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DIAGNOSTIC SET
- The diagnostic set combines various mechanical equipment for medical examination of a patient
eye, ear, throat and nose.
- A light is beamed directly to the organ which can be examined via lens and speculum.
- Fibre optic technology make it possible to also examine the internal organs of the stomach.

Diagnostic set usually consists of:

 Ophthalmoscope
 Otoscope
 Laryngoscope
Ophthalmoscope – is used to examine the eyes
Otoscope – used to examine the ears
Laryngoscope – used to examine throat and nose.
- Rheostat is connected in series to regulate the brightness of the bulb by regulating the current
to the bulb.

Power supply with the battery

- Either primary cells – dry type or rechargeable secondary cells usually alkaline cells are used.
- The primary cell convert chemical energy into electrical energy whereby the process is not
reversible.
- The secondary cell is a storage battery. It receives electrical energy and stores it in form of
chemical energy which can be converted again.
- The battery charging unit is connected to a 240v power supply.

Charging unit
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Bulbs
- Commonly two different types of bulbs are used.
- Halogen bulbs and ordinary incandescent bulbs
- Halogen bulbs are mostly preferable.
Common technical features
- The organ to be examined will be illuminated and eventually magnified.
- A common feature of a diagnostic set therefore are:
 Lighting system
 Magnifying glass.
Lighting system
- A bulb of 2.5v or 3v or 3.5v is connected to a power supply which can either be batteries or
transformer unit.

- The organ to be examined should be illuminated for effective observation with additionally fixed
lenses (magnifying glasses) the examined points of the organ can be magnified.

ADDIONAL NOTES:
Laryngoscopes
- Is used to directly view the larynx and adjacent structures. Most commonly this is done for the
purpose of inserting an endotracked tube into the trachea.
- Most of the laryngoscope used today consists of parts:
 Handle
 blade
Handle
- Which is held by hand during use, usually have a rough surface for traction. It conducts or supply
energy for the light source.
- Source of energy most often come from batteries.
- Handles are available in several sizes.
- The connection point between the handle and blade is called the fitting or hinge.
Blade
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- It is part of laryngoscope which is inserted into the mouth.

- Blades are made more than one of different sizes.
- Blade consists of the following parts.
 Base – it engages the hinge pin of the handle and electrical contact.
 Tangue (spetula) – it manipulates the soft tissue or suppress tongue and the
lower jaw so the direct vision to the larynx is achieved. The long axis of the
tongue may be achieved.
 Flange – serves to guide the instrument and deflect interference tissues
 Tip (beak) – it elevates the epigllotis, it is usually thickened to reduce trauma.
 Socket – it accepts light bulb and electrical connections
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Ophthalmoscope
It has got two parts
 The handle which holds the batteries, on/off switch and rheostat that controls
the brightness
 The head which holds the lenses.
Head
- This is the most complicated part of the instrument. It contains many small lenses, light from the
bulb passes through the number of lens systems and mirror before entering patients’ eye.
- Some of this systems have their own adjustments.
Faults
- Corrode batteries – remove the batteries after sometimes to prevent corrosion.
- Faulty on/off switch or rheostat
Check for the bulbs
Test of brightness
Check confirmly on the rheostat
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Otoscope

- For ear examination of the patient, the Otoscope is used. A speculum tip (of different diameters
can be chosen) is pushed into the ear, a bulb is fitted to illuminate the ear drum via the ear
speculum tip with a fixed magnifying glass the organ to be examined can be magnified.
- The Otoscope can also be utilized for examination of the nose, nasal specular with variable sizes
are existing.
- It consists of,
Handle – it is the main part that holds bulbs and lenses.
Maintenance
 Check that specular fits properly and that it is not cracked.
 Check on the bulb
 Check on the lenses
 Check batteries.

