engineering  World  Health  
 By  Justin  Cooper  and  Alex  Dahinten                              Engineering  World  Health  Durham,  NC  




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Copyright  ©  2013  Engineering  World  Health.  All  Rights  Reserved.  
 
Reproduction  or   translation  of  any  part  of   this  work  beyond   that  permitted  by   sections  107  or  108  of   the  1976  United  States  Copyright  Act   (or   its   legal  successor)  without  the  express  written  permission  of  Engineering  World  Health  is  unlawful.  Requests  for  permission  to  copy  or  for  further  information  should  be  addressed  to  Engineering  World  Health,  The  Prizery,  Suite  200,  302  East  Pettigrew  Street,  Durham,  NC  27701.  
 
Printed  in  the  United  States  of  America  by  Engineering  World  Health




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Acknowledgements  
This  handbook   is   the   result  of  a   larger   team  effort.  The  authors  would   like   to   thank   following  students   for   their  invaluable  contributions:  Caroline  Kiritsy,  Karthik  Kumaravelu,  Kelsey  Goon,  Lauren  Oliveri,  Lucy  Corippo,  Ranjani  Sridhara   and   Shalki   Kumar   (Duke   University);   Adam   Naylor,   Elizabeth   Hyde   and   Ryan   Frisbie   (University   of  Michigan).   Special   thanks   also   go   to   Ron  Morey   and   Ruthann  Robinson   for   revising   the   flowcharts   and   offering  their   wealth   of   knowledge   to   this   project.   Finally,   thank   you   to   the   DHT   Lab   staff   at   Duke   University   for   their  support.    




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Contents  Contents  .......................................................................................................................................................................  4  Autoclave  ....................................................................................................................................................................  10  Flowchart  ...............................................................................................................................................................  10  Description  .............................................................................................................................................................  11  Preventive  Maintenance  ........................................................................................................................................  14  Thoughts/  Comments/  Ideas  ..................................................................................................................................  15  Bililight  ........................................................................................................................................................................  16  Flowchart  ...............................................................................................................................................................  16  Description  .............................................................................................................................................................  17  Preventive  Maintenance  ........................................................................................................................................  18  Thoughts/  Comments/  Ideas  ..................................................................................................................................  19  Blood  Pressure  Monitor  (Automatic)  .........................................................................................................................  20  Flowchart  ...............................................................................................................................................................  20  Description  .............................................................................................................................................................  21  Preventive  Maintenance  ........................................................................................................................................  22  How  To:  Taking  Blood  Pressure  ..............................................................................................................................  23  Thoughts/  Comments/  Ideas  ..................................................................................................................................  24  Blood  Pressure  Monitor  (Manual)  ..............................................................................................................................  25  Flowchart  ...............................................................................................................................................................  25  Description  .............................................................................................................................................................  26  How  To:  Dissemble  a  Mercury  Manometer  ...........................................................................................................  27  How  To:  Clean  Mercury  ..........................................................................................................................................  27  How  To:  Take  Blood  Pressure  ................................................................................................................................  28  How  To:  Mercury-­‐Handling  Protocol  .....................................................................................................................  29  Thoughts/  Comments/  Ideas  ..................................................................................................................................  30  Cell  Counter  ................................................................................................................................................................  31  Flowchart  ...............................................................................................................................................................  31  Description  .............................................................................................................................................................  33  Preventive  Maintenance  ........................................................................................................................................  38  Thoughts/  Comments/  Ideas  ..................................................................................................................................  38  Centrifuges  .................................................................................................................................................................  39  Flowchart  ...............................................................................................................................................................  39  




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Description  .............................................................................................................................................................  40  Preventive  Maintenance  ........................................................................................................................................  42  Thoughts/Comments/Ideas  ...................................................................................................................................  43  Defibrillator  ................................................................................................................................................................  44  Flowchart  ...............................................................................................................................................................  44  Description  .............................................................................................................................................................  45  Preventative  Maintenance  .....................................................................................................................................  46  Thoughts/  Comments/  Ideas  ..................................................................................................................................  47  Electrocardiogram  (ECG)  ............................................................................................................................................  48  Flowchart  ...............................................................................................................................................................  48  Description  .............................................................................................................................................................  49  Preventative  Maintenance  .....................................................................................................................................  50  Electrode  Guide  ......................................................................................................................................................  51  Thoughts/  Comments/  Ideas  ..................................................................................................................................  53  Endoscope  ..................................................................................................................................................................  54  Flowchart  ...............................................................................................................................................................  54  Description  .............................................................................................................................................................  55  Preventive  Maintenance  ........................................................................................................................................  56  Thoughts/  Comments/  Ideas  ..................................................................................................................................  58  ESU  .............................................................................................................................................................................  59  Flowchart  ...............................................................................................................................................................  59  Description  .............................................................................................................................................................  60  Preventive  Maintenance  ........................................................................................................................................  61  Thoughts/  Comments/  Ideas  ..................................................................................................................................  62  Fetal  Doppler  ..............................................................................................................................................................  63  Flowchart  ...............................................................................................................................................................  63  Description  .............................................................................................................................................................  64  Preventive  Maintenance  ........................................................................................................................................  65  Thoughts/  Comments/  Ideas  ..................................................................................................................................  67  Infant  Incubator  ..........................................................................................................................................................  68  Flowchart  ...............................................................................................................................................................  68  Description  .............................................................................................................................................................  69  Preventative  Maintenance  .....................................................................................................................................  71  




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Thoughts/Comment/Ideas  .....................................................................................................................................  72  Infant  Warmer  ............................................................................................................................................................  73  Flowchart  ...............................................................................................................................................................  73  Description  .............................................................................................................................................................  74  Preventive  Maintenance  ........................................................................................................................................  76  Thoughts/  Comments/  Ideas  ..................................................................................................................................  77  Infusion  Pump  (Syringe)  .............................................................................................................................................  78  Flowchart  ...............................................................................................................................................................  78  Description  .............................................................................................................................................................  79  Preventative  Maintenance  .....................................................................................................................................  81  Thoughts/  Comments/  Ideas  ..................................................................................................................................  82  Infusion  Pump  (Feeding)  ............................................................................................................................................  83  Flowchart  ...............................................................................................................................................................  83  Description  .............................................................................................................................................................  84  Preventative  Maintenance  .....................................................................................................................................  86  Thoughts/  Comments/  Ideas  ..................................................................................................................................  87  Laryngoscope  ..............................................................................................................................................................  88  Flowchart  ...............................................................................................................................................................  88  Description  .............................................................................................................................................................  89  Preventative  Maintenance  .....................................................................................................................................  90  Thoughts/  Comments/  Ideas  ..................................................................................................................................  91  Microscope  .................................................................................................................................................................  92  Flowchart  ...............................................................................................................................................................  92  Description  .............................................................................................................................................................  93  Preventative  Maintenance  .....................................................................................................................................  94  Thoughts/  Comments/  Ideas  ..................................................................................................................................  95  Nebulizer  (Jet)  ............................................................................................................................................................  96  Flowchart  ...............................................................................................................................................................  96  Description  .............................................................................................................................................................  97  Preventive  Maintenance  ........................................................................................................................................  98  Thoughts/  Comments/  Ideas  ..................................................................................................................................  99  Nebulizer  (Ultrasonic)  ...............................................................................................................................................  100  Flowchart  .............................................................................................................................................................  100  




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Description  ...........................................................................................................................................................  101  Preventative  Maintenance  ...................................................................................................................................  102  Thoughts/  Comments/  Ideas  ................................................................................................................................  103  O2  Concentrator  .......................................................................................................................................................  104  Flowchart  .............................................................................................................................................................  104  Description  ...........................................................................................................................................................  105  Preventive  Maintenance  ......................................................................................................................................  106  Thoughts/  Comments/  Ideas  ................................................................................................................................  107  Ophthalmoscope  ......................................................................................................................................................  108  Flowchart  .............................................................................................................................................................  108  Description  ...........................................................................................................................................................  109  Preventative  Maintenance  ...................................................................................................................................  110  Thoughts/  Comments/  Ideas  ................................................................................................................................  111  OR  LIGHT  ...................................................................................................................................................................  112  Flowchart  .............................................................................................................................................................  112  Description  ...........................................................................................................................................................  113  Preventative  Maintenance:  ..................................................................................................................................  115  Thoughts/Comments/Concerns  ...........................................................................................................................  117  Otoscope  ..................................................................................................................................................................  118  Flowchart  .............................................................................................................................................................  118  Description  ...........................................................................................................................................................  119  Preventative  Maintenance  ...................................................................................................................................  120  Thoughts/  Comments/  Ideas  ................................................................................................................................  121  Power  Supply  (Overall)  .............................................................................................................................................  122  Flowchart  .............................................................................................................................................................  122  Description  ...........................................................................................................................................................  123  Preventive  Maintenance  ......................................................................................................................................  125  Thoughts/  Comments/  Ideas  ................................................................................................................................  126  Power  Supply  (Battery)  .............................................................................................................................................  127  Flowchart  .............................................................................................................................................................  127  Description  ...........................................................................................................................................................  128  Preventive  Maintenance  ......................................................................................................................................  129  Thoughts/  Comments/  Ideas  ................................................................................................................................  130  




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Power  Supply  (Fuse)  .................................................................................................................................................  131  Flowchart  .............................................................................................................................................................  131  Description  ...........................................................................................................................................................  131  Preventive  Maintenance  ......................................................................................................................................  131  Thoughts/  Comments/  Ideas  ................................................................................................................................  132  Power  Supply  (Outlet  Plug)  ......................................................................................................................................  133  Flowchart  .............................................................................................................................................................  133  Description  ...........................................................................................................................................................  134  Preventive  Maintenance  ......................................................................................................................................  134  Thoughts/  Comments/  Ideas  ................................................................................................................................  135  Power  Supply  (Transformer)  ....................................................................................................................................  136  Flowchart  .............................................................................................................................................................  136  Description  ...........................................................................................................................................................  137  Preventive  Maintenance  ......................................................................................................................................  138  Thoughts/  Comments/  Ideas  ................................................................................................................................  139  Printer  (general)  .......................................................................................................................................................  140  Flowchart  .............................................................................................................................................................  140  Description  ...........................................................................................................................................................  141  Preventive  Maintenance  ......................................................................................................................................  142  Thoughts/  Comments/  Ideas  ................................................................................................................................  143  Pulse  Oximeter  .........................................................................................................................................................  144  Flowchart  .............................................................................................................................................................  144  Description  ...........................................................................................................................................................  145  Preventive  Maintenance  ......................................................................................................................................  146  Thoughts/  Comments/  Ideas  ................................................................................................................................  148  Respiratory  Monitor  .................................................................................................................................................  149  Flowchart  .............................................................................................................................................................  149  Description  ...........................................................................................................................................................  150  Preventative  Maintenance  ...................................................................................................................................  151  Thoughts/  Comments/  Ideas  ................................................................................................................................  152  Scales  (Analog)  .........................................................................................................................................................  153  Flowchart  .............................................................................................................................................................  153  Description  ...........................................................................................................................................................  154  




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Preventative  Maintenance  ...................................................................................................................................  155  Thoughts/Comments/Ideas  .................................................................................................................................  156  Scales  (Digital)  ..........................................................................................................................................................  157  Flowchart  .............................................................................................................................................................  157  Description  ...........................................................................................................................................................  158  Preventative  Maintenance  ...................................................................................................................................  159  Thoughts/Comments/Ideas  .................................................................................................................................  160  Suction  Machine  .......................................................................................................................................................  161  Flowchart  .............................................................................................................................................................  161  Description  ...........................................................................................................................................................  162  Preventive  Maintenance  ......................................................................................................................................  165  Thoughts/Comment/Ideas  ...................................................................................................................................  166  Ultrasound  ................................................................................................................................................................  167  Flowchart  .............................................................................................................................................................  167  Description  ...........................................................................................................................................................  168  Preventive  Maintenance  ......................................................................................................................................  169  Thoughts/  Comments/  Ideas  ................................................................................................................................  171  Water  Bath  ...............................................................................................................................................................  172  Flowchart  .............................................................................................................................................................  172  Description  ...........................................................................................................................................................  173  Preventive  Maintenance  ......................................................................................................................................  175  Thoughts/  Comments/  Ideas  ................................................................................................................................  176  Common  Technical  Terms  ........................................................................................................................................  177        




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Autoclave  
Flowchart  


   




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Description  #   Text  Box   Comments  
1   Begin:  Autoclave   Start  the  diagnostic  process  for  a  work  order  on  an  autoclave  
2   Does  the  indicator  lamp  illuminate?   Provide  appropriate  power  supply  to  the  autoclave  and  observe  indication  that  the  device  turns  on  
3   Troubleshoot  power  supply   If  the  device  is  connected  to  power  but  does  not  turn  on,  there  is  a  problem  with  the  power  supply.  This  could  be  a  problem  with  the  wiring  or  connections  within  the  device.  See  BTA  skills  on  Power  Supply  
4   Is  voltage  across  heating  element  equal  to  the  expected  value?   Use  a  multimeter  to  test  the  wires  leading  to  the  heating  element  to  determine  if  it  is  receiving  the  expected  voltage  (wall  voltage)  
5   Troubleshoot  control  circuitry   If  the  device  is  receiving  power  but  improper  voltage  is  reaching  the  heating  element,  there  is  likely  a  problem  with  the  control  circuit.  Ensure  that  all  settings  are  what  they  should  be  for  normal  autoclave  function  
6   Does  the  heating  element  warm  up?   Attach  autoclave  to  power  with  lid  open  and  observe  whether  the  heating  element  begins  to  get  hotter  
7   Look  for  rusted  or  cracked  connections   Examine  connections  involved  with  the  heating  element  to  determine  whether  they  are  adequate  for  proper  functionality  
8   Clean/Mend  poor  connections   See  BTA  skills  on  Connections  
9   Is  the  resistance  across  the  heating  element  less  than  20  Ohms?   Use  a  multimeter  across  the  heating  element  to  determine  its  total  resistance  
10   Replace  heating  element  if  necessary   If  the  resistance  across  the  heating  element  is  greater  than  20  Ohms,  it  needs  to  be  replaced.  To  replace  the  wire  within  the  element,  nichrome  wire  must  be  used.  See  BTA  skills  on  Heating  Element  
11   Do  temp  and  pressure  gauge  needle(s)  move?   While  autoclave  runs  cycle,  observe  motion  of  temperature  and  pressure  gauge(s).  There  must  be  displayed  values  for  BOTH  parameters  to  advance  from  this  step  12   Does  temperature  gauge  remain  at  zero?   Determine  if  value  of  zero  is  given  for  temperature  despite  temperature  increase  13   Does  pressure  gauge  remain  at  zero?   Determine  if  value  of  zero  is  given  for  pressure  when  pressure  is  expected  to  have  increased  
14   Clean  gauge  vent   If  the  gauge  works  but  does  not  move  during  autoclave  cycle,  then  the  vent  leading  to  the  gauge  input  may  be  blocked.  Flush  vent  with  distilled  water  to  remove  blockage.  CAUTION:  do  not  submerge  gauge  in  water.  See  BTA  skills  on  Blockage  
15   Inspect  gauge  components  


If  the  cycle  runs  but  the  needle  in  the  gauge  doesn’t  move,  there  is  a  problem  with  the  gauge.  Remove  gauge  from  autoclave  and  examine  interior.  Gently  manipulate  the  gauge  to  mimic  response  to  rising  temperature  and  pressure  within  the  device.  If  the  needle  can  be  made  to  move  easily  and  smoothly,  then  the  gauge  components  are  functional  




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16   Clean  gauge  vent   If  the  gauge  works  but  does  not  move  during  autoclave  cycle,  then  the  vent  leading  to  the  gauge  input  may  be  blocked.  Flush  vent  with  distilled  water  to  remove  blockage.  CAUTION:  do  not  submerge  gauge  in  water.  See  BTA  skills  on  Blockage  
17   Inspect  gauge  components  


If  the  cycle  runs  but  the  needle  in  the  gauge  doesn’t  move,  there  is  a  problem  with  the  gauge.  Remove  gauge  from  autoclave  and  examine  interior.  Gently  manipulate  the  gauge  to  mimic  response  to  rising  temperature  and  pressure  within  the  device.  If  the  needle  can  be  made  to  move  easily  and  smoothly,  then  the  gauge  components  are  functional  18   Inspect  autoclave  for  leaks   Examine  all  parts  of  autoclave  to  find  any  leaks.  Visually  inspect  for  steam  escaping  from  autoclave.  See  BTA  skills  on  Leaking  19   Replace  gauge(s)  is  necessary   If  the  gauge  needle  cannot  be  made  to  move  as  described  in  #15  and  #17,  then  the  gauge  is  likely  broken  and  may  need  to  be  replaced  
20   Do  temperature  and  pressure  reach  required  values?  


Verify  that  interior  of  autoclave  reaches  temperature  and  pressure  values  required  to  achieve  sterilization  Common  temperature  values:  121˚C  for  15  minutes,  134˚C  for  3  minutes  21   Are  measured  values  too  low?   Determine  if  the  autoclave  reaches  temperature  and  pressure  values  below  those  required  for  sterilization  by  reading  the  gauge  values.  
22   Are  measured  values  too  high?   Determine  if  the  autoclave  reaches  temperature  and  pressure  values  above  those  required  for  sterilization  by  reading  the  gauge  values.  
23   Check  valves  for  leaks   Visually  inspect  closed  valves  throughout  cycle.  If  air  escapes  closed  valve,  then  there  is  a  leak  in  the  valve  that  must  be  mended.  See  BTA  skills  on  Leaking  24   Check  valve  mechanisms   Check  functionality  of  valve  components  by  ensuring  that  they  are  able  to  open  and  close  smoothly  
25   Check  valve  connections  and  lid/door  seal  for  leaks  


Examine  points  at  which  valves  connect  to  autoclave  to  ensure  that  they  are  adequately  sealed  If  autoclave  door/lid  has  a  metal-­‐to-­‐metal  seal,  lubricate  seal  If  autoclave  door/lid  has  a  gasket  seal,  determine  adequacy  of  gasket.  If  gasket  is  dry  or  cracked,  it  needs  to  be  replaced  See  BTA  skills  on  Seals  26   Check  inlet/outlet  tubing  for  leaks   Visually  examine  autoclave  tubing  for  leaks.  See  BTA  skills  on  Leaking  
27   Check  valves  and  exhaust  tubing  for  blockages   Open  valves  and  ensure  that  air  can  pass  through  them.  Also  verify  that  exhaust  tubing  is  unobstructed.  See  BTA  skills  on  Blockages  
28   Clear  blockages  by  flushing  with  water   If  any  blockages  are  found,  flush  the  blocked  components  with  distilled  water  to  remove  blockages.  See  BTA  skills  on  Blockage  
29   Check  inlet/outlet  filters  for  clogs   Examine  autoclave  filters  for  clogs.  If  clogs  are  found,  clean  or  replace  filter(s).  See  BTA  skills  on  Filters  
30   Are  temperature  and  pressure  values  maintained  for  required  amount  of  time?  


Determine  if  the  sterilization  temperature  and  pressure  values  are  maintained  for  enough  time  to  sterilize  autoclave  contents  
31   Adjust  time  controls   Ensure  that  time  is  on  correct  setting  Common  times:  121˚C  for  15  minutes,  134˚C  for  3  minutes  




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32   Troubleshoot  timing  circuit   If  settings  are  correct,  but  autoclave  does  not  maintain  required  temperature  and  pressure  values  for  proper  duration,  there  is  a  problem  with  the  circuit  controlling  the  timing  of  the  cycle.  Examine  this  circuit  for  broken  or  damaged  connections  and  components.  See  BTA  skills  on  Electrical  Simple  
33   Do  temperature  and  pressure  decrease  after  cycle?  


Ensure  that  the  temperature  and  pressure  within  the  autoclave  decrease  after  the  completion  of  the  sterilization  cycle  by  observing  the  decrease  in  the  measured  values  displayed  on  the  device  
34   Check  valves  and  exhaust  tubing  for  blockages  


Note  steam  escape  from  open  valves  to  ensure  that  they  are  not  blocked  If  temperature  and  pressure  values  do  not  decrease  after  the  completion  of  the  autoclave  cycle,  it  could  be  due  to  a  blocked  exhaust  tube.  See  BTA  skills  on  Blockages  
35   Troubleshoot  timing  circuit   If  settings  are  correct,  but  autoclave  does  not  maintain  required  temperature  and  pressure  values  for  proper  duration,  there  is  a  problem  with  the  circuit  controlling  the  timing  of  the  cycle.  Examine  this  circuit  for  broken  or  damaged  connections  and  components.  See  BTA  skills  on  Electrical  Simple  
36   If  autoclave  tape  is  available,  do  strips  confirm  sterilization?   Run  test  cycle  with  autoclave  test  tape  to  verify  that  sterilization  is  achieved.  If  tape  is  not  available,  biological  indicators  can  also  be  used  for  sterilization.  37   Consider  replacing  autoclave   Autoclave  may  be  beyond  repair.  Discontinue  autoclave  use  or  refer  to  specialist    
Note  about  autoclave  tape:  


• Autoclave   tape   is  an  adhesive  used  to   indicate  whether  a  specific   temperature  and  pressure  have  been  reached  
• Strips  of  this  tape  are  applied  to  items  before  they  are  placed  into  the  autoclave  
• The   tape   has   diagonal  markings   that  will   change   color  when   the   target   temperature   and   pressure   are  achieved  
• If   the   tape   markings   are   still   their   original   color   after   going   through   the   autoclave   cycle,   then   the  autoclave  did  not  reach  the  temperature  and  pressure  required  for  sterilization  
• Biological  indicators  can  be  used  to  monitor  the  sterilization  of  an  autoclave,  by  testing  its  capability  to  kill  microorganisms.   Only   Bacillus   stearothermophilus   spores   can   be   used   to   monitor   the   effectiveness   of  steam  autoclaves.
• A   biological   indicator   system   consists   of   the   growth   medium   with   spores   and   indicator   dye.   After  autoclaving   the   indicator,   it   has   to   be   incubated   at   56°C   for   up   to   three   days.   Any   signs   of   turbidity  (indicating  growth)  indicate  the  autoclave  did  not  function  properly.      




14  
 


Preventive  Maintenance  
• After  each  use:  Clean  the  inside  of  the  autoclave  and  around  valve  and  vents  o Empty  all  water  from  chamber  and  thoroughly  dry  o Wipe  off  metal-­‐to-­‐metal  seal  with  clean  towel  to  remove  build-­‐up  • Make  sure  valves  are  not  clogged  o Periodically  clean  control  valve  with  hot,  soapy  water  • Check  air  exhaust  tube  by  flushing  water  through  it  to  make  sure  it  is  not  blocked.    • Descale  the  chamber:  most  effective  to  use  detergent  meant  for  lime  scale  removal.  Vinegar  diluted  with  distilled  water  can  also  be  used.  • Check  for  signs  of  wear  and  damage.  Ensure  sufficient  seal  around  lid:  o For  a  metal-­‐to-­‐metal  seal,  lubrication  of  the  seal  must  be  maintained  o For  a  gasket  seal,  the  seal  must  be  pliable.  If  it  is  cracked  or  dry,  then  it  should  be  replaced  • Valve  safety  check:  Test   the  safety  pop-­‐off  any   time  there   is  pressure  built  up   in   the  sterilizer.  Test   the  valve  below  the  operating  pressure  with  the  use  of  a  screwdriver  to  pop  the  pressure  relief  valve.  Make  sure  your  hand  is  away;  otherwise  the  steam  can  cause  burns.    




15  
 


Thoughts/  Comments/  Ideas      




16  
 


Bililight  
Flowchart  


     




17  
 


Description  
#   Text  Box   Comments  1   Begin:  Bililight   Start  the  diagnostic  process  for  a  work  order  on  a  bililight.  
2   Does  device  power  on?   Displays,  lights,  and  sounds  are  all  indicators  that  the  device  has  turned  on.  
3   Troubleshoot  power  supply  (separate  flowchart).   Most  bililights  have  an  AC-­‐DC  power  supply.  See  Flowchart  for  Power  Supply,  and  BTA  Skills  for  Power  Supply  4   Change  battery  if  necessary.   Some  bililights  may  have  a  battery.  See  BTA  skills  on  Batteries.  5   Do  lights  come  on?   Do  the  blue  lights  illuminate  when  they  are  switched  on?  6   Does  power  reach  bulb?   Use  a  voltmeter  to  determine  whether  the  appropriate  voltage  reaches  the  bulb  input.  7   Revise  intensity  control  knob.   Make  sure  any  intensity  control  knob  is  turned  up  to  allow  the  lights  to  illuminate.  
8   Check  for  bad  switches  and  knobs.   Review  switches  and  potentiometers  for  faults.  See  BTA  skills  on  Switches.  
9   Check  for  bad  connections  and  open  circuits   Open  circuits,  bad  connections,  and  bad  wires  can  prevent  the  lights  from  illuminating.  See  BTA  skills  on  Connections.  
10   Ensure  device  is  not  overheating.  Repair/maintain  fans  and  filters  if  necessary.  


Some  bililights  have  a  safety  mechanism  that  turns  the  lights  off  when  the  device  overheats.  If  this  is  the  case,  try  allowing  the  device  to  cool  before  attempting  to  turn  the  lights  on  again.  If  this  was  the  problem,  consider  ways  to  improve  ventilation.  
11   Replace  bulbs.   If  the  appropriate  voltage  reaches  the  bulbs  and  they  do  not  illuminate,  the  bulbs  must  be  replaced.  
12   Is  light  intensity  >  4μW/cm2/nm   Measure  the  light  output  at  patient-­‐level.  4μW/cm


2/nm  is  the  minimum  output  for  a  bililight,  though  many  have  outputs  higher  than  this  (e.g.  15μW/cm2/nm)  
13   Reposition  light  source.   If  the  intensity  is  too  low,  the  light  source  may  be  positioned  too  far  from  the  patient.  
14   Revise  intensity  control  knob.   The  light  intensity  might  be  increased  by  manipulating  the  intensity  control  knob.  
15   Clean  interior  of  machine.   If  the  interior  of  the  machine  or  the  bulbs  are  dirty,  it  might  obstruct  the  light  source  or  cause  overheating  of  the  device.  
16   Go  to  begin.   Start  the  diagnostic  process  again  to  see  if  the  corrective  measures  have  solved  the  problem.  
17   Bililight  is  working  properly.   The  light  intensity  is  above  the  minimum,  and  the  device  can  be  used  with  patients.      




18  
 


Preventive  Maintenance    
• Check  for  signs  of  physical  damage  or  abuse  • Check  for  evidence  of  fluid  spills    • Check  AC  plug/cord/receptacle    • Check  strain  relief  at  both  ends  of  cord    • Check  controls/switches    • Check  power-­‐on  sequence    • Check  for  unusual  noise  or  vibration    • Clean  interior/exterior  as  required    • Test  all  audible  &  visual  alarms  and  indicators    • Measure  chassis  ground  resistance    • Measure  chassis  leakage  current    • Clean  air  filter  • Electrical  safety  • Measure  light  output      




19  
 


Thoughts/  Comments/  Ideas      




20  
 


Blood  Pressure  Monitor  (Automatic)  
Flowchart  


     




21  
 


Description  #   Text  Box   Comments  1   Begin:  Automatic  Blood  Pressure  Cuff   Testing  and  maintenance  is  advised  when  the  automatic  blood  cuff  fails  to  give  out  a  complete  or  accurate  blood  pressure.  2   Does  machine  power  on?   Lights,  displays,  and  sounds  are  signs  that  the  device  is  powered  on.  
3   Troubleshoot  power  supply  (separate  flowchart).  


NIBP  (Noninvasive  Blood  Pressure)  machines  have  varying  sources  of  power.  Some  require  batteries,  and  others  can  be  plugged  directly  into  the  wall.  It  is  always  best  to  ensure  that  the  proper  power  is  being  administered.  Machines  requiring  110-­‐120V,  for  example,  should  not  be  plugged  into  a  socket  with  a  power  of  220-­‐240V  without  the  proper  transformer.  See  Flowchart  on  Power  Supply,  or  BTA  skills  on  Power  Supply.  4   Change  battery  if  necessary.   If  batteries  are  required,  test  that  they  are  able  to  receive  and  hold  a  charge.  See  BTA  skills  on  Batteries.  
5   Wrap  cuff  around  arm.   Try  wrapping  cuff  around  your  arm  before  beginning  function  test.  NIBP  will  require  either  pulses  or  vibrations  brachial  artery,  so  it  is  important  that  the  cuff  is  on  correctly.  Follow  the  User  Guide  for  more  detailed  instructions.  6   Press  "start.”   For  some  machines,  a  flashing  light  or  image  will  suggest  the  machine  is  ready  to  begin  the  blood  pressure  measurement.    7   Can  air  be  pumped  into  the  cuff?   Once  engaged,  the  machine’s  pump  will  begin  inflating  the  cuff.  Does  the  cuff  readily  inflate?  Is  a  reading  able  to  be  obtained?  
8   Test  for  leaks  and  cracks  in  tubing,  connections,  and  cuff  outside  machinery.   Use  BTA  skills  on  Connections,  Leaks  and  Blockages  to  assess  for  cracks,  leaks,  or  occlusions.    
9   Open  up  apparatus  and  assess  inside  tubing  for  cracks,  leaks,  and  occlusions,  as  needed.  


If  cuff  still  has  difficulty  inflating,  carefully  open  the  apparatus  and  observe  what  happens  to  inside  tubing  when  the  pump  is  activated.  Listen  for  escaping  air  and  use  BTA  skills  on  Connections,  Leaking,  Seals  and  Blockages  to  assess,  replace,  repair,  or  clean  tubing  and  parts  as  needed.  
10   Is  the  correct  amount  of  input  voltage  entering  the  pump?   Test  the  voltage  going  into  the  pump  using  a  multimeter.  Compare  the  measured  voltage  to  the  required  DC  input  voltage,  which  can  usually  be  found  as  a  marking  somewhere  on  the  pump.  
11   Troubleshoot  the  electrical  connections  around  pump.  Repair  or  replace  any  components  as  needed.  


If  the  pump  is  not  receiving  the  proper  input  voltage,  this  has  something  to  do  with  the  electrical  circuitry  or  connections  supplying  power  to  the  pump.  Use  BTA  skills  on  Electrical  Simple  to  observe,  assess,  and  repair  any  circuit  components  and  connections.    
12   Troubleshoot  the  pump  and  pump  motor.  Replace  pump  as  needed.  


If  the  pump  is  receiving  the  proper  input  voltage,  but  still  not  properly  inflating  the  cuff,  try  troubleshooting  the  pump  and  its  motor  using  BTA  skills  on  Motors  and  Mechanical.  Pump  may  have  to  be  replaced  if  irreversibly  damaged.  13   Go  to  step  6.   Restart  cuff  inflation  to  see  if  the  corrective  measures  have  repaired  the  machine.  
14   Do  any  alarms  go  off  to  indicate  blood  pressure  is  too  high  or  low?  


Some  NIBP  machines  are  equipped  with  alarms  that  indicate  whether  or  not  a  blood  pressure  is  within  an  acceptable  healthy  range,  preset  by  the  machine’s  parameters.  
15   Change  parameters  as  needed  if  original  range  is  too  narrow.  


