Chapter






Strengthening Specialised Clinical Services in the Pacific


































April 2015














































Strengthening Specialised Clinical Services in the Pacific
(A DFAT funded initiative)


April 2015




User Care of Medical Equipment


A first line maintenance guide for end users




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


2




Foreword



Pacific Island Countries face many challenges when providing quality health care services. At


the 2011 Pacific Ministers of Health and the SSCSiP’s Regional meetings the Procurement


and Maintenance of Biomedical equipment was identified as one of the most important


challenges faced by Pacific Island Countries.




SSCSiP has been working with the Pacific Island Countries to improve the Procurement and


Maintenance of Biomedical equipment. This maintenance guide for end users provides


guidelines to care and maintain a range of equipment that are commonly used.




The easy-to-follow User Checklists can be easily printed and kept beside respective


equipment as a reference and reminder to end-users to conduct maintenance on equipment


at regular intervals.




We are certain that the manual would empower end-users with basic troubleshooting and


maintenance of equipment they use, contributing towards improved clinical and biomedical


services.









Prof Ian Rouse


Dean


College of Medicine Nursing & Health Sciences


Fiji National University




September 2014







The User Care of Medical Equipment Manual has been compiled by Mr Andrew Gammie of Fishtail Consulting
Ltd (UK).







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


3


Contents



Foreword ……………………………………………………………………………. 2


Contents ……………………………………………………………………………. 3


Chapter 1. Introduction .................................................................................................. 4


Chapter 2. How to use this manual ................................................................................ 5


Chapter 3. Provision for Maintenance ........................................................................... 7


Chapter 4.1 Anaesthetic Machines and Ventilators ......................................................... 9


Chapter 4.2 Autoclaves and Sterilizers .......................................................................... 12


Chapter 4.3 Dental Unit ................................................................................................. 15


Chapter 4.4 ECG (Electrocardiograph) Machines ......................................................... 18


Chapter 4.5 Electronic Diagnostic/Monitoring Equipment ........................................... 21


Chapter 4.6 Electrosurgical Units (ESU) and Cautery Machines .................................. 24


Chapter 4.7 Endoscopes ................................................................................................. 27


Chapter 4.8 Incubators (Infant) ...................................................................................... 30


Chapter 4.9 Laboratory Equipment ................................................................................ 33


Chapter 4.10 Lamps ......................................................................................................... 36


Chapter 4.11 Nebulizers ................................................................................................... 39


Chapter 4.12 Oxygen Concentrators ................................................................................ 42


Chapter 4.13 Oxygen Cylinders and Flowmeters ............................................................ 45


Chapter 4.14 Pulse Oximeters .......................................................................................... 48


Chapter 4.15 Refrigerators and Freezers ......................................................................... 51


Chapter 4.16 Scales .......................................................................................................... 54


Chapter 4.17 Sphygmomanometers (B.P. sets) ............................................................... 57


Chapter 4.18 Stethoscopes ............................................................................................... 60


Chapter 4.19 Suction Machines (Aspirators) ................................................................... 63


Chapter 4.20 Tables – (Operating Theatre and Delivery) ............................................... 66


Chapter 4.21 Ultrasound Machines .................................................................................. 69


Chapter 4.22 X-Ray Machines ......................................................................................... 72


Chapter 5. Handling Waste .......................................................................................... 75


Chapter 6. Installation of equipment ............................................................................ 78


Chapter 7. Disposal of equipment ................................................................................ 80


Chapter 8. Basics of electrical safety ........................................................................... 81


Chapter 9. References .................................................................................................. 85





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


4


Chapter 1. Introduction


1. The purpose of this manual
This manual is intended to be a guide for the medical equipment user to carry out basic equipment care
tasks. As the majority of equipment problems are either simple or user-related it is the aim that the
better care and regular maintenance enabled by this manual will have a significant positive effect on the
delivery of healthcare. The tasks are limited to simple „first-line‟ maintenance, that is:


 tasks that can be done by the user of the equipment
 tasks that take place at the point of equipment use
 tasks that do not require the opening of the main body of the equipment




This manual is not intended as a complete maintenance guide – that is the role of a biomedical
technician. Neither is it intended to be a guide to the actual use of equipment – it is assumed that the
user is trained in the correct operation of the equipment. Users are asked to note that while every care
has been taken to make the contents as clear and accurate as possible, neither the authors nor SSCSiP
can take responsibility for the results of actions taken as a consequence of using this manual.


2. The format of this manual
The text of the manual is in English and is designed for on-line access as well as hardcopy prints.
General topics on maintenance and disposal are covered by individual chapters. Chapter 4 covers the
most commonly found equipment in detail. Each equipment section comprises:


 a brief description of the function and working of the equipment
 a line drawing of the equipment and its parts
 a troubleshooting checklist for common problems and their solution
 a user care checklist for daily and weekly tasks




The checklists are on separate pages so they can be copied and laminated for display near the equipment.

The choice of which equipment to include was guided initially by the 2010 revision of the Indian Public
Health Standards. Equipment specified for health institutions up to the size of a 50 bed hospital was
included, on the basis that this will cover the vast majority of simple equipment also found elsewhere.
Other equipment was added after consultation with attendees of the WHO Global Forum on Medical
Devices 2013 and the team of SSCSiP Project in Fiji.


3. Acknowledgements
This manual draws on work done by many in this field. In particular, the authors acknowledge:


The UK Department for International Development for initial project funding
The World Health Organization for permission to use material
Voluntary Service Overseas, UK for permission to use material
The Nick Simons Institute, Nepal for permission to use material
Crown Agents, UK for initial project support and management
The Ministry of Health and Family Welfare, India.
Engineers S B Sinha and S Bindal, India, for the first version of the manual.
SSCSiP for supporting this revision of the manual in 2014



A R Gammie, N Kapadia April 2015.





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


5


Chapter 2. How to use this manual

The tasks outlined in this manual are only part of the picture. Healthcare technology management needs
to involve all staff in the hospital. It is thus essential that some discussion on using this manual takes
place with managers as well as technical and clinical personnel. Maintenance checklists are no good
unless someone actually does the job!


1. Management


1.1. Involve Managers


Chapter 3 describes maintenance within the context of the whole process of healthcare
technology management. It will be helpful to discuss these with the people in charge of
purchasing and storing equipment and also with those in overall charge of the institution. It is
important to explain that day to day maintenance tasks cannot solve all of the problems. If poor
equipment is supplied or rats have eaten the wires, there is little point cleaning it! If a major
problem occurs, trained technical help will be needed. Encourage your workplace to plan for
the whole life cycle of equipment – see chapter 3 - or use the material referred to in chapter 9.


1.2. Involve Users


The key to effective care is keeping it regular. This means that people need to know WHAT to
do, WHEN to do it and WHO is going to do it. Users must be allowed time in their regular
schedule to carry out these tasks – they will not take long, but the benefits will be enormous. In
each department, it will be helpful to assign responsibility for each item of equipment, and if
possible insert the phrase „care of equipment‟ into their job description. Each person can then
ensure that the tasks are actually carried out. It will help to have a nominated person in overall
charge of equipment for each section of the site, so that cover can be arranged when people
transfer or are absent.


2. Maintenance


2.1. Plan the tasks


The user care tasks are placed in daily and weekly checklists. This will help in planning time
for them to be carried out. In most cases for daily tasks, the beginning of the working day will
be best, but any time will suit as long as the job is done. For weekly tasks, it may be easier to
allocate a different day for each type of equipment, in order to spread the load through the week.
A simple timetable with the person responsible can be used as a reminder.


2.2. Display the lists


The user care checklists are designed to fit on a single page per section. This makes it easy to
print or copy them and display them near the equipment. The lists will only be useful if they are
easy to see, so placing them on the equipment or on a wall nearby will be best. Each page could
be covered with plastic laminate or taped inside a plastic wallet. The same could be done with
the troubleshooting checklists, or these could be stored nearby for when needed.


2.3. Record the work
It is normally helpful to have some way of recording when user care has been done. This will
tell colleagues or the next shift that the daily check has been carried out, or remind the user
themselves that the weekly job has been done. It can also be helpful to show supervisors and
patients that care is being taken of equipment. An example record sheet is shown on the next
page, which can be copied for use with each piece of equipment.




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


6







User care task record sheet – sign and date when user care done



Equipment:……………………... Location:………………………..





Daily Tasks



Date Signed Date Signed Date Signed Date Signed Date Signed

























































Weekly tasks




Date







Signed










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


7




Chapter 3. Provision for Maintenance


1. The equipment management cycle
Maintenance of healthcare equipment is not just a question of repairing broken things. It can be Corrective
Maintenance (repair) but also Preventive (or Planned) Maintenance, which makes sure problems either do not
occur or are picked up when they are small. Both are an integral part of managing the whole lifecycle of
equipment. The following diagram illustrates this cycle:






It can be seen that maintenance and repair is just one element. To make the whole cycle work properly, a
number of different inputs are required. A full description of such a system, and the steps needed to begin one,
will be found in the “How to Manage Series for Healthcare Technology” listed in chapter 9.


2. Recommended resources
The user should not be left on their own. Once a piece of equipment is installed, commissioned and
accepted and once the user has been fully trained in operation, they will need these resources to carry out
the use and maintenance of the equipment well:


 Manuals in a fluent language
 Scheduled Maintenance
 Repair Services
 Maintenance Contract Management
 Consumables supply
 Spares Supply




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


8




3. Levels of Maintenance

There are three levels of maintenance commonly identified:


 Level 1, User (or „first-line‟)
o The user or technician will clean the filters, check fuses, check power supplies etc. without


opening the unit and without moving it away from the point of use. Note that even this level of
maintenance will require infection prevention measures for many types of equipment.




 Level 2, Technician
o It is recommended to call the local technician when first-line maintenance cannot rectify a fault


or when a six monthly check is due.


 Level 3, Specialized
o Equipment such as CT Scanners, MRIs etc. will need specialized engineers and technicians


trained in this specific equipment. They are normally employed by third party or vendor
companies.




As stated in the introduction, this manual is focussed on the User or First-Line Maintenance level. The reference
section can be used to discover material for the other maintenance levels. Rather than „maintenance‟, which
implies specialist training, in this manual we will refer to level 1 as „User Care‟.




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


9


Chapter 4.1 Anaesthetic Machines and Ventilators


Function
The anaesthetic machine (or anaesthesia machine in America) is used by anaesthesiologists and nurse


anaesthetists to support the administration of anaesthesia. The most common type of anaesthetic machine is the
continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of
medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour
(such as halothane or isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines
incorporate a ventilator, suction unit, and patient monitoring devices. Ventilators are designed to maintain
patient breathing when they are incapable of doing so themselves effectively. They carefully maintain pressure,
flow and breathing rate to the levels set by clinical staff, and set off an alarm when these levels are not
maintained.


