Medical/Healthcare
Going Under - Anesthesia Equipment
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Over the years, anesthesia equipment has evolved from simple pneumatic devices to sophisticated computer-based systems, but the basic objective remains the same: to safely put someone to sleep and wake them up again.
“There have been changes in how we service machines and in how they are manufactured, but the basics are still there,” says Gail Larkin, CE, who manages the service and maintenance for the University of Connecticut Health Center, Farmington, Conn. “There are still flowmeters to regulate how much anesthetic agent is going to the patient, and there still has to be a ventilator on the side plus a bag to manually ventilate the patient.”
A World of Difference: Biomeds Abroad
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Overseas, certification/education standards vary as do job duties and the role of associations.
Biomeds in the United States follow a pathway of education, training, and work experience, plus involvement in associations that support the industry. But what are career paths like for biomeds around the globe, who may be coping not only with medical technology systems at varying levels of development, but also with less-structured educational and training options? And what should American biomeds expect if they elect to work abroad, as some do for organizations like the Michigan-based non-governmental organization (NGO) International Aid (IA)?
Rewriting NFPA 99
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For more than two decades, the National Fire Protection Agency’s (NFPA) Standard for Health Care Facilities—NFPA 99—has defined the guidelines for repair, maintenance, and safety compliance inspections of electrical and electronic appliances that generate high-frequency currents. Biomeds turn to the document on a regular basis, viewing it as an invaluable guide to minimizing the hazards of fire, explosion, and electricity in health care facilities. Some states have even adopted the document’s recommended standards as regulations in the field.
Maintaining Defibrillators
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Electrical defibrillation is the single most important therapy for the treatment of patients in cardiac arrest. Most victims of sudden cardiac death initially suffer from ventricular fibrillation, which can lead to a complete absence of electrical and mechanical heart activity within 15 minutes. Cardiopulmonary resuscitation (CPR) may keep blood and oxygen circulating through the body, but only defibrillation can reestablish normal contraction rhythms.
Original defibrillator technology used a monophasic damped sine waveform, which delivered energy through the heart in one direction. Newer technology uses biphasic damped sine waveforms, which send the electrical current through the heart in one direction and then reverse polarity to travel in the opposite direction.
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The escalating number of computerized medical devices in use today presents new challenges for hospitals and health care systems. No longer are infusion pumps, ventilators, and bedside monitoring systems stand-alone devices that clinical engineers (CEs) and biomedical medical equipment technicians (BMETs) can easily maintain and troubleshoot.
Now, such equipment is integrated with information technology (IT), allowing vital signs data to be collected directly from electrocardiogram monitors and distributed to a patient’s electronic medical record (EMR), or data sets for medication dosages, which can be uploaded directly into infusion pumps. All of which is aimed at reducing the possibility of error.
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Although the demand for the certification exam for BMETs stays high, perceived lack of interest in the clinical engineering exam led AAMI to discontinue providing it. Convinced that the CE exam is important, ACCE has stepped in to fill the gap.
Standard practices. Higher salaries. Increased safety. These are just a few of the benefits of certification, which is mandatory for many health care professions. But the role of certification for biomedical equipment technicians (BMETs) and clinical engineers (CEs) is somewhat less clear.
Whither Certification
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As digital x-ray equipment gains popularity, biomeds must upgrade their skills.
Servicing and maintaining x-ray equipment has long been a fundamental component of the work of biomedical technicians. For the most part, such equipment has consisted of large, immovable, durable, analog-based pieces. Advances in technology, though, mean that smaller, digital-based x-ray equipment is steadily gaining ground in the marketplace; and that means biomeds must upgrade their skills to better manage it.
Dave Ogren is a unique member of the biomed community and a moving force in establishing new California Medical Instrumentation Association chapters. He relates his saga in a special feature.
After spending 3 decades in the biomedical equipment industry, Dave Ogren was happy to retire early. At age 57, he stayed in Reno and took up his favorite hobbies—fly-fishing and golf—on a full-time basis. He even became a master fly-fishing guide and traveled around the world to enjoy his chosen sports. What Ogren did not plan for, however, was growing restless with his now-ample leisure time.