If  machine  parameters  are  causing  alarms  to  go  off  when  a  healthy  blood  pressure  is  causing  the  alarms  to  go  off,  it  may  be  possible  to  change  them.  Check  parameters  by  pressing  the  “menu”  button,  if  applicable.  Consult  with  clinical  staff  to  see  how  these  parameters  should  be  set.  




22  
 


16   Is  BP  measurement  displayed?     After  pressing  start,  is  a  numerical  value  for  blood  pressure  displayed?  NIBPs  will  usually  display  a  systolic,  diastolic,  and  pulse  rate  after  measurement.  
17   Ensure  proper  cuff  usage.   Is  the  cuff  the  proper  size  for  your  arm  or  the  patient’s  arm?  Are  the  leads  in  the  cuff  over  the  brachial  artery?  NIBPs  can  be  very  sensitive.  Check  the  User  Guide  to  ensure  proper  machine  usage.  
18   Is  a  service  manual  available?   Many  service  manuals  will  instruct  the  user  on  the  meaning  of  displayed  error  messages  for  the  specific  NIBP  system.  These  messages  can  also  point  to  general  areas  of  the  device  that  can  be  troubleshot  using  the  relevant  BTA  skills.  
19   Use  manual  to  interpret  the  meaning  of  display  and  respond  appropriately.   Most  of  the  time  these  messages  are  accompanied  by  a  proposed  set  of  actions.  20   Go  to  Begin.   Restart  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
21   Open  up  apparatus  and  confirm  good  electrical  connections.  Especially  between  BP  module  and  display.  


Sometimes  a  problem  in  the  circuit  is  to  blame  for  inaccurate  or  incomplete  measurements.  Use  BTA  skills  on  Electrical  Simple  to  observe,  assess,  and  repair  any  circuit  components  and  connections.  
22   Repair  and  replace  parts  as  needed.   If  there  is  any  obvious  damage,  repair  connections  and  replace  necessary  parts  using  the  appropriate  BTA  skills.  
23   Ensure  cuff  accuracy  by  comparing  with  manual  method.  


After  obtaining  a  blood  pressure  measurement,  have  the  clinical  staff  take  a  blood  pressure  on  the  same  individual  using  a  working  manual  blood  pressure  cuff.  A  good  NIBP  will  be  within  5  mmHg,  but  ultimately  it  is  up  to  the  staff  whether  or  not  the  cuff  should  be  used  on  patients.  24   Cuff  is  working  properly.   Return  apparatus  to  appropriate  clinical  staff.  
Preventive  Maintenance  


• Check  power  supply.  If  the  machine  uses  batteries,  check  their  voltage  and  replace  when  output  is  low.  If  wall  input  is  utilized,  ensure  that  the  proper  power  is  being  used.  • Inspect  power  cords  and  plugs.  Check  AC  plug   for   loose  or  damaged  parts.  Verify  proper   insulation  and  integrity  of  cords.  • Assess  for  leaks,  cracks,  and  occlusions  in  the  cuff,  connections,  and  tubing  inside  and  outside  apparatus.  Inspect  all  fittings  and  connectors.  • Inspect  inside  circuitry.  Verify  that  all  switches  operate  properly  as  well.  • Check  that  any  alarms  go  off  when  the  measured  blood  pressure  is  outside  of  an  acceptably  healthy,  that  is  if  the  NIBP  has  this  capability.  The  clinical  staff  should  establish  this  range.  To  test  this  on  yourself,  set  the   parameters   such   that   they   should   go   off   when   you   take   your   own   blood   pressure.   Once   you   are  assured  that  the  alarms  are  functional,  be  sure  to  set  the  parameters  back!  • Perform  a  self-­‐test  on  the  BP  cuff  to  ensure  cuff  is  working  properly  and  within  reasonably  accuracy  (±5  mmHg).  Accuracy  can  be  determined  by  having  the  clinical  staff  take  your  blood  manually.        




23  
 


How  To:  Taking  Blood  Pressure  1. Prepare  the  patient.  o Sitting  or  lying  down  o Arm  unobstructed  o Ask  about  blood  pressure  history  o Ensure   that   it   is   a  quiet   space  and   that   the  patient  doesn’t  move   too  much  –  many  NIBPs   are  sensitive  to  noise  and  movement  2. Wrap  the  cuff  around  the  upper  arm  with  leads  facing  the  brachial  artery.  Be  sure  that  it  is  the  proper  cuff  size   for   the  patient’s   arm.   The   cuff   should  be   about   1-­‐2   cm  above   the   elbow  and   about   level  with   the  patient’s  heart.  3. Turn  on  the  machine,  and  press  “start”  when  ready  to  measure  blood  pressure.  4. Have  the  patient  remain  still  and  quiet  until  a  blood  pressure   is  displayed.  Often  times  a  pulse  rate  will  also  be  measured  and  displayed.  5. If   the  patient  has   a  higher   than  usual   blood  pressure,  many  NIBPs  will   allow   the  user   to  hold   the   start  button  until  the  monitor  inflates  30-­‐40  mmHg  higher  than  the  expected  blood  pressure.  6. If  the  cuff  needs  to  be  deflated  or  reset  during  inflation  for  any  reason,  press  the  off  button.  7. Record  the  blood  pressure.    
Examples  of  ranges  for  healthy  blood  pressures:  


Age   BP  (Systolic/  Diastolic)  Child,  <6  months   90-­‐105/70  Child,  6  months  to  7  years   105-­‐117/70  Adult   120/80      




24  
 


Thoughts/  Comments/  Ideas      




25  
 


Blood  Pressure  Monitor  (Manual)  
Flowchart  


 




26  
 


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:  -­‐Using  a  stiff  wire,  push  a  small  piece  of  cotton  or  gauze  through  the  rise  tube  several  times  -­‐Gently  tap  mercury  tank  (with  opening  facing  downwards)  onto  tray  to  make  sure  all  mercury  has  been  removed  -­‐Wash  tube  and  tank  in  a  detergent  and  water  solution  -­‐Dry  thoroughly  -­‐Clean  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.  




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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.  
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    




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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:  160-­‐180  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   90-­‐105/70  Child,  6  months  to  7  years   105-­‐117/70  Adult   120/80  




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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  well-­‐ventilated  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        




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Thoughts/  Comments/  Ideas      




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Cell  Counter  
Flowchart    




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Description  #   Text  box   Explanation  or  comment  1   Begin   Start  troubleshooting  process  for  a  work-­‐order  on  a  Cell  or  Coulter  Counter.  2   Is  the  device  free  from  debris?   Check  exterior  of  device  for  any  dirt,  dust  or  other  debris.    
3   Clean  exterior  of  device   Often  parts  appear  broken  or  malfunctioning  when  they  are  simply  not  clean.  It  is  most  important  to  ensure  that  all  openings,  hinges  and  connecting  or  interacting  pieces  are  clean.  See  BTA  skills  for  Cleaning.  
4   Is  the  device  free  of  external  damages?   Check  for  dents,  scratches,  and  other  major  damage  to  the  outside  of  the  device.  In  particular,  look  to  see  if  there  is  evidence  of  whether  or  not  the  device  has  been  dropped.  
5   Assess  severity  of  damage  


Damage  to  the  exterior  of  the  device  can  indicate  the  presence  of  internal  damage  and  offer  insight  as  to  where  inside  the  casing  to  begin  looking  for  damage.  If  damage  to  the  exterior  is  minimal  it  can  likely  be  ignored.  If  too  severe,  it  is  possible  the  device  will  not  function  at  all.  6   Repair  as  applicable   Using  appropriate  BTA  skills  on  Casing,  Attachment  and  Cleaning,  repair  scratches,  dents,  etc  as  possible.  
7   Make  sure  you  have  all  necessary  reagents,  solutions  and  trouble-­‐shooting  tools  


It  is  a  possible  user  error  that  the  device  is  simply  missing  key  components  that  are  involved  in  its  use  but  are  not  inherently  present  within  the  device.  If  possible,  check  the  user  manual  or  any  other  type  of  documentation,  to  determine  whether  or  not  the  appropriate  auxiliary  components  are  being  used,  and  being  used  properly.  
8   Is  the  device  on  a  clean,  sturdy,  level  surface?   The  measurements  that  this  device  makes  are  minute  and  precision  is  of  the  utmost  importance.  A  sturdy  and  level  surface  is  necessary  to  ensure  accurate  results.  
9   Move  device  to  a  clean,  sturdy,  level  surface   A  clean,  sturdy,  level  surface  is  one  that  does  not  wobble  visibly  or  tangibly  when  the  device  is  operated,  is  not  on  a  slant,  and  is  wiped  free  from  dust  and  debris.  
10   Is  the  atmospheric  temperature  between  16-­‐34  C?   Use  a  thermometer  to  check.  16-­‐34  C  is  the  optimal  operating  temperature  for  both  the  electronic  and  liquid  components  of  the  device.  
11   Move  device  to  a  room  with  appropriate  temperature  range,  or  adjust  temperature  of  current  room   Execute  as  possible.  
12   Is  device  near  any  EM  field  inducing  device?  


EM  (Electro  Magnetic)  fields  are  generated  by  very  powerful  devices  such  as  x-­‐ray  machines,  scanners,  anything  with  a  radar,  etc.  These  fields  can  interfere  with  the  circuitry  and  the  accuracy  of  device  measurements.  
13   Move  device  away  from  strong  EM  devices   The  simplest  solution  to  this  problem  is  to  move  the  device,  which,  though  bulky,  is  likely  much  more  portable  than  any  of  the  EM  field  generating  devices.  14   Power  device  on   Press  the  “on”  or  “power”  button  or  switch.  15   Does  the  device  turn  on?   Look  for  visible  signs  that  the  device  has  turned  on.  Indicators  could  be  sounds  of  pieces  within  the  device  loading  up  and  




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moving,  a  screen  lighting  up,  an  LED  (typically  green)  illuminating,  etc.  16   Troubleshoot  power  supply   Consult  BTA  skills  on  Power  Supply  and  Power  Supply  flowchart  for  assistance.  
17   Open  device  casing.  Check  for  loose,  worn-­‐out  wires  and  corrupt  circuit  boards.  


Inspect  the  way  that  the  casing  is  put  together  and  use  BTA  skills  for  Casing  to  determine  the  order  that  the  pieces  need  to  be  removed.  Inspect  for  worn-­‐out,  frayed,  rusted,  etc  wires.  Use  BTA  skills  Electrical  Simple  to  repair  as  necessary.  
18   Does  the  screen  respond  to  the  appropriate  input?  


Press  the  keypad  or  screen  (if  touchscreen)  or  appropriate  buttons  to  prepare  device  as  if  to  run  a  cycle.  Determine  whether  or  not  the  screen  is  responding  as  it  should.  Possible  examples  of  incorrect  screen  inputs  include  moving  to  the  incorrect  menu  (one  that  does  not  correspond  to  the  input  pressed),  a  frozen  screen,  an  error  message,  etc.  
19   Set  up  the  device  to  run  as  normal   Set  all  system  modes  and  settings  as  if  a  sample  were  to  be  run  normally.  This  verifies  that  the  device  is  being  used  properly  and  that,  as  troubleshooting  continues,  user  error  is  not  a  factor.  
20   Does  the  screen  show  an  error  message?  


Error  messages  are  fairly  obvious  as  they  are  accompanied  by  the  words  “caution”,  “error”,  “warning”,  etc.  Error  messages  serve  as  an  internal  way  for  the  device  to  give  a  better  indication  of  which  area  of  the  device  is  malfunctioning.  21   Is  it  possible  to  follow  on-­‐screen  instructions  to  troubleshoot?   With  higher-­‐level  and  more  modern  models,  the  device  may  have  software  designed  to  guide  the  troubleshooting  process.  
22   Follow  on-­‐screen  troubleshooting  instructions   If  it  is  built  into  the  software,  the  device  will  guide  through  the  steps  to  take  to  approach  problems  associated  with  the  malfunctioning  part  of  the  machine.  
23   Run  control  cycle  


Control  cycles  are  run  with  deionized  water.  The  system  is  set  to  run  as  it  would  normally  with  a  sample,  but  only  deionized  water  is  used  for  the  “sample”  and  each  of  the  reagents.  This  enables  the  observation  of  all  of  the  moving  parts  within  the  device  and  also  shows  whether  or  not  the  device  is  functioning  mechanically,  even  if  it  does  not  display  that  proper  results  or  values.  24   Follow  PM  procedure   See  accompanied  PM  (Preventative  Maintenance)  procedure.  25   Device  is  ready   Device  should  be  functioning  properly  26   Run  a  test  cycle   A  test  cycle  is  the  same  as  a  control  cycle.  See  explanation  for  Box  23.  
27   Does  the  test  run  to  completion?   The  test  cycle  has  run  to  completion  if  the  cycle  drew  the  water  through  all  of  the  appropriate  channels,  was  not  stopped  along  the  way,  produced  no  error  messages,  and  displayed  results  at  the  end.  
28   Does  the  probe  or  aperture  appear  damaged?  


The  sample  probe  is  a  thin  metal  rod  with  a  small  opening,  like  a  needle,  that  is  open  to  the  exterior  of  the  device.  It  is  used  to  draw  up  the  sample  into  the  device  to  initiate  a  run  cycle.  A  damaged  probe  is  likely  to  be  bent  or  chipped.  The  aperture  is  inside  the  device  and  is  sized  on  the  order  of  millimeters.  A  damaged  aperture  is  likely  to  be  cracked  or  corroded.  
29   Is  the  probe  or  aperture  clogged?   As  the  probe  serves  to  draw  fluid  up  and  into  the  device  and  as  the  aperture  facilitates  fluid  flow  through  the  device,  it  is  possible  that  debris  may  build  up  causing  either  to  clog  and  thereby  inhibit  the  analysis  of  the  sample.  See  BTA  Skills  on  Blockages.  




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30   Does  the  probe  rest  in  its  neutral  home  position?  
The  neutral  home  position  of  the  probe  should  be  marked,  either  by  a  tick  mark  or  a  line  on  the  casing,  or  on  the  probe  itself.  If  this  mark  exists,  make  sure  that  the  probe  is  aligned  properly  so  that  it  is  functioning  at  maximum  capacity.  If  the  device  does  not  have  a  marking  to  indicate  the  neutral  home  position,  place  an  empty  sample  collection  container  in  the  appropriate  position  as  if  the  device  were  to  run  a  test,  and  verify  that  the  probe  is  in  a  position  so  that  it  can  draw  up  the  entirety  of  the  contents  of  the  sample  collection  container.  


31   Manually  adjust  probe  to  home  position  
It  is  possible  that  the  probe  may  be  adjusted  or  calibrated  via  instructions  and  a  process  through  the  device  software  on  the  screen.  See  BTA  skills  on  Calibration.  If  this  is  the  case,  follow  these  instructions.  Otherwise,  it  is  likely  that  the  probe  is  held  in  position  by  a  series  of  set  screws  that  can  be  manually  adjusted.  


32   Does  the  device  output  the  appropriate  values?  
Look  at  the  display  screen  to  verify  that  the  software  of  the  machine  is  functioning.  Specific  values  vary  by  model  and  brand;  the  main  objective  of  this  step  is  to  make  sure  that  the  electronic  components  of  the  device  are  functional,  if  not  necessarily  accurate.  33   Go  to  box  49    34   Problem  is  a  user  or  sample  error   Each  of  the  components  of  the  device  are  functioning  properly.  35   Replace  probe,  if  possible   If  not  possible,  the  device  cannot  function.  


36   Unclog  
Probe  may  be  unclogged  simply  by  soaking  and  washing  with  warm,  deionized  water.  If  necessary,  it  may  also  be  unclogged  using  a  small  needle  or  brush,  depending  on  the  size  of  the  probe  and  its  opening.  Aperture  can  be  unclogged  using  a  small  needle  or  brush,  but  must  be  done  gently  so  as  not  to  damage  the  device.  See  BTA  skills  on  Blockages.  


37   Open  casing  
If  it  hasn’t  been  done  yet,  open  the  casing  as  described  in  step  16.  Opening  the  casing  not  only  allows  for  inspection  of  the  electronic  elements,  but  also  provides  an  opportunity  to  inspect  the  basic  physical  and  mechanical  workings  of  the  device.  See  BTA  skills  on  Casing.  38   Can  fluid  flow  through  tubing  easily?   Indicators  of  fluid  not  flowing  easily  are  bubbles,  leaks  or  the  machine  stopping.  See  BTA  skills  on  Blockages.  


39   Check  for  clogged  tubing  
Tubing  may  be  clogged  simply  by  having  folded  in  on  itself,  or  having  been  pinched  to  prevent  flow.  It  may  also  be  clogged  by  debris  or  build-­‐up.  Any  cause  of  clogging  should  be  removed,  if  possible,  by  removing  and  rinsing  the  tubing  or  using  a  small  brush  if  the  clog  is  near  the  opening.  If  necessary,  tubing  can  also  be  replaced.  See  BTA  skills  on  Blockages.  


40   Are  there  any  leaks?   Leaks  can  stem  from  defective  tubing,  broken  valves,  broken  reservoirs,  or  any  of  the  connections  between  these  parts.  Clamps  are  also  a  suitable  solution  to  this  problem.  See  BTA  skills  on  Leaking  and  Clamps.  41   Skip  to  box  45    
42   Check  valve  functionality   An  alternative  and  more  specific  source  of  leaks  may  be  the  valves.  Valves  or  valve  parts  that  wear  down  (like  O-­‐rings)  can  wear  down  and  lose  their  water-­‐tight  properties.  43   Check  connections  to  waste  system,   Leaks  will  often  stem  not  from  a  particular  part,  but  the  places  




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reservoirs,  reagent  supplies,  etc   where  parts  intersect  and  interact.  These  can  be  replaced,  tightened,  or  patched  up  accordingly.  See  BTA  Skills  on  Connections  and  Seals.  
44   Check  piston  pressure  and  seals  


Not  every  model  of  the  device  will  contain  pistons,  however  many  do,  and  the  purpose  of  the  pistons  is  to  draw  up  and  transport  solution  to  different  parts  and  processes  within  the  device.  It  is  imperative  that  the  piston  is  actually  drawing  up  liquid.  If  not,  the  seals  can  be  adjusted  and  tightened.  If  the  problem  persists,  the  piston  probably  needs  to  be  replaced.  See  BTA  skills  on  Seals  and  Motors.  
45   Close  casing   When  opening  casing,  be  sure  to  keep  track  of  all  panels  and  screws.  Close  the  casing  in  the  exact  reverse  of  opening  the  casing.  See  BTA  skills  on  Casing.  
46   Do  all  moving  pieces  operate  smoothly?  


As  the  control/test  cycle  runs,  verify  that  pieces  that  are  supposed  to  be  moving,  are  doing  so  properly.  The  device  can  break  down  is  via  the  wear  and  tear  of  basic  mechanical  components.  Although  it  cannot  be  predicted  which  pieces  exactly  are  of  critical  loading,  visually  inspecting  the  system  as  it  runs  can  verify  whether  or  not  there  is  anything  grinding,  catching,  in  need  of  lubrication,  broken,  blocked,  caught,  etc.  See  BTA  skills  on  Mechanical  and  Motors.  
47   Are  all  pieces  aligned  properly?   It  is  possible,  especially  if  there  is  any  evidence  of  external  damage  or  dents,  the  device  is  not  functioning  properly  because  the  moving  parts  are  misaligned.    
48   Align  any  misaligned  pieces  


Most  pieces  or  parts  are  held  in  place  by  set  screws  or  hex  screws  that  can  be  loosened  to  allow  for  the  adjustment  of  the  piece.  As  a  general  rule,  all  interacting  parts  with  a  round  geometry  should  align  concentrically  and  all  translational  parts  should  move  in  straight,  perpendicular  lines.  
49   Do  the  temperatures  of  the  baths  match  the  indication  on  the  attached  cables?  


For  most  models,  the  desired  temperature  range  for  the  baths  or  reservoirs  of  each  of  the  liquids  or  reagents  used  in  a  run  cycle  will  be  marked  on  the  small  cable  connecting  the  hot  plate  (or  similar  mechanism)  that  maintains  the  temperature,  to  the  power  supply.  Use  a  thermometer  to  verify  that  the  temperature  of  the  specific  liquid  falls  within  the  appropriate  range.  However,  if  the  temperature  does  not  match  properly,  very  few  models  have  associated  processes  to  fix  the  problem.  
50   Empty,  clean  and  refill  baths  


Reagents  in  device  should  be  discarded  appropriately.  The  device  can  be  cleaned  using  deionized  water  only,  and  running  a  test  or,  if  the  model  has  one,  a  cleaning  cycle.  Baths  can  then  be  refilled.  It  is  possible  that  temperature,  and  even  general  device  running  issues  stem  from  build-­‐up  in  the  tubing,  reservoirs  and  baths.  
51   Check  for  broken  gears,  bands  or  parts   As  the  control  cycle  runs,  visually  check  for  any  mechanical  load  bearing  or  linking  parts  that  may  have  broken.  Fix  these  as  possible.  
52   Check  for  blocked  pathways  


As  parts  move  within  the  device,  it  is  possible,  especially  if  there  is  evidence  of  external  damage,  that  pieces  or  parts  within  the  device  have  shifted  or  been  knocked  out  of  place.  In  addition  to  throwing  off  alignment,  this  can  manifest  itself  as  the  blockage  of  the  pathway  of  a  moving  part.  Any  blockages  should  be  cleared,  and  if  any  of  the  blockages  involve  broken  or  misplaced  parts,  




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these  should  be  reattached  or  replaced  as  appropriate.  
53   Are  the  motors  functioning  properly?  


Although  not  the  case  for  all  models  of  the  device,  many  power  the  movement  and  coordination  of  internal  parts  and  pieces  with  motors.  To  ensure  that  the  device  is  working  properly,  check  to  see  if  the  motors  are  functioning  properly.  A  properly  functioning  motor  will  make  a  small,  continuous  whirring  sound  when  operating,  and  will  lead  to  the  motion  of  another  piece  or  part  within  the  device.  See  BTA  skills  on  Motors.  
54   Troubleshoot  motors   Motors  commonly  fail  in  two  ways:  mechanically  and  electrically.  Motors  can  wear  out,  or  jam  or  their  rotor  may  be  blocked.  Electrically,  the  wiring  in  and  around  the  motor  can  be  checked  as  well.  See  BTA  skills  on  Motors  and  Electrical  Simple.  


55   Is  internal  lamp  functional?  
In  addition  to  a  resistance  or  voltage-­‐based  aperture  measurement,  many  models,  especially  the  more  modern  models,  have  a  lamp  or  light  device  of  some  kind  that  is  used  in  conjunction  with  photosensors  to  take  various  measurements  from  a  sample.  To  check  if  the  lamp  is  functional,  first  verify  whether  or  not  the  lamp  is  “on”  when  the  device  is  “on.”  It  may  also  be  possible  to  use  the  software  menus  to  turn  the  lamp  on  or  off.  A  lamp  is  deemed  functional  if  it  emits  light  under  the  appropriate  conditions.  56   Remove  bulb  and  check  voltage  drop  of  socket   Use  potentiometer  to  verify  that  the  lamp  component  is  receiving  current.  See  BTA  skills  for  Lighting/Indicators.  


57   Does  voltage  drop  across  socket  correspond  to  bulb  specifications?  
If  the  lamp  has  a  bulb  component,  it  is  likely  to  have  printed  specifications  as  to  the  current  and  voltage  that  correspond  to  the  optimal  functionality  of  the  bulb.  Use  a  multimeter  to  check  the  voltage.  See  BTA  skills  for  Lighting/Indicators.  


58   Check  wires  and  connections  to  socket  
The  simplest  way  that  the  lamp  component  may  fail,  other  than  a  broken  or  worn  out  bulb,  is  in  the  immediate  circuitry  connecting  the  lamp  to  the  power  supply.  See  BTA  skills  for  Lighting/Indicators.  


59   Replace  bulb   If  the  socket  is  receiving  the  appropriate  current  and  voltage,  the  problem  lies  within  the  bulb,  which  should  be  replaced.  See  BTA  skills  for  Lighting/Indicators.  
60   Verify  lamp  alignment  


More  modern  models  typically  have  software  menus  to  guide  through  the  lamp  alignment  process.  If  not,  the  lamp  can  be  more  roughly  aligned  by  verifying  that  the  accompanying  photosensors  are  responding  appropriately.  As  with  many  of  the  moving  parts  of  the  device,  the  lamp  can  be  adjusted  manually  after  loosening  the  appropriate  set  screws.  61   Are  all  internal  resistors  and  driving  electrodes  receiving  current?   Use  a  multimeter  to  check  that  there  is  a  voltage  drop  across  and  current  is  running  through  the  key  electric  components.  62   Device  is  beyond  repair    63   Clean  electrodes   Electrodes  can  be  cleaned  with  deionized  water.  See  BTA  skills  on  Switches  and  Connectors.  
64   Close  casing   When  opening  casing,  be  sure  to  keep  track  of  all  panels  and  screws.  Close  the  casing  in  the  exact  reverse  of  opening  the  casing.  See  BTA  skills  on  Casing.  65   Device  is  ready    




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Preventive  Maintenance    
• Clean  casing  • Check  to  make  sure  all  proper  reagents  and  auxiliary  equipment  are  being  used  • Inspect  power  cords  and  plugs  • Check  menu  and  software  settings  • Check  for  clogged  probe  • Run  a  test  cycle  using  deionized  water  


Thoughts/  Comments/  Ideas        




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Centrifuges  
Flowchart    


 
 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




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Description  #   Text  box   Explanation  or  Comment  
1   Begin:  testing  centrifuge  function   Start  the  diagnostic  process  for  a  work  order  on  a  centrifuge.  
2   Ensure  unit  is  level  when  in  operation.  


Operating  an  unbalanced  centrifuge  can  cause  inaccurate  speeds,  damage  to  the  machine,  or  damage  to  operators.  To  ensure  levelness,  each  tube  being  spun  should  have  a  counter-­‐balance  tube  placed  in  the  position  directly  across  from  it.  If  the  number  of  samples  being  spun  is  uneven,  a  tube  filled  with  an  equivalent  volume  of  water  will  suffice  to  balance.  3   Does  the  motor  make  noise  when  turned  on?   If  the  centrifuge  is  working  properly,  the  motor  will  spin  and  create  noise.  
4   Is  power  reaching  the  motor?   Use  a  multimeter  to  test  the  wires  leading  to  the  motor  to  determine  if  it  is  receiving  the  expected  voltage.  
5   Is  interlock  switch  open?   The  interlock  switch  prevents  the  motor  from  operating  with  the  lid  open.  If  the  switch  is  open,  power  is  disconnected  from  the  motor.  
6   Troubleshoot  power  supply  (separate  chart).  


If  interlock  switch  is  closed  and  no  power  reaches  the  motor,  there  is  a  problem  with  the  power  supply.  This  could  be  an  issue  with  the  wiring  or  fuse  for  AC  motors.  See  Power  Supply  flowchart,  and  BTA  skills  on  Power  Supply  and  Electrical  Simple.  
7   Can  interlock  be  repaired?   The  lid  is  closed  and  the  interlock  switch  is  open,  so  the  interlock  must  be  repaired.  Search  for  a  mechanical  solution  to  trip  the  switch  when  the  lid  closes.  See  BTA  skills  on  Attachment  and  Casing.  
8   Repair  interlock.   A  mechanical  adjustment  could  be  made  to  trigger  the  switch,  or  possibly  the  switch  could  be  replaced.  See  BTA  skills  on  Attachment  and  Casing.  
9   Discuss  bypassing  interlock  with  clinical  staff.  


If  the  interlock  switch  can't  be  repaired,  it  can  be  bypassed  by  hard-­‐wiring  the  two  wires  together.  This  will  eliminate  the  safety  feature  and  allow  the  rotor  to  spin  with  the  lid  open.  Discuss  the  safety  implications  with  the  clinical  staff  to  determine  if  this  solution  is  acceptable,  and  see  BTA  skills  on  Connections,  Connectors  and  Switches.  10   Clean  and  lubricate  motor.   See  BTA  skills  on  Cleaning  /  Lubrication  of  Motors.  
11   Clean  motor  brushes  (if  applicable).   See  BTA  skills  on  Motor  Brushes.  
12   Does  the  motor  spin?   Test  if  corrective  measures  have  allowed  motor  to  spin.  
13   Consider  replacing  the  motor  or  the  entire  unit.   The  motor  is  powered  and  cannot  spin  after  corrective  measures.  Replace  motor  or  entire  unit.  
14   Does  the  motor  stay  on  for  selected  duration?   Select  a  duration  using  the  timer  switch  and  verify  the  accuracy  with  a  stopwatch.  
15   Is  RPM  wrong?   Measure  RPM  using  paper  tachometer  and  fluorescent  bulb  technique.  16   Is  rotor  damaged?   Check  rotor  for  cracks,  imbalances,  and  irregularities  in  the  rotor.  




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17   Replace  rotor.   If  the  rotor  is  damaged  beyond  repair,  it  must  be  replaced.  It  is  unsafe  to  operate  a  centrifuge  with  a  damaged  or  imbalanced  rotor.  18   Was  motor  recently  serviced?   The  RPM  is  wrong.  Has  the  motor  been  serviced  recently?  
19   Clean  and  lubricate  rotor  and  other  moving  parts.   See  BTA  skills  on  Bearings  and  Motors.  
20   Is  RPM  wrong?   Measure  RPM  using  paper  tachometer  and  fluorescent  bulb  technique.  
21   Can  centrifuge  be  clinically  useful  with  the  current  RPM?   The  correct  RPM  cannot  be  attained.    
22   Repair  or  replace  centrifuge's  tachometer.   The  tachometer  determines  the  RPM.  A  faulty  tachometer  can  cause  an  incorrect  RPM.  23   Discuss  with  clinical  staff.   Consult  with  clinical  staff  to  see  if  current  RPM  is  still  useful.  
24   Does  interlock  allow  motor  to  spin  with  lid  open?   Check  if  motor  can  spin  with  an  open  lid.  
25   Safety  concern.   If  the  motor  is  allowed  to  operate  with  the  lid  open,  there  is  a  concern  that  someone  could  be  injured  by  the  rapidly  spinning  rotor.  
26   Does  brake  decelerate  centrifuge  smoothly?   Check  if  the  rotor  decelerates  smoothly  while  the  brake  button  or  lever  is  held.  
27   Balance  rotor  with  dummy  tubes.   The  rotor  needs  to  be  loaded  such  that  each  tube  is  countered  by  one  on  the  opposite  side  to  ensure  balance.  
28   Replace  or  repair  brake.   The  brake  might  be  mechanical  or  a  resistor  that  is  placed  across  the  motor.  
29   Test  timer  switch  with  a  stopwatch.   Compare  the  time  period  set  by  the  switch  to  the  actual  duration  using  a  stopwatch.  
30   Will  switch  open  after  a  set  time  period?   Will  the  timer  switch  open  and  stop  the  motor  after  any  amount  of  time,  even  if  the  time  isn't  correct?  
31   Re-­‐calibrate  timer  switch  using  stopwatch.  


If  the  timer  switch  stops  the  motor,  but  not  at  the  right  time,  the  timer  switch  can  be  calibrated.  Re-­‐label  the  timer  switch  to  indicate  the  actual  time  durations  that  were  measured.  See  BTA  skills  on  Calibration.  
32   Bypass  timer  switch.  