How it works
Oxygen (O2), nitrous oxide (N2O) and sometimes air sources are connected to the machine. Through gas


flowmeters (or rotameters), a controlled mixture of these gases along with anaesthetic vapour passes through a
vaporizer and is delivered to the patient. With ventilators or a re-breathing patient circuit, soda lime canisters are
used to absorb the exhaled carbon dioxide and fresh gases are added to the circuit for reuse. Pressure gauges are
installed on the anaesthesia machine to monitor gas pressure. Generally, 25% (or 21%) oxygen is always kept in
the circuit (delivered to patient) as a safety feature. The device which ensures this minimum oxygen in the circuit
is called a hypoxic guard. Some basic machines do not have this feature, but have a nitrous lock which stops the
delivery of N2O in absence of O2 pressure. Machines give various alarms to alert operators.


Ventilators are powered by electricity with battery backup, though some models use compressed gas,
and have several modes of operation which assist or control patient breathing, or regulate by controlling volume
or pressure. Combination modes are also available. The unit may include a heater and/or humidifier to decrease
respiratory stress.












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


10


Troubleshooting – Anaesthesia Machines and Ventilators




Fault Possible Cause Solution


1.



Equipment is not running



No power at mains socket







Electrical cable fault



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

Refer to electrician for repair



2.



No gas output



No O2 pressure in cylinder / gas
supply.

Check pressure gauges for gas
pressure (about 4 bar or 4 kg/cm2)



Restore gas supply or replace gas
cylinders.

Replace O2 cylinder and/or N2O
cylinder in case of low pressure.




3.



O2 failure, power failure or
breathing alarm not working





Alarm battery is low.

Alarm device is not working





Call biomedical technician to fix
the problem.





4.



Machine has leaks





Poor seal
(commonly occurring around
tubing connections, flow valves
and O2 / N2O yokes)

Cylinders not seated in yokes
properly



Clean leaking seal or gasket,
replace if broken. If leaks remain,
call technician for repair.


Refit cylinders in yokes and
retest. If leaks remain, call
technician for repair.





5.



Flowmeter fault



Over tightening of the needle
valve or sticking of the float / ball





Refer to biomedical technician





6.



Electrical shocks



Wiring fault



Refer to electrician immediately





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


11


User Care Checklist – Anaesthesia Machines and Ventilators


Daily


Cleaning




 Remove any dust, dirt, water, waste matter, tape and paper




Audio-Visual
checks




 If any leak is audible, check with soapy solution


 Check all seals, connectors, adapters and parts are tight


 Check all moving parts move freely, all holes are unblocked




Function
checks




 Report any faults to technician immediately


 After checks, depressurize system and replace all caps / covers




Weekly


Cleaning


 Clean inside and outside with damp cloth and dry off


 Remove dirt from wheels/any moving parts




Audio-Visual
checks




 Check connections for leakage with soap solution and dry off


 Check all fittings and valves for proper assembly


 Replace soda lime if it has changed colour


 Replace any deteriorated hoses and tubing


 If seal, plug, cable or socket are damaged, replace




Function
checks




 When next used, check pressure gauges rise


 When next used, check there are no leaks




Every six months
Biomedical Technician check required





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


12


Chapter 4.2 Autoclaves and Sterilizers


Function
Sterilization is the killing of microorganisms that could harm patients. It can be done by heat (steam,


air, flame or boiling) or by chemical means. Autoclaves use high pressure steam and sterilizers use boiling water
mixed with chemicals to achieve this. Materials are placed inside the unit for a carefully specified length of
time. Autoclaves achieve better sterilization than boiling water sterilizers. Autoclaves can be small table top
designs (e.g. dental departments), portable upright units (e.g. small clinics) or large fixed systems.


How it works
Heat is delivered to water either by electricity or flame. This generates high temperature within the


chamber. The autoclave also contains high pressure when in use, hence the need for pressure control valves and
safety valves. Users must be careful to check how long items need to be kept at the temperature reached.










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


13


Troubleshooting – Autoclaves and Sterilizers


Fault Possible Cause Solution



1.





Equipment is not heating



No power at mains socket






Electrical cable fault


Damaged heating element



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

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

Send to electrician if broken or covered in
limescale (see picture below). Remove small
amounts of limescale by light scraping and
long soaking in distilled water.



2.



Pressure rises above the
marked level





Blocked valve



Clean the pressure regulating valve, safety
valve.

Pressure vessel may be over filled.

Retest autoclave under pressure with water
only.





3.





Steam is constantly escaping





Poor seal



Clean leaky valve and hole, replace if
defective.

Clean leaking seal or gasket, replace if broken.





4.





Electrical shocks



Wiring fault



Refer to electrician










Limescale on heating element




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


14


User Care Checklist – Autoclaves / Sterilizers


Daily

Cleaning




 Remove any dust / dirt with damp cloth and dry off


 Remove water and waste matter from inside



Visual checks




 Check all screws, connectors and parts are tightly fitted


 Check all moving parts move freely, all holes are unblocked



Function
checks




 Use troubleshooting guide if problems occur





Weekly

Cleaning




 Unplug, clean inside and outside with damp cloth and dry off


 Remove gasket, clean with a damp cloth and replace



Visual checks




 Scrape off any small deposits of limescale


 Send for repair if heating element covered with limescale


 If plug, cable or socket are damaged, replace



Function
checks




 When next used, check pressure / temperature gauges rise


 When next used, check there are no leaks




Every six months
Biomedical Technician check required




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


15


Chapter 4.3 Dental Unit


Function
A dental unit comprises a patient chair (often motorised), inspection light, sink and drain for swilling


and multiple connectors for handpieces. Handpieces can be for drills, oral suction, ultrasonic scalars and
polishers. The whole unit is normally a single installation and is the main feature in a dental department offering
cleaning, fillings, dental repairs, extractions and checkups.


The unit must be used under the direction of a trained operator. This is particularly important for
infection prevention. These notes do not contain full guidance for safe use of dental units, they merely focus on
equipment care.


How it works
Within the base unit, a compressor generates air at pressure, a vacuum pump provides suction, and a


water pump provides cooling and mouthwash water. Control is effected by fingertip controls on the handpiece,
foot switch control of air, water and motors, and control panel operation of lights and chair movement.













handpieces


Foot controls


light




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


16


Troubleshooting – Dental Unit


Fault Possible Cause Solution



1.





Unit not operating,
power failure.



No power from mains socket







The unit‟s circuit breaker has
been set off.



Electrical cable fault



Check mains switch is on and plug
inserted. Replace fuse with correct
voltage/current if blown.
Check mains power is present at socket
using equipment known to be working.
Contact electrician for repair if required.

Press reset button if present. Note there
may be separate fuses / breakers for the
different parts of the dental unit
(compressor, pump, chair etc.).

Check power cable is not damaged.
Contact electrician for repair if required.




2.

Light not functioning



System electrical fault

Controls not correctly used


Light bulb broken



Check as above

Check operator manual for control panel
configuration

Replace bulb according to manual with
correct type



3.



Chair not moving



Electrical fault
(electrical systems)

Hydraulic fault
(hydraulic systems)



Check electrical problems as above in
section 1.

Check level of hydraulic fluid in system,
refill if required.
Check pedals operate smoothly, lubricate
and clean if required.




4.

Handpiece jammed or
noisy



Mechanical fault



Refer to specialist technician.



5.



Water or air leakage



O-ring sealing worn



Replace O-ring according to
manufacturer‟s instructions.



6.



No water or air



Valves are closed or not
connected



Check inlets are connected.
Check filters are clean.
Check valves are all open.



7.



Electrical shocks



Wiring fault



Refer to electrician





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


17


User Care Checklist – Dental Unit


Daily


Cleaning




 Remove any dust / dirt with damp cloth and dry off


 Clean all surfaces near patient with disinfectant



Visual checks




 Check for water, oil or air leakage, cleaning and repairing
if required



Function
checks




 Lubricate and sterilise handpieces according to
manufacturer‟s instructions





Weekly

Cleaning




 Remove dirt and dust from compressor with soft, dry
brush or cloth


 Check all filters and clean if necessary



Visual checks




 Check all screws, tubes and parts are tightly fitted


 If mains plug, cable or socket are damaged, replace



Function
checks




 Check light, footswitch and control panel operation


 Check full movement of chair





Every six months
Biomedical Technician check required







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


18


Chapter 4.4 ECG (Electrocardiograph) Machines


Function
ECG machines are used to monitor the electrical activity of the heart and display it on a small screen or


record it on a piece of paper. The recordings are used to diagnose the condition of the heart muscle and its nerve
system.


How it works
The electrical activity is picked up by means of electrodes placed on the skin. The signal is amplified,


processed if necessary and then ECG tracings displayed and printed. Some ECG machines also provide
preliminary interpretation of ECG recordings. There are 12 different types of recording displayed depending
upon the points from where the recordings are taken. Care must be taken to make the electrode sites clean of dirt
before applying electrode jelly. Most problems occur with the patient cables or electrodes.












Thermal Paper


Patient Cable
and Electrodes




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


19


Troubleshooting – ECG Machines


Fault Possible Cause Solution


1.



ECG traces have artefacts or
base line drift



Improper earthing



Check for good connection of reference
electrode

Try with battery power only. If the
recording improves then problem is with
earthing. Check the earthing

Power the machine from another outlet
with proper electrical earth



2.



ECG traces have artefacts in
one or more traces, but not in
all traces



Improper electrode connection
with patient or problem with
the ECG cable



Check the patient cable continuity with
continuity tester. Replace cable if found
faulty

Check the electrodes expiration date

Check patient skin preparation

Reposition electrodes

Check limb electrodes and chest
electrodes for damage, replace if
necessary



3.



Paper feed not advancing



Incorrect paper loading



Use instructions to reload paper



4.



Printing not clear or not
uniform



Printing head problem



Adjust the printing head temperature or
position

Clean the printing head with head
cleaner. If no improvement, replace the
printing head.

Check the paper roller and replace if not
smooth



5.



The machine shuts down after
a few minutes while on
battery power.



Problem with battery or
charging circuit



Recharge the unit overnight

If there is no improvement then replace
the battery (if accessible)

If still no improvement, refer to
technician





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


20


User Care Checklist – ECG Machines


Daily

Cleaning




 Clean off dust with dry cloth


 Wipe gel off reusable electrodes after every use



Visual checks




 Check that battery charge indicator, power indicator and
patient cable connector indicators are working





Function
checks




 Check operation of machine before use using 1mV pulse


 Check the baseline of the ECG recording is steady


 Check the printing is clear and replace dust cover





Weekly

Cleaning




 Clean the printing head, electrodes and connectors



Visual checks




 Check all cables are not bent, knotted or damaged


 Replace any damaged electrical plugs, sockets or cables


 Check all knobs, switches and indicators are tightly fitted



Function
checks




 Check the operation of recordings with 1mV pulse button


 Check battery power can operate the equipment




Every six months
Biomedical Technician check required





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


21


Chapter 4.5 Electronic Diagnostic/Monitoring Equipment


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


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



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


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




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


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










External power supply mounted in cable


Items of electromedical equipment, with
internal power supplies.