See the attachments

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BY CALLEB OGADA - BIOMEDICAL ENGINEER/LECTURER LOITOKTOK CUMPUS

BLOOD PRESSURE MEASURING EQUIPMENT

- Blood pressure measuring equipment is one of the most common instruments used in
healthcare. Doctors, nurses and paramedical staff regularly record blood pressure
measurements. Decision on medical treatment, investigation and in some countries even fitness
for insurance and employment are based on these measurements.
- Blood pressure measuring equipment is used directly on the patient’s body in order to measure
his or her blood pressure.

Basic knowledge on the principles of operation of blood measuring equipment

- In order to understand blood pressure, you first need clear understanding of pressure in
general.

Mass, Weight and Force

 Mass- Is the amount of matter it contains. The unit of mass is kilogram (Kg)
 Weight- Is the force exerted by gravity, weight may change depending on the gravity’s force.
The unit of force is Newton (N)
 Pressure- Pressure on an object is the force acting normally per unit of area.

Note:
 Mercury is used for measuring blood pressure. Is expressed in number of mm, a mercury
column can be lifted. Each mm of mercury lifted is equal to a pressure of 1360pa(0.136N/cm2
or 13.6cm H2O)

Cardio-vascular system
- It is an organ system which transports nutrients, gases and wastes to and from cells of the body.
This system is commonly known as circulatory system.
- It also helps in fighting diseases and to stabilize body temperature and pit to maintain a
favorable internal environment.
- Human have closed circulatory system meaning that the body nerve leaves the network of blood
vessels.
- Cardiovascular system composed of the heart, blood vessels. The blood vessels of the body
function to transport blood around the body, circulatory substances such as oxygen, carbon
dioxide, nutrients, hormones and waste products.
- The blood vessels can mainly be categorized as arteries, veins and capillaries.
- Primary function of the heart is to continually pump blood around the cardiovascular system.
The contraction of the heart is controlled by the sino-atrial (SA) mode.

NOTE: Draw a human cardiovascular system.

BLOOD
NOTE: Read on Blood circulation.
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Heart is like a hollow ball of muscle which can squeeze and release itself. The pumping takes
place in separate pushes (the pulse). Inside the heart there are special valves to make sure blood flows
in one direction.
The heart pumps cycle has two stages:
 Relaxation – filling up (diastole). The muscles of the heart becomes soft and longer. This allows
the ball to become bigger and blood to enter via the inlet blood vessel (main vein) until the
heart is filled with blood.
 Squeezing – pumping up (systole). The muscles of the heart contract (make themselves shorter)
and squeeze the blood out into the outlet blood vessel. Blood flow as heart goes through its
two pumping stages.
 Diastole – the relaxation stroke (filling up) the heart is at rest with its muscles relaxed.
 Systole – the pumping stroke. Muscles of the heart suddenly squeeze themselves (contracts)
and the blood is pushed into the main arteries.

Blood pressure
- When the heart is relaxing and taking in the blood from the veins, the pressure of blood in the
arteries is lower, when the heart is squeezing itself and pushing the blood out, the pressure is
much higher. So the pressure of the blood in the blood vessels (blood pressure) is going up and
down, following the pumping stroke of the heart.
- Under normal conditions the heart will beat about 72 times per minute. But if you have to work
hard, the body will need more oxygen and energy via the blood and so the heart pumps faster
The number of beats per minute is called the pulse rate.

Measuring blood pressure

- Know the pressure of the blood in the vessels will help you to find out whether the person is in
good health or not. Therefore an instrument to measure is needed.
- A special instrument for measuring blood pressure is called blood pressure machine or
sphygmomanometer.

Direct and indirect measuring of blood pressure

- In fact there are ways to measure blood pressure where pressure sensing device is put directly
into the blood stream. This method is called invasive blood pressure measurement.
- In measuring blood pressure where the measurent is carried out or from outside the body, not
from the blood stream. It requires no surgery and is not painful at all. Listening to sound is very
important in this case. This method is called invasive blood pressure measurants (indirect)

Location of measuring blood pressure – indirect method

- Two places are used to measure blood pressure using indirect method
 the artery in the upper arm (left or Right)
 the artery in the thigh (left or right)
Most of the measurements is done using the artery of the upper arm.