If  the  timer  switch  will  never  stop  the  motor,  consider  bypassing  this  switch  or  replacing  it  with  a  simple  “on-­‐off”  switch.  The  clinician  will  have  to  turn  the  machine  on  and  off  manually.  Perhaps  another  watch  or  timer  can  be  used  to  time  the  centrifuge  manually.  See  BTA  skills  on  Electrical  Simple,  33   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
34   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  35   Centrifuge  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.  36   Ensure  lid  is  closed.   The  lid  must  be  closed  to  open  the  interlock  switch.  




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37   Is  interlock  switch  open?   The  interlock  switch  prevents  the  motor  from  operating  with  the  lid  open.  If  the  switch  is  open,  power  is  disconnected  from  the  motor.  
38   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.    
 Preventive  Maintenance    


• Lubricate  and  clean  motor.  • Clean  case.  • Inspect  power  cords  and  plugs.  • Inspect  controls  and  switches.  • Ensure  appropriate  menu  settings  for  proper  use.  • Ensure  tightness  of  rotor.  • Check  lights  and  indicators.  • Verify  that  alarms  are  operating  properly.    • Ensure  interlock  is  functioning.  • If  refrigerated,  ensure  temperature  reading  is  working.Replace/repair  gaskets,  seals,  and  vacuum  pump  (if  applicable).    
NOTES:    
Check   holders   for   rubber   stoppers   that   cushion   tubes.   All   holders   should   have   then   or   the   centrifuge   will   be  unbalanced  and  will  wear  the  brushes  and  rotor.  
Check  carbon  brushes  and  replace  with  same  size.  
Cleaning  should  be  step  one.   It   is   important   to  disinfect/decontaminant  before  doing  any  other  maintenance  or  repair.  Often  centrifuges  have  had  broken  tubes  of  blood  or  urine  so  will  be  a  source  of  contamination.  
   




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Thoughts/Comments/Ideas    




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Defibrillator  
Flowchart  


 




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Description  
  Text  Box   Comments  1   Start:  Defibrillator  Troubleshooting.         Begin  diagnostic  process  for  a  work  order  on  Defibrillator  2   Is  the  defibrillator  free  of  any  external  damage/defects?   Inspect  defibrillator  for  external  cracks,  broken  switch,  knobs  and  indicators.  3   Identify  and  replace  damaged  switches,  indicators.   See  BTA  skill  set  on  Switches  and  Lighting/Indicators  to  identify  and  replace  damaged  switches  and  indicators.  
4   Clean  casing,  pads  using  Alcohol.   Examine  casing,  pads  and  cables  of  defibrillator  for  gel  and  dirt.  Refer  BTA  skill  set  on  Cleaning  to  clean  the  defibrillator.  If  necessary,  address  damage  to  casing  with  BTA  skills  on  Casing.  
5   Does  the  defibrillator  power  on  from  ac  power  line?   Power  the  device  from  ac  line  and  turn  it  on.  
6   Inspect  AC  adapter  cable  for  cuts,  broken  wires  and  replace  if  necessary.   See  BTA  skill  set  on  Connections  and  Connectors  for  identifying  and  replacing  damaged  cables.  
7   Inspect  and  fix  broken  wires  or  bad  connections  inside  the  defibrillator.  


Inspect  wires  and  connections  from  power  supply  circuit  board  to  other  boards  using  multimeter.  See  BTA  skill  set  on  Connections  for  identifying  and  fixing  broken  wires  and  bad  connections.  8   Identify  and  replace  blown  fuse.   See  BTA  skill  set  on  Fuse  to  identify  and  replace  blown  fuse.  
9   Troubleshoot  power  supply.   Most  defibrillators  can  power  on  from  battery  and  ac  power  mains.  See  flowchart  on  Power  Supply,  and  BTA  skills  on  Power  Supply.  
10   Does  the  defibrillator  power  on  with  battery?  


Disconnect  defibrillator  from  ac  power  line.  Turn  the  device  on.  • If  battery/status  indicator  is  red  then  battery  needs  to  be  charged  or  replaced  (non-­‐rechargeable).  • If  defibrillator  fails  to  power  on  then  battery  is  fully  depleted  or  damaged.  11   Recharge  battery  if  applicable  or  replace  it.   See  BTA  skill  set  on  Batteries  to  replace  and  identify  damaged  batteries.  
12   Troubleshoot  charging  circuit  if  battery  doesn't  or  charges  very  slowly.   See  BTA  skill  set  on  Transformer  and  Regulators  to  troubleshoot  charging  circuit.  13   Run  the  defibrillator  self-­‐test.   Power  the  device  from  ac  line  and  turn  it  on.  The  device  will  run  an  automatic  self-­‐test.  14   Does  display  show  error  or  status  indicator  is  red?   The  result  of  the  self-­‐test  will  be  displayed  (on  the  screen)  or  status  indicator  will  change  red/green.  15   Are  the  defibrillator  paddles  and  cables  damaged,  wet?   The  paddles  should  be  clean  and  dry.  Inspect  the  pad  cables  and  connectors  for  cuts  and  broken  wires.  16   Does  the  defibrillator  use  paddle  electrodes?   Paddle  electrodes  consist  of  a  metal  paddle  with  an  insulated  handle.  
17   Clean  paddles  using  alcohol.  Identify  and  replace  damaged  paddles  and  cables.  


Paddle  electrodes  are  reusable  and  should  be  cleaned  after  every  use.  See  BTA  skill  set  on  Connections  and  Connectors  for  identifying  and  replacing  damaged  cables.  




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Preventative  Maintenance  Common  Reasons  for  Failure:  
• Damaged  device  • Damaged  pads  or  cables  • Improper  power  supply  • Improper  functioning  of  internal  circuitry    


18   Replace  the  Self-­‐adhesive  electrode.   Self-­‐adhesive  electrodes  should  be  replaced  after  every  use.  19   Does  the  hospital  have  a  defibrillator  tester?   Defibrillator  testing  can  be  done  on  a  commercial  tester  or  a  large  piece  of  meat.  
20   Test  defibrillator  using  the  defibrillator  tester.  


Connect  pads  to  defibrillator  analyzer.  Select  energy  and  press  charge  button.  Once  charged  push  discharge  button.  Record  delivered  energy  from  display  of  defibrillator  analyzer.  Repeat  the  procedure  for  different  energy  levels.  
21   Is  delivered  energy  >=  limit  set  by  manufacturer  (refer  manual)  for  different  energy  levels?  


Improper  functioning  of  internal  circuitry  if  the  defibrillator  delivers  less  or  no  energy  than  the  limit  set  by  manufacturer.    
22   Test  the  defibrillator  using  a  large  piece  of  meat.  


Set  energy  to  maximum  and  press  charge  button.  Once  charged  place  pads  on  a  large  piece  of  meat.  Press  discharge  button.  Repeat  the  procedure  10  times.  The  piece  of  meat  should  be  large  enough  so  that  the  defibrillator  paddles  can  be  placed  greater  than  6  inches  apart.  23   Are  there  no  burn  marks  on  the  meat  (after  10  shocks)?   Failure  of  internal  circuitry  if  no  burn  marks  are  found  on  the  piece  of  meat.  24   Refer  equipment  to  device  manufacturer.          Refer  equipment  to  device  manufacturer  for  possible  repair  and  replacement  of  internal  circuitry  components.  
25   Perform  preventive  maintenance  on  defibrillator.  Return  defibrillator  to  clinical  personnel.                          


Defibrillator  is  working  properly.  Perform  preventive  maintenance  before  returning  the  device  to  clinical  personnel.    




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Thoughts/  Comments/  Ideas      




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Electrocardiogram  (ECG)  
Flowchart  


     




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Description  #   Text  Box   Comments  1   Begin:  ECG  flowchart   Start  diagnostic  process  for  a  work  order  on  an  ECG  
2   Does  ECG  power  on?   Lights,  displays,  and  sounds  are  indications  that  device  is  powered  on.  Also,  check  the  power  cords  for  continuity.  See  BTA  skills  on  Connections.  3   Troubleshoot  power  supply  (separate  flowchart)   ECG’s  have  an  AC  to  DC  power  supply.  See  Flowchart  on  Power  Supply,  and  BTA  skills  on  Power  Supply.  4   Change  battery  if  necessary.   If  there  is  a  battery,  test  its  ability  to  receive  and  hold  a  charge.  See  BTA  skills  on  Batteries.  5   Does  screen  turn  on?   No  obvious  brightness  or  color  change  on  display  screen?  6   Check  brightness  level.   If  possible,  raise  brightness  level  of  screen.  7   Check  internal  connections.   Check  for  obvious  wiring  issues  such  as  damaged  or  disconnected  wires.  See  BTA  skills  for  Connections  and  Electrical  Simple.  8   Go  to  begin.   Return  to  box  1,  Begin:  ECG  
9   Is  “Lead  off”  light  on?   “Lead  off”  light  will  likely  be  near  display  window.  It  indicates  that  there  is  a  bad  connection  somewhere  between  the  patient  electrodes  and  the  machine.  (1)  See  BTA  skills  for  Electrical  Simple.  10   Are  the  electrodes  in  working  condition?   Check  for  damage  or  corrosion  to  the  electrode  or  electrode  insulation.  
11   Replace  electrodes  or  adjust  their  placement.  


See  electrode  guide  below  for  replacement  of  electrodes  as  well  as  electrode  placement  and  a  conducting  gel  recipe.  If  possible,  attach  a  patient  simulator  to  the  patient  cables.  If  proper  signal  with  simulator,  electrodes  are  non-­‐functional.  
12   Check  connections.  


If  possible,  attach  patient  simulator  to  patient  cables,  if  no  signal  replace  cables.  Ensure  proper  connections  between  ECG  and  electrodes  and  ensure  patient  is  not  moving.  Make  sure  electrode  has  proper  contact  with  patient’s  skin.  (1)  See  BTA  skills  for  Electrical  Simple.  13   Go  to  Begin.   Return  to  box  1,  Begin:  ECG  
14   Does  lead  print  as  square  wave?   Does  one  or  more  lead  display  as  a  square  wave?  (1)  
15   Is  there  a  wandering  baseline?  


Does  display  show  an  unsteady  baseline  signal?  
(1)  Note:  In  an  analog  ECG  machine,  a  wandering  baseline  may  be  caused  by  the  INSTO  adjust  or  if  the  stylus  pegs  violently  


16   Is  there  muscular  interference  or  AC  interference?  
Does  display  show  muscular  or  AC  interference  (picture):  Even  peaked,  regular  voltage  superimposed  on  waveforms?  


(1)  
17   Are  leads/electrodes  in  working  condition?   Check  for  damage  or  corrosion  to  the  electrode  or  electrode  insulation.  If  possible,  attach  a  patient  simulator  to  the  patient  cables.  If  proper  signal  with  simulator,  electrodes  are  non-­‐functional.  18   Replace  or  repair  intermittent   See  electrode  guide  below  for  replacement  of  electrodes  as  well  as  




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leads/electrodes  or  adjust  their  placement.   electrode  placement  and  a  conducting  gel  recipe.  
19   Check  connections.  


If  possible,  attach  patient  simulator  to  patient  cables,  if  no  signal  replace  cables.  Ensure  proper  connections  between  ECG  and  electrodes  and  ensure  patient  is  not  moving.  Make  sure  electrode  has  proper  contact  with  patient’s  skin.  (1)  See  BTA  skills  for  Electrical  Simple.  
20   Fix  muscular  interference.   Make  sure  patient  is  comfortable  and  not  tense,  if  possible  turn  on  muscular  filter.    See  user’s  manual  for  instructions  on  muscular  filter.  (1)  
21   Fix  AC  interference.   Verify  that  patient  is  not  touching  any  metal.  Verify  power  cable  is  not  touching  patient  cable.  If  possible,  turn  on  AC  filter  according  to  instructions  in  user’s  manual.  Also,  try  running  on  battery  power,  if  possible.  (1)  See  BTA  skills  on  Power  Supply  and  Electrical  Simple.  22   Unexpected  ECG  morphology?   Does  display  show  an  unexpected  ECG  morphology?  23   Reference  electrode  guide.   Check  electrode  guide  below,  particularly  on  lead  placement  to  ensure  proper  location.  
24   Check  connections.  


If  possible,  attach  patient  simulator  to  patient  cables,  if  no  signal  replace  cables.  Ensure  proper  connections  between  ECG  and  electrodes  and  ensure  patient  is  not  moving.  Make  sure  electrode  has  proper  contact  with  patient’s  skin.  (1)  See  BTA  skills  for  Electrical  Simple.  25   Is  there  a  printer  problem?   Does  printer  not  print  or  print  output  that  does  not  match  display  
26   Refer  to  printer  guide     Use  Printer  flowchart  to  determine  possible  problems  with  printer  output.  ?  If  it  is  an  analog  ECG  machine,  the  stylus  heat  and  pressure  can  cause  poor  trace  display.  Refer  to  the  service  manual  or  online  documentation.  27   Go  to  Begin   Return  to  box  1,  Begin:  ECG  
28   Check  connections  


If  possible,  attach  patient  simulator  to  patient  cables,  if  no  signal  replace  cables.  Ensure  proper  connections  between  ECG  and  electrodes  and  ensure  patient  is  not  moving.  Make  sure  electrode  has  proper  contact  with  patient’s  skin.  (1)  See  BTA  skills  for  Electrical  Simple.  29   ECG  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.  
 
Preventative  Maintenance  


• Clean  casing  • Clean  electrodes  and  inspect  for  corrosion  or  adhered  debris  after  each  use  • Inspect  insulation  for  defects  and  debris  • Inspect  cables  for  defects,  replace  if  necessary  • If  battery-­‐powered,  regularly  check  batteries  to  prevent  corrosion  • Re-­‐stock  and  refill  ink  and  paper  as  needed      




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Electrode  Guide  Proper  Placement  of  12  Lead  ECG  
For  the  4  extremity  electrodes  placement:  


• L  or  LA  is  placed  on  the  left  arm  • R  or  RA  is  placed  on  the  right  arm  • N  -­‐  neutral,  on  the  right  leg  (=  electrical  earth,  or  point  zero,  to  which  the  electrical  current  is  measured)  • F  -­‐  foot,  on  the  left  leg  • It  does  not  matter  whether  the  electrodes  are  placed  on  the  bottoms  or  tops  of  extremities,  but  be  consistent.  Place  electrodes  in  similar  spots  on  extremities.  (eg.  do  not  attach  an  electrode  on  the  left  shoulder  and  one  on  the  right  wrist).  Also,  avoid  bony  parts  such  as  elbows  or  knees.      
 
For  the  6  chest  electrodes  placement:  


• V1  is  placed  to  the  right  of  the  sternum  in  the  4th  intercostal  space.  • V2  is  placed  to  the  left  of  the  sternum  in  the  4th  intercostal  space  • V3  is  placed  between  V2  and  V4  • V4  is  placed  in  the  5th  intercostal  space  on  the  nipple  line.  Place  V4  beneath  the  breast  in  women.  • V5  is  placed  between  V4  and  V6  • V6  is  placed  in  the  midaxillary  line  on  the  same  height  as  V4  on  the  horizontal  line  from  V4  (not  necessarily  in  the  5th  intercostal  space)    
Common  lead  misplacements:  


• Right  and  left  arm  electrode  reversal  • Right  leg  and  right  arm  electrode  reversal  • Left  arm  and  left  leg  electrode  reversal  • Right  arm  and  left  leg  electrode  reversal  • Left  arm  and  right  leg  electrode  reversal    
 
 




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To  make  replacement  ECG  pads:  
Materials  1.  Bottle  caps  2.  Nickel-­‐plated  brass  sewing  snap  buttons,  size  3  3.  Flathead  screwdriver  4.  Utility  knife  (boxcutter,  X-­‐Acto  or  another  sharp-­‐bladed,  small  knife)  5.  Pot,  water  and  a  stove  6.  Optional:  tweezers/forceps  
Steps  1.  Boil  the  bottle  caps  in  water  for  30  minutes.  2.  Peel  off  the  lining.  Start  the  peel  by  prying  an  edge  off  with  the  screwdriver,  then  carefully  pull  the  rest  out  with  your  fingers  or  with  tweezers  or  forceps.  Take  care  not  to  rip  the  lining  during  this  process.  If  the  lining  is  too  hard  to  remove,  heat  the  cap  in  the  water  again.  3.  Make  an  “X”  in  the  center  of  the  lining,  about  1cm  big.  4.  Insert  a  size-­‐3  nickel-­‐plated  brass  sewing  snap  into  it.  5.  Trim  the  tiny  corners  of  plastic  from  the  edge  of  the  button  nub.  
To  make  ECG  conductive  gel:  
Materials  1.  Water,  one  cup  2.  Salt,  two  tablespoons  3.  Flour,  one  cup  4.  Bleach  
Steps  1.  Mix  the  water  and  salt.  2.  Slowly  pour  in  the  flour.  The  mixture  will  become  gelatinous.  Mix  it  until  it  the  consistency  is  the  same.  3.  Add  a  drop  of  bleach  (to  make  the  gel  sterile).  
Proper  skin  preparation:  


1. Shave  body  hair  before  application,  if  in  excess.  2. Avoid  placing  electrodes  on  any  burn  or  scar  tissue.  3. Make  sure  electrodes  have  some  sort  of  conductive  gel  between  skin  and  metal  contact.  4. Make  sure  electrode  is  firmly  attached  to  skin.  Apply  tape,  if  necessary.  5. If  steps  1-­‐4  struggle,  use  a  light  skin  abrasive  such  as  sand  paper.  6. Reapply  conducting  gel  every  couple  of  hours  to  avoid  skin  irritation  and  loss  of  signal.      




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Thoughts/  Comments/  Ideas      




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Endoscope  
Flowchart  


     




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Description  #   Textbox   Explanation  1   Begin  endoscope  troubleshoot   Start  the  diagnostic  process  for  a  work  order  on  the  endoscope.  
2   Is  sufficient  light  reaching  the  eyepieces?  


After  turning  on  and  connecting  the  light  source  to  the  light  guide  cable,  hold  the  tip  of  the  scope  up  to  another  bright  external  light.  Does  an  equally  bright  image  appear  through  the  eyepiece?  There  should  be  few  to  no  black  spots  (broken  fiber  optic  wires).  More  than  10%  of  the  image  being  black  is  considered  unacceptable.  
3   After  ensuring  that  the  light  source  is  connected  and  turned  on,  visually  inspect  the  objective  lens  and  eyepiece.  


Double  check  to  make  sure  the  light  source  is  powered  on,  its  power  source  is  working,  and  all  connections  from  light  source  to  endoscope  are  tight  and  fitted  properly.  Then  inspect  both  the  eyepiece  and  the  objective  lens  on  the  distal  tip.  Both  should  be  free  of  dust/dirt/buildup.  Check  lens  for  cracks  or  scratches.  See  BTA  skills  on  Electrical  Simple  –  Connections.  
4   Are  the  objective  les/eyepiece  free  from  external  debris/moisture?   Is  there  a  buildup  of  anything  on  the  external  surface  of  either  the  objective  lens/eyepiece?  This  could  include  dust,  dirt,  fluid,  scratches,  cracks,  etc.  
5   Clean  objective  lens/eyepiece  with  70%  ethyl  solution.  


Wipe  the  external  surface  with  a  clean,  lint-­‐free  cloth  moistened  with  70%  ethyl  or  isopropyl  alcohol.  Never  use  an  abrasive  cleanser  which  might  scratch  the  lens  surface.  If  scratches  are  present,  eyepiece/lens  may  need  to  be  replaced.  See  BTA  skills  on  Cleaning.  
6   Are  the  objective  lens/eyepiece  free  from  internal  debris/moisture?  


After  cleaning  the  outside  of  the  lens/eyepiece,  if  the  image  still  appears  dark,  visually  inspect  for  internal  buildup  or  moisture.  Moisture  would  make  the  image  appear  foggy/unfocused.  
7   Internal  problems  cannot  be  repaired  by  a  technician  and  must  be  sent  out  for  repair.  


It  is  not  possible  to  disassemble  the  endoscope  to  repair  internal  damage  and  water  leaks.  The  equipment  should  be  sent  out  for  repair  or  replaced.  
8   Damaged  fiber  optic  cables.  Device  must  be  sent  out  for  repair.  


If  dark,  black  spots  appear  in  the  image,  some  of  the  fiber  optic  cables  are  broken.  If  more  than  10%  of  the  image  appears  black,  consider  replacing  the  fiber  optic  cable.  Do  not  attempt  to  disassemble  and  fix.  Device  must  be  sent  out.  
9   Is  the  image  in  focus?   Does  the  objective  appear  through  the  eyepiece  clearly?  The  image  should  not  appear  “fuzzy”  or  unfocused.  Sufficient  focus  is  important  for  many  procedures.  
10   After  ensuring  the  optics  control  on  the  eyepiece  is  adjusted  sufficiently,  inspect  the  objective  lens  and  eyepiece.  


Adjust  the  controls  on/near  the  eyepiece  on  the  endoscope  control  body.  Turn  the  knob  to  bring  the  image  in  and  out  of  focus  until  it  is  clear.  If  no  optic  control  setting  fixes  the  clarity,  inspect  the  lens  and  eyepiece  for  obstruction.  
11   Does  the  distal/bending  section  move  as  expected?  


Test  the  response  of  the  control  knobs  on  the  endoscope  control  body.  The  UP/DN  knob  should  move  the  distal  tip  up  and  down,  and  the  R/L  knob  should  turn  the  tip  from  side  to  side.  Check  to  make  sure  the  knobs  turn  with  ease  and  are  not  loose  or  cracked.  See  BTA  skills  on  Mechanical  –  Attachment.  
12   Do  not  force  the  distal  end  to  angulate  if  it  does  not  move  freely.   If  the  tip  does  not  angulate,  DO  NOT  TRY  TO  FORCE  IT.  Angulation  problems  are  usually  a  result  of  water  damage  or  physical  strain  on  the  internal  wires.  
13   Physically  inspect  the  insertion  tube/bending  section  for  bumps/bends/tears.  


Run  hand  down  the  length  of  insertion  tube  from  its  connection  to  the  control  body  down  to  the  distal  tip  and  objective  lens.  Physically  feel  and  visually  look  for  any  holes,  tears,  wrinkles,  buckles,  bends,  etc.  14   If  these  exist,  the  problem  is   If  any  external  damage  exists  on  the  insertion  tube,  it  should  be  




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internal  and  the  device  must  be  sent  out  for  repair.   replaced.  Do  not  attempt  to  repair  the  insertion  tube  with  epoxy/sealant,  as  this  could  damage  the  device  further  or  put  the  patient  at  serious  risk.  
15   Is  the  monitor  functioning  correctly?  (Skip  this  step  if  image  is  viewed  through  eyepiece  only).   If  the  endoscope  is  connected  to  a  monitor  for  viewing:  Check  display  on  monitor.  The  image  should  appear  as  it  does  through  the  eyepiece.  16   Does  the  image  appear  on  the  monitor?   Does  the  monitor  display  an  image?  
17   Ensure  the  monitor  is  connected  to  the  power  supply.  Troubleshoot  power  supply  if  necessary.   Make  sure  the  monitor  is  powered  on,  connected  to  a  power  source.  See  flowchart  for  Power  Supply  and  BTA  skills  on  Power  Supply.  
18   Ensure  cables  are  connected  to  correct  ports.   Check  that  the  “video  out”  cable  from  the  endoscope  is  connected  to  the  “video  in”  port  on  the  monitor.  Make  sure  the  connection  is  tight,  and  that  the  wire  is  undamaged.  See  BTA  skills  on  Electrical  Simple.  19   Ensure  correct  video  signal  source  is  selected.   Check  monitor  settings  for  the  input  source.  If  “NO  SIGNAL”  appears  on  the  monitor,  cycle  through  input  sources  until  an  image  appears.  
20   Reset  all  monitor  settings  (brightness,  color,  contrast)  to  default  settings.   Default  all  monitor  display  settings.  21   Does  the  image  remain  on  the  screen  without  flickering/rolling?   Once  an  image  appears,  does  it  remain  on  the  screen?  The  display  should  not  bounce,  flicker,  or  roll  across  the  monitor.  
22   Ensure  all  cables  and  connectors  are  securely  connected,  and  in  good  condition.   Tighten  all  connections  on  endoscope  and  monitor.  Make  sure  there  are  no  tears  in  the  wires.  See  BTA  skills  on  Electrical  Simple.  
23   If  image  is  rolling,  turn  the  VERTICAL  HOLD  (V-­‐HOLD)  knob  slowly  until  the  image  becomes  stable.  


If  there  are  lines  rolling  across  the  monitor  or  the  display  is  unsteady,  locate  the  Vertical  Hold  knob/button  on  the  back  of  the  monitor.  Adjust  this  setting  slowly  until  the  image  no  longer  jumps.  24   Device  is  working  properly.   The  endoscope  is  in  good  working  condition.  
 
Preventive  Maintenance    


• Ensure   the   scope   is   stored   in   a   dry,   safe   place   where   it   is   free   from   damage   and   environmental  contamination.  It   is  preferable  for  the  scope  to  hang  vertically,  to  facilitate  drying  and  prevent  moisture  buildup  • Before   and   after   each  use  of   the   endoscope   it   is   important   to   inspect   the   equipment   to   prevent   small  problems  from  becoming  larger  • MAKE  SURE  o No  parts  are  missing  or  loose  o The  scope  is  free  of  damage  (run  your  hand  down  the  length  of  the  insertion  tube-­‐down  to  the  distal  end  to  feel  for  dents,  cracks  or  bends)  § If   damage   is   present:  THE  DEVICE   SHOULD  BE   SENT  OUT   FOR  REPAIR   IMMEDIATELY.  While  the  device  may  seem  functional  and  able  to  be  used,  small  cuts  and  tears  can  lead  to  major  fluid  invasion,  which  will  cause  a  much  larger/more  expensive  problem.  o The  scope  is  free  of  dirt  or  debris  anywhere  on  its  exterior  




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§ If   dirt   is   present:   thoroughly   rinse   with   water.   Remove   persistent   debris   with   a   non-­‐acidic  cleaning  agent.  Rinse  again  with  water.  Use  a  non-­‐abrasive,  soft,  lint-­‐free  cloth  to  dry  equipment.  o All   optical   surfaces   (eyepiece   cover   lens,   objective   lens,   video   adapter   lenses)   are   free   of  dirt/moisture  § If  dirt  is  present:  clean  with  70%  ethanol  using  a  non-­‐abrasive,  lint-­‐free  cloth    




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Thoughts/  Comments/  Ideas    
   




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ESU  
Flowchart    
   




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Description  #   Textbox   Explanation  1   Start:  ESU  Troubleshooting.   Begin   troubleshooting   process   for   a   work   order   on  ESU.  2   Is  the  ESU  free  of  any  external  damage/defects?   Check   for   dents,   scratches   and   any   other   noticeable  problems  with  the  cover  or  casing.  3   Identify   and   replace   damaged   switches,   indicators,  knobs.   The  easiest  damages   to   fix  are   those  on   the  exterior  of   the   device.   See   BTA   skills   on   Mechanical   Casing  and  Mechanical  Attachment.  4   Clean  device  using  alcohol.   Generally,   a   maximum   of   70%   ethanol   solution   or  clean   water   should   be   used.   See   BTA   skills   on  Mechanical  Cleaning.  5   Does  the  ESU  turn  on?   Check   for  visible  signs  of  power   reaching   the  device.  Lights,   sounds,   audible   motor   whirring,   etc   are   all  signs  that  the  device  is  receiving  power.  6   Inspect   AC   adapter   cable   and   pins   for   cuts,   broken  wires,  and  replace  if  necessary.   See  flowchart  for  troubleshooting  Power  Supply,  and  se  BTA  skills  on  Power  Supply  and  Electrical  Simple.  7   Identify  and  replace  blown  fuse.   See  flowchart  for  troubleshooting  Power  Supply,  and  se  BTA  skills  on  Power  Supply  and  Electrical  Simple.  8   Troubleshoot  power  supply.   See  flowchart  for  troubleshooting  Power  Supply,  and  se  BTA  skills  on  Power  Supply  and  Electrical  Simple.  9   Is  the  device  free  from  any  alarm  sound  or  the  device  doesn’t  turn  off  by  itself  when  in  use?   Alarms   and   sudden   power   loss   are   indications   that  the  device  is  functioning  improperly.    10   Ensure   proper   placement   of   ground   electrode   on  patient.    11   Ensure  low  patient  impedance.    12   Inspect   cable   connecting   the   ground   electrode   to  ESU   for   cuts,   broken   wires,   damage   and   replace   if  necessary.   See   BTA   skills   on   Power   Supply   Plug/Cable   and  Electrical  Connections  Simple  13   Test  ESU  using  a  piece  of  meat.   Power  device  as  normal,  attach  electrode  to  one  side  of   a   piece   of   raw  meat   and   touch   ESU  pencil   to   the  meat.  14   Are  there  no  cuts  on  the  meat?   Burn  marks  or  cuts  underneath  the  pencil  and  return  electrode  are  signs  that  the  device  is  functioning.  Lack  of   these   marks   mean   that   the   electrodes   are   not  being  charged  properly  15   Perform   preventative   maintenance   on   ESU.   Return  ESU  to  clinical  personnel.   Device  is  ready  for  use.  16   Does  the  device  use  monopolar  electrodes?   Monopolar   electrodes   are   used  when   the   generator  of   the   device   sends   a   current   from   one   electrode,  through   tissue,   and   to   the   other.   When   the   device  uses   and   ESU   pencil   and   a   large,   flat,   metal   return  electrode,  the  device  uses  monopolar  electrodes.  17   Are  the  bipolar  electrodes  properly  insulated?   Bipolar  electrodes  are  both  contained  in  the  tip  of  the  ESU  pencil  and  they  pass  current  between  them  on  a  much   smaller   scale.   The   exterior   of   the   bipolar  electrodes  must   be   insulated   to   localize   energy   and  current  transfer  between  the  electrodes.  18   Ensure   proper   insulation   between   the   two   active    




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(bipolar)  electrodes.  19   Does  the  return  electrode  have  two  sections?   Is   the   face   of   the   return   electrode   segmented   into  two  sections?  20   Is   the   return   electrode   free   from   any   short   circuits  between  the  two  sections?   Use   a   multimeter   to   measure   the   resistance   or  voltage  drop  between  the  two  sections.  See  BTA  skills  on  Electrical  Simple.  21   Replace  return  electrode  if  necessary.   This   step   would   require   a   readily   available  replacement  part  or  the  device  cannot  function.  22   Go  to  step  24.   Proceed  to  step  24.  23   Is  the  return  electrode  flat?   The  return  electrode  must  be  flat  in  order  to  function  properly.  24   Is   the   footswitch   pedal   properly   connected   to   the  device?   See   BTA   skills   for   Mechanical   Attachment   and  Mechanical  Casing.  25   Inspect   for   cuts,   broken   wires   in   the   cable   and  replace  if  necessary.   See  BTA  skills  for  Electrical  Connections.  26   Is  the  ESU  pencil  free  of  any  damage/defects?   The  ESU  pencil  is  a  small  metal  electrode.  Visually  and  tactilely  scan  it  for  obvious  damage.  27   Inspect  pencil  cable  and  connectors  for  cuts,  broken  wires  and  replace  if  necessary.   See  BTA  skills  for  Electrical  Connections  and  Electrical  Connectors.  28   Replace  pencil  tip  if  disposable.   This   step   hinges   on   the   assumption   that   tips   are  readily  available.  29   Device  is  ready  for  use.   Device  is  ready  for  use.  
 