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


22


Troubleshooting – Electronic Diagnostic/Monitoring Equipment


Fault Possible Cause Solution


1.





Equipment is not running



No power from mains socket







Electrical cable fault





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

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



2.



Fuse keeps blowing



Power supply or cable fault



Refer to electrician



3.



Equipment not fully operational



Part malfunction



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

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

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



4.



Signals erratic or large



Reference connection loose


Wire broken inside cable (due to
bending or crushing)

Dirt build up on electrodes or
contacts



Check reference connection for
good contact

Replace with spare cable


Clean as instructed in the user
manual



5.



Electrical shocks



Wiring fault



Refer to electrician




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


23


User Care Checklist – Electronic Diagnostic/Monitoring Equipment


Daily

Cleaning




 Wipe dust off exterior


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



Visual checks




 Check all fittings and accessories are mounted correctly


 Check there are no cracks in covers or liquid spillages



Function
checks




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


 Cover equipment after checks


Weekly

Cleaning




 Unplug, clean outside with damp cloth and dry off


 Clean any filters or covers as directed by user manual



Visual checks




 Check all screws and parts are fitted tightly


 Check mains plug screws are tight


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



Function
checks




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


 Check all switches operate correctly




Every six months
Biomedical Technician check required




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


24


Chapter 4.6 Electrosurgical Units (ESU) and Cautery Machines


Function
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to


cut, coagulate, desiccate, or fulgurate tissue. Its benefits include the ability to make precise cuts with limited
blood loss in hospital operating rooms or in outpatient procedures. Cautery, or electrocautery, is the application
of heat to tissue to achieve coagulation. Although both methods are sometimes referred to as „surgical
diathermy‟, this chapter avoids the term as it may be confused with therapeutic diathermy, which generates
lower levels of heat within the body.


How it works
In electrosurgical procedures, the tissue is heated by an alternating electric current being passed through


it from a probe. Electrocautery uses heat conduction from an electrically heated probe, much like a soldering
iron. Electrosurgery is performed using an electrosurgical generator (also referred to as power supply or
waveform generator) and a hand piece including one or several electrodes, sometimes referred to as an „RF
Knife‟, or informally by surgeons as a "Bovie knife" after the inventor. Bipolar electrosurgery has the outward
and return current passing through the handpiece, whereas monopolar electrosurgery returns the current through
a plate normally under the patient. Electrosurgery is commonly used in dermatological, gynecological, cardiac,
plastic, ocular, spine, ENT, orthopedic, urological, neuro- and general surgical procedures as well as certain
dental procedures.









Return plate


Probe




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


25


Troubleshooting – Electrosurgery Units / Cautery Machines


Fault Possible Cause Solution
1.



Equipment is not turning on


No power from mains socket







Electrical cable fault



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

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


2.



Equipment is on but shows
error signal




Footswitch pedal may have been
depressed as unit is turned on or
front panel buttons may be
stuck.

Probe, patient cable or plate
malfunction

Possible internal malfunction


Note error code and turn unit off.
Check footswitch and front panel
buttons. Disconnect all foot pedals.
Turn on unit again.

Check connections and plugs on all
cables are tight

Call biomed technicians.


3.



Equipment is on but output is
absent, weak or intermittent


Power setting is too low

Malfunctioning accessory

Incomplete or incorrect
connection

Possible internal malfunction


Adjust power, check manual

Check connection or replace item

Check correct probe / footswitch cord
are well connected

Call biomedical technician


4. Continuous interference with
monitors


Faulty earth connection



Poor filtering systems in
monitoring equipment


Check all monitors and power
connections. Use separate outlets for
each medical device.

Replace monitoring device


5. Monitor interference occurs
only when electrosurgery is
activated


Metal-to-metal sparking

Cords and cables are bundled,
touching or damaged

High power setting


Continued interference


Check all connections are tight

Remove cable cluttering, replace
damaged cords

Reduce power setting, use blend
mode

Contact biomedical technician


7. Pacemaker or internal cardiac
defibrillator interference


Equipment activation is causing
battery or implant malfunction


Stop procedure immediately, perform
emergency care and call implant
supplier before restarting procedure.


8. Electrical shocks to user


Wiring fault Refer to electrician





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


26


User Care Checklist – Electrosurgery Units / Cautery Machines


Daily


Cleaning




 Remove any dust / dirt and replace equipment cover


 Remove any tape, paper or foreign body from equipment




Visual checks




 Check all fittings and cables are properly connected


 Check there are no signs of spilled liquids or cable damage




Function
checks




 Check foot / probe switch smooth operation.


 Check return plate cable disconnection alarm before use.





Weekly


Cleaning




 Unplug, clean outside with damp cloth and dry off




Visual checks




 Inspect filters, clean or replace if needed.


 Check footswitch is not damaged and is working properly


 If any plug, cable or socket is damaged, replace


Function
checks




 Check proper operation of all controls, indicators and visual
displays on the unit.




 If not recently used, check operation on wet soap





Every six months
Biomedical Technician check required




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


27


Chapter 4.7 Endoscopes


Function
Endoscopy means looking inside the body using an endoscope, an instrument used to examine the


interior of a hollow organ or cavity of the body. Endoscopes are inserted directly into the organ.
An endoscope can consist of a rigid or flexible tube, a light delivery system (light source), an optical


fibre system, a lens system transmitting the image to the viewer, an eyepiece and often an additional channel to
allow entry of medical instruments, fluids or manipulators.


There are many different types of endoscopy, including arthroscopy, bronchoscopy, colonoscopy,
colposcopy, cystoscopy, laparoscopy and laryngoscopy.


How it works
Endoscopes may be rigid or flexible, although most endoscopes in routine use are flexible. Both use


lenses, tubes and light to magnify and view the internal structures of the body. Water and air, as well as surgical
instruments that may be necessary to take a tissue sample, can also be passed along the hollow centre of the
endoscope. The view can be recorded by a camera and displayed on a computer screen.



Rigid endoscopes are usually much shorter than flexible endoscopes. They are often used to look at the


surface of internal organs, and may be inserted through a small cut in the skin or a natural orifice. Gas or fluid is
sometimes used to move the surface tissues of organs in order to see them more clearly. Rigid endoscopes are
commonly used to examine the joints and bladder.









Eyepiece


Flexible tip


Connection to light source


Rigid endoscope
(cut away view)




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


28


Troubleshooting – Endoscopes


Fault Possible Cause Solution


1.





No fluid flow or suction through
scope



Blocked air / water nozzle




Loose or damage setscrew



Press fluid valve and flush
Clean and lubricate valve (see
user manual)
Check tubes are not kinked.

Refer to biomedical technician.



2.



Leakage in flexible endoscope



Tears or cut in flexible shaft



Refer to biomedical technician



3.





Fluid invasion, e.g.


- Image stains
- Foggy images
- Electrical malfunction





Water or other fluids in dry parts
of flexible scope due to holes,
tears or improper cleaning.



Perform leak test after every
procedure

If any fluid invasion occurs, refer
to biomedical technician.



4.



Picture is cloudy or with dark
spots



Build-up of matter on the distal
lens.

Broken fibres in cable



Clean the lens with an alcohol
wipe.

If these significantly affect use,
return to manufacturer



5.





Cannot freely bend to the degree
specified



Over-bending portion of scope.
Fluid invasion



Do not force bending.
Refer to biomedical technician



6.



Instruments do not pass easily
through the biopsy / access
channel



Damaged forceps and brushes



Flush channel through.
Check for burrs and nicks by
rubbing a gloved hand over all
surfaces of the accessory.
Refer to biomedical technician if
problem remains



7.



Light not functioning



Bulb blown

Fuse blown

No power from socket



Replace bulb with correct type

Replace fuse with correct rating

Check power switch is on.
Check mains power is present at
socket using equipment known to
be working. Contact electrician
for rewiring if power not present.



8.



Electrical shocks



Wiring fault



Refer to electrician





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


29


User Care Checklist – Endoscopes


Daily


Cleaning




 Flush, rinse, dry and disinfect endoscope after every use


 Remove any tape, paper or foreign body from equipment




Visual checks




 Check all accessories and fittings are properly connected.


 Check there are no signs of damage to the flexible tube


 Store in correct packaging for protection


Function
checks




 Check operation of controls and tubes before use




Weekly


Cleaning




 Flush, rinse, dry and disinfect endoscope


 Perform leak test as per manufacturer‟s guidelines, making
sure water resistant cap is in place




 Unplug light source, clean with damp cloth and dry off
.




Visual checks




 Inspect optics for cloudiness, foreign bodies or dark spots


 Check sturdiness of trolley if used


 If any plug, cable or socket is damaged, replace


Function
checks




 Check proper operation of all controls, indicators and lamps




Every six months
Biomedical Technician check required





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


30


Chapter 4.8 Incubators (Infant)


Function
An infant incubator is a closed chamber in which a controlled environment is provided to the premature


or critically ill baby. The user can select the appropriate temperature, humidity and oxygen level suitable for the
baby.


How it works
The general principle is that air is processed before it reaches baby. An electric fan draws room air


through a bacterial filter which removes dust and bacteria. The filtered air flows over an electric heating element.
The filtered and heated air then passes over a water tank where it is moistened. It then flows on to the incubator
canopy. The incubator canopy is slightly pressurised. This allows expired carbon dioxide to pass back into the
room via the vent holes and most of the air to be re-circulated. It also prevents unfiltered air entering the system.












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


31


Troubleshooting – Incubators (Infant)


Fault Possible Cause Solution

1.



Incubator is not running



No power from mains socket







Electrical cable fault





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

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



2.



Fuse keeps blowing



Power supply or cable fault



Refer to electrician



3.



Alarms not working



Alarm battery dead



Replace the battery (if accessible)
and recheck. Send for repair if
problem remains.



4.



Temperature not properly controlled



Incubator placed in direct
sunlight or near a draught /
fan.

Air leakage or door open


Temperature probe and
sensor not working


Fan, filter or air duct problem



Move incubator if placed near heat
or draught


Check all seals and doors are tight.

Check the temperature probes and
sensor connections.
Replace the temperature probe and
sensor and recheck.


Call technician if fan not working.
Unblock air duct and clean filter if
obstructed.



5.



Incubator not heating even when the
heater lamp is on.



Heating element problem



If accessible, replace heating
element. Otherwise refer to
technician for repair



6.