Process of measuring Blood pressure by-listening.

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1) An inflatable cuff – it is wrapped around the patient arm (upper arm)

2) Pressure gauge – manometer – to measure the pressure in the cuff.
3) Pumping bulb – which pumps air into the cuff.
4) Stethoscope is used to listen to the sounds in the arm.

Remarks: when an automated, electric Bp apparatus is used, usually no pumping bulb or stethoscope is
needed.

Unit of pressure used for indicating Blood pressure.

- The maximum (systolic) pressure in a normal health persons vessels is between 140 and 190cm
water column. This means it can push a column of water up to between 140 and 190cm.
- If water was used for measuring blood pressure, the B.p apparatus would have to be very large
(up to two meters high) which is obviously in practical for general use in the hospital.
- A fluid with much higher density is used: mercury which is 13.6 times heavier than water.
- Blood pressure is expressed in millimeters (mm) of mercury or mmhg (Hg is the chemical for
mercury)

How the upper and lower pressure are determined.

When measuring blood pressure both the upper (systolic) pressure as well as the lower
(diastolic) pressure in the artery of the upper arm are recorded. This is how they are
determined.
 The cuff is fastened around the patient’s upper arm.
 With pumping bulb, the pressure is increased in the cuff to a value above the highest
pressure in the artery of the upper arm so the blood vessels are squeezed. No blood can
flow through and no sound can be heard.
 By slightly opening the pumping bulbs release bulb is gradually reduced. When the
pressure in the cuff reaches the highest pressure in the artery of the arm (systole
pressure) some blood will be pressed through the artery under the cuff, this is when you
can hear the first tapping sounds of the rhythm of the heartbeat, this pressure is
recorded.
 Listen carefully as the pressure continues to be reduced.
 At some point the pressure in the cuff will become the same as the lowest pressure in
the artery (diastolic pressure). This happens when the blood vessels is no longer
squeezed blood can now passfuely and the sound disappear. The measurement taken at
this time is also recorded.

Normal blood pressure

Blood pressure is measured in millimeters of mercury written as mmHg. Blood pressure has two
components:
 Systolic or upper level
 Diastolic or lower level
- Upper level is produced by the contraction of the heart while lower level is produced by cardiac
relaxation.
- The upper and lower levels are written as 110/60 mmHg.
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- Normal blood pressure is said to range from about 150/90 mmHg.

Factors that influence blood pressure.

- Age - Exercise
- Alcohol - Pain
- Race - Illness
- Smoking - Emotion
- Temperature - Obesity.

Differentiate between:
Invasive (direct) and non-invasive (indirect) blood pressure measurement.

Invasive
- It shows the actual variation of the blood pressure in the bronchial artery. It requires that the
skin be cut and the pressure sensor is actually inserted in the place of the measurement.
- It is often required for the ill and injured patient who needs consistent monitoring, so that the
changes in their conditions can be rapidly accessed and easily action taken.
- It requires cannula needle to be inserted in the artery.
Advantages
- It can monitor the pressure of the patient constantly.
- Wave-form of pressure against time can be mounted.
This method is employed in the ICU during anesthesia.
Dis-advantages
- Complicated
- Require surgery.

Non-invasive method (indirect)

- It is use of stethoscope and sphygmomanometer. This method is also known as auscultatory
method – as it involves listening to the particular sound while the measurement is being done.
- It is quicker and simpler than invasive method.
- It involves less expertise
- Has no complications
- It is hardly unpleasant and painful to the patient.
- It fields a lower accuracy.