Preventive  Maintenance    


• Clean  and  care  for  electrodes  and  ESU  pencil.  Make  sure  they  are  free  from  debris,  dirt  and  damages.  • Check  and  store  wires  and  cables  properly.      




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Thoughts/  Comments/  Ideas    
   




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Fetal  Doppler  
Flowchart    
   




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Description     Textbox   Explanation  1    Begin  Fetal  Doppler  Flow  Chart   Begin  diagnostic  process  for  a  work  order  on  Fetal  Doppler  2    Does  it  turn  on?   Does  it  turn  on?  3   Trouble  shoot  Power  Supply   See  Flowchart  on  Power  Supply,  and  BTA  skills  on  Power  Supply.  4   Does  the  screen  turn  on?   Does  the  screen  turn  on?  5   Check  circuit  components   Troubleshoot  the  electrical  components.  See  BTA  skills  on  Electrical  Simple.  6   Does  the  speaker  work?   Is  sound  audible?  7   Check  speaker/  circuit  components   Troubleshoot  the  electrical  components.  See  BTA  skills  on  Electrical  Simple.  8   Is  it  measuring  a  signal?   Is  the  monitor/Doppler  producing  HR  sound?  9   Check  if  probe  is  connected   Check  if  the  probe  is  connected  to  the  fetal  doppler/monitor.  10    Connect  the  probe   Connect  the  probe.  See  BTA  skills  on  Mechanical  –  Attachments.  11    Check  if  probe  is  clean   Clean  the  probe.  See  BTA  skills  on  Cleaning.  12    Check  internal  circuitry,   Troubleshoot  the  electrical  components.  See  BTA  skills  on  Electrical  Simple.  13    Check  if  you  need  more  gel   Apply  ultrasound  gel  to  the  probe.  
14    Is  the  heart  rate  in  a  normal  range?   Is  the  heart  rate  in  a  normal  range?  
15    Check  circuitry  and  check  gel   Troubleshoot  the  electrical  components  and  apply  ultrasound  gel  to  the  probe  as  necessary.  See  BTA  skills  on  Electrical  Simple.  16    Does  the  printer  print?   Is  there  a  marking  on  the  paper?  17    Is  the  correct  paper  in>   Do  you  have  the  proper  thermal  paper?    18    Check  paper   Check  to  see  whether  paper  is  full.    19    Is  it  calibrated?   Is  the  proper  Heart  Rate,  timing,  and  contraction  output?  Is  the  proper  calibration  signal  upon  start?  20    Close  printer  door   Close  door.  21    Does  the  needle  work?   Does  the  needle  work?  22    Clean  or  replace  needle   Clean  or  replace  needle.  See  BTA  skills  on  Mechanical.  23    Does  the  motor  run?   Does  the  motor  rotate?  24    Check  motor   See  motor  guide  and  BTA  skills  on  Motors.  
25    Does  the  roller  work?   Does  the  roller  move  the  paper  at  the  correct  rate  without  slipping?  Are  there  cracks  or  damage  to  the  roller?  Is  the  roller  hard  and  showing  signs  of  age?  26    Fix  or  replace  Roller   Fix  or  replace  Roller.  
27    Go  to  begin.   Go  to  begin.  
28    Is  the  machine  reading  the  contractions?   Does  the  machine  show  numbers  for  the  uterine  contractions?  




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29    Is  the  belt  fastened?   Is  the  belt  fastened?  
30    Fasten  belt.   Fasten  belt.  
31    Go  to  begin.   Go  to  begin.  
32    Does  the  signal  make  sense?   Does  the  uterine  contraction  signal  correlate  with  the  contractions  the  mother  is  having?  


33    Does  the  machine  give  the  appropriate  metrics?   Does  the  machine  output  sensible  numbers  for  contraction  force  and  frequency?  
34    Check  the  circuitry.   Troubleshoot  the  electrical  components.  See  BTA  skills  on  Electrical  Simple.  
35    Is  the  belt  connected?   Is  the  belt  connected  to  the  fetal  monitor?  
36    Connect  the  belt.   Connect  the  belt.  
37    Does  the  tachometer  record  force?   Does  the  tachometer  record  force  numbers?  
38    Replace  or  check  circuitry.   Replace  the  contraction  belt  or  troubleshoot  the  circuit  (see  troubleshooting  guide)  
39    End   End  the  flow  chart.  
40    Go  to  begin.   Go  to  begin.  
41    Go  to  begin.   Go  to  begin.    
Preventive  Maintenance    Fetal  Doppler/Monitor  Preventative  Maintenance  


1. Clean  the  probe  before  every  use  to  disinfect.  2. Clean  the  probe  and  cable  after  every  use  with  a  damp  cloth  to  remove  gel.    3. Check  the  batteries  periodically  to  ensure  no  corrosion  and  proper  charge.  




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 Fetal  Doppler  Proper  usage  guidelines  
1. Remove  the  battery  if  not  in  use  for  an  extended  period.  2. When  cleaning  the  probe  prior  to  use,  use  a  sort  non-­‐abrasive  cloth  or  disposable  wipe  soaked  in  disinfectant.  Avoid  aerosol  disinfectants  or  solutions  containing  organic  solvents  or  alcohol.  Then  wipe  the  probe  with  a  non-­‐abrasive  cloth  soaked  in  water.  Finally  dry  the  probe  and  package  in  a  clean  bag,  covered  tray  or  other  way  or  careful  storage  and  transport.  3. To  sterilize  the  Fetal  Doppler  or  probes,  use  cold  gas  sterilization  such  as  ethylene  oxide  at  less  than  140  ⁰F  or  the  Sterad  System.  4. Store  at  a  temperature  between  -­‐10⁰C  and  60⁰C  with  a  humidity  of  between  15  and  90%.  


Printer  Usage  
• For  Thermal  Paper  (must  use  company  provided  paper)  o Thermal  side  facing  up  o Make  sure  plastic  cover  and  sticky  tab  are  removed  o Printer  door  must  be  closed  correctly  o 30-­‐240  BPM  (USA)  scale  or  50-­‐210  BPM  scale  (foreign)  


 
   




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Thoughts/  Comments/  Ideas    
   




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Infant  Incubator  
Flowchart  


 




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Description  #   Text  box   Explanation  or  Comment  1   Begin:  Infant  incubator   Start  the  diagnostic  process  for  a  work  order  on  an  infant  incubator.  2   Does  incubator  power  on?   Lights,  displays,  and  sounds  are  signs  the  device  is  powered  on.  
3   Troubleshoot   power   supply  (separate  flowchart).   Infant  incubators  generally  have  an  AC-­‐DC  power  supply.  See  Flowchart  on  Power  Supply,  or  BTA  skills  on  Power  Supply.  4   Change  battery  if  necessary.   If   there   is  battery,  test   its  ability  to  receive  and  hold  a  charge.  See  BTA  skills  on  Batteries.  
5   Does   incubator   maintain   selected  temperature   within   1ºC   for   every  temperature  between  34  and  40ºC?  


An  infant  incubator  should  maintain  preset  temperatures  between  34  and  40ºC.  First   test   to   see   if   the   temperature   is   between   these   limits.   Second,   ensure  temperature   increases   and   decreases   with   the   control   knob   or   selector.   Third,  ensure  the  temperature  inside  the  incubator  is  within  one  degree  of  the  value  set  by   the   knob   or   control   panel.   It   may   be   necessary   to   use   an   external  thermometer.  
6   Does   temperature   control   work   at  some   temperatures   but   not   at  others?  


The   incubator  does  not  pass   the   third   test  of   controlling   temperature   to  within  one   degree   at   all   temperatures.   Does   the   temperature   increase   and   decrease  with   controls,   but   not   maintain   the   correct   temperature   at   all   selected  temperatures?    
7   Is   actual   temperature   generally   too  low?   The   incubator   cannot   accurately   control   the   temperature   at   any   temperature  level.  Is  the  actual  temperature  generally  lower  than  the  setting?  
8   Temperature  is  generally  too  high.   The   incubator   cannot   accurately   control   temperature   at   any   level   and   the  temperature  is  not  too  low.  Therefore,  the  temperature  is  generally  too  high.  
9   Does  high  temperature  alarm  sound  when  temperature  exceeds  40ºC?   Does  a  safety  alarm  sound  when  the  actual  temperature  exceeds  40ºC?  Alarm  is  likely  to  be  a  sound  though  it  may  include  a  light  or  flashing  display.  


10   Check   alarm   speaker   if   it   cannot  sound.   Ensure  the  machine  is  not  in  silent  mode.  If  the  machine  is  not  in  silent  mode  and  no   alarm   sounds   at   high   actual   temperatures   check   the   temperature   sensor  placement  and  the  speaker.  


11   Consider   replacing   temperature  sensor.  
The   incubator's   temperature   is   too   high   and   the   machine   is   having   trouble  regulating  the  temperature  with  controls.  Check  the  connections  and  placement  for  the  machine's  temperature  sensor.  It  might  not  be  located  in  the  correct  area  of   the   incubator   to   read   the   high   temperatures.   See   BTA   skills   on   electrical  connections   and   connectors.   If   the   technical   issue   cannot   be   resolved,   consult  with  clinical  staff.  If  the  clinical  staff  approves,  they  might  be  able  to  operate  the  incubator  with  a  separate  thermometer  and  turn  the  entire  machine  off  and  on  to  regulate  the  temperature  and  prevent  it  from  overheating  the  infant.  




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12   Clean/replace  fan  filter  if  necessary.   Low  temperature  can  result  from  problems  with  the  intake  fan  or  from  leaks.  Fan  filter  needs  to  be  cleaned  or  replaced  periodically  when  dirty.  The  filter  might  be  washable  with  water  and  detergent.  13   Ensure  fan  is  working  properly.   Use  a  multimeter  to  ensure  the  proper  voltage  reaches  the  fan.    
14   Inspect  case  and  doors  for  leaks.   Large  leaks  can  be  detected  by  using  your  hand  to  sense  warm  air  escaping.  Small  leaks   can   be   found   by   using   a   toothbrush   to   apply   detergent   around   seals   in  doors  and  case.  See  BTA  skills  for  Plumbing  Leaks.  Leaks  might  be  repaired  with  sealant.  
15   Does   incubator   use   incandescent  bulb  to  generate  heat?   Some  older   incubators   use   an   incandescent   bulb   to   generate   heat   instead   of   a  heating  element.  
16   Ensure   heating   element   is  working.  Replace  if  necessary.  


If   a   resistive  heating  element   is   used,  measure   its   resistance  with  a  multimeter  and   compare   to  manufacture   specifications.   The   element   can   be   replaced  with  any   resistor   with   the   same   resistance   and   power   ratings.   See   BTA   skills   on  Connections.  
17   Does   incubator   maintain   sufficient  temperature?   Does   the   incubator  maintain   sufficient   temperature  after  any  corrective  actions  on  the  bulb  or  heating  element?  
18   Consider   replacing   temperature  sensor  or  rheostat  if  necessary.  


If   the  temperature  controls  work  only  at  some  temperatures,  or   if   the  bulb  and  heating   element   are   both   working   and   the   temperature   is   still   too   low,   there  might   be   a   problem   with   the   incubator's   temperature   sensor   not   accurately  reading   the   temperature.   Check   its   connections   (see   BTA   skill   on   electrical  Connections).  Consider  replacing  temperature  sensor  or  rheostat.  
19   Change  bulb  if  burnt  out.   If  the  incandescent  bulb  is  burnt  out  it  will  need  to  be  replaced  with  one  with  the  same  power  rating.  
20   Ensure  rheostat  knob  is  tight.   Some  rheostats  include  a  knob  that  is  affixed  to  the  shaft  with  a  set  screw.  Ensure  the  screw  is  tight.  If  the  knob  is  broken,  search  for  another  plastic  knob  that  can  replace   it.   If  no  knob  can  be   found,   it  might  be  possible   to  control   the  rheostat  using  pliers  to  turn  the  shaft.  See  BTA  skills  on  Mechanical  Attachment.  
21   Clean   any   dust   or   dirt   from  rheostat.   See  BTA  skills  on  Cleaning  and  Repairing  Switches.  
22   Does   incubator   maintain   selected  O2  concentration?   O2   concentration   can   be   measured   with   a   sensor   or   with   an   EWH   skill   using  locally  available  resources.  Contact  EWH  for  more  information.  
23   Check   for   leakages   or   blockages   in  O2  tubes.   See  BTA  skills  on  Plumbing  Leaks  and  Blockages.  
24   Replace  O2  sensor  if  necessary.   The  O2  sensor  may  not  be  accurately  reading  the  oxygen  concentration.  See  BTA  skills  on  Electrical  Connections.    




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25   Is  fan  quiet  (<65dB)?   The  fan  should  not  be  excessively  noise  (below  65  db).  Assuming  you  don’t  have  a  sound  meter  with   you,   try   to   estimate   the   noise   of   the   fan  with   your   own   ear  placed  where  the  baby’s  will  be.  It  should  be  so  quiet  that  you  could  comfortably  hear  all  the  conversations  in  the  room  around  you.  
26   Lubricate  fan.   A   noisy   fan   may   need   lubrication.   See   BTA   skills   on   Motor   Cleaning   and  Lubrication.  
27   Tighten  any  screws  securing  fan.   A   noisy   fan   might   be   unbalanced   or   insecure.   See   BTA   skills   on   Mechanical  Attachments.  
28   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
29   Infant   incubator   is   working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.    


Preventative  Maintenance  1. Clean  humidification  chamber.  2. Check  seals  around  doors  and  ports.  3. Lubricate  fan  and  tighten  bolts  to  prevent  noise.  4. Clean  or  replace  bacterial  filter  on  air  intake  (this  is  needed  more  frequently  in  dusty  environments).  5. Clean  incubator  (use  warm  water,  detergent,  and  antiseptic  only).  6. Ensure  doors  and  ports  stay  shut  when  latched.  7. Check  electrical  plug.  8. Check  that  cradle  tilt  is  working  and  adjustable.  9. Drain  and  dry  tray.  Refill  with  sterile  water  immediately  before  re-­‐use.  Change  water  daily.  10.  Check  O2  circuit  connections  and  O2  concentration  inside  unit.  11. Inspect  wheels/casters.  12. Clean  air  intake  filter  with  detergent  if  washable  and  necessary.  13. Check  leakage  current  (<300  microamps).  14. Check  ground  resistance  (<0.5  ohms).  15. Search  for  air  leaks  on  case,  especially  at  junctions  or  joints  of  different  plates  or  pieces  (using  detergent  and  toothbrush  while  unit  is  sealed  can  reveal  leaks).  16. Check  for  evidence  of  fluid  spills  and  clean  any  found  spills.  17. Verify  controls  and  switches  are  operating  properly.  18. Check  for  unusual  noise  or  vibration.  19. Test  audible  and  visible  alarms  and  indicators.    




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Thoughts/Comment/Ideas  
   




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Infant  Warmer  
Flowchart  


     




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Description  
#   Text  Box   Comments  1   Begin:  Infant  warmer   Begin  diagnostic  process  for  infant  warmer.  2   Does  warmer  power  on?   Lights,  displays,  and  sounds  are  all  indications  that  the  device  has  powered  on.  3   Troubleshoot   power   supply  (separate  flowchart)   Most  infant  warmers  have  AC-­‐DC  power  supplies.  See  Flowchart  for  Power  Supply  and  BTA  skills  on  Power  Supply.  4   Does   unit   heat   when   switched  on?   Does  the  device  produce  heat  when  the  warmer  is  switched  on?  5   Does   power   reach   the   heating  element?   If   no   heat   is   produced,   use   a  multimeter   to   test   if   the   proper   voltage   is  reaching  the  heating  element.  
6   Repair  any  open  circuits  or  bad  connections.   If   power   does   not   reach   the   heating   element,   there   might   be   an   open  circuit,   bad   connection,   or   broken   wire.   See   BTA   skills   on   Electrical  Connections.  7   Replace  switch,  relay,  or  triac.   A  switch,  relay,  or  triac  may  be  used  to  control  current  flow  to  the  heating  element.  Ensure  it  is  working  properly.  See  BTA  skills  on  Electrical  Switches.  
8   Is  heating  element  resistive?   Infant  warmers   typically  use  a   resistive  element  or  a  bulb   to   create  heat.  Check  which  one  is  used  in  this  device.  
9   Replace  bulb.   If   a   bulb   is   used   and   the   proper   voltage   is   reaching   the   bulb,   it  must   be  replaced.  See  BTA  skills  on  Electrical  Lighting.  
10   Replace  heating  element.   If   a   resistive   element   is   used   and   the   proper   voltage   is   reaching   the  resistor,   the   element   must   be   replaced.   See   BTA   skills   on   Electrical  Heating  Element.  
11   Is   the  warmer   designed   to   use  a  temperature  probe?   If   the   warmer   heats,   it's   necessary   to   check   the   temperature   control  methods  of  the  device.  Is  a  temperature  probe  (thermometer)  used,  either  on  the  skin  of  the  infant  or  in  the  air?  
12   Is  temperature  >  38  degrees  C?   If  there  is  no  thermometer,  the  temperature  must  be  measured  at  patient  level   to   ensure   it   stays   at   the   desired   level   (typically   between   34   and   38  degrees  C).  
13   Is  temperature  <  34  degrees  C?   If   the   temperature   is   below   38   degrees   C,   confirm   that   is   above   the  minimum  temperature  (34  degrees  C).  
14   Increase  temperature.   Increase   the   temperature   if   it   is   below   34   degrees   C.   This   might   be  accomplished  by  using  control  knobs   to   increase  heat  output,  moving   the  heating  element  closer  to  the  patient,  and/or  reducing  ventilation.  
15   Decrease  temperature.   Decrease   the   temperature   if   it   is   above   38   degrees   C.   This   might   be  accomplished  by  using  the  control  knob  to  decrease  output  of  the  heating  element,  moving   the  element   farther   from   the  patient,   and/or   increasing  ventilation.  
16   Is  probe  present?   Confirm  that  the  probe  is  present.  Missing  or  damaged  temperature  probes  are  a  common  problem.  Some  warmers  may  have  a  manual  mode  to  set  a  fixed  heat  output  if  the  temperature  probe  is  missing.  




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17   Is  probe  thermistor?   If  there   is  a  temperature  probe  present,   it  will  be  either  a  thermistor  or  a  thermocouple.  Attempt  to  verify  which  it  is.  
18   Replace   probe   or   improvise  thermocouple.  


If  the  probe  is  a  thermocouple,  it  works  by  providing  a  voltage  source  that  varies  in  response  to  the  input  temperature.  A  battery  and  voltage  divider  might   be   able   to   be   used   to   improvise   the   voltage   output   at   a   particular  level  to  convert  the  infant  warmer  to  manual  mode.  
19   Replace   probe   or   improvise  thermistor  


If  the  probe  is  a  thermistor,  it  works  by  providing  a  resistance  that  varies  in  response   to   the   input   temperature.  A  potentiometer  or   resistor  might  be  able  to  be  used  to  improvise  the  resistance  at  a  particular  level  to  convert  the  infant  warmer  to  manual  mode.  
20   Does   warmer   maintain   temp  within  1  degree  C?   If  the  probe  is  present,  test  the  temperature  output  at  various  temperature  levels  to  ensure  the  device  can  maintain  the  selected  temperature  within  1  degree  C.  
21   Replace  or  correct  probe.   If  the  device  does  not  maintain  a  temperature  close  to  the  input,  the  probe  must  be  replaced  or  corrected.  
22   Go  to  begin.   Begin   the   diagnostic   process   again   to   determine   if   corrective   measures  have  repaired  the  device.  
23   Go  to  begin.   Begin   the   diagnostic   process   again   to   determine   if   corrective   measures  have  repaired  the  device.  
24   Infant   warmer   is   working  properly.   The  infant  warmer  maintains  the  appropriate  temperature.  The  repair  was  successful.  
25   Is  temperature  between  34  and  38  degrees?   Does   the  warmer  maintain   an   appropriate   temperature   (between  34  and  38   degrees   C)   when   operating   in   manual   mode   (without   a   temperature  probe)?      




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Preventive  Maintenance    
• Check  for  signs  of  physical  damage  or  abuse  especially  concerning  the  heater(s)  elements.    • Check  for  evidence  of  fluid  spills    • Check  for  secure  mounting    • Check  casters/brakes/mounting    • Check  AC  plug/cord/receptacle    • Check  strain  relief  at  both  ends  of  cord    • Check  controls/switches    • Check  caution/operation  labels  present  &  legible    • Check  filters.  Clean/replace  as  needed    • Check  power-­‐on  sequence    • Test  all  audible  &  visual  alarms  and  indicators    • Clean  interior/exterior  as  required    • Test  HI  Temp  Alarm    • Measure   temperature   at   a   minimum   of   2   set   temperatures.   Check   high   temperature   alarm.   Measure  chassis  ground  resistance    • Measure  chassis  leakage  current    • Check  battery  • Check  that  the  unit  is  clean  and  disinfected  prior  to  use.    • Clean  skin  temp  sensor  • Check  for  corrosion  and  tightness  of  the  heating  element  connections.      




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Thoughts/  Comments/  Ideas      




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Infusion  Pump  (Syringe)  
Flowchart  This  type  of   infusion  pump  uses  a  syringe  driven  by  a   lead  screw  to  deliver  precise  amounts  of   liquid  medication  intravenously.  


   




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Description  #   Text  Box   Comments  1   Begin:  IV  infusion  pump  (syringe)   Start  the  diagnostic  process  for  a  work  order  on  an  Infusion  pump  (syringe).  2   Device  turns  on?   Displays,  lights,  and  sounds  are  all  indications  the  machine  has  turned  on.  
3   Troubleshoot  power  supply  (separate  flowchart).   Syringe  pumps  generally  have  an  AC-­‐DC  power  supply.  See  flowchart  on  Power  Supply  and  BTA  skills  on  Power  Supply.  4   Test  or  replace  battery  if  necessary.   Old  batteries  are  a  common  problem  with  syringe  pump  batteries.  See  BTA  skills  for  Batteries.  5   Device  runs  on  battery  only  (no  AC)?   Check  if  the  machine  will  run  on  battery  when  power  is  unplugged.  This  is  a  safety  feature  on  nearly  all  syringe  pumps.  
6   Pump  creates  correct  flow  rate?   Measure  the  flow  rate  using  a  container  of  known-­‐volume  to  collect  the  fluid  and  a  stopwatch.  For  small  flow  rates,  it  may  be  necessary  to  use  a  precision  scale  to  measure  the  fluid  output.  Flow  rate  is  volume  divided  by  time.  7   Is  flow  rate  zero?   Check  if  the  machine  will  generate  any  output  of  fluid.  
8   Is  flow  rate  too  high?   Compare  the  measured  flow  rate  to  the  amount  programmed  in  the  machine.  
9   Confirm  clutch  is  not  slipping.   Low  flow  can  be  caused  by  a  clutch  slipping  on  the  lead  screw.  Repair  slip  if  necessary.  
10   Clean  and  lubricate  lead  screw  as  necessary.   See  BTA  skills  on  Cleaning  and  Lubrication.  
11   Confirm  syringe  is  loaded  properly.   Incorrect  flow  rate  can  be  caused  by  improperly  loaded  syringe.  
12   Confirm  cables  to  and  from  sensors  and  motor  are  seated  properly.   See  BTA  skills  on  Electric  Connections.  
13   Replace/calibrate  sensors  as  necessary:  syringe  position  sensor,  and  syringe  size  sensor  (if  applicable).   Faulty  sensors  can  cause  faults  in  controlling  the  flow  rate.  
14   Is  flow  rate  correct?   Measure  the  flow  rate  using  a  container  of  known-­‐volume  to  collect  the  fluid  and  a  stopwatch.  For  small  flow  rates,  it  may  be  necessary  to  use  a  precision  scale  to  measure  the  fluid  output.  
15   There  may  be  a  fault  with  microprocessor.   If  corrective  measures  don't  resolve  the  incorrect  flow  rate,  a  problem  with  the  microprocessor  or  computing  software  is  possible.  
16   Consider  replacing/disposing.   If  the  problem  lies  with  the  microprocessor,  the  machine  may  need  to  be  disposed.  
17   Confirm  syringe  is  loaded  properly.   Incorrect  flow  rate  can  be  caused  by  improperly  loaded  syringe.  




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18   Confirm  proper  menu  settings  and  options  are  in  use.   User  error  may  be  a  problem  if  machine  is  reported  for  lack  of  flow.  
19   Clean  and  lubricate  lead  screw  as  necessary.   See  BTA  skills  on  Cleaning  and  Lubrication.  20   Is  flow  rate  zero?   Check  if  the  machine  will  generate  any  output  of  fluid.  
21   Repair  or  replace  stepper  motor.   If  corrective  measures  don't  start  fluid  output,  there  may  be  a  problem  with  the  motor  that  drives  the  syringe.  See  BTA  skills  on  Motors.  
22   Flow  ceases  when  syringe  pump  is  off?   Verify  that  the  flow  ends  when  the  pump  is  turned  off  or  the  control  panel  is  used  to  end  the  flow.  
23   Confirm  syringe  is  loaded  properly.   An  incorrectly  loaded  syringe  could  leak  fluid  when  flow  is  turned  off  by  controls.  24   Correct  leaks  in  tubing.   See  BTA  skills  on  Plumbing  Leaks.  
25   Confirm  syringe  plunger  will  not  move  freely  without  motor.   If  plunger  moves  independently  of  machine  controls,  check  mechanical  connections.  See  BTA  skills  on  Mechanical  Attachment.  
26   Does  high  pressure  alarm  sound  when  tube  is  pinched  after  syringe?   If  the  output  tube  is  occluded,  the  machine  should  emit  a  high  pressure  alarm.  
27   Is  machine  always  silent?   Investigate  if  machine  makes  noises  due  to  any  other  inputs  or  alarms.  
28   Replace/calibrate  force  sensor  on  syringe  plunger.   High  pressure  alarm  is  not  sounding.  Check  the  force  sensor  that  measures  the  force  applied  to  the  syringe  plunger.  
29   Ensure  force  sensor  cables  are  properly  connected  and  seated.   See  BTA  skills  on  Electric  Connections  and  Connectors.  
30   Replace  speaker.   Machine  is  not  in  silent  mode,  but  it  does  not  make  noise.  Replace  the  speaker.  
31   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
32   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  33   IV  pump  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.  
34   Verify  machine  not  in  silent  mode.   Silent  mode  may  be  preventing  the  alarm.  Turn  off  silent  mode  and  check  alarm  again.      




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Preventative  Maintenance  
• Examine  plug  and  line  cord.  • Examine  internal  cables  and  connectors.  • Verify  software  and  menu  settings  are  appropriate  for  clinical  application.  • Examine  controls  and  switches  for  proper  function.  • Verify  battery  chargers  and  indicators  are  working  • Check  suggested  replacement  date  for  the  battery  to  see  if  the  date  is  passed  or  approaching.  • Confirm  lights,  indicators,  and  displays  are  working.  • Verify  flow  stops  when  device  is  turned  off.  • If   device   includes   a   feature   that   requires   the   IV   set   to   be   closed   before   it   is   disconnected   (either  automatically  or  manually),  verify  that  this  mechanism  is  operating  properly.  • Calibrate  machine  for  flow  rate.  • Replace  battery  if  necessary.  • Check  for  unusual  noise  or  vibration.  • Run  self-­‐test,  if  equipped.  • Lubricate  lead  screw,  gears,  and  other  moving  parts  as  required.  • Measure  chassis  leakage  current.  • Measure  ground  resistance.  • Test  audible  and  visual  alarms  and  indicators.      




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Thoughts/  Comments/  Ideas      




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Infusion  Pump  (Feeding)  This  type  of  infusion  pump  delivers  higher  volumes  of  nutritional  fluid  enterally.  This  chart  includes  enteral  pumps  working  with  two  basic  mechanisms:  a  peristaltic  pump  using  actuated  “fingers”  to  pump  fluid  through  a  flexible  tube  and  a  cassette  pump,  in  which  the  pumping  is  achieved  by  a  cassette  as  part  of  a  circuit  that  detaches  from  the  machine.  
Flowchart  


 




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Description  #   Text  Box   Comments  1   Begin:  feeding  pump  (enteral)   Start  the  diagnostic  process  for  a  work  order  on  a  feeding  pump.  2   Device  turns  on?   Lights,  displays,  and  sounds  are  signs  the  device  is  powered  on.  
3   Troubleshoot  power  supply  (separate  flowchart).   Feeding  pumps  generally  have  an  AC-­‐DC  power  supply.  See  flowchart  on  Power  Supply  and  BTA  skills  on  Power  Supply.  
4   Replace  battery  if  necessary.   Old  batteries  are  a  common  problem  with  feeding  pumps.  Test  battery's  ability  to  receive  and  hold  a  charge.  See  BTA  skills  on  Batteries.  
5   Device  runs  on  battery  only  (no  AC)?   Check  if  the  machine  will  run  on  battery  when  power  is  unplugged.  This  is  a  safety  feature  on  nearly  all  feeding  pumps.  
6   Pump  creates  correct  flow  rate?   Measure  the  flow  rate  using  a  container  of  known-­‐volume  to  collect  the  fluid  and  a  stopwatch.  Flow  rate  is  volume  divided  by  time.  7   Is  flow  rate  zero?   Check  if  the  machine  will  generate  any  output  of  fluid.  
8   Is  flow  rate  too  high?   Compare  the  measured  flow  rate  to  the  amount  programmed  in  the  machine.  
9   Check  for  leaks  in  tubing.   Tubing  leaks  can  cause  low  flow  rate.  See  BTA  skills  on  Plumbing  Leaks.  
10   Change  cassette  (if  applicable).   Some  feeding  pumps  use  a  cassette  or  pump  set  as  an  accessory  that  must  be  changed  and  refilled  periodically.  Sometimes  the  cassette  must  be  “primed”  or  “reset”  using  menu  options  on  the  machine  after  refilling.  
11   Adjust  rollers  to  ensure  proper  distance  from  tube  (for  peristaltic  pump).   For  peristaltic  feeding  pumps,  incorrect  flow  rates  can  result  from  rollers  that  are  either  too  far  or  too  close  to  the  tube.  
12   Replace/calibrate  any  flow  sensors.   Incorrect  flow  rates  can  be  caused  by  faulty  or  disconnected  flow  sensors.  See  BTA  skill  on  Electrical  Connections  and  Connecters.  
13   Change  cassette  (if  applicable).   Some  feeding  pumps  use  a  cassette  or  pump  set  as  an  accessory  that  must  be  changed  and  refilled  periodically.  Sometimes  the  cassette  must  be  “primed”  or  “reset”  using  menu  options  on  the  machine  after  refilling.  
14   Verify  free  flow  valve  closes  when  door  is  open.  


Some  feeding  pumps,  especially  peristaltic  feeding  pumps,  have  a  free-­‐flow  valve  that  closes  to  prevent  flow  when  the  machine  case  is  open.  Ensure  the  valve  is  working  properly  and  clean  it  or  adjust  it  mechanically  if  necessary.  See  BTA  skills  on  Plumbing.  
15   Replace/calibrate  any  flow  sensors.   Incorrect  flow  rates  can  be  caused  by  faulty  or  disconnected  flow  sensors.  See  BTA  skill  on  Electrical  Connections  and  Connecters.  
16   Verify  cassette  is  properly  attached  (if  applicable).   An  improperly  loaded  cassette  or  pump  set  can  prevent  any  fluid  output.  