Electrical shocks



Wiring fault



Refer to electrician immediately







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


32


User Care Checklist – Incubators (Infant)


Daily


Cleaning




 Wipe dust off exterior


 Remove any tape, paper or foreign body from equipment




Visual checks




 Check all fittings and accessories are mounted correctly




Function
checks




 Drain off the water tray. Run machine for 30 minutes to dry
the tray. Refill tray with sterile water just before re-use.


 Cover equipment after checks


Weekly


Cleaning




 Unplug, clean outside with damp cloth and dry off


 Remove any dirt from wheels


 Wash (or replace) the air filters, dry thoroughly for reuse




Visual checks




 Check mains plug screws are tight


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


 Check doors, cable and tray. Repair if damaged




Function
checks




 Check all controls operate correctly


 Check the readings of thermometer and oxygen sensors
change when breathed upon




 Check any batteries are working properly.




Every six months
Biomedical Technician check required




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


33


Chapter 4.9 Laboratory Equipment


Function
A modern hospital has a huge variety of equipment designed to assist in diagnosis. Samples are


prepared and cleaned using incubators, water baths and centrifuges, while sterilisation might be done with
autoclaves or hot air ovens. Analysis is carried out with photometers and colorimeters in even the simplest of
laboratories, and the microscope and weighing balance are essential for most laboratory services. For more
details on care and maintenance of laboratory equipment, see the WHO publication “Maintenance Manual for
Laboratory Equipment”.


How it works
With only a few exceptions, equipment is powered by electricity. The equipment power supply will run


light sources, amplifiers, meters or heaters according to the design and function. All equipment will be dealing
with human body samples, usually fluids, so good clinical practice and infection prevention are necessary. The
display will be by meter, screen or eye observation, so a clean and comfortable working environment are also
required.











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


34


Troubleshooting – Laboratory Equipment


Fault Possible Cause Solution

1.





Equipment is not running



No power from mains
socket






Electrical cable fault



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

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



2.



Fuse keeps blowing



Power supply or cable fault



Refer to electrician



3.





Equipment not fully
operational



Part malfunction



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

Check all bulbs, heaters, thermostats
and connectors for function, heating
elements for limescale.
Repair or replace if necessary.



4.



Visibility of sample is
poor



Illumination set low


Dust or dirt in system


Mould on eyepiece or
sample window



Increase illumination or check bulb
wattage.

Check screen and surfaces for dirt,
cleaning if necessary.

Clean lens as directed in user manual
using correct cleaning solution.



5.



Fluid leakage



Poor seal


Damaged housing



Tighten where leaking.
Clean or replace seal.

Identify leak and arrange for local
repair.



6.



Noisy operation



Loose parts



Electrical sparks



Check rotors etc. are tight and
equipment is on level surface with
feet adjusted.

Check where burning is visible or
audible and replace / repair.



7.



Electrical shocks



Wiring fault



Refer to electrician




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


35


User Care Checklist – Laboratory Equipment


Daily

Cleaning




 Wipe dust off exterior and cover equipment after checks


 Remove any tape, paper or foreign body from equipment



Visual
checks




 Check all fittings and accessories are mounted correctly


 Check there are no cracks in covers or liquid spillages



Function
checks




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




Weekly

Cleaning




 Unplug, clean outside with damp cloth and dry off


 Clean any filters or lenses as directed by user manual



Visual
checks




 Check all screws and parts are fitted tightly


 Check mains plug screws are tight


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



Function
checks




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


 Check all switches and door / lid locks operate correctly




Every six months
Biomedical Technician check required





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


36


Chapter 4.10 Lamps


Function
There are many kinds of sources of light used in medicine. This chapter deals with large lights for


operating theatres or delivery suites, ultraviolet or infrared phototherapy units, ophthalmic slit lamps, handheld
and head worn lamps for ENT clinics, dental curing lights and domestic torches. However, the principles here
will help in the user care of any kind of light source. Endoscopes are dealt with separately in chapter 4.7.


How it works
Each type of lamp will have a power source with switch and a bulb. Some will also have controls for the


brightness or focus of the light, while others will also have lenses to direct the light where required. Some lights
operate off mains electricity, while others use batteries instead. Some lights have both, using the batteries for
back-up power in case of mains supply failure. Electric bulbs and batteries have limited life and will need
regular checking. Bulbs can last from hundreds of hours operation to thousands of hours. Some equipment, e.g.
UV phototherapy units, will indicate when bulbs need replacing. Turning bulbs on and off frequently can reduce
the bulb life. A stock of spares should be kept of all the correct voltages and wattages (ratings) of parts.



















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


37


Troubleshooting – Lamps




Fault Possible Cause Solution

1.





No light or „power on‟ visible



No power at mains socket







Dead battery

Blown bulb


Battery leakage



Electrical cable fault



Internal wiring fault



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

Charge or replace batteries

Replace bulb with correct voltage
and wattage

Remove batteries (if accessible),
clean battery terminals and
replace with new battery

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

Refer to electrician



2.



Fuse / bulb keeps blowing



Fuse or bulb is wrong rating

Power supply or cable fault



Replace with correct rating

Refer to electrician



3.



Light cannot be made bright
enough



Dirt on lens or tube

Poor power supply


Wrong bulb rating

Control malfunction



Clean area with dry, clean cotton

Check power line or replace
batteries

Check bulb rating is correct

Refer to electrician



4.



Electrical shocks



Wiring fault



Refer to electrician





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


38


User Care Checklist – Lamps


Daily

Cleaning




 Wipe dust off exterior and cover equipment after checks



Visual checks




 Check all fittings and accessories are mounted correctly


 Check there are no cracks in glass / covers or liquid spillages



Function
checks




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





Weekly

Cleaning




 Unplug, clean outside with damp cloth and dry off


 Clean any filters, covers and battery compartment


 Remove dirt from wheels/any moving part



Visual checks




 Check all screws and parts are fitted tightly


 Check mains plug screws are tight


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



Function
checks




 Check all switches operate correctly


 Remove or charge batteries if out of use




Every six months
Biomedical Technician check required




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


39


Chapter 4.11 Nebulizers


Function
A nebulizer is a device used to administer medication in the form of a mist inhaled into the lungs.


Nebulizers are commonly used for treatment of cystic fibrosis, asthma and other respiratory diseases. The reason
for using a nebulizer for medicine to be administered directly to the lungs is that small aerosol droplets can
penetrate into the narrow branches of the lower airways. Large droplets would be absorbed by the mouth cavity,
where the clinical effect would be low.


How it works
The common technical principle for all nebulizers is to use oxygen, compressed air or ultrasonic power


as means to break up medical solutions or suspensions into small aerosol droplets. These are passed for direct
inhalation either through the mouthpiece of the device or a hose set. Gas powered devices use a small pump to
force the gas through the solution and will normally have a filter for the gas inlet. Ultrasonic devices use a small
crystal to generate vibrations in the solution that cause droplets to break off.












Nebulizing chamber


Air inlet




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


40


Troubleshooting – Nebulizers


Fault Possible Cause Solution


1.





Equipment is not working



No power from mains socket







Electrical cable fault



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

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



2.





Machine is working but flow is
absent or low





Filter is blocked

Pipe is twisted or nebulizer
chamber / mouthpiece is blocked.

Worn out pump tubing

Compressor (or air source) is
broken obstructed or leaking



Clean filter

Connect pipe properly, clean
chamber / mouthpiece

Replace tubing

Remove any blocking material or
call biomedical technician to fix
the problem.



3.





Inadequate nebulizing amount



Output adjustment not correctly
set

Mouthpiece cracked

Internal fault





Adjust output as directed in user
manual

Replace mouthpiece

Refer to biomedical technician



4.





Electrical shocks or fuse keeps
blowing



Wiring fault



Refer to electrician







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


41


User Care Checklist – Nebulizers



Daily


Cleaning




 Clean and sterilize mouthpiece and medicine chamber


 Wipe dust from machine and replace cover after checks




Visual checks




 Check all parts are present and tightly fitted


 Check all moving parts move freely, all holes are unblocked




Function
checks




 Check the whole system function before use






Weekly


Cleaning




 Unplug, clean outside with damp cloth and dry off


 Clean filter and air chamber of compressor




Visual checks


 Check chamber, body and tube seals, replace if cracked


 If mains plug, cable or socket are damaged, replace them




Function
checks




 When next used, check for adequate nebulization.


 Check compressor fan is working without excessive noise.





Every six months
Biomedical Technician check required






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


42


Chapter 4.12 Oxygen Concentrators


Function
An oxygen concentrator draws in room air, separates the oxygen from the other gases in the air and


delivers the concentrated oxygen to the patient. When set at a rate of two litres per minute, the gas that is
delivered by the concentrator is more than 90% oxygen. It is used for situations where bottled gas supply is
impractical or expensive, and can be used by patients in the hospital or the home.


How it works


Atmospheric air consists of approximately 80% nitrogen and 20% oxygen. An oxygen concentrator uses
air as a source of oxygen by separating these two components. It utilizes the property of zeolite granules to
selectively absorb nitrogen from compressed air. Atmospheric air is gathered, filtered and raised to a pressure of
20 pounds per square inch (psi) by a compressor. The compressed air is then introduced into one of the canisters
containing zeolite granules where nitrogen is selectively absorbed leaving the residual oxygen available for
patient use. After about 20 seconds the supply of compressed air is automatically diverted to the second canister
where the process is repeated enabling the output of oxygen to continue uninterrupted. While the pressure in the
second canister is at 20 psi the pressure in the first canister is reduced to zero. This allows nitrogen to be released
from the zeolite and returned into the atmosphere. The zeolite is then regenerated and ready for the next cycle.
By alternating the pressure between the two canisters, a constant supply of oxygen is produced and the zeolite is
continually being regenerated. Individual units have an output of up to five litres per minute with an oxygen
concentration of up to 95%.





Humidifier bottle


Flow meter




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


43


Troubleshooting – Oxygen Concentrators


Fault Possible Cause Solution


1.






Unit not operating, power failure
alarm sounds




No power from mains socket







Concentrator circuit breaker has
been set off.

Electrical cable fault




Check mains switch is on and
cable inserted. Replace fuse with
correct voltage / current if blown.
Check mains power is present at
socket using equipment known to
be working. Contact electrician
for repair if required.

Press reset button if present


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



2.



Unit not operating, no power
failure alarm



Alarm battery dead



Replace battery (if accessible)
and test as above



3.





No oxygen flow



Flow not visible



Tubes not connected tightly


Water or matter blocking the
oxygen tubing

Blocked flow meter or humidifier
bottle





Place tube under water and look
for bubbles. If bubbles emerge
steadily, gas is indeed flowing

Check tubing and connectors are
fitted tightly

Remove tubing, flush through and
dry out before replacing

Replace meter / bottle or refer to
biomedical technician



4.



Temperature light or low oxygen
alarm is on



Unit overheated or obstructed



Remove any obstruction caused
by drapes, bedspread, wall, etc.
Clean filters.
Turn unit off and use backup
oxygen system. Restart unit after
30 minutes.