Stethoscope
- It is a caustic medical device for listening to the internal sound of human body. It is often used to
listen to the heart sounds and blood flows in the arteries.
- A mechanical stethoscope operates in the principle of transmission of sounds from the chest
piece by means of air filled hollow tubes to the listener ears.
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- Chest piece generally consists of two sides that can be placed against the patient body for
sensing sound. One side has a diaphragm or a plastic disc and the other has a bell or a hollow
cup.
- If diaphragm is placed on a patient body the sound vibrates the diaphragm creating a caustic
pressure waves which travel up tubing to the listener ear.
- This method is referred to as auscultator method.
- In case the stethoscope is not available the systole pressure can be measured by feeling the
pulse. This is called palpation method, however this method cannot be used for measuring
diastolic pressure.

Types of B.p machines

There are three (3) types of B.p machines namely:
 Digital (electronic) B.p
 Mercury type B.p
 Aneroid type B.p
It sometimes summarized as 3 manometers (pressure gauges)
 Mercury type
 Bellow type
 Electronic type
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Electronic type B.p

- Nowadays many automatic oscillometric blood pressure measuring devices are available in the
market.
- They don’t require manual listening to korotcoff sounds.
- This type of B.p has got in built automatic pump for inflating the cuff and release the pressure
through the release valve. This is also done automatically.
- Systolic and diastolic pressure is displayed along with pulse rate.
- The readings are flushed on the digital display.
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- Electronic B.p has pressure sensor (transducer) and does not depend upon the kind of sound
sensor to detect korotcoff.
- Its principles is that when the blood flows a partially blocked, it simultaneously produces small
pulsations occurs marked the systolic pressure. Similarly when the pulsations stops marks the
diastolic pressure.
- The frequency of the pressure pulses is the pulse rate.
- After inflation and deflection is complete, the micro-process or based circuit is able to compute
and display the systolic/diastolic pressure along with the pulse rate.

There are various methods or models of electronic B.p based on different principles.
Measuring methods
- Auscultatory – by listening
- Oscillometric – variations of pressure
- Ultrasound – sound above hearing pitch.

Other techniques are:

i) Phase shift
ii) Oscillographic detection
iii) Tonometry
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Major parts of electronic B.p machine

 Electric air pump – to inflate the cuff
 Electric controlled pressure release valve – once the cuff is inflated the valve opens,
electronically controlled
 Electric pressure sensing and display – converts the analog signals to digital value
 Timer – particularly in ICU when the pressure is measured regularly.

Mercury and Aneroid B.p

They have common number of parts
i) An inflatable compressing bladder enclosed within an inextensible cuff which can be closed
around the arm to compress the brachial artery.
ii) Measuring scale to indicate the applied pressure.
iii) An inflation bulb which allows air to be blown into the flatable bladder
iv) A control valve which can be adjustable to deflate the bladder at any desired rate.

The cuff:
 This is elastic cloth that encircles the arm and encloses an inflatable rubber bladder. It
is secured around the arm by wrapping its tapping ends into the encircling cuff, by
Velcro-surface or by hook.

Bladder:
- The dimension of the bladder enclosed in the cuff should depend on the size of the limb in
which pressure is being measured, selecting the best dimensions for the inflatable rubber
bladder is important.
- The best width for the bladder is generally agreed to be 12 to 14cm.

Mercury B.p machine

It works on a simple hydrostatic principle. Consists of a U-tube filled with mercury.
- When the tube is verified with both ends open to the atmospheric pressure, the mercury will be
at the same level on each side – the level is the zero reference point of the instrument.
- If the pressure is now applied to one limb of the U-tube the mercury will be pushed down on
one side and up on the opposite side until the applied pressure is counter balanced by the
weight of the mercury it displaces. This is the point of hydrostatic equilibrium.
- The unknown pressure which is being measured is equal to the difference in the levels of
mercury in the two legs of the u-tube. The difference can be measured by placing a scale beside
the u-tube.
- Mercury reservoir should be made of steel with cross-sectional area which can be accurately be
determined.
- It should have a trap at the upper end. It should not allow mercury to leak, it must not interfere
with free flow of air into and out of the reservoir.
The tube (scale)
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- Should preferably glass, although plastic is often used.