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17   Verify  free-­‐flow  valve  is  open.   The  free-­‐flow  valve  must  be  open  to  allow  fluid  output.  Ensure  the  valve  is  working  properly  and  clean  it  or  adjust  it  mechanically  if  necessary.  
18   Check  for  any  leaks  inside  machine.   A  leak  in  the  tubing  can  cause  a  spill  and  prevent  flow.  See  BTA  skills  on  Plumbing  Leaks.  19   Is  flow  rate  zero?   Check  if  the  machine  will  generate  any  output  of  fluid.  
20   Repair  or  replace  cassette  or  peristaltic  actuators  if  necessary.  


Some  feeding  pumps  use  a  cassette  or  pump  set  as  an  accessory  that  must  be  changed  and  refilled  periodically.  Sometimes  the  cassette  must  be  “primed”  or  “reset”  using  menu  options  on  the  machine  after  refilling.  Peristaltic  pumps  use  rollers  that  are  controlled  and  moved  by  electromechanical  actuators.  Lubricate  or  replace  the  actuators  as  necessary.  
21   Flow  ceases  when  pump  is  off?   When  the  flow  is  turned  off  by  unplugging  the  machine  or  via  user  controls,  verify  that  the  fluid  output  stops.  
22   Verify  cassette  is  properly  attached  (if  applicable).   An  improperly  loaded  cassette  or  pump  set  might  leak  fluid  after  the  device  is  turned  off.  23   Correct  leaks  in  tubing.   See  BTA  skill  on  Plumbing  Leaks.  
24   Repair  or  replace  free-­‐flow  valve  if  necessary.   Ensure  the  free-­‐flow  valve  is  working  properly  and  clean  it  or  adjust  it  mechanically  as  necessary.  See  BTA  skills  on  Plumbing.  
25   Does  occlusion  alarm  sound  when  output  tube  is  pinched?   When  the  output  tube  is  occluded,  the  machine  should  sound.  
26   Is  machine  always  silent?   Investigate  if  machine  makes  noises  due  to  any  other  inputs  or  alarms.  
27   Ensure  occlusion  sensor  cables  are  properly  connected  and  seated.   See  BTA  skills  on  Electric  Connections  and  Connectors.  
28   Replace/calibrate  occlusion  sensor.   See  BTA  skills  on  Electric  Connections  and  Connectors.  Consider  replacing  sensor  if  it  cannot  be  repaired.  
29   Replace  speaker.   Machine  is  not  in  silent  mode,  but  it  does  not  make  noise.  Replace  the  speaker.  
30   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
31   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
32   Feeding  pump  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.  
33   Check  if  machine  is  in  silent  mode.   Silent  mode  may  be  preventing  the  alarm.  Turn  off  silent  mode  and  check  alarm  again.      




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Preventative  Maintenance  
• Clean  machine  and  chassis  from  any  enteral  solution  residue.  • Examine  plug  and  line  cord.  • Examine  internal  cables  and  connectors.  • Verify  software  and  menu  settings  are  appropriate  for  clinical  application.  • Examine  controls  and  switches  for  proper  function.  • Verify  battery  chargers  and  indicators  are  working.  • Check  suggested  replacement  date  for  the  battery  to  see  if  the  date  is  passed  or  approaching.  • Confirm  lights,  indicators,  and  displays  are  working.  • Verify  flow  stops  when  device  is  turned  off.  • Calibrate  machine  for  flow  rate.  • Replace  battery  if  necessary.  • Check  for  unusual  noise  or  vibration.  • Check  rollers  and  tubing  to  see  if  replacement  is  necessary.  • Run  self-­‐test,  if  equipped.  • Lubricate  any  rollers  or  actuators  as  necessary.  • Measure  chassis  leakage  current.  • Measure  ground  resistance.  • Test  audible  and  visual  alarms  and  indicators.      




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Thoughts/  Comments/  Ideas      




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Laryngoscope  
Flowchart  


     




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Description  
#   Text  Box   Comments  
1   Start:  Laryngoscope  Troubleshooting           Begin  diagnostic  process  for  a  work  order  for  Laryngoscope.  2   Is  the  laryngoscope  free  of  any  external  damage/defects?   Inspect  laryngoscope  for  external  cracks,  damage,  or  dirt.  3   Rinse  blade  under  tap  water  and  disinfect/sterilize.   Clean  and  dry  the  blade.  4   Clean  any  build-­‐up  of  material  on  contact  strips.                                                 Examine  the  contact  strips  (blade-­‐handle  interface)  of  laryngoscope  for  dirt.    
5   Remove  any  peeling  chrome  (from  blade)  with  a  scalpel  blade  and  rub  over  the  edge  with  sandpaper.    


Examine  the  blade  for  any  peeling  chrome  and  remove  peels  with  care.  Ensure  that  there  is  no  damage  to  the  blade  during  the  removal  process.  
6   Does  the  light  bulb  power  on  with  battery?   Power  on  the  device  with  battery.  Examine  whether  light  bulb  gives  sufficient  illumination.  
7   Recharge  battery  if  applicable  or  replace  it.           Refer  BTA  skill  set  on  Batteries  to  identify  and  replace  damaged  batteries.  
8   Replace  bulb  if  necessary.                       Refer  BTA  skill  set  on  Lighting/Indicators  to  replace  non-­‐functional  light  bulbs.  
9   Inspect  and  fix  broken  wires  or  bad  connections  between  the  battery  and  bulb.                                        


Inspect  wires  and  connections  from  battery  to  bulb  using  multimeter.  Refer  BTA  skill  set  on  Connections  for  identifying  and  fixing  broken  wires  and  bad  connections.  
10   Does  the  device  use  a  fiber  optic  cable  and  still  the  light  bulb  doesn't  power  on  with  battery?    


There  are  two  types  of  laryngoscopes:  • Conventional  laryngoscope  • Fiber  optic  laryngoscope  If  the  bulb  still  doesn’t  power  on  then  there  might  be  cracks  in  the  fiber  optic  strands.  So  the  unit  might  have  to  be  replaced.  
11   Inspect  for  cracks  in  fiber  optic  strands  and  replace  the  unit  if  necessary.               If  the  illumination  is  not  sufficient  then  inspect  for  cracks  in  fiber  optic  strands.  12   Is  the  lens  free  from  cracks/defects?   Any  defect  in  the  lens  obstructs  vision  of  larynx  and  vocal  cords.  
13   Replace  lens  if  necessary.             Identify  and  replace  with  a  suitable  lens.  
14   Is  the  blade  and  handle  connected  properly?   Improper  connection  between  blade  and  handle  may  result  in  faulty  operation  of  the  device.  15   Refer  device  manual  to  assemble  the  parts.   Follow  instructions  in  the  device  manual  to  assemble  the  parts.  
16   Perform  preventive  maintenance  on  Laryngoscope.  Return  device  to  clinical  personnel.   Laryngoscope  is  working  properly.  Perform  preventive  maintenance  before  returning  the  device  to  clinical  personnel.    




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Preventative  Maintenance  
• Clean/sterilize  blades  and  ensure  that  there  is  no  build-­‐up  or  debris  on  blades  or   in  areas  of  connection  between  blade  and  handle  • Scan  lens  for  cracks  • Keep  lens  clean  of  debris  using  soft  cloth  and  water  or  ethanol  solution  • Check/replace  bulb  and  battery  as  needed      




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Thoughts/  Comments/  Ideas      




92  
 


Microscope  
Flowchart  


 




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Description  #   Text  Box   Comments  
1   Begin:  Microscope   Begin  diagnostic  process  for  a  work  order  for  Microscope.  Maintenance  is  generally  requested  on  a  microscope  when  a  specimen  cannot  be  viewed  clearly  or  at  all.  2   Does  the  microscope  power  on  when  plugged  in?   When  plugged  in,  the  microscope  should  power  on  completely.    
3   Troubleshoot  power  supply  (separate  chart).   If  no  power  reaches  the  machine,  there  may  be  problems  with  the  switch,  fuse,  power  supply  components,  or  wiring.    See  flowchart  on  Power  Supply  and  BTA  skills  on  Power  Supply.  4   Does  the  light  source  turn  on  and  stay  on?   The  light  source  should  remain  constant  across  the  stage  when  on.  
5   Does  the  light  turn  on  and  flicker?   If  the  light  turns  on  but  does  not  remain  constant,  there  may  be  a  minor  problem  that  can  be  fixed  without  replacing  the  bulb  completely.  
6   Ensure  contact  is  clean  and  secure  any  loose  connection.   The  inside  of  the  lamp  house  or  the  connections  may  be  dirty.  The  connections  should  also  be  secured  firmly.  See  BTA  skills  for  Connections.  7   Is  resistance  at  each  end  of  the  filament  0  ohms?   This  checks  if  the  filament  in  the  bulb  is  functioning.  
8   Check  internal  circuitry,  dimmer  knob,  or  diaphragm,  if  applicable.   Ensure  that  the  circuitry  that  connects  to  the  light  source  is  intact.  In  addition,  ensure  the  dimmer  knob  is  turned  on  and  that  the  diaphragm  is  open.  
9   Replace  bulb  with  same  type  of  bulb.   If  the  light  source  still  does  not  turn  on,  replace  the  bulb  with  another  of  the  same  type.  If  the  same  type  of  bulb  is  not  available,  a  new  source  can  be  wired  in.  See  BTA  skills  on  Replacement  of  Light  Bulbs  and  Light  Fixtures.  10   Go  to  begin.   Restart  the  diagnostic  process.  11   Focus  the  microscope  at  the  lowest  objective.   Begin  this  portion  of  the  diagnostic  process  at  the  lowest  objective.  12   Can  the  specimen  be  viewed  clearly?   If  the  specimen  is  out  of  focus  or  cannot  be  viewed  at  all,  the  objectives  may  need  attention.  
13   Clean  dirty  objective  using  a  soft  brush,  a  lint-­‐free  cloth,  and  lens  cleaner.  


Objectives  can  be  unscrewed  or  removed  for  cleaning.  Unscrew  eyepiece  to  use  as  a  magnifying  glass  if  one  is  not  available  to  inspect  objective  for  scratches,  nicks,  cracks,  deterioration  of  seal  around  lens  or  oil  seepage  into  lens.  Blow  off  any  dust  with  canned  air  before  cleaning.  Start  cleaning  objective  lens  from  center  and  spiral  out  with  cotton  swab  or  cloth.  If  lens  cleaner  is  not  available,  ethyl  ether,  xylene,  petrol  can  be  used.  Alcohol,  acetones  or  any  other  ketones  should  not  be  used,  as  they  may  dissolve  sealants.    
14   Do  the  mechanical  adjustment  knobs  turn  easily?   The  knobs  and  stage  should  be  able  to  move  freely  and  also  maintain  a  steady  position.  The  screws  holding  each  in  place  may  need  some  adjustment.  
15   Ensure  the  correct  amount  of  lubricant  has  been  used.  


Clean  off  excess  lubricant  (especially  if  it  has  dried  and  is  clumping)  using  a  soft  cloth  dampened  with  alcohol.  Do  not  use  solvents  that  leave  residue  or  lint  on  the  surface.  Dust,  clean  (with  solvent  listed  above),  polish  (with  metal  polish,  if  available)  and  lubricate  adjustments  if  they  are  stuck  or  difficult  to  turn.  16   Ensure  the  microscope  is  covered  to  avoid  dust  settling  on  it.     When  covering  the  microscope,  put  a  small  amount  of  uncooked  rice  to  prevent  fungal  growth.  Replace  uncooked  rice  weekly.  




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17   Microscope  is  working  properly.   Return  the  machine  to  the  appropriate  clinical  personnel.  
Preventative  Maintenance    Complete  every  six  months.  


• Clean  machine  with  air  brush  or  air  blower,  lint  free  cloth  with  lens  cleaner.  Start  cleaning  objective  lens  from  center  and  spiral  out  with  cotton  swab  or  cloth.  If  lens  cleaner  is  not  available,  ethyl  ether,  xylene,  petrol   can  be  used.  However,   alcohol,   acetones  or   any  other   ketones   should  not  be  used,   as   they  may  dissolve  the  sealants  around  the  lens.  • Check  for  and  remove  any  present  fungal  growth.  • Ensure  a  specimen  can  be  viewed  clearly   through  all  objectives.  Do  not  scratch  or  damage  the   lens.  Oil  lens  -­‐  X100  needs  a  drop  of  oil  to  confirm  clear  image.  Clean  all  objectives  and  eyepieces  first,  and  then  check  for  image  clarity.    • Check  optical  alignment.  • Lubricate  adjustments.  • Ensure  light  source  is  working  properly.  • Inspect  for  signs  of  damage,  scratches,  or  dirt.  • Examine  switches  and  controls  for  proper  function.  • Replace  uncooked  rice  before  storage  to  prevent  fungal  growth.    
Kohler   Illumination:     It   is   a   method   of   illumination   which   involves   optimizing   a   microscope’s   optical   train   to  produce   homogenously   bright   light   free   from   artifacts   and   glare.   In   Kohler   illumination,   four   separate   planes  combine  to  form  conjugate  planes  in  both  the  illumination  and  image-­‐forming  light  pathways.  The  lamp  filament,  aperture   diaphragm,   back   focal   plane   of   the   objective   lens,   and   the   eye   point   which   is   approximately   one  centimeter  above  the  top   lens  of  the  ocular,   form  the   illumination  conjugate  plane.  The  conjugate  planes  of  the  imaging  light  path  are  the  field  diaphragm,  specimen,  the  fixed  diaphragm  of  the  ocular,  and  the  retinal  plane  of  the  viewer.  In  Kohler  illumination  the  collector  lens  or  field  diaphragm  collects   light  from  the  illumination  source  and  focuses  it  at  the  front  focal  plane  of  the  sub-­‐stage  condenser’s  aperture  diaphragm  which,  in  essence,  projects  an  image  of  the  lamp  filament  onto  the  lens.      




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Thoughts/  Comments/  Ideas      




96  
 


Nebulizer  (Jet)  
Flowchart  A  jet  nebulizer  works  by  using  a  compressor  to  force  a  jet  of  air  through  a  container  with  liquid  medication.  This  converts  the  liquid  medication  into  a  mist  for  breathing.  


 




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Description  #   Text  Box   Comments  
1   Begin:  Jet  Nebulizer   Begin  diagnostic  process  for  a  work  order  for  Jet  Nebulizer.  Maintenance  is  generally  requested  on  a  jet  nebulizer  when  it  is  offering  weak  or  no  output.  2   Does  the  compressor  make  noise  when  turned  on?   A  working  suction  machine  has  a  motor  or  pump  that  makes  noise  when  the  device  is  turned  on.  
3   Is  power  reaching  the  compressor?   Wires  should  enter  the  motor  to  provide  power.  Use  a  multimeter  to  determine  if  the  proper  voltage  is  reaching  these  wires.  
4   Troubleshoot  power  supply  (separate  chart).   If  no  power  reaches  the  pump,  there  may  be  problems  with  the  switch,  fuse,  or  wiring.  If  the  motor  is  DC,  check  the  power  supply.  See  flowchart  on  Power  Supply  and  BTA  skills  on  Power  Supply.  5   Lubricate  and  clean  compressor.   See  BTA  skills  on  Motors.  6   Clean  motor  brushes.   See  BTA  skills  on  Motor  Brushes.  
7   Replace  or  resurface  vanes  (if  applicable).   The  vanes  on  rotary  vane  pumps  may  wear  out  over  time.  The  vanes  may  be  replaced,  but  are  often  expensive  and  difficult  to  find.  They  can  be  lubricated  by  hand,  using  motor  or  compressor  oil,  if  done  carefully.  8   Replace  filter  if  necessary.   Nebulizers  have  an  air  intake  filter  that  needs  periodic  replacement.  If  it  appears  gray  or  dirty,  look  for  a  replacement.    
9   Clean/replace  diaphragm  or  valve  plate  if  necessary.   The  diaphragm  of  a  valve  plate  or  membrane  pump  should  be  cleaned  periodically.  See  BTA  skills  on  Mechanical  Cleaning.  10   Does  compressor  run?   After  each  attempt  to  repair  the  motor,  test  to  see  if  it  works.  
11   Consider  replacing  compressor.   If  the  motor  can't  be  repaired,  it  is  time  to  replace  the  motor  or  the  entire  unit.  
12   Is  air  output  sufficient?   Has  clinical  staff  noticed  a  reduction  in  air  output?  Test  the  air  flow  by  measuring  displacement  of  water  from  a  jar.  Typically  a  nebulizer  will  displace  18-­‐23  liters/min.    13   Tighten  hose  connections  and  repair  leaks.   See  BTA  skills  on  Plumbing.  
14   Does  compressor  labor  when  air  device  not  in  use?   The  motor  should  not  shake  or  make  excessive  noise  when  the  air  device  is  not  in  use.  
15   Remove  occlusions  in  tubing  or  install  means  of  venting  excess  air.   See  BTA  skills  on  plumbing  blockages.  A  pressure  regulator  could  be  installed  to  vent  excess  air.  
16   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  17   Nebulizer  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.      




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Preventive  Maintenance  
• Inspect  exterior  of  equipment  for  damaged  or  missing  hardware.    • Inspect  the  power  cord,  strain  relief  and  plug/s  for  any  signs  of  damage.    • Turn  unit  off,  open  user  accessible  covers  and  inspect  unit  for  damage.  • Clean  unit  interior  components  and  exterior  with  vacuum  or  compressed  air.  • Inspect  interior  for  signs  of  corrosion  or  missing  hardware.  Repair  as  required.  • Inspect  electrical  components  for  signs  of  excessive  heat  or  deterioration.      • Inspect  water  jet  assembly  including  orifice.  Check  for  water  leakage.    • Check  gaskets  and  O-­‐rings.  • Verify  correct  operation  of  all  buttons,  controls,  displays  and/or  indicators.      • Verify  correct  operation  of  unit  in  all  functional  modalities.  • Clean  exterior  of  unit  including  all  accessories,  cables,  controls  and  displays.  • Change  air  intake  filter  when  it  is  gray  or  dirty.      




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Thoughts/  Comments/  Ideas      




100  
 


Nebulizer  (Ultrasonic)  An  ultrasonic  nebulizer  uses  a  vibrating  piezoelectric  element.  This  element  creates  an  ultrasonic  wave  and   is   in  contact  with  liquid  medication,  causing  a  fine  mist  with  homogenous  droplet  size.    
Flowchart  


 




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Description  #   Text  Box   Comments  
1   Begin:  ultrasonic  nebulizer   Start  the  diagnostic  process  for  a  work  order  for  ultrasonic  nebulizer.  
2   Does  nebulizer  power  on?   Lights,  displays,  and  sounds  are  signs  the  device  is  powered  on.  
3   Troubleshoot  power  supply  (separate  flowchart).   Ultrasonic  nebulizers  generally  have  an  AC-­‐DC  power  supply.  See  flowchart  for  Power  Supply  and  BTA  skills  on  Power  Supply.  4   Change  battery  if  necessary.   If  there  is  battery,  test  its  ability  to  receive  and  hold  a  charge.  See  BTA  skills  on  Batteries.  
5   Does  nebulizer  power  on  with  battery  only  (if  this  option  applies)?  


Check  if  the  machine  will  run  on  battery  when  power  is  unplugged.  Some  ultrasound  nebulizers  may  not  offer  this  feature.  Disregard  this  step  if  there  are  no  batteries.  
6   Does  nebulizer  chamber  fill  with  liquid?   The  nebulizer  may  have  a  liquid  reservoir  that  fills  with  the  liquid  medication.  Verify  that  machine  will  fill  this  chamber.  
7   Remove  blockages  or  pinches  in  tubing.   See  BTA  skills  on  Plumbing  Blockages.  
8   Remove  air  bubbles  in  feed  tube.   Remove  the  bottle,  invert,  and  replace  to  get  air  bubbles  out  of  the  tubing.  
9   Loosen  float  in  nebulizer  chamber.   Ensure  float  system  is  loose  and  moves  freely  and  there  are  no  obstructions  in  the  cap  or  lid.  
10   Is  ultrasonic  activity  visible  in  nebulizer  chamber?   Ultrasonic  nebulizers  use  sound  vibrations  to  create  vapor  droplets  from  liquid.  This  ultrasonic  activity  should  be  visible.  
11   Ensure  nebulizer  chamber  is  properly  aligned.   Verify  mechanical  connections  are  correct  and  secure.  See  BTA  skills  on  Mechanical  Attachments.  
12   Ensure  sufficient  liquid  in  nebulizer  chamber.   Add  liquid  to  the  chamber.  
13   Loosen  float  in  nebulizer  chamber.   Ensure  float  system  is  loose  and  moves  freely  and  there  are  no  obstructions  in  the  cap  or  lid.  14   Check  cleanliness  of  air  filter.   Air  filters  must  be  changed  periodically  when  they  become  dirty.  See  BTA  skills  on  Filters.  15   Is  aerosol  output  zero?   Verify  that  some  aerosol  mist  is  produced.  
16   Is  aerosol  output  sufficient?   Clinical  staff  has  complained  of  low  aerosol  (medicine)  output  even  at  maximum  power.  
17   Allow  chamber  liquid  to  de-­‐aerate.   Wait  for  machine  to  de-­‐aerate.  18   User  warmer  liquid.   Warm  the  liquid  in  use.    19   Wash  nebulizer  chamber.   Use  water  and  diluted  vinegar  or  alcohol.  See  BTA  skills  on  Mechanical  Cleaning.  20   Remove  any  blockages  in  tubing.   See  BTA  skills  on  Plumbing  Blockages.  
21   Check  for  contamination  of  nebulizer  chamber.   Use  water  and  diluted  vinegar  or  alcohol.  See  BTA  skills  on  Mechanical  Cleaning.  




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22   Nebulizer  is  working  properly.   Return  the  machine  to  service.  
Preventative  Maintenance  


• Inspect  exterior  of  equipment  for  damaged  or  missing  hardware.    • Inspect  the  power  cord,  strain  relief  and  plug/s  for  any  signs  of  damage.    • Turn  unit  off,  open  user  accessible  covers  and  inspect  unit  for  damage.  • Clean  unit  interior  components  and  exterior  with  vacuum  or  compressed  air.  • Inspect  interior  for  signs  of  corrosion  or  missing  hardware.  Repair  as  required.  • Inspect  electrical  components  for  signs  of  excessive  heat  or  deterioration.      • Inspect  oxygen  inlet  orifice  for  restrictions.    • Inspect  water  jet  assembly  including  orifice.  Check  for  water  leakage.    • Check  gaskets  and  O-­‐rings.  • Verify  correct  ultrasonic  output  for  sharp  water  cone  and  misting.      • Verify  correct  operation  of  low-­‐water  cut-­‐off  circuit.      • Tune  RF  output  if  needed.    • Verify  correct  operation  of  all  buttons,  controls,  displays  and/or  indicators.      • Verify  correct  operation  of  unit  in  all  functional  modalities.  • Clean  exterior  of  unit  including  all  accessories,  cables,  controls  and  displays.  • Clean  air  filter.  • Clean  nebulizer  chamber  and  lid  daily  or  between  each  patient.  • Clean  hoses  and  tubes  daily.  
 
 
     




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Thoughts/  Comments/  Ideas      




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O2  Concentrator  
Flowchart  


 




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Description  
#   Text  Box   Explanation  1   Begin  O2  Concentrator  Testing   Start  the  diagnostic  process  for  a  work  order  on  O2  Concentrator.  
2   Does  the  machine  power  up?   With  unit  plugged  in,  and  power  switch  turned  on,  the  display  should  light  up  and  compressor  should  run,  making  noise.  
3   Is  the  inlet  filter  in  place?   Some  models  require  the  compressor  inlet  filter  to  be  in  place  in  order  for  machine  to  start.  For  all  other  models,  proceed  to  step  5.  4   Install  inlet  filter   If  available,  install  the  foam  inlet  filter.  
5   Troubleshoot  the  power  supply  (separate  chart)  


Use  a  multimeter  at  the  leads  of  the  compressor  to  ensure  that  sufficient  voltage  is  reaching  the  machine.    If  insufficient,  there  may  be  a  problem  with  the  wiring  or  fuse.  See  flowchart  on  Power  Supply  and  BTA  skills  on  Power  Supply.  6   Does  the  alarm  sound  during  power  up?   Both  display  lights  and  an  audible  alarm  should  sound  after  power  switch  is  turned  on.  7   Replace  9V  battery   Unplug  machine,  ensure  current  battery  has  correct  polarity,  and  replace  with  a  new  battery  if  necessary.    
8   Does  the  pump  create  a  sufficient  flow?  


Flow  is  identifiable  by  the  floating  ball  in  the  flow  meter  and  by  bubbles  in  the  humidifier.  To  check  if  there  is  sufficient  flow,  remove  humidifier  and  place  finger  at  air  outlet.  When  outlet  is  covered,  the  ball  should  fall  down.  When  outlet  is  unobstructed  the  ball  should  float.  When  flow  rate  is  set  to  highest  setting  (5  liters  per  minute)  the  ball  should  be  at  its  highest  level  in  flow  meter.    
9   Is  the  compressor  functioning  correctly?   Check  voltage  into  leads  of  compressor,  and  then  check  flow  rate  at  exit.  If  the  compressor  is  not  producing  max  flow  rate  at  sufficient  voltage  (120V),  the  compressor  is  not  functioning  correctly.  (Proceed  to  13)  
10   Clean  inlet  filter   Foam  inlet  filter  should  be  cleaned  weekly  by  washing  with  soap  and  water.  Ensure  filter  is  dry  before  replacing.  See  BTA  skills  on  Filters  (Plumbing)    
11   Ensure  that  correct  sized  tubing  is  used  and  that  connections  are  tight.  


Check  that  the  diameter  of  all  O2-­‐carrying  tubing  matches  the  machine  inlet  diameters.  Ensure  that  all  connections  are  tight.  Also  ensure  that  the  tubing  being  used  cannot  diffuse  O2.    See  BTA  skills  on  Connections  (Plumbing)  
12   Look  and  listen  for  leaks  in  tubing   While  air  is  flowing,  listen  for  sound  of  escaping  O2  and  run  hand  over  tubing  to  feel  stream.  If  holes  exist,  tube  should  be  replaced,  not  patched.  See  BTA  skills  on  Leaking  (Plumbing)  13   Clean  all  O2-­‐carrying  tubing   Dirt  or  water  droplets  could  block  the  airway.  See  BTA  skills  on  Blockages  (Plumbing)  14   Clean  compressor   See  BTA  skills  on  cleaning/lubricating  (Motors)  15   Defective  Compressor:  Consider  replacing   If  compressor  is  clean,  and  is  still  not  producing  correct  flow  rate  it  is  probably  faulty  and  needs  to  be  replaced.  16   Is  the  O2  Concentration  over  60%?   See  BTA  skills  for  Oxygen  Concentration  Measurement  




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Preventive  Maintenance    Always  run  machine  for  a  few  hours  after  maintenance  before  patient  use  


1. Clean  humidifier  and  tubes  a. Wash  in  warm  soapy  water,  rinse  thoroughly,  and  replace  2. Change  distilled  water  3. Remove  and  clean  the  foam  air  intake  filter    a. Wash  with  soap  and  water  b. Ensure  filter  is  dry  before  replacing  but  do  not  use  heat  to  dry  4. Check  Alarm  system  battery  a. An  audible  alarm  should  sound  when  the  machine  is  turned  on  b. Replace  9V  battery  when  necessary  5. Check  if  Zeolite  Canisters  have  expired  (25,000  hours).  The  granules  become  grey  when  they  are  no  longer  effective.    6. Felt  pre-­‐filter  should  be  changed  once  a  month  (if  available)  7. Replace  patient  bacterial  filter  annually  (if  available)    


(Mechanical-­‐Calibration)  
17   Has  the  zeolite  canister  expired?   Zeolite  canisters  should  be  replaced  every  25,000  hours.  The  granules  start  black  and  appear  gray  when  they  are  no  longer  efficient  for  use.  18   Replace  if  possible   If  available,  replace  expired  zeolite  canisters  with  new  granules.  19   Check  tubing  for  kinks  or  blockages   Ensure  that  all  O2-­‐carrying  tubes  are  elongated  and  not  twisted  or  bent.  See  BTA  skills  on  Blockages  (Plumbing)  
20   Check  for  restrictions  in  muffler  and  resonator.     A  restricted  muffler  would  prevent  waste  gas  from  exiting  the  system  freely.  Disconnect  the  muffler  and  operate  unit  to  see  if  this  fixes  concentration.  21   Defective  part:  Consider  replacing  PC  board.   PC  board  could  have  tears  or  kinks  that  may  be  irrecoverable.    22   Does  the  machine  run  without  overheating  and  making  excessive  noise?   The  unit  should  not  feel  hot  to  the  touch  or  make  loud  excessive  noises.  
23   Ensure  exhaust  vent  is  at  least  3”  from  wall.   The  exhaust  pipe  should  be  far  enough  away  from  external  obstructions  that  the  waste  gas  can  flow  freely  into  the  atmosphere.  
24   Open  unit  and  check  foam   Foam  inside  the  machine  degrades  over  time  and  can  fall  into  compressor.  Clean  and  replace  foam  if  possible.  See  BTA  skills  on  Cleaning  (Mechanical)  
25   Check  muffler  for  damage   Ensure  all  tubing  to  muffler  is  intact  and  connected.  Check  muffler  for  cracks,  damages.  Consider  replacing  if  broken.  26   Check  that  fan  is  connected  and  installed  correctly   Ensure  leads  to  fan  are  connected  correctly.  Check  that  fan  is  installed  in  correct  direction  of  airflow.    27   Device  is  working  properly.   With  sufficient  air  flow  and  O2  concentration,  the  machine  can  be  returned  to  service.  




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Thoughts/  Comments/  Ideas    
   




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Ophthalmoscope  
Flowchart  


 




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Description  #   Text  Box   Comments  
1   Start:  Ophthalmoscope  troubleshooting.   Begin  diagnostic  process  for  a  work  order  for  Ophthalmoscope.  2   Is  the  device  free  of  any  dirt/contamination?   Inspect  ophthalmoscope  for  external  cracks,  damage  and  dirt.  3   Clean  device  using  cloth  moistened  with  alcohol.   Examine  the  device  for  dirt  and  contamination.    See  BTA  skills  on  Mechanical  Cleaning.  4   Does  the  light  bulb  power  on  with  battery?   Power  on  the  device  with  battery.  Examine  whether  light  bulb  gives  sufficient  illumination.  
5   Rotate  the  aperture  dial  so  they  are  not  in-­‐between  positions.                                             Aperture  dial  can  be  in-­‐between  positions.  
6   Recharge  battery  if  applicable  or  replace  it.           Refer  BTA  skill  set  on  Batteries  to  identify  and  replace  damaged  batteries.  
7   Replace  bulb  if  necessary.   Refer  BTA  skill  set  on  Lighting/Indicators  to  replace  non-­‐functional  light  bulbs.  
8   Inspect  and  fix  broken  wires  or  bad  connections  between  battery  and  bulb.  