Call biomedical technician if
problem not solved.



5



Electrical shocks



Wiring fault



Refer to electrician





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


44


User Care Checklist – Oxygen Concentrators



Daily

Cleaning




 Remove any dust / dirt with damp cloth and dry off


 Fill humidifier bottle up to marker with clean distilled water



Visual checks




 Check screws, connectors, tubes and parts are tightly fitted



Function
checks




 Check oxygen flow before clinically required





Weekly

Cleaning




 Wash filter in warm water and dry. Replace if damaged


 Clean humidifier bottle thoroughly and dry off


 Remove dirt from wheels/any moving part



Visual checks




 Replace humidifier bottle if covered with limescale.


 If mains plug, cable or socket are damaged, replace



Function
checks




 Run machine for two minutes and check no alarms occur


 Check (see bubbles) that flow rate varies with flow control





Every six months
Biomedical Technician check required






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


45


Chapter 4.13 Oxygen Cylinders and Flowmeters


Function


Medical gases such as oxygen, nitrous oxide etc. are intended for administration to a patient in
anaesthesia, therapy or diagnosis. An oxygen cylinder is a cylindrically shaped metal container used to store
oxygen that has been compressed to a very high pressure. Oxygen cylinders, which come in different sizes, are
usually black coloured with a white top; in some cases, it may be a small cylinder that is entirely black. The
black colour helps to differentiate it from other substances that are stored in similar containers. Cylinders are
fitted with customized valves (either „bullnose‟ or „pin index‟ type) with valve guards, which are opened with
valve keys.



A flowmeter is an instrument used to measure the flow rate of a liquid or a gas. In healthcare facilities,


gas flowmeters are used to deliver oxygen at a controlled rate either directly to patients or through medical
devices. Oxygen flowmeters are used on oxygen tanks and oxygen concentrators to measure the amount of
oxygen reaching the patient or user. Sometimes bottles are fitted to humidify the oxygen by bubbling it through
water.











Flow control
knob


Flowmeter


Pressure gauge


Humidifier bottle




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


46


Troubleshooting – Oxygen Cylinders and Flowmeters




Fault Possible Cause Solution


1.



No oxygen is flowing




Empty cylinder

Flow meter knob or cylinder
valve is closed.

Faulty regulator



Replace cylinder

Open valves, then check flow
meter registers flow

Close all valves and replace
regulator



2.



Leakage from cylinder or
flowmeter



Cylinder is not connected to
pressure regulator properly

Faulty or missing washer between
regulator and cylinder

Flowmeter seal damaged or loose

Cylinder faulty



Tighten all fittings


Replace washer


Tighten flowmeter

Label „Faulty‟ and return to
manufacturer



3.



Leakage cannot be located



Leakage too small to be heard



Apply detergent solution (NOT
oily soap) to joints. Bubbles will
show at leak point. Clean/replace
washer and tighten at that joint.



4.



Flowmeter ball not moving, yet
oxygen is flowing



Faulty flow meter



Close all valves, disconnect
flowmeter and clean inside.
Reconnect and test.

If problem persists, replace
flowmeter



5.



Pressure gauge does not show
pressure, yet oxygen is flowing



Faulty pressure gauge



Refer to biomedical technician for
replacement







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


47


User Care Checklist – Oxygen Cylinders and Flowmeters



Daily

Cleaning




 Ensure delivery tubes and masks are sterile


 If humidifier bottle is used, refill with clean water



Visual checks




 Check cylinder is correct type and marked oxygen


 Check all parts are fitted tightly and correctly



Function
checks




 Before use, ensure cylinder is filled and flow is present


 Close cylinder valve and fasten cylinder safely after each use.





Weekly

Cleaning




 Clean cylinder, valve and flowmeter with damp cloth



Visual checks




 Check for leakage: hissing sound or reduction in pressure


 Check cylinder mount or chain is secure



Function
checks




 Remove valve dust with brief, fast oxygen flow


 Check flow can be varied using flow control






Every six months
Biomedical Technician check required





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


48


Chapter 4.14 Pulse Oximeters


Function
A pulse oximeter is a device that non-invasively monitors the oxygen saturation of a patient's blood. It


measures the amount of oxygen in a patient‟s arterial blood during operations and diagnosis. This level of
oxygen, or „oxygen saturation‟ is often referred to SpO2, measured in %, and this is displayed on the pulse
oximeter. A pulse oximeter also displays pulse rate.




How it works
The coloured substance in blood, haemoglobin, is carrier of oxygen and the absorption of light by


haemoglobin varies with the amount of oxygenation. Two different kinds of light (one visible, one invisible) are
directed through the skin from one side of a probe, and the amount transmitted is measured on the other side.
The machine converts the ratio of transmission of the two kinds of light into a % oxygenation. Pulse oximeter


probes can be mounted on the finger or ear lobe.













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


49


Troubleshooting – Pulse Oximeters


Fault Possible Cause Solution


1.



Equipment is not running



No power from mains socket







Battery (if present) is discharged

Electrical cable fault





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

Recharge or replace battery

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





2.



SpO2 or pulse rate not displayed
or unstable



Probe is not mounted correctly

Probe not able to read through
dirt, nail polish, etc.

Patient movement

Patient‟s SpO2 value is too low to
be measured

Internal malfunction



Connect probe and cable properly

Remove grease, dirt, nail polish
and clean probe

Request patient to remain still

Further clinical examination of
patient. Resite probe if necessary

Call biomedical technician.



3.



“Probe off” displayed on screen





Probe is not connected properly

The connection between the
probe and oximeter is loose



Connect the sensor

Refer to biomedical technician for
repair



4.




“Error” displayed on screen



Faulty probe or control circuit



Refer to biomedical technician



5.




Continuous alarm sounds

Alarm limits set too low or high

Power disconnected

Internal malfunction



Set appropriate alarm limits

Connect power cable

Refer to biomedical technician



6.



Electrical shocks



Wiring fault



Refer to biomedical technician
immediately




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


50


User Care Checklist – Pulse Oximeters


Daily

Cleaning




 Remove any dust / dirt


 Remove any tape, paper or foreign body from equipment


 Clean probe with alcohol wipe after each use



Visual checks




 Check all parts are present and connected


 Check cables are not twisted and remove from service if any
damage is visible





Function
checks




 Check operation on healthy subject before use


 Store probe and cable carefully, replace equipment cover





Weekly

Cleaning




 Unplug, clean outside with damp cloth and dry off



Visual checks




 Check all screws and parts are fitted tightly


 If plug, cable or socket are damaged, replace



Function
checks




 Check operation of all lights, indicators and visual displays


 Check probe disconnection alarm.




Every six months
Biomedical Technician check required




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


51


Chapter 4.15 Refrigerators and Freezers


Function
Both refrigerators and freezers keep medical supplies or blood products cool in order to prolong their


life. Refrigerators can keep the contents between +2oC and +6oC, but are normally set around +4oC. They are
used for laboratory reagents, vaccines and red blood cells. Freezers generally operate below -15oC, and blood
plasma freezers are required to keep contents at -40oC. They need to maintain these temperatures whatever the
outside temperature.


How it works
Refrigeration works by using an energy source to move heat from inside the unit to the outside


environment. The energy source is usually electricity, but kerosene is still used where mains electricity or solar
power is not available. For transport boxes, ice packs (formed in a freezer) keep the contents cool until a
refrigerator or freezer is reached again. A thermostat sets the temperature required, and the energy source is
activated when the inside temperature goes above this point. The electric models will normally need a voltage
stabilizer with cut-out delay, to protect the system.


The contents of the refrigerator or freezer are kept on shelves, in boxes or in baskets to make removal
easy and to allow the cooling air to circulate freely.






Troubleshooting – Refrigerators and Freezers




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


52


Fault Possible Cause Solution



1.





Unit not operating, power
failure. Alarm sounds (if
present).



No power from mains socket






The unit‟s circuit breaker has
been set off.

Electrical cable fault



Check mains switch is on and plug
inserted. Replace fuse with correct
voltage/current if blown.
Check mains power is present at socket
using equipment known to be working.
Contact electrician for repair if required.

Press reset button if present.


Check power cable is not damaged.
Contact electrician for repair if required.



2.



Unit not operating, no power
failure alarm



Alarm battery dead



Replace battery (if accessible) and test
as above.



3.



Compressor runs
continuously

or

Temperature too warm



Door open


Air circulation poor



Ice build up



Thermostat fault



Reduce time door is open.
Check seal and replace if damaged.

Provide good clearance round unit for
compressor cooling.
Ventilate room.

Remove contents to alternate unit.
Defrost unit according to manufacturer
instructions.

Call technician for repair.



4.



Noisy operation



Floor not level or not firm


Tray or shelf vibrating

Internal fault



Move unit to firm, level floor.
Adjust feet to make unit level.

Adjust tray position

Call technician for repair





5. Temperature too cold



Temperature setting has been
changed by accident

Thermostat fault



Check temperature setting


Call technician for repair



6. Electrical shocks



Wiring fault



Refer to electrician




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


53


User Care Checklist – Refrigerators and Freezers


Daily


Cleaning




 Remove any dust / dirt with damp cloth and dry off



Visual checks




 Check lid is tightly closed



Function
checks




 Ensure power light is on when in operation





Weekly

Cleaning




 Clean shelves, drawers, door seal and inside walls with a
damp cloth


 Remove dirt and dust from compressor with soft, dry
brush or cloth



Visual checks




 Check all screws, tubes and parts tightly fitted


 If mains plug, cable or socket are damaged, replace


 Check contents are not too tightly packed


 (Kerosene units) Check fuel level and clean flue



Function
checks




 Ensure any internal lighting and alarms operate





Every six months
Technician check required







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


54


Chapter 4.16 Scales


Function
Measuring patient weight is an important part of monitoring health as well as calculating drug and


radiation doses. It is therefore vital that scales continue to operate accurately. They can be used for all ages of
patient and therefore vary in the range of weights that are measured. They can be arranged for patients to stand
on, or can be set up for weighing wheelchair bound patients. For infants, the patient can be suspended in a sling
below the scale or placed in a weighing cot on top of the scale.


How it works
Mechanical scales have a spring deflected by patient weight. The spring pushes a pointer along a


display or rotates a disc to indicate weight. Electronic scales have a sensor that bends under patient weight and
the circuitry converts this to displayed digits.








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


55


Troubleshooting – Scales




Fault Possible Cause Solution


1.



Zero point cannot be set



Scales are not level


Zero control broken or internal
part jammed



Set scales on level ground and
retest

Send for repair



2.



Movement is stiff or jerky



Dirt lodged inside


Internal blockage



Remove any visible dirt or
foreign body and retest

Send for repair



3.



Reading is inaccurate



Zero not properly set

Calibration error



Reset zero and retest

Recalibrate or send for repair



4.