- The core of the tube must be 5mm or more
- It should be possible to remove the tube from the sphygmomanometer for cleaning
- The glass tube must be calibrated with the reservoir being used. As the core varies in difference.

Procedure of blood pressure measurement using analogue B.p machine.

1. Remove all clothing from the person’s arm.
2. Fasten the cuff around the bare upper arm. Usually the rubber tubes are facing down wards and
just pass the area of the site or the artery.
3. Feel the pulse of the artery (palpate) on the inner side of the person’s elbow (brachial artery)
put the chest piece of the stethoscope in this location.
4. Choose the valve
5. Pump up the pressure until the pressure reaches 200mmHg, the blood will stop flowing through
the arm.
6. Very slow release the pressure in the cuff by loosening the screw on the rubber bulb.
7. With stethoscope listen carefully from the pulse as you continue letting the air out of the cuff.
Take the first reading the moment you begin to hear soft thumbing of the pulse (systolic)
Take the second reading when the second sound of pulse begins to fade or disappear (diastolic)
8. Release the rest of air and remove the cuff from the person’s arm.

INDIRECT METHODS OF BLOOD PRESSURE MEASUREMENTS-NON INVASIVE

- The classification method of making indirect measurement of blood pressure is by use of a cuff
over the limb containing an artery.
- This technique was introduced by Riva-Rocci for the determination of systolic and diastolic
pressures.
- Initially the pressure in the cuff is raised to a level well above the systolic pressure so that the
flow of blood is completely terminated. The cuff pressure is then released at a particular rate,
when it reaches level which is below systolic pressures, a brief flow occurs. If the cuff pressure is
allowed to occur further, fast below the diastolic pressure value, the flow becomes normal and
un-interrupted.
- This method give korotcoff and based on the sound produced by the flow changes is the one
used in the sphygmomanometer.
- The sound first appear when the cuff pressure falls fast below the systolic and persists as the
cuff pressure falls, the sound disappear or change in character when the cuff pressure falls
below the diastolic pressure, when the flow is no longer interrupted.
- The sound is picked up by using microphone placed over an artery distal to the cuff.
- The sphygmomanometric technique is an auscultory method, it depends upon an operator
recognizing the occurrence and disappearance of korotkoff sounds with variations in cuff
pressure.
- A number of automated blood pressure measuring instruments have been designed which make
use of Riva-Rocci method. They differ in the method of detecting the pulses, the operation is
similar to human operation only that for automatic is done by the equipment self ie electric
pumping, automatic cuff pressure release.
Automatic blood pressure measuring – digital B.P machine
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- This method consists of putting a cuff around the upper arm of the patient, and apply the
microphone over the branchial artery. The compressed air required for inflating the cuff is
provided by a pumping system incorporated in the apparatus. The inflating is done to preset
pressure level, well beyond the systolic value at the rate of 30mmHg/s.
- The pressure in the cuff is then decreased at a relatively slow pace at the rate of 3-5mmHg/s
- Korotkoff sounds are picked up by special Piezo-electric microphone.
- The corresponding electrical signals are fed to the pre-amplifier. The amplifier signals ara then
fed on to the band pass filter.
- Appearance of korotcoff sounds switches in the systolic manometer and locks the reading on
the indicating meter.
- In similar way the diastolic value is fixed by the last Korotkoff sound then the cuff is completely
deflected automatically.