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On the Road Again
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Are universal ventilators the next big thing in respiratory care? We look at the pros and cons and discover that sometimes the old technology may be the best.
It is said that there is nothing new under the sun. It is also said that everything old is new again. Both adages are apropos when talking about ventilators—especially from a biomedical technician’s viewpoint. Although newer universal ventilators may be in place at some facilities (see sidebar), in many locations the challenges facing biomedical technicians still involve streamlining maintenance of their traditional complement of equipment.
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What is the best method to establish a framework for selecting appropriate equipment safety levels? An expert explains the benefits of three strategies to reduce risk.
Setting the standards for risk management has been a job left to biomedical engineers for at least a decade, but questions persist in the industry over how best to establish a framework for selecting appropriate equipment-safety levels. The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) previously required an inventory of all medical equipment and maintenance at least twice yearly, but that changed in 1989.
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With the promise of benefits, such as improved productivity, better patient outcomes, and decreased cost of care, wireless technology is rapidly transforming the face of health care. It is not unusual to see today’s clinicians accessing electronic medical records through any phone in the hospital, or using handheld personal digital assistants to enter and receive data at a patient’s bedside.
Manufacturers likewise are working as quickly as possible to make their devices comply with the Institute of Electrical and Electronics Engineers Inc’s wireless standards, and information technology (IT) companies are fine-tuning methods of creating ubiquitous coverage, despite the inherent obstacles in hospital design.
Orthodontic Products
Giving patients responsibility and rewards for their dental hygiene improves compliance.It’s likely that every orthodontist has had at least one case where a treatment plan was progressing perfectly—until an unmotivated patient’s lack of hygiene got in the way.
Poor compliance with a hygiene program can be one of the most frustrating aspects of patient care; and it can add a tremendous amount of unnecessary time and cost to the treatment plan, or even derail the efforts of the orthodontist altogether.
Decisions in Axis Imaging
The radiology community has increasingly been confronted with a surge in the volume of images, making a shift in image interpretation and management inevitable. Indeed, the Society for Computer Applications in Radiology (SCAR) even developed a new initiative titled TRIP", Transforming the Radiological Interpretation technology.
In his presentation "Data Explosion I: Current Solutions for a Busy Clinical Practice," Geoffrey D. Rubin, MD, section chief in cardiovascular imaging at Stanford University Medical Center in Palo Alto, Calif, pointed out the basic premise behind 3D visualization.
Decisions in Axis Imaging
Radiologists have spent the past decade eagerly monitoring the use of MRI for breast cancer screening and diagnosis. In recent years in particular, clinical studies are bearing out the potential of this modality to help diagnose breast cancer earlier and among high-risk women.
In 2002, the Journal of Clinical Oncology reported that MRI demonstrates high sensitivity for breast cancer.1 The next year, the American Cancer Society released updated guidelines for breast cancer screening indicating that breast MRI, when used with mammography, may enhance the effectiveness of screening and diagnosis.2 In 2004, The New England Journal of Medicine published strong evidence to suggest that breast MRI studies are effective in finding tumors in women at high risk for breast cancer.3
Decisions in Axis Imaging
Colonoscopies, fecal occult blood tests, sigmoidoscopies, and barium enemas are known for their use as screening tools for the early detection of colorectal cancer,1 yet many people still find these procedures over age 50 get screened for colon polyps. A 1995 survey even found that people who had never had a colonoscopy would rather give up 3 months of life than undergo the test.2
In the face of such obvious patient aversion, virtual colonoscopya more comfortable yet still effective screening examination performed using a multidetector CT (MDCT) scanis emerging as an alternative that may open the door to a much higher patient participation rate.
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Suggested revisions to JCAHO equipment management standards seek to allow flexibility while ensuring reliable performance.
When the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released fairly extensive revisions to its medical equipment management standards last year, the clinical engineering and biomedical community understandably looked to the commission’s new accreditation process, “Shared Visions—New Pathways,” for guidance. After studying and attempting to apply the new standards, six professionals in the field decided to form a study group with the intention of developing recommendations that would help the Joint Commission and health care organizations improve the application of standards using the knowledge and experience accumulated by the clinical engineering community.