Electronic display is blank



Battery / power failed


Internal error



Replace battery (if accessible) or
power supply and retest

Send for repair







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


56


User Care Checklist – Scales



Daily

Cleaning




 Wipe off dust and dirt from exterior


 Clear away any dirt or hair on controls and feet



Visual checks




 If bent, cracked or damaged, send for repair



Function
checks




 Check zero at start of day and before each patient


 Replace dust cover after checks






Weekly

Cleaning




 Clean exterior with damp cloth and dry off


 Send for repainting if any exposed or rusted metal



Visual checks




 Check all screws and parts are fitted tightly



Function
checks




 Check reading is accurate using a known weight


 Send for repair if inaccurate or sticking


 Replace battery or charge if display shows low battery




Every six months
Biomedical Technician check required




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


57


Chapter 4.17 Sphygmomanometers (B.P. sets)


Function
Blood pressure is an indicator of several diseases as well as of general health. It is an easy screening test


using simple equipment. A sphygmomanometer can be used to measure the blood pressure at the high point
(systolic) and low point (diastolic) of the cardiac pressure cycle. Pressure is usually measured using a cuff on
the upper arm.


How it works
The cuff on the arm is inflated until blood flow in the artery is blocked. As the cuff pressure is
decreased slowly, the sounds of blood flow starting again can be detected. The cuff pressure at this point marks
the high (systolic) pressure of the cycle. When flow is unobstructed and returns to normal, the sounds of blood
flow disappear. The cuff pressure at this point marks the low (diastolic) pressure.
Pressure can be measured using a meter with dial (aneroid type), a mercury column or an electronic
display. The sounds are normally detected using a stethoscope, but some electronic equipment uses a different,
automatic technique with pressure sensors. The two methods do not always give the same results and the
stethoscope method is generally seen to be more accurate for all types of patient.








Cuff


Cuff


Inflation bulb and
valve


Inflation bulb and
valve




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


58


Troubleshooting – Sphygmomanometers (B.P. sets)




Fault Possible Cause Solution


1.



Mercury leakage
OR
Mercury not at zero level



Mercury leakage or overfilling



Refer to technician for correction



2.



Mercury is dirty



Oxidation of mercury



Refer to technician for cleaning



3.



Pressure does not increase easily
OR
Pressure increases after inflation



Valve or tube blockage



Remove and clean all valves and
tubes. Reassemble and test



4.



Aneroid instrument does not
return to zero



Zero setting has moved



Rotate collar on base until zero
setting achieved and tighten.
If still malfunctioning, refer to
technician



5.



Pressure does not remain steady



Leakage of air



Isolate leak by closing off parts of
tubing.
Replace leaking section and retest





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


59


User Care Checklist – Sphygmomanometers (B.P. sets)


Daily

Cleaning




 If mercury is spilled, seal unit and send to technician



Visual checks




 Ensure all parts are present and are tightly fitted


 Check display is zero when cuff deflated



Function
checks




 Before use, check pressure rises and returns to zero


 Check equipment is safely packed





Weekly

Cleaning




 Remove all dust and dirt with damp cloth or by hand



Visual checks




 Remove or replace any cracked rubber parts



Function
checks




 Check correct operation of inflation bulb and valves


 Remove any batteries if not in use for more than one month


 Inflate to 200 mmHg and check leakage is not faster than
2 mmHg in 10 seconds






Every six months


 Biomedical Technician check required


 Check calibration of aneroid devices against mercury device





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


60


Chapter 4.18 Stethoscopes


Function
A stethoscope is used to listen to sounds within the body. These might be sounds generated by


breathing, coughing, blood flow or the stomach. The sounds are picked up and transmitted to the ears of the
medical staff for diagnosis.


How it works
A membrane on the stethoscope chestpiece picks up the vibrations caused by internal sounds and


transmits them to the stethoscope tube. The sounds pass up the tube through the earpiece to the user. The
stethoscope chestpiece also contains an open bell which is used to pick up lower frequency sounds. The head
picks up the sound from a wide area so it sounds loud to the user. Care must therefore be taken not to hit or
shout into the stethoscope while in use.















Earpieces


Tube connector


Chestpiece




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


61


Troubleshooting – Stethoscopes




Fault Possible Cause Solution


1.



Faint or no sound heard



Leakage or blockage



Remove all parts and check for
leakage and blockage. Water or
blowing air can be used to flush
tubes through.
Assemble and retest



2.



Tube connector does not stay in
chestpiece



Broken locking mechanism



Refer to technician for repair



3.



Parts damaged or faulty



Broken part



Replace with part taken from
other units







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


62


User Care Checklist – Stethoscopes


Daily

Cleaning




 Remove any dirt visible



Visual checks




 Check all parts are present and tightly fitted



Function
checks




 Tap chestpiece gently before use to check operation


 Check equipment is safely packed





Weekly

Cleaning




 Remove all dirt with damp cloth or by hand


 Remove earpieces and clean inside with warm water



Visual checks




 Remove or replace any cracked rubber parts


 Replace membrane if broken



Function
checks




 Check tube connector rotates easily within chestpiece


 Check sound can be heard from both sides of chestpiece




Every six months
Biomedical Technician check required






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


63


Chapter 4.19 Suction Machines (Aspirators)


Function
Suction machines (also known as aspirators) are used to remove unwanted fluid from body cavities.


They are found in operating theatres, delivery suites, ENT and emergency departments. Smaller specialised
suctions are used in dental departments.


How it works
Suction is generated by a pump. This is normally an electrically powered motor, but manually powered


versions are also often found. The pump generates a suction that draws air from a bottle. The reduced pressure
in this bottle then draws the fluid from the patient via a tube. The fluid remains in the bottle until disposal is
possible. A valve prevents fluid from passing into the motor itself. Often a second bottle is used, so that suction
can still occur while a bottle is being cleaned. It also gives another stage of protection from liquid ingress to the
motor.









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


64


Troubleshooting – Suction machines


Fault Possible Cause Solution


1.



Machine is not running



No power from mains socket





Fuse blown




Electrical cable fault



Internal wiring or switch fault



Check power switch is on. Check
mains power is present at socket
using equipment known to be
working. Contact electrician for
rewiring if power not present.

Check for leaks or wire causing
fuse to blow and correct this.
Replace fuse with correct voltage
and current rating. Test operation.

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

Refer to electrician



2.



Poor fluid flow, pressure gauge
low



Tube /seal / bottle leaking or
disconnected



Air outlet valve blocked

Control valve stuck


Internal or control error



Close different tubes by bending.
When pressure gauge changes,
leakage point has been passed.
Replaced damaged tube or seal.

Clean outlet valve

Operate control valve through full
range. Send for repair if stuck

Refer to technician



3.



Poor fluid flow, pressure gauge
high



Blocked filter or tube



Disconnect each tube one at a
time. When gauge changes,
blockage has been passed.
Replace filter or unblock tube.



4.



Filter discoloured



Floating valve broken



Change filter, clean or replace
floating valve



5.



Electrical shocks



Wiring fault



Refer to electrician



6.



Manual suction is jammed



Internal slider stuck



Refer to technician for greasing





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


65


User Care Checklist – Suction Machines


Daily

Cleaning




 Wipe dust off exterior and cover equipment after checks


 Wash bottle and patient tubing with sterilising solution



Visual checks




 Check all fittings and accessories are mounted correctly


 Check filter is clean




Function
checks




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





Weekly

Cleaning




 Unplug, clean outside with damp cloth and dry off


 Wipe round bottle seal with damp cloth, replace if cracked


 Remove dirt from wheels / moving parts



Visual checks




 Check parts are fitted tightly and replace any cracked tubes


 Check mains plug screws are tight


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




Function
checks




 Check all switches and vacuum control operate correctly





Every six months
Biomedical Technician check required





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


66


Chapter 4.20 Tables – (Operating Theatre and Delivery)


Function
Tables are required to hold the patient in a position comfortable both for themselves and for medical


staff during procedures. They can include dedicated supports for head, arms and legs and often have movable
sections to position the patient appropriately. They are made both with wheels and on static platforms and can
have movements powered by electric motors, hydraulics or simply manual effort. They can be found in
emergency departments, operating theatres and delivery suites.


How it works
Where the table has movement, this will be enabled by unlocking a catch or brake to allow positioning.


Wheels have brakes on the rim or axle of the wheel, while locks for moving sections will normally be levers on
the main table frame. Care should be taken that the user knows which lever applies to the movement required, as
injury to the patient or user may otherwise result. The table will be set at the correct height for patient transfer
from a trolley then adjusted for best access for the procedure.


















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


67


Troubleshooting – Operating Theatre and Delivery Tables




Fault Possible Cause Solution


1.



Table cannot be relocated



Wheels jammed

Electric motor not operational
(electrically driven table)



Clean wheels, remove obstruction

Check power to table
Replace fuse if blown
If problem persists, refer to
technician



2.



Table section or body cannot be
moved



Lock or lever is jammed


No power to electric table


No oil in hydraulic table



Clean jammed part, remove rust
and dirt, lightly oil and replace

Check correct switch is used
Check power and fuses

Refill hydraulic oil if needed
Check no leakage occurs



3.



Oil leakage from hydraulic table



Oil leakage



Locate leak and block it.
Clear spillage.
Refer to technician.



4.



Electric shocks



Wiring fault



Refer to technician immediately





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


68


User Care Checklist – Operating Theatre and Delivery Tables


Daily

Cleaning




 Clean, dry and disinfect all parts


 Remove all paper, tape and foreign matter



Visual checks




 Check all parts are present and tightly fitted


 Replace mattress if worn or damaged


 Check no oil is leaking from hydraulics



Function
checks




 Check essential movements before use




Weekly

Cleaning




 Clean and dry table, base and underneath table and base


 Wipe off any escaped oil or grease from joints



Visual checks




 Fully inspect mattress and table for signs of wear


 Replace any worn items and send for repair



Function
checks




 Check wheel brakes function and wheels rotate


 Ensure all moving parts can move, applying grease if needed




Every six months
Technician check required





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


69


Chapter 4.21 Ultrasound Machines


Function
Diagnostic ultrasound machines are used to give images of structures within the body. This chapter does


not deal with other kinds of machine (e.g. therapeutic and lithotripsy). The diagnostic machine probes, which
produce the ultrasound, come in a variety of sizes and styles, each type being produced for a particular special
use. Some require a large trolley for all the parts of the unit, while the smallest come in a small box with only a
audio loudspeaker as output. They may be found in cardiology, maternity, outpatients and radiology
departments and will often have a printer attached for recording images. Unlike X-rays, ultrasound poses no
danger to the human body.


How it works
The ultrasound probe contains a crystal that sends out bursts of high frequency vibrations that pass


through gel and on through the body. Soft tissue and bone reflect echoes back to the probe, while pockets of
liquid pass the ultrasound straight through. The echoes are picked up and arranged into an image displayed on a
screen. The machine offers a number of processing options for the signal and image and also allows the user to
measure physical features displayed on the screen. This requires the machine to incorporate a computer.