Disadvantages arising from this method – indirect

- Measurements is not continuous, not stored for future reference.
- Errors due to pressure applied to the exterior vessel wall is not necessary identical to the cuff.
- Automatic built in pump must be provided with safety devices so that the patient does not
experience any discomfort in case of failure.
Methods of automatic blood pressure measurements – digital B.P machine
Rheograpgic method
- Here the change in impedance between two points under the occluding cuff forms the basis of
detection of the diastolic pressure.
- Three electrodes attached to the cuff are placed in contact with the slun.

Differential auscultatory technique

- A special cuff mounted sensor consisting of a pair of pressure sensitive elements isolate the
signal created each time artery is forced to open.

Oscillometric measurement method

- It has advantage over the auscultatory method. Since sound is not used to measure the blood
pressure in the oscillometric technique. This technique does not require microphone or
transducer in the cuff.
- The oscillometric technique operates on the principle that as an occluding cuff deflates from a
level above systolic pressure, the artery walls begin to vibrate or oscillate as the blood flows
turbulently through the partially occluded artery and these vibrations will be sensed in the
transducer systems monitoring cuff pressure.
- The Piezo-electric transducer is connected to the cuff, it picks pressure fluctuations caused by
the arterial wall movements.

Ultra dropper shift method

- Automatic blood pressure monitors have been designed based on ultrasonic detection of
arterial wall motion. The control logic incorporated in the instrument analyzes the wall motion
signals to detect the systolic and diastolic pressures and displays the corresponding values.
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Direct methods of blood pressure measurements.

- It is used in the highest degree of absolute accuracy, dynamic response and continuous
monitoring is required.
- It is also referred to as invasive blood pressure measurements.
- It is used to measure the pressure in deep regious in accessible by the direct means.
- A catheter or a needle type probe is inserted through a vein or artery to the area of interest.

Types of probes used

- Catheter tip probese with the sensor mounted on tip.
The pressure exerted on it are converted to the electrical signals proportional to it.
- Out-filled catheter type
It transmits the pressure exerted on its fluid –filled column to an external transducer
then transducer converts it to electrical signals.
The electrical signals can be amplified and displayed or recorded.

NOTE:
Measurements by direct or invasive methods gives the following results
 Systolic
 Diastolic
 Mean pressure
 Visualization of pulse contour
 Stroke volume
 Duration of systolic
 Ejection time
- It is also convenient to draw the blood samples to determine the cardiac output, blood
gas.
- In the fluid-filled system, before it is inserted - the catheter into the blood vessel. It is
important that fluid filled system should be thoroughly flushed. This is done by passing
a steady flowing normal saline through the catheter to prevent blood from clotting. This
ensures that there is no air bubbles in the systems – air bubbles deepens the frequency
response.
- The figure attached shows a setup of fluid filled system.

Simplified circuit diagram used for processing the electrical signals receive from the
pressure transducer for measurement of arterial pressure.
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Special considerations for the design of the pressure transducers.

- Physiological transducers are usually linked directly to the patient’s heart hence they must
ensure complete safety of the patient. It is of this reason that the construction of the
transducer ensure complete safety of the patient. Hence should provide the following
i) Complete patient safe isolation
ii) Should be able to withstand high voltages arising from the
defibricalators or electro cuttery cause they are usually used in the
intensive care units.
iii) Need to be sterilized after every use – used chemical sterilization
method.
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See the attachments

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REVISION QUESTIONS

1.Differentiate between direct[invasive] and indirect [noninvasive]

2.Name 3 types of BP machines, with aid of sketch draw the a above and name parts

3.Name the parts of digital BP that are not in other types

4.Draw name parts of stethoscope. Design a simple electronic stethoscope.

5.Briefly explain how to use mercury type of BP Machine

6, With the aid of a sketch explain two anemometers used in BP machines

7,Name 3 methods used in automatic BP Measurements

8.NAME types of probes used in direct methods

9,STAte the results gotten in indirect measurements

Refference book;TECHNICIAN HANDBOOK FOR MEDICAL ENGINEERING,BIOMEDICAL

INSTRUMENTATION BY RS KHANDPUR