Inspect  wires  and  connections  from  battery  to  bulb  using  multimeter.  Refer  BTA  skill  set  on  Connections  for  identifying  and  fixing  broken  wires  and  bad  connections.  9   Clean  lenses  with  cotton  swab.   Clean  lenses  to  remove  any  dirt  and  contamination.  See  BTA  skills  on  Mechanical  Cleaning.  
10   Are  the  lenses  and  mirror  free  from  cracks/defects?   Any  defect  in  the  lenses  and  mirror  will  not  provide  a  clear  view.  
11   Replace  lenses  and  mirror  if  necessary.     Identify  and  replace  with  a  suitable  lens  to  get  a  clear  view.  
12   Does  the  device  provide  a  sharp  focus  and  free  from  any  glare?   The  lenses  and  mirror  are  dirty.  
13   Clean  lenses  and  mirror  with  cotton  swab.       Clean  lenses  and  mirror  to  remove  any  dirt  and  contamination.    
14   Perform  preventive  maintenance  on  ophthalmoscope.  Return  device  to  clinical  personnel.          


Ophthalmoscope  is  working  properly.  Perform  preventive  maintenance  before  returning  the  device  to  clinical  personnel.          




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Preventative  Maintenance  
• Clean  lenses  and  mirror  components  with  ethanol  solution  or  water,  and  soft  cloth  or  cotton  swab  • Regularly  check  battery  and  bulb  for  corrosion,  and  replace  as  needed  • Check  for  debris  in  rotating  parts.  Use  a  slender  rigid  object  to  prod  dirt  and  debris  free  as  needed  • Refocus  device  with  each  use      




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Thoughts/  Comments/  Ideas      




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OR  LIGHT  
Flowchart    




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Description  #   Text  box   Explanation  or  Comment  
1   Begin:  Troubleshoot  OR  Light   Start  the  diagnostic  process  for  a  work  order  on  an  OR  Light.  
2   Do  all  bulbs  illuminate?   Provide  the  light  with  power  and  observe  whether  or  not  all  of  the  bulbs  produce  light.  
3   Is  voltage  delivered  to  non-­‐functional  bulbs?  


If  some  of  the  bulbs  do  not  illuminate,  it  could  be  due  to  issues  with  the  bulb  or  the  power  supply.  Use  a  multimeter  to  check  that  appropriate  voltage  is  being  delivered  to  the  bulb  housings.    See  BTA  skills  on  Electrical  Lighting/Indicators.  
4   Troubleshoot  bulb  connections    


If  bulbs  do  not  illuminate  and  are  not  receiving  power,  then  there  may  be  something  wrong  with  the  connections  from  the  bulb  housing  to  the  bulb  itself.  Inspect  the  housing,  clean  any  residue  on  connections  and  mend  poor  connections.  
5   Check  continuity  of  power  supply  wires  to  bulb  housings   Ensure  that  the  bulb  housings  are  connected  to  the  power  supply.  Use  a  multimeter  to  check  the  continuity  of  the  wires  running  from  the  power  supply  to  the  bulbs.    
6   Troubleshoot  power  supply   If  the  device  is  connected  to  power  but  does  not  turn  on,  there  is  a  problem  with  the  power  supply.  This  could  be  a  problem  with  the  wiring  or  connections  within  the  device.  See  BTA  skills  on  Power  Supply.  
7   Are  bulbs  incandescent?   Incandescent  light  bulbs  use  a  tungsten  filament  encased  inside  a  glass  housing.  
8   Are  bulbs  halogen?   Halogen  bulbs  have  a  tungsten  filament  encased  inside  a  quartz  housing.  The  housing  is  much  closer  to  the  filament  than  in  incandescent  light  bulbs.  
9   Are  bulbs  fluorescent?   Fluorescent  bulbs  have  a  sealed  glass  tube  filled  with  mercury  and  an  inert  gas.    
10   If  bulb  type  is  unknown,  use  only  the  voltage  capacity  to  determine  the  replacement   Reference  BTA  skills:  Unit:  Lighting/Indicators,  Skill:  Fixtures.  
11   Use  replacement  bulb  from  manufacturer  if  available   Acquire  the  bulb  designed  for  the  OR  lamp  unit  by  the  same  manufacturer  as  the  unit.  Use  this  replacement  bulb  to  replace  any  




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broken  bulbs  in  the  lamp.  
12   Find  incandescent  bulb  replacement   Match  the  voltage  capacity  and  wattage  of  replacement  bulb  to  original.  
13   Use  CFL,  LED,  or  halogen  replacement  bulb   If  a  CFL  or  LED  bulb  can  be  found  that  matches  the  voltage  of  the  original  incandescent  bulb,  then  it  may  be  used  to  replace  the  original  bulb.  
14   If  using  CFL  or  LED,  match  lumens  of  replacement  to  original  bulb   If  using  a  CFL  or  LED  as  a  replacement,  ensure  that  the  lumens  value  of  the  replacement  bulb  matches  that  of  the  original.  
15   Find  halogen  bulb  replacement   Match  the  voltage  capacity  and  wattage  of  replacement  bulb  to  original.  
16   Use  CFL  or  LED  replacement  bulb   If  a  CFL  or  LED  bulb  can  be  found  that  matches  the  voltage  of  the  original  incandescent  bulb,  then  it  may  be  used  to  replace  the  original  bulb.  
17   Check  ballasts  and  replace  if  necessary   Reference  instruction  document.  
18   Find  fluorescent  bulb  replacement   Match  the  voltage  capacity  and  wattage  of  replacement  bulb  to  original.  
19   Check  ballasts  and  replace  if  necessary   Reference  instruction  document.  
20   Use  incandescent  bulb  replacement   If  an  incandescent  bulb  can  be  found  that  matches  the  voltage  of  the  original  incandescent  bulb,  then  it  may  be  used  to  replace  the  original  bulb.  
21   Match  voltage  capacity  of  replacement  bulb  to  original   If  the  bulb  type  of  the  original  is  unknown,  then  the  voltage  capacity  alone  may  be  used  to  find  a  replacement.  Match  this  value  of  the  replacement  bulb  to  that  of  the  original.  
22   If  necessary  retrofit  light  socket  to  fit  replacement  bulb   Reference  BTA  skills:  Unit:  Lighting/Indicators,  Skill:  Fixtures.  
23   Go  to:  Begin   Go  back  to  step  1  to  restart  the  troubleshooting  process.  
24   Do  all  bulb  have  an  IR  filter  in  front  of  them?   Check  that  all  of  the  functional  bulbs  have  infrared  filters  between  the  bulb  and  the  operating  field.  This  filter  usually  looks  like  a  plastic  sheet  




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sitting  in  front  of  the  bulb  in  its  housing.  
25   Do  not  use  bulbs  without  filter   DO  NOT  use  the  lamp  if  any  illuminating  bulbs  do  not  have  a  filter.  This  filter  is  necessary  to  ensure  the  safety  of  patients.  
26   Replace  missing  filters  


Insert  infrared  filters  wherever  missing.  These  filters  can  be  taken  from  bulb  housings  containing  non-­‐functional  bulbs  or  from  other  OR  lamp  units.    
DO  NOT  handle  filters  with  bare  hands.  


27   Go  to:    28   Do  all  parts  of  light  and  support  move  freely?   Manipulate  the  lamp  to  ensure  that  all  moving  parts  can  be  easily  adjusted.  
29   Add  grease  to  resistive  parts   If  any  moving  parts  of  the  lamp  resist  adjustment,  lubricate  these  parts  using  grease  or  oil.  
30   Loosen  braking  screws   Locate  the  braking  screws  on  the  lamp  unit.  Loosen  these  screws  to  allow  for  more  fluid  movement.  
31   Adjust  spring  force  screws   Locate  and  adjust  the  tightness  of  spring  force  screws  on  the  lamp  unit  to  change  the  amount  of  tension  in  the  lamp  supports.  
32   Go  to:    
33   Does  light  stay  in  place  after  adjustment?   Ensure  that  the  lamp  stays  in  place  after  it  has  been  adjusted.  Try  several  manipulations  of  the  lamp  and  let  lamp  stand  in  each  for  a  few  minutes.  Observe  any  deviations  from  the  original  adjustment.  
34   Tighten  braking  screws   If  lamp  moves  after  adjustment,  tighten  the  braking  screws  to  prevent  this  movement.  
35   Go  to:    
36   Light  is  functioning  properly    


 
Preventative  Maintenance:  


• Checking  mechanical  functionality  (grease,  tightening,  etc.),    o Check  supporting  framework  for  mobility    o If  framework  is  high  resistive  to  movement,  grease  resistive  parts  and/or  loosen  braking  screws  




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o If  framework  moves  too  easily  (does  not  stay  in  place  after  adjustment),  tighten  braking  screws  • Cleaning  bulb  housings  o Clean  the  bulb  housings  periodically  so  lengthen  bulb  life  and  improve  light  quality  o Do  not  touch  IR  filters  with  bare  hands  o Fingerprints  left  on  bulbs/filters  will  cause  overheating  and  could  damage  lamp  • Keep  any  bulbs  that  could  be  viable  replacements  available  o Salvage  functional  light  bulbs  from  non-­‐functional  OR  lamps  and  keep  for  future  use  as  replacements  in  other  lamps  o Keep  any  bulbs  that  are  viable  replacements  for  those  in  lamp  to  use  as  replacements  when  needed      




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Thoughts/Comments/Concerns  
   




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Otoscope  
Flowchart  


   




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Description  #   Text  Box   Comments  
1   Start:  Otoscope  Troubleshooting           Begin  diagnostic  process  for  a  work  order  on  Otoscope.  
2   Does  the  light  source  power  on  with  battery?   Power  on  the  device  with  battery.  Examine  whether  light  bulb  gives  sufficient  illumination.  
3   Recharge  battery  if  applicable  or  replace  it.           Refer  BTA  skill  set  on  Batteries  to  identify  and  replace  damaged  batteries.  
4   Replace  bulb  if  necessary.                       Refer  BTA  skill  set  on  Lighting/Indicators  to  replace  non-­‐functional  light  bulbs.  
5   Inspect  and  fix  broken  wires  or  bad  connections  between  the  battery  and  bulb.                                        


Inspect  wires  and  connections  from  battery  to  bulb  using  multimeter.  Refer  BTA  skill  set  on  Connections  for  identifying  and  fixing  broken  wires  and  bad  connections.  
6   Does  the  device  use  a  fiber  optic  cable  and  still  the  light  source  doesn’t  power  on  with  battery?  


There  are  two  types  of  otoscopes:  • Conventional  otoscope  • Fiber  optic  otoscope  If  the  bulb  still  doesn’t  power  on  then  there  might  be  cracks  in  the  fiber  optic  strands.  So  the  unit  might  have  to  be  replaced.  
7   Inspect  for  cracks  in  fiber  optic  strands  and  replace  the  unit  if  necessary.               If  the  illumination  is  not  sufficient  then  inspect  for  cracks  in  fiber  optic  strands.  8   Is  the  lens  free  from  cracks/defects?   Any  defect  in  the  eyepiece  lens  obstructs  vision  of  ear  canal.  
9   Replace  lens  if  necessary.             Identify  and  replace  with  a  suitable  lens.  
10   Is  the  head  and  handle  connected  properly?   Improper  connection  between  head  and  handle  may  result  in  faulty  operation  of  the  device.  11   Refer  device  manual  to  assemble  the  parts.   Follow  instructions  in  the  device  manual  to  assemble  the  parts  together.  12   Block  the  tip  of  speculum  with  finger.   This  test  is  performed  to  detect  any  air  leaks  in  the  device.  Connect  the  pressure  bulb  to  the  connector  in  otoscope  to  perform  this  test.  13   Apply  pressure  with  insufflator  bulb.   Apply  pressure  continuously  over  a  period  of  time  and  check  whether  it  can  be  felt  at  the  tip  of  speculum.  14   Is  the  device  free  from  air  leaks?   If  the  flow  of  air  due  to  pressure  is  not  felt  at  the  tip  of  speculum  then  there  is  a  possible  air  leak  in  the  device.  
15   Inspect  and  troubleshoot  the  otoscope  for  any  cracks,  physical  damage.   Inspect  otoscope  for  external  cracks,  damage,  or  dirt.  
16   Perform  preventive  maintenance  on  Otoscope.  Return  device  to  clinical  personnel.  


Otoscope  is  working  properly.  Perform  preventive  maintenance  before  returning  the  device  to  clinical  personnel.          




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Preventative  Maintenance  
• Ensure  use  of  proper  tips  that  are  clean  and  free  of  defects  • Make  sure  tips  are  connected  tightly  for  each  use  • Regularly  recharge  or  replace  battery,  as  needed  • Clean  lenses  with  soft  cloth  or  cotton  swab,  and  water  or  ethanol  solution  • Remove  debris  from  any  rotating  parts,  use  a  thin,  rigid  member  if  necessary  • If  using  hand  pump,  ensure  connections  are  tight  and  tubing  is  free  of  defects      




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Thoughts/  Comments/  Ideas      




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Power  Supply  (Overall)  
Flowchart  


   




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Description  #   Text  Box   Comments  1   Begin:  Power  Supply   Begin  diagnostic  process  for  a  work  order  on  Power  Supply.  Testing  and  maintenance  is  advised  when  a  device  fails  to  turn  on.  2   Does  device  utilize  batteries?   A  device  may  run  on  primary  or  chargeable  batteries.  This  can  be  in  addition  to  a  wall  input.  3   Troubleshoot  batteries.  See  battery  flowchart.   Refer  to  the  battery  troubleshooting  guide  to  ensure  the  proper  functionality  of  the  device  batteries.  4   Does  device  turn  on?   If  after  successfully  troubleshooting  the  batteries,  the  device  power  supply  problem  may  resolve.  5   Does  device  utilize  an  outlet  and  plug?   A  device  may  run  on  the  AC  voltage  input  from  wall  sockets.  6   Troubleshoot  outlet  and  plug.  See  outlet/plug  flowchart.   Refer  to  the  output/plug  troubleshooting  guide  to  ensure  the  proper  functionality  of  the  device’s  input  power.  7   Does  device  turn  on?   If  after  successfully  troubleshooting  the  outlet  and  plug,  the  device  power  supply  problem  may  resolve.  8   Does  device  utilize  an  external  transformer?   A  device  may  require  that  the  AC  wall  input  is  transformed  into  the  appropriate  voltage  for  device  functioning.  9   Troubleshoot  transformer.  See  transformer  flowchart.   Refer  to  the  transformer  troubleshooting  guide  to  ensure  the  proper  functionality  of  the  device’s  transformer.  10   Does  device  turn  on?   If  after  successfully  troubleshooting  the  transformer,  the  device  power  supply  problem  may  resolve.  
11   Power  supply  is  working.  Be  sure  to  calibrate  and  troubleshoot  device  before  putting  it  back  into  service.   Be  sure  to  troubleshoot,  calibrate,  and  appropriately  test  medical  device  before  releasing  to  clinician.    12   Inspect  the  cable  from  AC  input  feeding  power  into  the  device.   Notice  any  deformities  or  exposed  wires  in  power  cord.  13   Is  the  cable  in  good  condition?   If  any  deformities  or  exposed  wires  are  found,  the  cable  is  not  in  good  condition.  14   Using  BTA  skills,  repair  or  replace  cable.   Cable  can  be  resoldered,  taped,  and  assembled  such  that  the  cable  is  functional  and  safe.  Replace  it  if  these  methods  are  not  adequate.  
15   Carefully  open  up  the  device.  Use  a  voltmeter  to  check  that  voltage  has  made  it  into  the  device.  


Follow  the  power  cord  into  the  device.  Immediately  check  the  voltage  at  the  point  where  the  cord  does  not  pass  through  any  circuit  components.  16   Does  voltage  make  it  into  the  device?   Voltage  may  not  properly  conduct  through  a  poorly  conducting  cable.  
17   Check  the  switching  capabilities  by  testing  the  input  voltage  to  the  rest  of  the  device  when  in  on/off  stages.   Using  voltmeter  to  measure  voltages  in  on  and  off  states  of  the  device’s  power  switch.  
18   Device  should  yield  the  appropriate  voltage  when  switched  on  and  no  voltage  when  switched  off.  


When  turned  on  and  connected,  the  voltage  should  conduct.  When  device  is  switched  off,  there  should  be  an  open  current  in  which  no  electrical  conduction  occurs.  19   Does  the  device  switch  properly?   If  voltage  conducts  when  switch  is  on,  and  fails  to  conduct  when  switch  is  off,  the  device  switches  properly.  
20   Using  BTA  skills,  repair  switch  or  replace  components  to  ensure  the  device  switches  properly.  


Mechanical  switches  require  simple  observation  and  repair.  An  electrical  transducer  and/or  relay  will  require  the  engineer  uses  the  voltmeter  to  determine  if  an  open  circuits  are  occurring  in  any  of  the  circuit  components.  These  parts  will  have  to  be  replaced  as  necessary.  See  BTA  skills  on  Mechanical  Switches  and  Electrical  




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Simple.  21   Does  device  utilize  a  fuse?   Use  a  mulitmeter  to  assess  whether  or  not  the  fuse  shorts.  A  shortage  indicates  a  functioning  fuse.  22   Troubleshoot  fuse.  See  fuse  flowchart.   If  the  fuse  shorts,  it  is  still  functioning.  
23   Inspect  condition  of  components  within  power  supply.   Are  any  capacitors  puffy?  Are  any  components  melted  or  burnt?  Are  there  any  signs  of  rust  or  corrosion?  These  obvious  faults  should  clearly  indicate  any  problem  within  the  power  supply.  
24   Do  any  components  need  replacing?  


If  any  components  are  not  found  to  be  in  good  condition,  they  will  need  to  be  replaced  exactly.  This  may  not  always  be  possible,  and  harvesting  components  from  old,  dysfunctional  equipment  is  always  a  safe  bet.  
25   Replace  leaking  or  corroded  components  with  exact  replacements  if  possible.  Otherwise  power  supply  will  need  replacing.  


The  determined  components  should  be  removed  and  replaced  using  solder  and  a  soldering  iron.  If  exact  or  equivalent  replacements  cannot  be  made,  the  power  supply  will  need  replacing.    
26   Does  the  device  utilize  a  bulky  internal  transformer?   After  opening  the  device,  and  large  transformer  with  input  and  output  specification  should  be  obvious  in  a  linear  power  supply.  
27   Device  uses  a  “linear  power  supply.”  


Linear  power  supplies  are  characteristic  of  bulky  and  large  devices.  These  power  supplies  use  a  transformer,  rectifier,  regulator,  and  filter  in  series  to  achieve  the  desired  and  necessary  voltage  signal  for  the  device.  28   Troubleshoot  transformer.  See  transformer  flowchart.   Refer  to  the  transformer  troubleshooting  guide  to  ensure  the  proper  functionality  of  the  device’s  transformer.  
29   Use  voltmeter  to  check  for  shorts  within  any  components.   Using  the  connection  mode  on  the  voltmeter,  methodically  move  through  each  component  of  the  power  supply  to  determine  if  there  are  any  shorts  to  ground.  30   Do  any  connections  short  to  ground?   It  should  be  clear  if  a  component  is  not  conducting  properly  by  assessing  with  a  multimeter.  
31   Power  supply  is  working.  Be  sure  to  calibrate  and  troubleshoot  device  before  putting  it  back  into  service.   Be  sure  to  troubleshoot,  calibrate,  and  appropriately  test  medical  device  before  releasing  to  clinician.  32   Troubleshoot  voltage  regulator.  Pull  out  3-­‐pin  regulator.   Voltage  regulator  handles  large  spikes  in  voltages.  Pull  out  the  3-­‐pin  to  determine  if  the  regulator  has  failed.  
33   Does  short  go  away  in  overall  circuit?   Using  the  connection  mode  on  the  voltmeter,  methodically  move  through  each  component  of  the  power  supply  to  determine  if  there  are  any  shorts  to  ground.  34   Replace  voltage  regulator.   If  the  circuit  does  not  short  when  voltage  regulator  is  removed,  the  voltage  regulator  needs  replacing.  
35   Replace  shorted  components  with  exact  replacements  if  possible.  Otherwise  power  supply  will  need  replacing.  


The  determined  components  should  be  removed  and  replaced  using  solder  and  a  soldering  iron.  If  exact  or  equivalent  replacements  cannot  be  made,  the  power  supply  will  need  replacing.  
36   Device  uses  a  “switching  power  supply.”   Switching  power  supplies  are  characteristically  lighter  than  linear  power  supplies.  They  also  use  a  transformer,  but  less  bulky  ones.  They  fit  amount  the  other  smaller  circuit  components.  
37   Use  voltmeter  to  check  for  shorts  within  any  components.   Using  the  connection  mode  on  the  voltmeter,  methodically  move  through  each  component  of  the  power  supply  to  determine  if  there  are  any  shorts  to  ground.  38   Were  any  shorts  detected?   It  should  be  clear  if  a  component  is  not  conducting  properly  by  




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assessing  with  a  multimeter.  
39   Replace  shorted  components  with  exact  replacements  if  possible.  Otherwise  power  supply  will  need  replacing.  


The  determined  components  should  be  removed  and  replaced  using  solder  and  a  soldering  iron.  If  exact  or  equivalent  replacements  cannot  be  made,  the  power  supply  will  need  replacing.  
40   Using  a  voltmeter,  check  for  the  presence  of  DC  voltage  after  rectification  and  before  the  small  internal  transformer.  


Using  the  voltage  mode  on  the  voltmeter,  methodically  move  through  each  component  of  the  power  supply  to  determine  if  there  the  appropriate  DC  voltage  is  being  conducted.  
41   Troubleshoot  internal  transformer.  It’s  important  that  the  input  and  output  is  of  the  appropriate  voltage.  


Refer  to  the  transformer  troubleshooting  guide  to  ensure  the  proper  functionality  of  the  device’s  transformer.  If  the  internal  transformer  in  a  switching  power  supply  is  not  functioning,  it  will  need  to  be  replaced.  
42   Using  a  voltmeter,  check  for  the  presence  of  DC  voltage  after  rectification  after  the  transformer.  


Using  the  voltage  mode  on  the  voltmeter,  methodically  move  through  each  component  of  the  power  supply  to  determine  if  there  the  appropriate  DC  voltage  is  being  conducted.  43   Is  voltage  present  in  all  components?   It  should  be  clear  if  a  component  is  not  conducting  properly  by  assessing  with  a  voltmeter.  
44   Replace  any  non-­‐function  components  with  exact  replacements  if  possible.  Otherwise  power  supply  will  need  replacing.  


The  determined  components  should  be  removed  and  replaced  using  solder  and  a  soldering  iron.  If  exact  or  equivalent  replacements  cannot  be  made,  the  power  supply  will  need  replacing.  
45   Power  supply  is  working.  Be  sure  to  calibrate  and  troubleshoot  device  before  putting  it  back  into  service.   Be  sure  to  troubleshoot,  calibrate,  and  appropriately  test  medical  device  before  releasing  to  clinician.  
Preventive  Maintenance  


• Clean  device  clean.  Avoid  using  water  to  do  so.  • Store  in  a  dry  place  with  no  possibility  of  contact  with  water.  • Store  within  the  range  of  -­‐40-­‐55°C  • If   device   is   not   used   frequently,   unplug   from   wall   input   to   prevent   possibilities   of   voltage   spikes.  Regulators  often  malfunction  after  high  voltage  inputs,  and  keeping  it  unplugged  reduces  the  risk.    




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Thoughts/  Comments/  Ideas        




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Power  Supply  (Battery)  
Flowchart  


 




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Description  #   Text  Box   Comments  1   Begin:  Batteries   Begin  diagnostic  process  for  a  work  order  for  Batteries.  Testing  and  maintenance  is  advised  when  a  device  using  batteries  fails  to  turn  on.  2   Observe  the  condition  of  batteries.   Are  there  any  signs  of  leaking,  rust,  corrosion?  These  obvious  faults  should  clearly  indicate  any  problems  within  batteries.  3   Are  batteries  leaking  or  corroding?   If  any  batteries  are  not  found  to  be  in  good  condition,  they  should  be  discarded  and  replaced.  
4   Replace  batteries.  See  step  6  for  secondary  batteries  or  step  20  for  primary  batteries.   The  identified  problematic  batteries  should  be  discarded  and  replaced  following  the  guidelines  for  their  type.  5   Are  the  batteries  rechargeable?   NiCd,  Lead  Acid,  NiMH,  Li-­‐ion  batteries  are  common  chargeable  batteries.  Lithium  or  carbon-­‐zinc  are  not  rechargeable.  6   Batteries  are  considered  “secondary  batteries.”   Secondary  batteries  have  the  ability  to  be  recharged.  7   Is  a  functional  charger  available?   Chargers  typically  accompany  types  of  rechargeable  batteries.  
8   Use  BTA  skills  to  construct  a  charger  for  secondary  batteries  using  a  wall  transformer.  See  box  description  for  further  details.  


If  no  charger  is  available,  use  BTA  skills  to  construct  an  appropriate  charger.  BTA  protocol  states  that  this  can  be  done  using  a  wall  transformer  with  a  female  coaxial  cable  connector.  Transformer  must  match  the  input  voltage  (110  vs.  240  V),  the  output  voltage,  voltage  type  (AC/DC),  and  the  output  current  capacity  of  the  batteries.  If  the  original  charger  is  not  available,  connections  to  the  batteries  can  be  made  by  opening  the  device  and  wiring  in  new  connections.  Alligator  clips  should  suffice.  
9   Ensure  that  the  batteries  are  fully  charged.  Use  a  voltmeter  to  test  output  voltage.   Fully  charge  batteries  before  assessing  their  ability  to  hold  their  charge  over  time.  10   Do  batteries  output  their  specified  voltage?   Measure  and  note  the  initial  voltage  before  leaving  them  to  sit  overnight.  
11   If  battery  does  not  output  its  specified  voltage  by  70%  after  being  fully  charged,  it  will  need  to  be  replaced.  


If  this  initial  voltage  is  not  at  least  70%  of  its  rated  value  at  full  charge,  it  is  not  acceptable  and  should  be  replaced.    
12   After  charging,  leave  the  battery  out  overnight.  Compare  final  voltage  with  the  initial  voltage.   Let  the  battery  sit  overnight  (connected  to  nothing)  to  assess  its  ability  to  hold  a  charge  over  time.  13   Do  batteries  discharge  less  than  25%  of  its  initial  voltage?   If  more  than  75%  of  charge  is  maintained,  the  battery  is  suitable  for  use.  
14   Secondary  battery  is  working  properly.  See  power  supply  flowchart  for  further  instructions.  


Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Be  sure  to  troubleshoot,  calibrate,  and  appropriately  test  medical  device  before  releasing  to  clinician.  
15   If  battery  discharges  25%  or  more  voltage  overnight,  it  will  need  to  be  replaced.   If  less  than  75%  of  charge  is  maintained,  the  battery  is  not  suitable  for  use  and  will  need  to  be  placed.  
16  


Rechargeable  batteries  will  need  to  be  replaced  with  a  rechargeable  of  the  exact  type  or  of  a  similar  type.  Refer  to  box  description  for  more  details.  
Replacements  should  be  an  exact  match  with  type,  voltage,  and  capacity.  An  imperfect  match  is  permitted  if  substituting  with  a  primary  battery  of  a  larger  capacity  with  same  type  and  voltage.  




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17   Can  batteries  be  replaced  appropriately?   Exact  replacements  may  not  be  realistic  or  available.  


18  
If  proper  replacements  cannot  be  made,  use  BTA  skills  to  replace  the  batteries  with  a  wall  transformer.  See  box  description  for  more  details.  


Here  are  some  additional  suitable  substitutions:    -­‐NiCd  for  NiMH  of  the  same  voltage  and  capacity  –  matching  voltage  takes  priority  -­‐NiMH  for  NiCd  of  the  same  voltage  and  capacity  –  matching  voltage  takes  priority    The  only  downside  is  that  NiCd  have  lower  capacities  and  operate  for  shorter  periods  of  time  before  needing  to  be  charged.  
19   Troubleshoot  new  replacement  to  ensure  it’s  working  properly.  Go  to  beginning.   Once  an  appropriate  replacement  or  substitution  has  bee  made,  troubleshoot  device  with  new  battery  solution.  20   Batteries  are  considered  “primary  batteries.”   Primary  batteries  are  not  reusable  and  cannot  be  recharged.  21   Use  a  voltmeter  to  measure  the  output  voltage.   Check  the  output  of  the  primary  batteries  as  is.  22   Is  the  measured  voltage  70-­‐100%  of  its  rated  value?   If  voltage  is  less  than  70%  of  its  rated  value,  it  must  be  discarded  and  replaced.  
23   Primary  battery  is  working  properly.  See  power  supply  flowchart  for  further  instructions.  


Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Be  sure  to  troubleshoot,  calibrate,  and  appropriately  test  medical  device  before  releasing  to  clinician.  
24   Primary  batteries  will  need  to  be  replaced  with  a  primary  of  the  exact  type  or  of  a  similar  type.  Refer  to  box  description  for  more  detail.  


Replacements  should  be  an  exact  match  with  type,  voltage,  and  capacity.  An  imperfect  match  is  permitted  if  substituting  with  a  primary  battery  of  a  larger  capacity  with  same  type  and  voltage.    
25   Can  batteries  be  replaced  appropriately?     Exact  replacements  may  not  be  realistic  or  available.  


26  
If  proper  replacements  cannot  be  made,  use  BTA  skills  to  replace  the  batteries  with  a  constructed  “battery  pack”  in  series  or  in  parallel.  See  box  description  for  more  details.    


Create  a  battery  pack  by  adding  primary  batteries  in  series  or  in  parallel  to  achieve  the  same  total  voltage  and/or  capacity  ratings.  -­‐In  parallel:  Maintains  voltage,  Adds  Capacities  -­‐In  series:  Adds  voltages,  Maintains  Capacities  
27   Troubleshoot  new  replacement  to  ensure  it’s  working  properly.  go  to  beginning.   Once  an  appropriate  replacement  or  substitution  has  bee  made,  troubleshoot  device  with  new  battery  solution.  
Preventive  Maintenance  


• Regularly  (ideally  every  6  months)  check  for  faults,  leaking,  and  corrosion.  • Do  not  store  in  extreme  temperatures.  • When  using  an  alternative  source  of  power  in  the  device,  remove  the  batteries.  • For  secondary  batteries:  o Do  not  let  batteries  discharge  past  their  lower  voltage  limit  o Check  devices  with  secondary  batteries  every  6  months  and  perform  discharge  overnight  test.  




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Power  Supply  (Fuse)  
Flowchart  


 
Description  #   Text  box   Explanation  or  Comment  1   Begin:  Fuses   Begin  diagnostic  process  for  a  work  order  on  Fuses.  Testing  and  maintenance  is  advised  with  any  device  using  a  fuse.  2   Test  if  the  fuse  shorts  using  voltmeter.   Use  a  voltmeter  to  assess  whether  or  not  the  fuse  shorts  (working).  3   Does  the  fuse  short?   If  the  fuse  shorts,  the  transformer  must  not  be  functioning.  
4   Fuse  is  working  properly.  See  power  supply  flowchart  for  instructions.   Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Always  check  with  clinician  before  putting  a  device  back  into  clinical  use.  
5   Inspect  the  fuse  and  identify  its  amperage,  voltage,  and  type.  