Control


panel


Ultrasound
probes




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


70


Troubleshooting – Ultrasound Machines




Fault Possible Cause Solution


1.



Equipment is not running



No power from mains socket







Electrical cable fault





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

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



2.



Fuse keeps blowing



Power supply or cable fault



Refer to electrician



3.



Probe head damaged or noisy



Possible internal fault



Exchange probe
Send for testing and repair



4.



Image quality poor



Gel insufficient

Controls set incorrectly



Mains voltage is too low

Probe / display problem



Use more ultrasound gel

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

Use voltage stabiliser

Refer to biomedical technician



5.



Display / computer error



Software fault



Turn machine off and restart.
If problem persists, refer to
biomedical technician



6.



Electrical shocks



Wiring fault



Refer to electrician





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


71


User Care Checklist – Ultrasound machines


Daily

Cleaning




 Wipe dust off exterior and cover equipment after checks


 Remove any tape, paper or foreign body from equipment


 Wipe probe with alcohol-free tissue or cloth



Visual checks




 Check all fittings and accessories are mounted correctly


 Check cables are not twisted and probe is safely stored



Function
checks




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





Weekly

Cleaning




 Unplug, clean outside / wheels / rear with damp cloth, dry off


 Remove, clean and dry external filter if present



Visual checks




 Check mains plug screws are tight


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



Function
checks




 If machine has not been in use, run and test briefly




Every six months
Biomedical Technician check required





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


72


Chapter 4.22 X-Ray Machines


Function


X-Ray machines are used for imaging bones and hard tissues and diagnosing fractures, joint defects,
choked lungs etc. Sometimes contrast agents are also used to highlight any defects in the abdomen under X-rays.


How it works


X-rays are high energy electromagnetic waves. The transformer produces a high voltage that directs
electrons onto a target in the machine head. X-rays are produced by the target and are directed into beams by a
collimator towards the human body. Soft body tissue absorbs less X-rays, i.e., passes more of the radiation,
whereas bone and other solids prevent most of the X-rays from going through. A photographic film or electronic


sensor displays how much X ray has passed through, forming an image of the interior of the body. Bone appears
nearly white, because few X-rays strike the corresponding part of the film, leaving it largely unexposed; soft
tissue allows much more radiation to pass through, darkening the film in those places.


Users must ensure proper radiation safety protocols and supervision are in place. See Chapter 9 for
suitable references and further information.






collimator


X-Ray tube head


film cassette /
sensor


(control panel and transformer not shown)


patient
table




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


73


Troubleshooting – X-Ray Machines


Fault Possible Cause Solution


1.



X-Ray unit does not switch on.



Mains power not connected



Check the machine is plugged
into the mains socket and that all
switches are on.
Replace fuse with correct voltage
and current if blown.
Check mains power is present at
socket using equipment known to
be working. Contact electrician
for rewiring if power not present.



2.



X-Ray machine not exposing,
even when power is on.



Safety interlock is on

Exposure switch cable problem

Internal error



Check safety locks, all switches

Check for any loose connection

Refer to biomedical technician



3.



Poor X-Ray image quality



X-Ray tube problem



Check X-ray film cassette is
correct type and is undamaged

Refer to biomedical technician /
medical physicist



4.



The table does not move.



Table motor or cable problem.

Safety switch or fuse problem

Control circuit problem



Check all cable connections

Check relevant fuse or switch

Refer to biomedical technician



5.



Electrical shocks



Wiring fault



Refer to biomedical technician
immediately




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


74


User Care Checklist – X-Ray Machines


Daily

Cleaning




 Clean dust from the unit with a dry cloth


 Remove any tape, paper or foreign body from equipment



Visual checks




 Check all parts are present and connected


 Check cables are not twisted and remove from service if any
damage is visible





Function
checks




 Switch on power and check all indicators function




Weekly

Cleaning




 Clean all dust and dirt from the X-Ray machine and room



Visual checks




 If any plug, cable or socket is damaged, refer to biomedical
technician




 Check all knobs, switches and wheels operate properly


 Check lead aprons for any defects


 Check table, cassette holder and grids for smooth movement



Function check




 If machine has not been in use, wear lead apron and check
whether exposure indicator lights on switch operation




 Check collimator bulb, replace with correct type if needed




Every six months
Biomedical Technician check required





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


75


Chapter 5. Handling Waste


In a hospital, many type of waste are generated which may be classified as follows: General waste or scrap,
Sewage waste, Biomedical waste, Chemical waste, Radioactive waste, Electronic or e-Waste.

Most hospitals and countries will have clear guidelines on handling waste, particularly sharps and clinical
waste. Make sure those guidelines are clearly understood and followed in your workplace. The following
summaries may be helpful when training others or explaining to patients and visitors. The checklist on page
77 can be laminated and displayed where waste is generated or disposed.


1. General waste or Scrap
General waste or scrap is mostly bio-degradable or recyclable. Items such as building materials, iron,
material made from wood, etc. may be recycled and even generate a small amount of income for the
hospital. Waste food or cardboard may be kept separate and rotted down to use as compost, although care
must be taken to protect this from scavenging animals.


2. Sewage waste
Sewage waste is drained from toilets, sinks and baths and should be kept separate from hospital sluices. It
will be dealt with using soak-away pits or municipal sewage treatment.

All the other types of waste will need special consideration.


3. Biomedical waste
Biomedical waste is all waste tissue and body fluids, including clinical items contaminated with these.
Hospital management must take steps to segregate, manage and safely dispose of this waste. Equipment
users must be aware of the systems that exist for this and follow local procedures. Sharps (needles, cannulas
etc.) must be disposed of in a secure, separate container that is sealed when full and processed according to
local waste disposal guidelines. This would normally involve a secure, high temperature incinerator.

Most importantly, users must keep biomedical waste separate from other waste. Waste tissue, body
fluid and contaminated clinical items should never be accessible to people or animals.


4. Chemical waste
Chemical waste includes mercury, refrigerants such as CFCs, solvents, batteries and asbestos materials. It is
the responsibility of hospital management to ensure that hazardous chemical waste is not mixed with other
waste and is disposed of safely, not via informal waste collectors. Consult your local waste management
guidelines to see what materials are included in this category. Chemical waste normally requires specialist
companies for safe processing and disposal.

Most importantly for users, chemical waste should be stored separately and safely and never be
burned.




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


76


5. Radioactive waste
Radioactive waste, or equipment still capable of producing radiation, may be found in various items in or
disposed from a radiology or oncology department. Radioactive material can take a very long time to
become safe so should always remain in its protective container.

No user should ever be involved with radioactive waste without the involvement of the relevant
national authority and/or a qualified Medical Physicist. It should be labelled with the sign below.





6. E-waste
Electronic waste, also known as e-Waste or Waste Electrical and Electronic Equipment (WEEE) consists of
any broken or unwanted electrical or electronic appliance, including of course many medical devices. Many
components of such equipment are considered toxic and are not biodegradable, such as printed circuit
boards, wires, plastic material, cathode ray tubes (screens), liquid crystal displays, batteries and glass tubes.



E-Waste is a safety issue. If disposed improperly, it poses a potential threat to human health, groundwater
and the environment. E-Waste accounts for 40% of the lead and 75% of the heavy metals, such as silver and
gold, found in landfills. However, these can be recycled from it. As with chemical waste, e-waste normally
requires specialist companies for safe processing and disposal, and the institution can earn revenue through
this channel.


6.1. How to manage e-waste


Medical equipment and measuring instruments such as BP and multiparameter monitors, pulse oximeters,
analyzers and ultrasounds contain wires, printed circuit boards, displays, heavy metals such as mercury,
batteries, plastic material etc. which do not rot away. After condemnation of this equipment, it is vital to
dispose of them properly. Only use accredited scrap dealers for e-waste disposal, as health hazards will
result from improper disposal or burning. Users must make other colleagues and suppliers aware of the
potential hazards of the waste, as they will have a working knowledge of the contents of the equipment.




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


77


Handling Waste


Do’s

 Keep biomedical and chemical waste separate from other waste



 Segregate e-waste including batteries at a place set aside for the purpose



 Use protective gloves / goggles or boots while dealing with hazardous products



 Call manufacturer / supplier or authorized agency to dispose of your e-waste



 Procure material either having no or reduced toxicity / hazardous content



 Ensure hospital management is aware of waste rules & regulations



 Follow waste rules & regulations






Don’ts

× Do not be involved with radioactive waste without Medical Physics



× Do not throw used / discarded electronic items into the general waste bin



× Do not burn batteries, plastic or wires to dispose of them



× Do not sell your e-waste to informal middlemen or scrap dealers





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Chapter 6. Installation of equipment

Many common problems with medical equipment can be avoided if it is properly installed. The aim of this
chapter is to assist those responsible for receiving and checking equipment when it arrives. If the right
equipment arrives in working order with the right parts and manuals then a long and useful life is more likely.


1. Roles and responsibilities
Each person in the chain of equipment supply has a particular role and responsibility to fulfil. This applies right
from when the need for new equipment is identified to the time when it is used. The following should be used to
remind each of their responsibilities and to check their performance.



Specifier - Make sure the specification is clear and thorough
Purchaser - Select, order and pay correctly, inform receiver of dates and details
Supplier - Check supply against specification, install on time, provide training
Carrier - Inform receiver before delivery, deliver safely and completely
Receiver - Prepare site for installation, check delivery against specification
Local technical staff - Ensure equipment is correctly installed, learn maintenance checks required
Stores - Ensure equipment is complete, report to purchaser, enter into inventory
User - Ensure installed in the right place, check function, get and use user manuals


2. Checklist
When equipment arrives, it will be necessary to record the fact and to check that everything has been supplied
that was ordered. It will also be necessary to check that the equipment is supplied in the right way. The
following list will help to record all details, and on the following page a single sheet of checks can be copied or
printed for each item of equipment to ensure correct installation is carried out.



INVENTORY NUMBER . . . . . . . . . . . . . . . . . . . . . . . . EQUIPMENT LOCATION . . . . . . . . . . . . . . . . . . . .

ACCEPTANCE DATE . . . . . . . . . . . . . . . . . . . . . . . . . . WARRANTY EXPIRY DATE . . . . . . . . . . . . . . . .

MAINTENANCE CONTRACT WITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EQUIPMENT TYPE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NAME OF EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TYPE/MODEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ORDER NUMBER . . . . . . . . . . . . . . . . . . . . . . . SERIAL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE RECEIVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MANUFACTURER . . . . . . . . . . . . . . . . . . . . . . SUPPLIER/AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PHONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





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


79


ACCEPTANCE CHECKS

DELIVERY
Yes / done No / not done Corrected if applicable

a) Representative of supplier present?





b) Correct number of boxes received?





c) After unloading, are boxes intact?





d) If damaged, has this been stated on the delivery
note and senior management informed?