Typically  the  amperage,  voltage,  and  type  is  printed  on  the  fuse  or  device  that  requires  it.  If  not,  make  an  educated  guess  by  comparing  with  fuses  of  known  specifications.  Additionally,  use  the  knowledge  of  the  device  to  estimate  which  fuse  is  best.  6   Can  a  fuse  be  found  with  the  exact  correct  specifications?   Exact  specification  matches  may  not  be  possible  or  realistic.  7   Replace  the  fuse  of  appropriate  type,  amperage,  and  voltage.   Simply  remove  and  replace  new  fuse  match.  
8  


Using  BTA  guidelines,  procure  a  fuse  with  as  many  specification  matches  as  possible.  Some  non-­‐matching  substitutions  can  be  made.  Refer  to  box  description  for  more  details.  
1.  Amperage:  Replace  with  lower  amperage  -­‐  will  need  to  be  replaced  more  frequently.  Do  not  replace  with  higher  amperage.  2.  Voltage:  A  higher  voltage  can  replace  a  lower  voltage  fuse;  a  lower  voltage  fuse  cannot  replace  a  higher  voltage  fuse.  3.  Type:  Fast  acting  fuse  can  replace  a  slow  acting  fuse  (it  will  need  to  be  replaced  more  frequently).  Slow  acting  cannot  replace  fast  acting.    


9   If  necessary,  use  BTA  skills  to  construct  a  temporary  fuse  until  the  replacement  can  be  found.   Obtain  a  suitable  fuse  that  matches  as  many  specifications  as  possible.  
Preventive  Maintenance  


• Best  to  keep  a  stock  of  frequently  use  fuses  in  the  workshop.  




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Power  Supply  (Outlet  Plug)  
Flowchart  


 Warning: Handling Electrical Equipment is dangerous. Please wear insulated gloves and use insulated equipment whenever handling high voltage outputs.    




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Description  #   Text  Box   Comments  
1   Begin:  Outlet/Plug   Begin  diagnostic  process  for  a  work  order  on  Outlet/Plug.  Testing  and  maintenance  is  advised  when  a  device  that  uses  a  wall  input  fails  to  turn  on.  
2   Carefully  take  apart  the  outlet  faceplate.  Inspect  the  circuitry  for  any  damage.    


Using  BTA  skills  for  Power  Supply,  carefully  take  off  the  outlet  faceplate.  Disconnecting  the  main  power  while  dismantling  is  advised.  3   Are  there  any  damaged  parts?   Inspect  components.  Is  anything  disconnected?  Is  anything  clearly  burned  or  melted?  4   Carefully  remove  and  replace  any  damaged  parts.   Remove,  replace,  or  reconnect  any  non-­‐functioning  parts.  


5   Is  the  outlet  wired  properly  and  grounded?  


Using  BTA  guidelines,  use  a  voltmeter  to  check  for  the  output  voltage  and  current.  Are  the  live,  neutral,  and  ground  wires  appropriate?  What  about  in  the  device  plug?  


 6   Carefully  rewire  the  outlet  and  add  a  ground  connection,  if  necessary.   Use  BTA  skills  to  carefully  rewire  anything  improperly  wired.  Disconnect  the  main  power!  7   Is  the  machine  set  to  accept  the  proper  power?   Check  the  machine  specifications.  Does  the  device  accept  the  appropriate  wall  power?  8   Alter  the  power  of  the  device  if  possible;  otherwise  use  transformer   Some  devices  allow  the  input  power  to  be  altered.  Otherwise  obtain  the  transformer  of  the  appropriate  input  and  output  voltages.  9   Troubleshoot  transformer.   See  the  transformer  troubleshooting  flowchart  to  ensure  the  new  transformer  is  working  properly.  10   Is  the  plug  of  the  appropriate  pin  type?   Does  the  plug  pin  configuration  fit  into  the  wall  socket?    
11   Obtain  appropriate  plug  type  and  replace.   Obtain  a  replacement  and  utilize  BTA  skills  to  replace.  Otherwise  obtain  a  pin  type  adapter.  Just  ensure  the  machine  is  of  the  appropriate  power,  as  pin  type  is  indicative  of  power  accepted.  12   Is  the  plug  in  good  condition?   Pins  shouldn’t  wiggle,  be  bent  or  rusted.  13   Refer  to  BTA  skills  to  fix  or  replace  plug  and  cable.   Tighten  pins  that  wiggle.  Straighten  any  bent  pins  with  pliers.  Remove  any  rust  with  sandpaper.  
14   Outlet  and  plug  are  working.  Reference  power  supply  flowchart  for  further  instructions.  


Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Always  check  with  clinician  before  putting  a  piece  of  equipment  back  into  use.  
Preventive  Maintenance  


• Verify  electrical  outlets  are  wired  properly  and  grounded  on  a  regular  basis,  at  least  annually.  • Insert  and  remove  wires  carefully.  When  removing,  pull  on  the  plug,  not  the  cable.  • Avoid  exhibiting  cables  to  sharp  bends.  • Use  electrical  tape  to  contain  fraying  wires.    




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Power  Supply  (Transformer)  
Flowchart  


   




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Description  #   Text  Box   Comments  
1   Begin:  Transformer   Begin  diagnostic  process  for  a  work  order  on  Transformer.  Testing  and  maintenance  is  advised  when  a  device  using  a  transformer  fails  to  turn  on.  
2   Ensure  that  the  transformer  is  appropriate  for  the  desired  input  and  output  voltages  by  inspecting  its  specifications.  


Transformers  typically  print  the  required  input  and  desired  output  voltages  on  its  surface.  It  is  necessary  to  adhere  to  these  requirements  for  safety  and  appropriate  transformer  performance.  
3   Is  this  a  wall  transformer?   A  wall  transformer  converts  AC  input  voltage  to  a  DC  output.  It  is  also  known  as  an  “AC/DC  adapter.”  
4   Using  a  voltmeter,  ensure  the  wall  outlet  is  outputting  the  proper  voltage.  Plug  in  the  wall  transformer.  


As  a  precaution,  it  is  always  good  to  ensure  that  the  input  to  the  transformer  is  of  the  correct  voltage  before  plugging  it  in.  
5   Using  a  voltmeter,  check  the  output  voltage  and  current  of  the  transformer.  


After  plugging  in  the  transformer,  place  one  probe  from  the  voltmeter  on  the  interior  DC  output  connector,  and  one  on  the  exterior  of  the  connector.  
 6   Are  voltage  and  current  measurements  appropriate?   After  checking,  ensure  that  these  measurements  match  the  wall  transformer’s  specifications.  7   Replace  wall  transformer.  Go  back  to  beginning.   If  accurate  voltage  and  current  outputs  are  not  obtained,  replace  the  wall  transformer.  


8   Wall  transformer  is  working  properly.  See  power  supply  flowchart  for  further  instructions.  
Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Always  check  with  clinician  before  putting  a  piece  of  equipment  back  into  use.  


9   Ensure  that  the  input  voltage  is  being  inserted  into  the  proper  side  of  the  transformer.  
It  is  absolutely  necessary  for  the  input  voltage  to  enter  the  correct  side  of  the  transformer  for  safety  and  appropriate  transformer  performance.  10   Does  the  transformer  output  the  proper  voltage?   Using  a  voltmeter,  check  the  output  voltage.  Ensure  that  these  measurements  match  the  transformer’s  specifications.  


11   Transformer  is  working  properly.  See  power  supply  flowchart  for  further  instructions.  
Move  on  to  the  next  step  of  the  power  supply  flowchart  if  device  still  does  not  turn  on.  Always  check  with  clinician  before  putting  transformer  back  into  clinical  use.  12   Is  the  output  voltage  zero?   If  the  voltage  is  zero,  absolutely  no  potential  is  being  emitted  from  the  transformer.  This  is  indication  of  further  damage.  13   Troubleshoot  transformer  fuse.   Use  a  voltmeter  to  assess  whether  or  not  the  fuse  shorts.  A  shortage  indicates  a  functioning  fuse.  


14   Does  the  transformer  fuse  short?   If  the  fuse  shorts,  it  is  still  functioning  and  the  transformer  is  not  functioning.    15   Replace  Transformer.  Go  back  to  the  beginning.   If  the  voltage  is  zero  and  the  fuse  is  working  properly,  the  transformer  is  should  not  be  repaired.  
16   Replace  the  fuse.  See  fuse  troubleshooting  flow  chart  for  appropriate  actions.   Refer  to  the  fuse  troubleshooting  guide  to  appropriately  replace  the  transformer  fuse.  17   Go  back  to  beginning.   Troubleshoot  entire  transformer  when  fuse  has  been  replaced.  




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18   Use  BTA  skills  to  assess  proper  resistances  of  coils,  between  coils,  and  between  the  coils  and  the  frames.  
If  the  voltage  is  not  zero,  but  also  not  the  appropriate  voltage,  use  the  BTA  skills  to  assess  the  resistances  within  the  transformer  to  determine  which  parts  may  need  to  be  recoiled.  Complete  this  step  only  if  recoiling  is  possible.  Otherwise,  the  transformer  will  need  replacing.  


19   Rewind  transformer  if  possible  and  necessary.  Otherwise  replace  transformer.   If  resistances  indicate  that  the  transformer  needs  recoiling,  rewind  if  coils  are  exposed.  Otherwise,  the  transformer  will  need  replacing.  
Preventive  Maintenance  


• Keep  transformer  clean.  Avoid  using  water  to  do  so.  • Store  in  a  dry  place  with  no  possibility  of  contact  with  water.  • Store  within  the  range  of  -­‐40-­‐55°C      




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Thoughts/  Comments/  Ideas      




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Printer  (general)  
Flowchart    
   




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Description  #   Textbox   Explanation  1   Begin:  Printer  (general)   Begin  troubleshooting  process  for  a  work  order  for  Printer  (general)  2   Is  the  device  casing  free  from  external  damage?   Scan  the  exterior  of  the  device  for  any  dents,  damage  or  debris.  Damage  to  the  exterior  can  be  indicative  of  more  severe  internal  damage.  3   Clean  exterior  of  dirt  and  debris.  Verify  that  any  dents  do  not  impact  inner  functionality   Devices  operate  best  when  uninhibited  by  dirt  and  debris.  See  BTA  skills  for  Mechanical  Cleaning  and  Mechanical  Casing.  4   Are  all  cables  and  plugs  free  from  nicks,  cuts  and  damage?   Damage  to  wires  can  inhibit  transfer  of  electrical  signal  throughout  device.  5   Repair  and  replace  cables  and  plugs  as  necessary   See  BTA  skills  for  Electrical  Simple  connections  and  Power  Supply.  6   Verify  all  plugs  and  cables  are  fully  connected   Plugs  and  cables  should  fit  firmly  in  their  ports.  Oftentimes  a  loose  cable  can  hamper  proper  electrical  functionality.  For  more  in  depth  information,  see  BTA  skills  on  Electrical  Simple  Connectors.  7   Does  device  power-­‐on?   Signs  of  a  device  that  is  “on”  include  but  are  not  limited  to  lights  and  sounds.  8   Does  device  receive  power  from  monitor?   For  some  medical  applications,  printers  receive  power  from  the  monitor  or  larger  device  to  which  they  are  connected,  instead  of  from  a  battery  or  an  A/C  line  or  fuse.  9   Unplug  power  and  monitor-­‐connecting  cables  for  10  seconds   Unplug  all  cables  from  printer.  Power  cords  should  also  be  unplugged  from  the  wall.  10   Check  and  troubleshoot  monitor  power  source   See  flowchart  for  Power  Supply  and  BTA  skills  for  Power  Supply.  11   Replace  or  repair  A/C  line  as  necessary   See  BTA  skills  for  Electrical  Simple  Connections  and  Electrical  Simple  Fabrication.  12   Firmly  re-­‐connect  cables   Plugs  and  cables  should  fit  firmly  in  their  ports.  Oftentimes  a  loose  cable  can  hamper  proper  electrical  functionality.  For  more  in  depth  information,  see  BTA  skills  on  Electrical  Simple  Connectors.  13   Does  device  power-­‐on?   Signs  of  a  device  that  is  “on”  include  but  are  not  limited  to  lights  and  sounds.  14   Troubleshoot  power  supply   See  flowchart  for  Power  Supply  and  BTA  skills  for  Power  Supply.  15   Do  device  or  monitor  display  error  messages?   Many  devices  have  built  in  mechanisms  that  trigger  error  message  displays  upon  malfunction  of  the  device.  16   Is  there  sufficient  paper  in  tray(s)?   Lack  of  paper,  or  paper  of  an  improper  size  or  thickness,  can  cause  jams  or  the  burn  out  of  internal  parts.  17   Replace  paper   Make  sure  to  pay  attention  to  size,  thickness  and  surface  finish  that  matches  either  the  device  or  its  settings.  




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18   Does  device  display  “off-­‐line”?   An  “off-­‐line”  error  message  may  not  be  accompanied  by  appropriate  on-­‐screen  instructions.  19   Follow  on-­‐screen  instructions   Devices  with  well-­‐designed  error  messages  will  usually  also  provide  step-­‐by-­‐step  on-­‐screen  instructions  for  repair.  20   Power-­‐off,  disconnect  monitor  and  power  cables,  and  wait  15  seconds.  Reconnect  and  power-­‐on   An  “off-­‐line”  error  message  may  not  be  accompanied  by  appropriate  on-­‐screen  instructions.  The  problem    can  usually  be  solved  by  re-­‐setting  all  connections  as  described  in  this  step.  21   Is  there  a  paper  jam?   Paper  jams  can  be  obvious  or  discrete.  They  occur  when  paper  is  improperly  fed  through  the  printer.  Even  the  smallest  of  scraps  of  paper  can  lead  to  a  jam.  22   Press  “Cancel”  or  “Stop  job”  and  gently  pull  out  jammed  paper   It  is  important  that  the  device  stop  trying  to  print  before  the  paper  is  removed.  When  removing  paper,  also  keep  an  eye  out  for  misalignment  in  the  gears  or  other  internal  components,  that  may  have  caused  the  paper  to  jam  in  the  first  place.  23   Make  sure  trays  and  doors  are  completely  shut   Sometimes  the  printer  will  not  function  because  all  of  its  openings  are  not  properly  closed.  To  troubleshoot  more  in  depth,  see  BTA  skills  for  Mechanical  Casing.  24   Re-­‐send  print  job   To  test  if  printer  is  functional  without  restarting  troubleshooting  process,  cancel  all  print  jobs  and  re-­‐send  the  most  recent.  25   Is  output  blurry  or  discolored?   A  blurry  or  discolored  output  appears  like  an  image  out  of  focus.  26   Replace  ink  cartridge   A  blurry  or  discolored  output  indicates  that  the  printer  itself  is  working  properly,  but  that  there  is  an  issue  with  the  ink.  27   Device  is  ready   Device  is  ready  for  use.  
 
Preventive  Maintenance    


• Keep  stock  of  printer  supplies  (ink  and  paper)  • Regularly  check  for  jams  • Make  sure   that  all  printer   settings  match   the   function  of   the   job,  and   the   type  and  size  of  paper  being  used      




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Thoughts/  Comments/  Ideas    
   




144  
 


Pulse  Oximeter  
Flowchart        




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Description  #   Text  Box   Explanation  or  Comment  
1   Begin:  Pulse  Oximeter   Begin  diagnostic  process  on  a  work  order  for  pulse  oximeter.  Maintenance  is  generally  requested  on  a  pulse  oximeter  when  it  cannot  read  SpO2  or  heart  rate  levels.  2   Does  the  pulse  oximeter  power  on?   The  displays  should  appear  on  working  pulse  oximeter  when  powered  on.    
3   Troubleshoot  power  supply  (separate  chart).  


If  no  power  reaches  the  machine,  there  may  be  problems  with  the  switch,  fuse,  or  wiring.  See  flowchart  for  Power  Supply  and  BTA  skills  on  Power  Supply.  
4   Does  the  pulse  oximeter  power  on  with  the  battery  only?  


Though  the  machine  can  still  be  used  even  if  the  battery  charging  circuit  is  faulty,  the  battery  should  be  checked  for  functionality.  
5   Test  battery  voltage.   Use  a  multimeter  to  determine  if  proper  voltage  is  reaching  the  pulse  oximeter.  See  flowchart  for  Batteries  and  BTA  skills  on  Power  Supply.  6   Charge  battery  if  needed  by  plugging  into  wall.   The  battery  needs  fourteen  hours  to  recharge  completely.    7   Does  the  battery  charge?   If  the  battery  does  not  hold  charge,  the  machine  may  still  be  used  when  plugged  in.  8   Check  battery  charging  circuit.   Ensure  that  the  circuitry  that  charges  the  battery  is  intact.  9   Change  battery  if  needed.   Check  the  battery’s  replacement  date  and  change  it  if  it  is  faulty  or  if  the  date  has  passed.  10   Go  to  begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  11   Disconnect  probe.   Remove  probe  from  pulse  oximeter.  
12   Does  the  alarm  sound?   The  alarm  should  not  only  sound  when  heart  rate  or  SpO2  levels  reach  outside  the  acceptable  ranges  but  when  the  probe  connection  with  the  machine  is  lost.  
13   Check  connection.   Ensure  that  there  is  nothing  blocking  the  probe  receptacle.  Clear  any  debris  or  dirt  that  may  interfere  with  probe  connection.  14   Check  internal  circuitry  and  speakers.   Ensure  internal  circuitry  and  speaker  connections  are  intact.  See  BTA  skills  for  Electrical  Simple.  15   Reconnect  probe.   Reinsert  probe  into  pulse  oximeter.  16   Does  the  alarm  stop  sounding?   Ensure  that  the  probe  connection  alarm  stops  when  the  probe  is  reconnected.  17   Check  probe  connector.  Replace  if  pins  are  damaged.   If  the  pins  on  the  probe  connector  are  damaged,  bent,  or  broken,  the  probe  should  be  replaced.  18   If  probe  is  still  not  being  recognized,  replace  probe.   If  the  alarm  continues,  the  problem  may  be  with  the  probe  itself.  Replace  the  probe.  19   Is  one  light  sensor  visible  in   There  should  be  one  red  light  being  visibly  emitted  




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the  probe?   from  inside  the  probe.  
20   Clean  probe  with  a  70%  isopropyl  alcohol  solution  or  a  mild  detergent.  


Probe  can  also  be  cleaned  with  warm  water,  liquid  soap,  mild  chlorine  bleach  solution,  or  a  hydrogen  peroxide  solution.  Do  not  use  acetone,  butyl  alcohol,  denatured  ethanol,  Freon,  trichloroethylene  or  any  petroleum-­‐based  solutions.  See  BTA  skills  on  Mechanical  Cleaning.  
21   Replace  probe  if  light  is  still  not  visible.   If  light  is  not  being  emitted,  the  photodetector  cannot  read  the  signals.  The  pulse  oximeter  cannot  calculate  the  SpO2  value  or  heart  rate.  
22   Place  probe  on  finger.  Ensure  ambient  light  cannot  enter  sensor.  


When  not  in  use,  the  probe  should  be  shielded  from  direct  light.  If  any  outside  light  enters  the  sensor,  it  can  drastically  affect  readings,  as  they  are  calculated  through  photodetection  sensors.    
23   Does  SpO2  rate  (and  heart  rate,  if  applicable)  appear  when  probe  is  placed  on  finger?  


The  rate(s)  should  appear  on  the  display  one  the  probe  is  placed  on  the  finger.  
24   Reposition  probe  on  finger.   The  probe  may  be  placed  incorrectly  on  the  finger.  Ensure  it  is  not  too  tight  or  loose  and  no  outside  light  is  entering  the  sensor.  
25   If  readings  still  do  not  appear,  check  internal  circuitry.   Ensure  internal  circuitry  is  intact  and  connections  are  strong.  See  BTA  skills  on  Electrical  Simple.  26   If  readings  still  do  not  appear,  replace  probe.   Ensure  correct  probe  is  being  used.  Other  probes  may  not  connect  correctly.  27   Hold  breath  for  10-­‐20  seconds.   This  is  to  manually  check  if  the  SpO2  readings  decrease  with  less  oxygen  supply.  
28   Do  SpO2  levels  decrease  to  under  95%  (or  at  least  by  2%)?   As  you  hold  your  breath  longer,  the  rate  should  decrease  a  few  percent  at  least.    29   Replace  probe.   Attempt  again  with  a  new  probe.  
30   If  applicable,  calculate  true  heart  rate  using  stopwatch/neck  artery  technique.  


If  applicable,  calculate  heart  rate  manually  using  a  stopwatch  and  counting  pulse  rate  of  neck  artery  (or  wrist).  
31   Do  heart  rate  values  match  to  within  1bpm?   Compare  manually  calculated  values  to  pulse  oximeter  display.  32   Replace  probe.   If  values  are  not  with  1bpm,  replace  probe.  33   Pulse  oximeter  is  working  properly.   Return  the  machine  to  the  appropriate  clinical  personnel.    
Preventive  Maintenance    


•  Inspect  exterior  of  equipment  for  damaged  or  missing  hardware.    




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• Inspect  the  power  cord,  strain  relief  and  plug/s  for  any  signs  of  damage.    • Turn  unit  off,  unplug***,  open  user  accessible  covers  and  inspect  unit  for  damage.  • Clean  unit  interior  components  and  exterior  with  compressed  air.  • Inspect  interior  for  signs  of  corrosion  or  missing  hardware.  Repair  as  required.  • Inspect  electrical  components  for  signs  of  excessive  heat  or  deterioration.    • Clean  exterior  with  warm  water  and  liquid  soap  or  mild  detergent.  • Replace  probe  if  disposable.  • Ensure   nothing   is   blocking   LEDs   or   photodetector   on   probe.   If   blocked,   clean   with  isopropyl   alcohol   solution   or   mild   detergent,   mild   chlorine   bleach   solution,   hydrogen  peroxide   solution,   or   isopropyl   alcohol.   Do   not   use   acetone,   butyl   alcohol,   denatured  ethanol,   Freon,   trichloroethylene   or   any   petroleum-­‐based   solutions.   Verify   red   light   is  being  emitted  in  probe.  • Place  probe  on  finger  and  make  sure  SpO2  and  heart  rates  (if  applicable)  appear.  • Remove  probe  from  finger  and  verify  that  alarm  is  working.  • Unplug  probe  and  verify  that  alarm  is  working.  • Examine  switches  and  controls  for  proper  function.  • Confirm  lights,  indicators,  and  displays  are  working.  • Verify  machine  can  run  on  line  power  without  battery.  • Check  suggested  replacement  date  for  battery  to  see  if  date  is  passed  or  approaching  and  replace  battery  if  necessary.    
 
   




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Thoughts/  Comments/  Ideas    
   




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Respiratory  Monitor  
Flowchart  


 




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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   User  error  is  one  of  the  main  reasons  for  false  




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during  testing?   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.      
 
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  device-­‐measured  respiratory  rate  with  a  manual  measurement    




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Thoughts/  Comments/  Ideas      




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Scales  (Analog)  
Flowchart  


 




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Description  #   Text  box   Explanation  or  comment  
1   Begin   Begin  diagnostic  process  for  a  work  order  on  scales  (analog).  Analog  scales  contain  no  electrical  components,  so  nothing  needs  to  be  turned  “on.”  Make  sure  that  scale  plate  is  clear  of  any  objects  or  debris  and  any  weighted  elements  are  set  to  zero.  2   Is  the  scale  body  free  of  dents?   By  looking  and  feeling  the  exterior  of  the  scale,  assess  for  major  external  damage.  3   Do  dents  affect  scale  function?   Depress  the  scale  platter  gently.  Does  the  external  damage  appear  to  hinder  the  movement  of  the  scale’s  needle?  4   Proceed  to  step  8   Proceed  to  step  8  5   Can  dents  be  hammered  or  pushed  out?   By  looking  and  feeling  the  exterior  of  the  scale,  gently  test  to  see  if  the  dents  can  be  removed  easily.  6   Scale  requires  spare  parts  or  must  be  retired   The  external  damage  is  beyond  simple  repair  and  impairs  scale  function.  7   Remove  dents   Gently  push  or  hammer  out  the  dents  in  the  scale  body.  8   If  the  scale  has  beams,  are  they  unbent?   Visually  assess  for  external  damage  in  beams.  9   Can  the  beams  be  bent  back  to  a  straight  position?   Gently  try  to  push  beams  back  into  a  straight  position.  10   Straighten  beam   Gently  try  to  push  beams  back  into  a  straight  position.  11   Place  a  spherical  or  cylindrical  object  on  surface  scale  sits  on   Any  object  that  rolls  will  suffice.  Ideal  objects  would  be  a  marble,  small  ball,  pen,  pencil,  dowel,  etc.  12   Is  the  scale  on  a  level  surface?   If  the  object  rolls  of  its  own  accord,  the  surface  the  scale  sits  on  is  not  level.  13   Move  to  a  level  surface   Move  scale  to  a  surface  on  which  the  spherical  or  cylindrical  object  does  not  roll  of  its  own  accord.  14   Place  a  spherical  or  cylindrical  object  on  scale  platter   Repeat  test  for  levelness  on  scale  platter.  15   Is  the  scale  level?   If  the  object  rolls  of  its  own  accord,  the  scale  platter  is  not  level  and  adjustments  need  to  be  made.  
16   Are  the  feet  uneven?   To  see  if  the  problem  lies  in  the  interface  between  the  scale  and  the  surface  it  sits  on,  press  on  each  of  the  corners  of  the  scale  body  and  verify  visually  and  audibly  whether  or  not  the  scale  wobbles.  17   Are  the  feet  adjustable?   On  some  models,  the  feet  can  be  adjusted  like  knobs  to  raise  or  lower  a  corner  of  the  scale.  
18   Place  paper  under  uneven  foot  or  edge  until  level  


If  the  scale  feet  cannot  be  adjusted,  the  scale  can  be  leveled  by  placing  paper  or  cardboard  under  the  problem  corner  until  the  scale  plate  is  level.  Use  spherical  or  cylindrical  object  to  determine  levelness.  19   Adjust  until  scale  is  level   Twist  knobs  until  scale  is  level.  Use  spherical  or  cylindrical  object  to  determine  levelness.  20   Return  to  step  15   In  order  to  double  check  the  level-­‐ness  of  the  scale,  return  to  step  15.  
21   Is  the  plate  unbalanced?   If  the  problem  is  not  in  the  feet,  the  lack  of  levelness  is  due  to  either  the  plate  itself  or  the  connection  between  the  plate  and  the  rest  of  the  scale  body.  22   Is  the  plate  removable?   Inspect  to  see  if  plate  can  be  removed.  May  need  to  slide,  twist,  




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remove  screws  or  pins,  etc.  See  BTA  skills  on  Mechanical  Attachment.  
23   Clean  connection  of  plate  to  scale  body  of  dust,  rust  and  debris   By  gently  blowing,  wiping  and/or  scraping  all  pieces  that  interface  between  the  plate  and  the  internal  mechanism.  See  BTA  skills  on  Mechanical  Cleaning.  24   Remove  plate   Remove  by  the  mechanism  detected  in  step  21.  
25   Reset  and  adjust  internal  brackets  and  levers  as  needed  


Some  of  the  pieces  inside  the  scale  body  may  have  been  dislodged  or  moved,  for  instance,  if  the  scale  has  been  dropped.  There  are  likely  to  be  grooves  or  marks  where  they  should  align,  both  inside  the  scale  body  and  on  the  underside  of  the  scale  plate.  26   Replace  plate   Replace  plate.  27   Clean  plate   Using  a  wet  cloth,  wipe  down  plate.  See  BTA  skills  on  Mechanical  Cleaning.  28   Does  the  needle  for  measurement  read  zero?   Visually  determine  if  the  needle  for  measurement  is  aligned  with  the  zero  tic-­‐mark.  29   Does  the  scale  have  a  radial  measurement  display?   Most  analog  scales  display  measurement  in  one  of  two  ways  –  with  a  radial  dial  or  a  system  of  beams  with  a  sliding  weight.  
30   Adjust  tare  block  until  needle  reads  zero   Tare  block  looks  like  a  small,  metal  bracket  with  an  adjustable  knob  on  the  back  that  holds  the  bracket  in  place.  Slowly  slide  the  bracket  along  the  beam  until  the  needle  reads  zero.  31   Remove  face   Remove  face,  may  need  to  twist.  32   Clean  dust,  rust  and  debris  from  pivot   By  gently  blowing,  wiping  and/or  scraping  in  pivot.  See  BTA  skills  on  Mechanical  Cleaning.  33   Lubricate  pivot   Using  WD40,  Vaseline,  or  an  acceptable  substitute.  See  BTA  skills  on  Lubrication.  
34   Place  on  an  object  of  a  known  weight  on  plate  


Suggested  items  would  be  any  pre-­‐packaged  object  with  a  pre-­‐scribed  weight,  though  this  rests  on  the  assumption  that  the  written,  packaged  weight  is  accurate.  An  acceptable  alternative  would  be  to  use  a  known  volume  of  water,  remembering  that  the  density  of  water  is  1  g/cm3  or  8.34  lb/gal.  35   Does  the  reading  match?   The  display  should  read  the  value  of  the  known  weight  of  the  object.  
36   Find  and  adjust  tare  knob   Most  models,  whether  radial  or  beam,  have  a  tare  knob  located  on  the  back  or  base  of  the  scale  body.  This  can  be  turned  to  manually  move  display  needle.  37   Does  the  scale  have  beams?   Most  analog  scales  display  measurement  in  one  of  two  ways  –  with  a  radial  dial  or  a  system  of  beams  with  a  sliding  weight.  
38   Adjust  tare  block  until  reading  matches   Tare  block  looks  like  a  small,  metal  bracket  with  an  adjustable  knob  on  the  back  that  holds  the  bracket  in  place.  Slowly  slide  the  bracket  along  the  beam  until  the  needle  reads  the  desired  value.  39   Remove  weight   Remove  weight.  40   Ready  for  use   Scale  is  ready  for  use.    
Preventative  Maintenance  


• Clean  plate  of  debris  after  each  use.  Use  a  brush,  if  possible,  to  avoid  placing  plate  under  excess  pressure  • Check  the  space  between  the  plate  and  the  base  for  dirt  and  debris.  If  debris  is  preventing  the  plate  from  displacing,  use  a  small,  thin  object  such  as  an  unfolded  paperclip  or  a  pin  to  clear  it  




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• Check  scale  regularly  for  levelness  • Check  scale  calibration  regularly  
Thoughts/Comments/Ideas    




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Scales  (Digital)  
Flowchart    


 




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Description  #   Text  box   Explanation  or  comment  1   Begin:  Turn  on  scale.  Wait  several  minutes   Start  the  diagnostic  process  for  a  work  order  on  Scales  (digital).  It  is  important  to  allow  scale  to  warm  up  before  use.  
2   Does  LCD  illuminate?   The  first  part  of  the  diagnostic  process  will  investigate  the  electronic  components  of  the  scale,  beginning  with  the  LCD  display.  Look  for  numbers,  a  decimal  point,  zeros,  dashes  or  a  weight  unit  of  measurement  on  display.  3   Press  LCD  display  gently  and  firmly  into  console   If  connection  between  LCD  display  and  internal  circuitry  is  loose,  a  simple  push  may  suffice  to  reconnect.  4   Is  the  scale  battery  powered?   Look  for  battery  cavity  covering  and  check  batteries  for  rust,  leakage  and  expiration.  See  BTA  skills  for  Batteries.  5   Replace  batteries   If  the  batteries  are  too  old,  power  cannot  be  supplied.  See  BTA  skills  on  Batteries.  
6   Check  cord  connections   Power  cord  may  disconnected  from  scale  console,  it  is  important  that  it  stays  in  contact  with  internal  circuitry  to  maintain  power  supply.  7   Now  does  LCD  illuminate?   See  #2  
8   Problem  most  likely  in  circuitry,  if  able,  open  scale  and  check  internal  LCD  connections   Troubleshoot  circuitry  for  loose,  rusted  or  otherwise  damaged  connections.  See  BTA  skills  for  Connections.  9   Make  sure  weigh  platter  is  clear  and  clean.  Press  tare  button   Tare  button  is  on  keypad  and  is  labeled  as  “ZERO”,  “0/T”,  “TARE”,  etc.  Pressing  this  button  resets  calibration  to  zero.  
10   Are  standard  calibration  weights  available?   Every  scale  should  come  with  official  calibration  weights  with  explicit  instruction  for  care  and  storage,  if  available,  these  should  be  used.  11   Check  scale  labels  for  scale  capacity  and  magnitude   Text  on  scale  exterior  should  give  an  indication  of  the  precision  and  degree  of  magnitude  for  which  the  model  is  designed.  12   Is  a  functional  scale  available  for  reference?   It  is  best  to  verify  calibration  of  scale  with  an  object  with  a  known  and  verified  weight  


13   Measure  out  a  mass  of  approx.  1/5  of  scale  capacity  of  a  known  medium  
If  a  functional  scale  is  available,  a  makeshift  calibration  weight  can  easily  be  found.  Suggested  mediums  for  weight  include  any  item  with  a  labeled  package  weight  (i.e.  bags  of  sugar  or  flour  for  scales  with  higher  magnitude  and  lower  precision  or  pre-­‐packaged  medical  substances  or  powders  for  scales  of  lower  magnitude  and  higher  precision),  or  plastic  containers  filled  with  water  (size  the  container  appropriately  and  proportionately  to  the  scale  magnitude).  It  is  important  to  record  the  weight  of  this  mass  for  reference.  