UNPACKING (refer to invoices, shipping documents and original specification)
Yes / done No / not done Corrected if applicable

a) Is the equipment intact and undamaged?





b) Equipment complete as ordered?





c) User/operator manual as ordered?





d) Service/technical manual as ordered?





e) Accessories and consumables as ordered?





f) Spare parts as ordered?





INSTALLATION (refer to manuals)
Yes / done No / not done Corrected if applicable

a) Was installation carried out satisfactorily?





b) Were all parts present and correctly fitted?





c) Were technical staff present as learners?





d) Was the equipment demonstrated as fully working?





e) Were staff trained in operation of the equipment?







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


80


Chapter 7. Disposal of equipment

Healthcare institutions must ensure that there are proper procedures in place for condemnation and disposal of
equipment that is unserviceable or that is no longer required. This will take old and potentially unsafe equipment
out of service, make sure hazardous materials are properly treated and make storage space available. The local
health authorities will have details of the procedures and regulations relating to this subject.
Disposal of equipment allows better planning for replacements, release of storage space, upgrading of
technology and allows surplus equipment to be used elsewhere.


1. Equipment may be declared surplus, obsolete or unserviceable if it is:


 Surplus to Requirement
o Where a surplus piece of equipment remains serviceable, management should be informed. It


may be decided to store the equipment, auction it or use it elsewhere.
 Unserviceable or unreliable


o If equipment cannot be repaired (either no parts available or not economical to repair) or it
cannot be maintained properly it should be scrapped and replaced.


 Obsolete
o When equipment is not usable because parts are out of date or the clinical technique is no longer


recommended it should be scrapped.
 Damaged through negligence or abuse


o Where abuse of equipment is suspected, this should be reported to management and the
equipment taken out of use


 Beyond its prescribed life period
o Such equipment should be reported to management and the condemnation committee. They


should take into account any period of storage in addition to use, examine the condition of the
equipment to see whether the item could be put to further use and if not they will declaring the
item obsolete/surplus or unserviceable as appropriate.


2. The Condemnation Committee
The condemnation committee should have several members including one nominee from Finance department.
Once they have passed equipment for disposal, a report will be prepared. In order to ensure unwanted items of
equipment do not cause unnecessary waste of space, it is important that equipment disposal is done as quickly as
possible but not later than six months after the decision for disposal.


3. User responsibilities in equipment disposal
 Keep management informed of equipment status


o e.g. report when parts are replaced, report when equipment is unreliable
 Be aware of hazards involved when equipment is disposed


o e.g. warn of the presence of mercury, asbestos etc
 Assist in planning for replacements


o e.g. comment on helpful or unhelpful features or suppliers
 Keep the asset register up to date


o e.g. report when equipment arrives new or is replaced
 Request regular maintenance work if it is delayed


o e.g. send reminders to service / maintenance group when work is due
 Inform maintenance department of any issue as soon as possible


o e.g. report promptly any work done or spares required





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


81


Chapter 8. Basics of electrical safety


If it is misused or poorly maintained, electrical equipment can be the cause of injury, death or fire. If it is well
maintained, electrical equipment can save lives, improve the quality of lives and reduce capital expenditure.
Electrical equipment and the electrical connections that supply power to it should always therefore be treated
with respect and care.

Careful consideration should always be given to the placing of equipment. Damp conditions should be avoided
and equipment should be positioned in a dry, clean, well-ventilated area on a solid, level base. Equipment
should be as near as possible to the electrical supply and extension leads should be discouraged.

Since most problems in this area occur with the plugs, sockets and cables supplying electrical power, this chapter
mainly focuses on safe use and maintenance of these.


1. Socket outlets and plugs
 A convenient and safe socket outlet should be available.
 Socket outlets should be at least 2 m from a sink or wash basin.
 The socket outlet should be adequate for the electrical capacity for the equipment.
 There should be proper earthing in the sockets.
 Plugs should match the socket outlets.





2. Wiring of sockets and plugs
The wiring of a plug is colour coded to help guard against electrical accidents. Colour codes normally found are
as follows


 Phase (or Live) – Red or Brown (in the US: Black)
o This carries the electrical drive current from the supplier to the equipment. It is the most


dangerous line. Only qualified staff should work with this.


 Neutral – Black or Blue (in the US: White)
o This returns the current to the supplier. It should not be connected to Earth.


 Earth (or Ground) – Green OR Green with Yellow lines
o This is used for safety and protection. If equipment is housed in a metal case, the earth line will


generally be connected to the case. The earth line in a socket is connected to a pipe or plate
buried in the ground.



Notes on earthing:


 The earthing will depend upon the type of equipment being used:
o If there are only two wires in the power cable, no earth connection is required
o If the cable fitted has three conductors then equipment needs to be earthed properly


 Always make sure that the earth wire is longer than the other two so that if the cable is accidentally
pulled out of the plug, the earth wire is the last wire to become disconnected




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


82


3. Sizes and types of sockets and plugs
The current rating (i.e. the amount and size of equipment they can supply) is measured in Amperes, written „A‟.
The rating and size of normally found plugs and sockets are:


 For low power operations 5 Amperes – small size
 For large power applications 15 Amperes – large size


Mains electricity comes at a specified voltage and is measured in Volts, written „V‟. The voltage may be 220-
240 V or in other countries it may be 110V. It is very important to make sure your equipment matches the local
voltage. Mains electricity is delivered at a specific frequency, measured in Hertz, written „Hz‟. Mains
electricity many countries is at 50 Hz, while in others it is 60 Hz. In general, equipment is not as sensitive to
frequency difference as it is to voltage, but it should not be used with a frequency that is not stated on its ratings.

A guide to the different plugs and sockets throughout the world can be found at www.iec.ch/worldplugs





Type A Type C Type D Type I




The type A American 2-flat pin plug (15A, 125V) is used in the Northern Pacific Islands. The type C European
2-pin plug and electrical outlet (2.5A, 230V), popularly known as the Europlug, likewise does not use earthing.
Type D 3-round pin plug (5A, 250V) is used in India, Nepal, Sri Lanka and Namibia, while type I Australian 2-
flat pin plug (10A, 240V) with an earthing pin is used in the Southern Pacific Islands.
It is very important to use the correct kind of plug and socket together. If they are not properly
combined, not only is there a danger of using the wrong voltage but there may be unsafe sparks and
exposed metal.


4. Mains cables
Electricity is carried to the equipment through the mains cable. Points to be aware of are:




 No bare metal or internal coloured wire should be visible – the plastic insulation is there for safety
 Cable should not be repaired with insulating tape – water can still get inside
 Long flexible leads are dangerous – leads should be as short as possible
 The cable, plug and socket should never be allowed to get wet – water can conduct electricity


5. Fuses
Fuses are used as protection. If the current through them is greater than their specified rating, they blow. This
breaks the circuit and stops the current, making the equipment safe. Points of safety regarding fuses are:


 Always use the correct rating of fuse – voltage V (volts) and current A (amperes)
 Always use the correct size of fuse – keep the old one to check against
 NEVER replace the fuse with bare wire – it will not be safe
 Circuit breakers are fuses that have buttons or switches for reset – they do not normally need replacing





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


83


Troubleshooting – Electrical Safety


Fault Possible Cause Solution


1.



Equipment is not running



No power from mains socket







Electrical cable fault



Internal problem



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

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

Refer to biomedical technician



2.



Fuse or circuit breaker blows a
second time after replacement



Internal equipment fault



Refer to electrician or biomedical
technician





3.



Coloured or metal wire visible in
cable, socket or plug



Insulation damaged



Remove item and refer to
electrician for repair.
DO NOT cover with tape.



4.



Cracks visible in socket or plug



Damaged cover



Remove item and refer to
electrician for repair.
DO NOT cover with tape.



5.



Electrical shocks



Wiring fault



Refer to electrician


Examples of electrical safety issues





Damaged cable grip Cracked casing Damaged cable sheath





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


84


User Care Checklist – Electrical Safety


Weekly Department Checklist

Cleaning




 Clean dust and liquid off with a DRY cloth


 Remove tape, oil and dirt from all cables, plugs and sockets



Visual checks




 Remove any cracked connectors or cables from service


 Check for and report any damaged room wiring or fittings


 Check for and report any signs of burning, melting or sparks


 Untangle all cables and store carefully



Function
checks




 Report any sockets that are loosely fitted or not working


 Check for and report and broken fans or lights





Example of simple Socket Tester to check an electrical socket






Plug the Socket Tester into a live socket and switch the socket on.

Indicator lamps across the front of the unit provide a clear indication
of a correctly wired socket.

Fault indications are quickly identified using the label:


 Line Neutral Reverse
 No Earth
 Neutral Fault
 Live Earth Reverse
 These devices will not detect Earth Neutral Reverse








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


85


Chapter 9. References

BMET/BMEAT training courses


Nick Simons Institute, Kathmandu, 2009

Care and Safe Use of Hospital Equipment


Skeet and Fear, VSO Books, 1995

Franks Hospital Workshop


www.frankshospitalworkshop.com. (Last accessed 15/4/2015)

Helen Day, www.medicalartist.org.uk
(illustrations on pages 9, 12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60, 66, 69, 72)

How to Organise a System of Healthcare Technology Management


Guide 1, „How to Manage‟ series, Ziken International. TALC, St Albans, 2005.
www.ziken.co.uk/our_expertise/how_to_manage_series.html
(source of illustration on page 7)



How to Operate Healthcare Technology Effectively and Safely


Guide 4, „How to Manage‟ series, Ziken International. TALC, St Albans, 2005.

Maintenance and Repair of Laboratory, Diagnostic Imaging and Hospital Equipment


WHO, Geneva, 1994.
(source of illustrations on pages 36, 63)



Maintenance Manual for Laboratory Equipment (2nd Edition)


WHO, Geneva, 2008.

Maintenance of Cold Chain Equipment
Ministry of Health and Family Welfare, New Delhi, 2009

Manual on the management, maintenance and use of blood cold chain equipment
WHO, Geneva 2005

Medical Instrumentation in the Developing World


R Malkin, Engineering World Health, Duke University, 2006

Procedure For Condemnation And Disposal Of Medical And Allied Equipment
Ministry of Health and Family Welfare, New Delhi, 2010

Sterilisation of Medical Supplies by Steam


Huys J. HEART Consultancy, Renkum, 2004.

WHO Manual of Diagnostic Imaging
WHO, Geneva, 2003.

X-ray Equipment Maintenance and Repairs Workbook for Radiographers and Radiological Technologists


WHO, Geneva 2004.

All illustrations are available for reproduction without cost, providing source is acknowledged.




Copyright 2016, Engineering World Health