14   Find  an  object  with  a  known  weight  of  the  same  order  of  magnitude  but  less  than  capacity  of  scale  
Suggested  items  would  be  any  pre-­‐packaged  object  with  a  pre-­‐scribed  weight,  though  this  rests  on  the  assumption  that  the  written,  packaged  weight  is  accurate.  15   Place  weight  on  scale  platter   Place  weight  on  scale  platter.  16   Does  the  display  match  the  known  weight?   If  the  scale  is  properly  calibrated,  the  display  should  show  the  known  weight  for  the  item.  17   Is  the  scale  on  a  level,  non-­‐vibrating  surface?   If  the  scale  is  on  an  uneven  or  vibrating  surface,  it  is  likely  to  display  an  incorrect  weight  reading.  18   Move  scale  to  a  level,  non-­‐vibrating  surface   Examples  of  level,  non-­‐vibrating  surfaces  include  a  paved  or  finished  floor,  a  counter-­‐top,  or  a  table.  




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19   Is  the  scale  in  an  environment  of  typical  temperature?   If  the  scale  is  in  an  environment  with  an  abnormal  temperature,  the  circuitry  may  not  function  properly.  A  typical  temperature  is  approximately  within  the  range  of  10-­‐32.2  degrees  C.  
20   Move  scale  to  a  level,  non-­‐vibrating  surface  in  an  environment  with  a  typical  temperature  


If  possible,  store  and  use  scale  in  a  temperature-­‐controlled  room.  Otherwise,  store  and  use  scale  in  shaded  area  away  from  moisture.  21   Is  the  scale  far  from  all  electrical  and  air  currents?   Electrical  currents  affect  the  internal  circuitry  and  air  currents  can  distort  the  effective  mass  on  top  of  the  scale.  
22   Move  scale  to  a  level,  non-­‐vibrating  surface  in  an  environment  with  a  typical  temperature  and  no  currents  


Electrical  currents  can  come  from  high-­‐power  machinery  or  appliances.  Air  currents  can  come  from  open  windows,  open  doors,  heating  or  cooling  vents.  Store  and  use  scale  as  far  from  all  of  these  as  possible.  
23   Find  leveling  bubble  on  top  of  scale   This  should  be  on  the  console  as  opposed  to  the  scale  platter,  probably  towards  the  rear  of  the  scale.  There  should  be  two  concentric  circles  showing  fluid  and  an  air  bubble  beneath.  24   Is  bubble  centered  in  circle-­‐shaped  guide-­‐lines?   The  bubble  should  be  about  the  size  of  the  smaller  circle,  the  scale  is  level  when  the  two  line  up.  
25   Adjust  scale  feet  until  bubble  is  centered  


All  four  scale  feet  should  be  adjustable  by  rotation  to  slowly  change  the  height  of  each  supporting  leg  of  the  scale.  There  may  also  be  a  fifth  “phantom”  leg  towards  the  front  of  the  scale  that  can  be  lowered  to  add  balance  while  adjusting  the  feet.  
26   Clean  scale  platter,  remove  any  dust  or  rust,  especially  in  crevices  


Scale  platter  should  be  cleaned  with  clean,  warm  water,  a  cloth  and  gentle  scrubbing.  A  cloth  can  typically  remove  dust  or  rust  from  crevices,  as  can  blowing  a  jet  of  air  gently  through  any  cracks  or  crevices.  See  BTA  skills  for  Mechanical  Cleaning.  27   Go  to  #9   Restart  calibration  process  to  ensure  that  scale  is  properly  calibrated.  28   Ready  for  use   Scale  is  ready  for  use.    
Preventative  Maintenance  
• Regularly  check  and  replace  batteries  • Check  power  cord  for  defects  • Check  calibration  regularly  • Check  for  levelness  • Ensure  that  device  is  free  of  debris,  corrosion,  dirt,  etc.    




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Thoughts/Comments/Ideas    




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Suction  Machine  
Flowchart  


 




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Description    
#   Text  box   Explanation  or  Comment  
1   Begin:  Pump  has  weak  or  no  suction   Begin  diagnostic  process  for  a  work  order  on  Suction  Pump.  Maintenance  is  generally  requested  on  a  suction  pump  when  it  is  offering  weak  or  no  suction.  
2   Does  the  pump  make  noise  when  turned  on?   A  working  suction  machine  has  a  motor  or  pump  that  makes  noise  when  the  device  is  turned  on.  
3   Is  power  reaching  the  pump?   Wires  should  enter  the  motor  to  provide  power.  Use  a  multimeter  to  determine  if  the  proper  voltage  is  reaching  these  wires.  See  BTA  skills  on  Electrical  Simple.  
4   Troubleshoot  switch,  fuse,  and  power  supply  (separate  chart).   If  no  power  reaches  the  pump,  there  may  be  problems  with  the  switch,  fuse,  or  wiring.  If  the  motor  is  DC,  check  the  power  supply.  See  BTA  skills  on  Power  Supply.  
5   Clean  air  intake  vents/filter.   The  pump's  air  intake  vent  or  filter  should  be  cleaned  for  dust  or  other  obstructions.  See  BTA  skills  on  Filters.  
6   Lubricate  and  clean  motor.   See  BTA  skills  on  Motor  Cleaning.  
7   Replace  or  resurface  diaphragm  (if  applicable).  


The  diaphragm  or  membrane  pump  should  be  cleaned  periodically.  Diaphragm  pumps  use  reed  valves  to  build  suction,  which  can  become  corroded  or  pitted.  If  the  head  metal  also  gets  pitted,  the  diaphragm  needs  to  be  replaced.  
8   Clean  brushes.   See  BTA  skills  on  Motor  Brushes    
9   Replace  or  resurface  vanes  (if  applicable).   The  vanes  on  rotary  vane  pumps  may  wear  out  over  time.  The  vanes  may  be  replaced,  but  are  often  expensive  and  difficult  to  find.  Vanes  can  also  become  pitted  and  grooved.  These  can  be  refaced  fairly  easily.  
10   Does  motor  run?   After  each  attempt  to  repair  the  motor,  test  to  see  if  it  works.  
11   Consider  replacing  the  motor  for  the  pump  or  the  entire  unit.   If  the  motor  can't  be  repaired,  it  is  time  to  replace  the  motor  or  the  entire  unit.  
12   High  pressure  gage  reading  when  "on"?  


Most  suctions  pumps  have  a  pressure  gage.  When  the  machine  is  first  turned  on,  does  the  gage  give  a  high  reading?  If  there  is  no  pressure  gage,  you  will  have  to  diagnose  the  strength  of  the  suction  at  different  points  in  the  pneumatic  circuit,  then  look  for  leaks  and  blockages  based  on  this  information.  See  BTA  skills  on  Plumbing  Blockages.  
13   Place  thumb  over  suction  tip.   Occlude  the  end  of  the  tubing  that  goes  in  the  patient.  




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14   Does  suction  reading  increase  significantly?   If  the  machine  is  working  properly,  the  pressure  gage  should  rapidly  increase  to  a  higher  reading  when  the  end  is  occluded.  
15   Try  using  completely  assembled  machine  to  aspirate  water  droplets.   Use  the  machine  to  aspirate  water  from  another  container.  Place  the  tip  just  at  the  surface  of  the  water.  The  pump  might  not  aspirate  if  the  tip  is  submerged  beneath  the  surface.  
16   Machine  can  aspirate  water  droplets?   Does  the  collection  bottle  gradually  fill  with  water?  
17   Disconnect  pump-­‐side  tube  from  bottle  lid.   Two  tubes  connect  to  the  lid  of  the  collection  bottle.  Disconnect  the  tube  that  goes  towards  the  pump  from  the  lid.  
18   Place  thumb  over  pump-­‐side  tube.   Occlude  the  end  of  the  tubing  that  used  to  connect  to  the  lid  of  the  collection  bottle.  
19   Does  suction  reading  increase  significantly?   If  the  machine  is  working  properly,  the  pressure  gage  should  rapidly  increase  to  a  higher  reading  when  the  end  is  occluded.  
20   Create  an  airtight  seal  on  bottle  lid.   See  BTA  skills  on  Plumbing  Seals.  Duct  tape  may  help  seal  leaks  between  the  collection  bottle  and  lid.  It  may  be  necessary  to  replace  the  collection  bottle  with  another  airtight  container  and  lid.  
21   Ensure  connections  between  tubes  and  bottle  lid  do  not  leak.   See  BTA  skills  on  Plumbing  Connections.  Try  a  tighter  piece  of  tubing.  
22   Ensure  patient-­‐side  tubes  do  not  leak.   See  BTA  skills  on  Plumbing  Leaks.  
23   Create  airtight  seal  on  fluid  trap  lid.   See  BTA  skills  on  Plumbing  Seals.  Duct  tape  may  help  seal  leaks  between  the  collection  bottle  and  lid.  
24   Ensure  connections  between  tubes,  pump,  and  fluid  trap  do  not  leak.   See  BTA  skills  on  Plumbing  Connections.  Try  a  tighter  piece  of  tubing.  
25   Ensure  pump-­‐side  tubes  do  not  leak.   See  BTA  skills  on  Plumbing  Leaks.  
26   Disconnect  pump-­‐side  tube  from  bottle  lid.   Two  tubes  connect  to  the  lid  of  the  collection  bottle.  Disconnect  the  tube  that  goes  towards  the  pump  from  the  lid.  
27   High  pressure  gage  reading  when  "on"?   Most  suctions  pumps  have  a  pressure  gage.  When  the  machine  is  first  turned  on,  does  the  gage  give  a  high  reading?  
28   Disconnect  all  tubing  from  pump  and  gage.   Remove  the  tubing  and/or  fluid  trap  that  connects  directly  to  the  pump.  




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29   High  pressure  gage  reading  when  "on"?   Most  suctions  pumps  have  a  pressure  gage.  When  the  machine  is  first  turned  on,  does  the  gage  give  a  high  reading?  
30   Clean  inside  of  motor.   The  motor  may  be  clogged  with  dust,  dried  blood,  or  other  obstructions.  See  BTA  skills  on  Motor  Cleaning.  
31   Empty  collection  bottle.   Clean  and  empty  the  bottle.  
32   Remove  any  blockages/kinks  in  patient-­‐side  tubing,  or  replace  patient-­‐side  tubing.   See  BTA  skills  on  Plumbing  Blockages.  
33   Empty  fluid  trap.   Clean  and  empty  fluid  trap.  Make  sure  ball  moves  freely.  
34   Remove  any  blockages/kinks  in  tubing  between  collection  bottle  and  pump.   See  BTA  skills  on  Plumbing  Blockages.  
35   Clean/replace  bacteria  filter.   Replace  the  bacteria  filter  with  another  filter  of  3  micron  size.  The  machine  can  run  for  a  short  time  without  this  filter,  but  the  motor  will  eventually  fail  if  there  is  no  filter.    
36   Go  to  Begin.   Restart  the  diagnostic  process  to  see  if  the  corrective  measures  have  repaired  the  machine.  
37   Machine  is  working  properly.   Return  the  machine  to  service  via  the  appropriate  clinical  personnel.  
   




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Preventive  Maintenance  
•  Clean  air  intake  filters.  • Ensure  electrical  plug  and  cord  are  in  good  condition.  • Sterilize   jars,   tubing,  other  components   that  come   into  contact  with  patient   fluids  between  each  use   in  solution  of  water,  detergent,  and  disinfectant.  • Change  bacteria  filter  if  wet  or  discolored.  Make  sure  there  is  a  sufficient  supply  of  bacterial  filters  • Check  collection  bottle/jar  for  cracks,  chips,  and  other  damage.  • Check  that  float  valve  moves  freely.  • Ensure  anti-­‐static  tubing  is  used.  • Clean  brushes  on  motors  as  necessary.  • Ensure  vacuum  works  over  full  range  of  suction  pressures  if  there  is  a  control/knob.  • Verify  that  overflow  valve  (float  valve)  works  properly  when  container  is  filled  with  water.  • Grounding  resistance  between  chassis  and  ground  pin  should  not  exceed  0.5  ohms.  • Maximum  chassis  leakage  current  with  ground  wire  disconnected  should  not  exceed  300  microamps.  • Check  for  unusual  noises  or  vibration  in  motor/pump.  • Check  for  evidence  of  fluid  spills.  Clean  any  spills  as  necessary.  • Measure  and  record  vacuum.  • Most   suction   pumps   run   in   the   20-­‐25inHg   range   when   fully   occluded.   If   the   suction   is   <20inHg   then  servicing  is  required.    


   




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Thoughts/Comment/Ideas    




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Ultrasound  
Flowchart    
   




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Description  1. Begin Ultrasound Flow Chart Begin Ultrasound Flow Chart 2. Does it turn on? Does it turn on? 3. Troubleshoot Power Supply See power supply flowchart 4. Does the screen turn on? Does the screen turn on? 5. Check circuit components Troubleshoot the circuit (see troubleshooting guide) 6. Does the probe work? Does the machine show an image? 7. Check gel. Is there enough of the proper gel. 8. Check probe. Ensure that the probe is properly connected and undamaged. 9. Repair or replace probe. Solder the broken connections or replace the probe. 10. Do the dials work? Do the dials properly control the machine? 11. Replace dials or use anticorrosive contact spray on dials. Replace or use anticorrosive contact spray on dials.
12. Is there a flickery or partial image Does the image on the screen have missing sections? Does the screen flicker?
13. Check probe.


Gently pull on the cable at different points to see when the image flickers. This is where the cable is broken. For composite probes wave a pencil across the transducer. If not seen, this is where the transducer is not connected. 14. Repair or replace probe. Solder the broken connections or replace the probe. 15. Go to begin. Go to begin. 16. Is there a noisy signal? Is there distortion in the produced image? 17. Replace motor or bearings Replace the motor or bearings if they are broken or damaged. 18. Is there major image deterioration? Is the image severely deteriorated? 19. Are there air bubbles in the probe? Does the oil in the probe have air bubbles in it?




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20. Replace oil. Replace oil. 21. Is there a sudden worsening quality of the image? Does the image have sudden changes in quality? 22. Check the preamplifier. Check the preamplifier. 23. Check the mains voltage range. Check the outlet voltage range. 24. Check that the probe is connected securely. Check that the probe is connected securely. 25. Is there a random change in greyscale quality? Is there a random change in greyscale quality? 26. Check the monitor and the preprocessing unit. Check the monitor and the preprocessing unit. 27. Can you change programs or make measurements on the machine? Can you change programs or make measurements on the machine? 28. Check the digital processor. Check the digital processor. 29. Is there a partial image despite an intact probe? Is there a partial image despite an intact probe? 30. Check the digital memory and the microprocessor. Check the digital memory and the microprocessor. 31. Is the image wavy? Is the image wavy? 32. Is the machine calibrated correctly? Is the machine calibrated correctly? 33. Go to begin. Got to begin. 34. Calibrate the machine. Calibrate the machine. 35. End End  
Preventive  Maintenance    


• After  every  use,  clean  the  probe  and  cable  with  a  damp  cloth  to  ensure  that  it  • is  free  of  gel.  • Replace  the  internal  battery  to  protect  internal  memory  if  necessary  o when  replacing  • read  the  manual  to  tell  you  what  to  do  • Clean  the  controls  by  wiping  them  with  a  damp  cloth  or  tissue  after  every    • working  day.  • Change  the  dust  filter  every  3  to  6  months.    • Ultrasound  Proper  Usage  o Ensure  proper  mains  voltage  range.  o When  changing  the  dust  filter,  if  the  original  filter  paper  cannot  be  found,  a    • piece  of  double  gauze  may  be  used.  




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o Ensure  there  is  no  air  between  the  probe  and  the  patient  by  having  enough    • ultrasonic  gel  to  ensure  a  quality  image.    o Do  not  soak  the  cable  with  gel.  o Do  not  turn  off  and  on  the  machine  quickly.  Leave  two  minutes  between  each    • to  retain  internal  memory  of  the  device.  Also,  leave  the  machine  running  for    • at  least  15  minutes  every  time.  o To  adjust  the  greyscale  during  a  session,  use  dynamic  controls  on  the    • machine  not  those  controls  on  the  monitor.  Otherwise  use  the  grey  wedge  on    • the  monitor.  o The  ultrasound  may  freeze  if  the  information  is  typed  in  too  quickly.  If  the    • machine  freezes,  turn  the  machine  off  and  wait  two  minutes  before    • restarting.  o Do  not  spill  liquids  on  the  machine.  o Do  not  hang  anything  for  the  controls  of  the  machine.  • 10.If  the  mains  voltage  varies  more  than  the  tolerance  of  the  machine  specified    • by  the  manufacturer  (usually  around  +  10%),  a  voltage  stabilizer  is  required.  • 11.Ventilation  holes  of  the  ultrasound  must  not  be  covered  by  papers,  forms,  or    • tissue  • 12.When  troubleshooting  the  electronics  of  the  device,  start  replacing  fuses  if    • necessary  and  checking  the  highly  stressed  circuit  that  powers  the  pulse    • generator.      




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Thoughts/  Comments/  Ideas    
   




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Water  Bath  
Flowchart  


 




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Description  
#   Text  Box   Explanation  1   Begin  Water  Bath  Testing   Start   the   diagnostic   process   for   a   work   order   on   a  Water  bath  2   Does  the  machine  power  up?   With   unit   plugged   in,   and   power   switch   turned   on,  the  display  should  light  up  
3   Is  power  reaching  the  control  board?   Use  a  multimeter  at  the  leads  of  the  control  board  to  ensure   that   sufficient   voltage   is   reaching   the  controller.   If   insufficient,   there   may   be   a   problem  with  the  wiring.    4   Faulty/Defective  control  board.   Replace  control  board  if  available.  5   Troubleshoot  the  power  supply  (separate  chart)    6   Replace  fuse  if  necessary   See   BTA   skill   under   Power   Supply   on   Identifying   a  Blown  Fuse  
7   Does  the  machine  heat  up?     Expose   the   heating   element   by   opening   up   the  machine.  Turn  the  unit  on  and  place  hand  over  coils.  You   should   be   able   to   feel   heat   being   produced   by  coils  if  machine  is  functioning  correctly  
8   Physically   inspect   heating   element   and   its  connections  for  signs  of  cracks,  rust  or  dust  


If   the   coils   do   not   produce   heat,   turn   unit   off   and  visually   inspect   coils   for   signs   of   damage.   Reference  BTA   skill   under   Mechanical   on   Cleaning   Rust,   and  Compressed  Air.  If  cracks  are  present  the  heating  unit  will  need  to  be  replaced.  
9   Is  voltage  reaching  the  heating  element?    


Using  a  voltmeter,  measure   the  voltage  entering   the  heating  unit.  To  inspect  if  the  circuit  is  open  or  closed,  see  BTA   skill   under  Electrical   Simple   for  Building  and  Using  a  Continuity  Tester  
10   Repair  any  open  circuits  or  bad  connections   Bad   connections   can   occur   due   to   buildup   of   rust,  corrosion,   or   broken   components.   See   BTA   skills  under   Electrical   Simple   for   Soldering,   Cleaning   of  Connectors,  Loose  Connectors.  
11   Faulty  thermostat.   If  no  voltage  is  reaching  the  heating  coil,  the  problem  could   also   lie   in   the  machine’s   thermostat.   Refer   to  BTA   skill   under   Electrical   Simple   on   Replacing  Temperature  Sensing  Device  to  repair.    
12   Is   the   resistance  of   the  heating  element   less   than  30  Ohms?  


Heating   elements   work   by   having   low   resistance  between  15-­‐30  ohms.  Attaching   a  multimeter   to   the  heating   element   should   conduct   electricity   and  produce   a   resistance   in   this   range.   If   the   resistance  reads  “open”  the  heating  coil  should  be  replaced.    
13   Replace  heating  element   Refer   to   BTA   skill   under   Electrical   Simple   on  Replacement   of   Heating   Element,   and   ensure   that  new  coil  matches  resistance  and  power  rating.  
14   Does   the   bath   reach   expected   temp   within   0.5  degrees?  


Using  a  thermometer,  test  the  bath  temperature  and  determine  if  it  matches  display/expected  temp  within  0.5   degrees.   Any   difference   greater   than   this   is   not  appropriate.    15   Ensure  temperature  sensor  is  connected  and  working   Use   methods   described   in   BTA   skill   under   Electrical  Simple   on   Replacement   of   Temperature   Sensing  




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Device,   to   determine   if   temp   sensor   is   working  properly.  Replace  if  necessary.  
16   Check  calibration  and  recalibrate  if  possible  


Most  digital  water  baths  have   the  capability   to   reset  their   calibration.   After   ensuring   the   temp   sensor   is  working   properly,   recalibrate   the   system.   Determine  water   bath   temperature   with   external   thermometer  and  make  sure  the  machine   is  calibrated  correctly   to  this  value.  17   Is  the  temperature  too  low?   The  bath  temperature  is  not  reaching  the  set  temp.  
18   Was  bath  recently  turned  on  or  water  added?   If   the  machine   just   turned   on,   or   room   temp/colder  water   recently   added   to   the   bath,   it  might   not   have  equilibrated  yet.  
19   Allow  for  2  hours  for  bath  temperature  to  equilibrate   Leave  at  least  2  hours  after  start  or  addition  of  water  for   the   bath   temperature   to   rise   to   set   temp  before  continuing  with  flow  chart.  
20   Safety  temperature  is  set  too  low  


Ensure   that   the   safety   temp   (or  maximum  allowable  temperature)   temperature   setting   is   not   lower   than  the  desired,  set  temperature.  The  machine  will  never  exceed   the   safety   temp,   even   if   it   is   lower   than  desired  temperature.  
21/22   Controller  Failure   The   PID   controller   is   not   providing   correct   or  sufficient   feedback   to   the   system.   Troubleshoot  controller  circuit  (include  rust  check).  
23   Does  display  remain  stable?   After   the  equilibration   time   (2  hours)   the  bath   temp  should   remain   stable   (within   0.5   degrees   of   the   set  temp).  
24   Check  bath  placement  and  room  conditions   Ensure   that   the   bath   is   not   placed   near   a   heat  generator  or  distributer  (i.e.  fan,  window,  radiator,  air  conditioner).   Ensure   that   room   temperature   is   not  fluctuating.  
25   Ensure  that  bath  has  at  least  2”  of  water   The   water   must   completely   cover   the   temperature  sensor,  which  is  generally  about  2”  on  the  base  of  the  bath.    
26   Check  controller  circuitry  for  rust  or  buildup.   Visually   inspect   all   controller   circuitry.   If   rust   or  buildup  has   formed  on   connections,   clean  using  BTA  skill   under   Electrical   Simple   for   Cleaning   Rust   and  Cleaning  of  Connectors.  
27   Check  connection  to  temperature  sensor     Use   methods   described   in   BTA   skill   under   Electrical  Simple   on   Replacement   of   Temperature   Sensing  Device  to  determine  if  temperature  sensor  is  working  properly.  Replace  if  necessary.    
28   Does  the  water  remain  in  bath  without  draining?   Other   than   because   of   evaporation,   water   height  should  remain  relatively  constant  over  time.  Check  to  see  if  water  level  is  changing  drastically,  due  to  cracks  or  leaks  
29   Ensure  that  all  fittings  and  connections  are  tight   Drain   bath.   Using   BTA   skills   under   Plumbing   for  Connections   tighten   all   connections   and   fittings   to  ensure  leak-­‐proof  seal.    30   Check  for  cracks  in  tank  and  repair  with  epoxy   Look  for  cracks  in  the  bath  tank.  Using  BTA  skill  under  Plumbing  on  Epoxy,  seal  any  cracks.  




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Preventive  Maintenance    Allow  machine  to  run  for  2  hours  for  bath  temperature  to  equilibrate.    


• If  you  use  the  bath  infrequently,  then  the  bath  should  be  kept  dry  between  uses.  • Use  only  distilled  water   in  a  water  bath.   If  non-­‐distilled  water  has  been  used,   it’s   important  to  clean  away  any  water  deposits  that  have  accumulated.    • Clean   the   water   bath   with   mild   soap   and   water   solution.  Do   not   clean   the   water   bath   with  chlorine-­‐based   bleaches,   as   they   will   damage   the   interior   of   most   tanks.   Most   water   baths  should  be  cleaned  with  mild  soap  and  water  only.    • Rinse  the  water  bath  with  clean  water  and  wipe  dry  with  a  soft  cloth.  Stainless  steel  does  not  rust,   but   foreign  materials   in   the   tank  may   rust   or   leave   rust   spots.   Never   use   steel   wool   to  remove  buildups.  (See  explanations  for  suggestions)    • Check  water   level   frequently  during  use,  especially  during  higher  operating   temperatures,  and  add  water  as  needed.  Running  a  dry  tank  can  strain  interior  surfaces  • Turn  off   the  bath  each  evening.  Otherwise  water  may  completely  evaporate,   leaving   the  bath  dry.  This  can  cause  damage  to  the  water  bath  and  create  a  fire  hazard.  • Plastic   racks   are   preferred   for   water   bath   use.   However,   if   the   water   bath   boils   dry   while  containing  plastic  test-­‐tube  racks,  the  plastic  will  melt.      


31   Ensure  that  circuitry  does  not  have  water  damage   If   leaks   have   occurred,   disassemble   bath   and   check  electrical  circuits  to  ensure  no  damage  has  occurred.  32   Does  the  rack  shake  as  expected?   If   bath   has   a   shaking   feature,   this   motion   should  occur  without  obstruction    33   Is  power  reaching  the  motor?   Using  a  multimeter,   check   the   leads  of   the  motor   to  ensure  voltage  is  reaching  the  motor  34   Repair  any  open  circuits  or  bad  connections   Refer  to  steps  9  &  10  for  BTA  skills.  
35   Check  for  obstructions   Visually  inspect  the  bath  and  rack  connections  to  find  any   objects   that   may   be   hindering   its   motion.   This  could   include   rust/calcium   buildup,   rack  deterioration,  or  solid  particles.    
36   Ensure  that  weight  on  rack  doesn’t  exceed  maximum   The   rack   itself   can   only   accommodate   a   limited  amount   of   weight.   This   varies   with   bath   size,   but  generally  should  not  exceed    37   Clean/lubricate  motor   See  BTA  skills  under  Motors  on  Cleaning/Lubrication.  




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Thoughts/  Comments/  Ideas    
   




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Common  Technical  Terms  Term   Definition   Examples  of  Devices  Associated  
Aperture   An  aperture  is  a  small  opening  whose  purpose  is  generally  to  allow  light  to  pass  through.   Cell  Counter,  Microscope,  Ophthalmoscope  Clutch   The  clutch  is  a  component  that  easily  connects  and  disengages  with  the  driving  component  of  a  pump.   Syringe  Pump  
Light  Guide  Cable   The  light  guide  cable  should  not  be  confused  with  normal  wires.  It  is  thicker  and  may  have  both  female,  both  male,  or  one  female  and  one  male  connector  on  the  ends.   Endoscope  Manometer   A  manometer  is  a  tube  or  column  of  liquid  used  to  measure  pressure.  It  is  most  often  filled  with  mercury.   Manual  Blood  Pressure  Monitor  
Probe   A  probe  is  a  thin  piece  of  metal  that  extends  out  of  the  body  of  a  device.  It  is  generally  used  to  draw  a  fluid  sample  in  devices  involving  liquids,  or  to  apply  fixed  quantities  of  localized  force  in  devices  used  to  measure  material  stiffness.   Cell  Counter  
Rheostat   A  rheostat  is  an  electrical  instrument  used  to  measure  and  adjust  electrical  resistance.  Change  in  electrical  resistance  may  correlate  to  other  device  properties,  such  as  temperature.   Infant  Incubator  Roller   The  roller  is  the  thin  cylinder  about  which  a  roll  of  paper  spins.  It  is  connected  to  the  motor.   Fetal  Doppler  
Rotary  Vanes   Rotary  vanes  often  look  like  fan  blades  and  are  the  components  on  a  pump  that  move  a  fluid  as  the  motor  spins  the  rotor  to  which  the  vanes  are  attached.   Jet  Nebulizer,  Suction  Machine  
Sphygmometer   The  sphygmometer  is  the  pressure  measuring  component  of  a  manual  BPM.  It  consists  of  inlet  tubing,  a  pressure  gauge  and  a  small  hand  pump.   Manual  Blood  Pressure  Monitor  Thermistor   A  thermistor  is  a  resistor  whose  impedance  or  resistance  varies  with  temperature.   Infant  Warmer  
Thermocouple   A  thermocouple  is  used  to  measure  temperature  and  it  is  made  of  two  different  conductors,  usually  metal,  that  are  joined  at  one  end.   Infant  Warmer  
Triac   A  triac  is  a  “triode  for  alternating  current”  that  serves  to  conduct  current  in  either  direction.  It  is  a  small  electrical  component  that  is  relatively  flat  and  has  three  prongs.   Infant  Warmer  
Zeolite  Canister   Zeolite  canisters  are  small  containers  that  hold  zeolite  stones.  Zeolite  stones  absorb  nitrogen  and  release  oxygen.  In  an  O2  Concentrator,  the  canisters  are  generally  pressurized.   O2  Concentrator      




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   Published  by:  Engineering  World  Health  
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