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AT PRINCE SAUD BIN JALAWY HOSPITAL

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Submitted by
Zaynab Hassan AlHassan
215026468

Supervised by
Dr. Mohammed Al-Yaari

Training duration
8weeks (June 26, 2018 – August 16, 2018)

Submission date
September 2, 2018

ABSTRACT
This report documents the knowledge and experience I have gained through my training program at Prince Saud bin Jalawy Hospital (PSJH) for eight weeks.
It will contain three main chapters as follows:
Chapter 01: Introduction to the Training Organization
This chapter will be an introduction to a training organization and will include information such as mission, vision and values.
Chapter 02: Technical Experience
The second chapter will focus on the experience, which I went through during my internship program, touching on topics such as device names, its function, the type of troubleshoot.
Chapter 03: Conclusion
This final chapter will be a summary of my internship.

ACKNOWLEDGMENT

It is my pleasure to thanks our university (King Faisal University), for giving us as students a wonderful opportunity in providing a training program as part to complete our bachelor degree. This helped us to increase our knowledge about biomedical engineering field in real life.
As a result, I would like to thank our dean Dr. Tawfiq Al-Mughanam and Dr.Nahed Solouma for their superior jobs.
It is my pleasure to thank of Dr. Mohammed Al-Yaari and Eng. Nazik Elsayed for their contribution to finding the traning entity.
it is my pleasure to thanks Eng. Mohammed Al-Makki, ahead of a biomedical department at PSJH, all other engineers, and technicians without exception who share their knowledge and helped me as a trainee in the answering all of my inquiries.

TABLE OF CONTENTS

Abstract …………………………………………………………………………………………………..i
Acknowledgements ………………………………………………………………………………. I
Table of Contents ………………………………………………………………………………….. Ii
List of Tables …………………………………………………………………………………………iii
List of Figure ……………………………………………………………………………………………. v
Chapter 01 – Introduction to Training ………………………………………………………. 1
1.1 Vision…………………………………………………….1
1.2 Mission………………………………………………….1
1.3 Values…………………………………………………….1
Chapter 02 – Training Experience………………………………………………………………
Chapter 03 – Conclusion ……………………………………………………………………………
References ………………………………………………………….
Appendix A – …………………………………………………………….
Appendix B – ………………………………………………

LIST of TABLES
Table No.
Caption Page No.

LIST of FIGURES

Figure No. Caption Page No.

1. INTRODUCTION TO TRAINING ENTITY

Prince Saud bin Jalawy Hospital building in Al-Ahsa is part of the new health projects in the governorate which will contribute to the development and growth of health services in the governorate. These developments will be reflected in the positive results of performance indicators for health services.
1.1 Vision
Achieve the highest level of excellence and quality in the provision of health services for all members of society.
1.2 Mission
Deliver and provide a safe health service with the highest quality for the people of Al-Ahsa province, and provide appropriate conditions to meet the largest possible of their health needs.
1.3 Values
1. Patient safety
For achieving this value there, a huge section at the hospital called central sterilization unit used to sterilizing every equipment after every patient to prevent any type of infection spread at the hospital.
2. Safety and preventing mistakes.
3. Being efficient in our services.
4. Job respect and improvement.
5. High adherence to Islamic and social values.

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2. TRAINING EXPERIENCE
As an intern, my primary goal is to get more information about a medical equipment and working environment at the hospital. On the first day, the engineers told us that the devices at the hospital are divided into under warranty and out of warranty depended on its class. The under warranty devices which is class A&B are under the vendor responsibility and supervised by a BME department. The out of warranty devices which is a class C is directly under BME department responsibilities.

However, the most important part of our job is Planned Preventive Maintenance involves maintenance performed to extend the life of the equipment and prevent its failure. PPM is usually scheduled at specific intervals and includes specific maintenance activities such as lubrication, calibration, cleaning (e.g. filters) or replacing parts that are expected to wear (e.g. bearings) or which have a finite life (e.g. tubing). The procedures and intervals are usually established by the manufacturer. In special cases, the user may change the frequency to accommodate local environmental conditions. Planned Preventive maintenance will be a statutory requirement for most of the medical equipment. It will enhance the efficiency, effectiveness, and reliability of medical equipment.

Our training was in many departments at the hospital, so in this report, I will summarize my information about each of them:

2.1INTENSIVE CARE UNIT (ICU)
ICU is protected department at the hospital have two section one is regular that used to keep patients with a critical situation like Stroke, coma and second section called isolation section used to keep patient with infection.

The most important instrumentation at ICU:

2.1.1 Ventilator (Class A)
It is one of life support devices that help an Unconscious patient to breathe and helps patients with lunges problems to breathe by them own.
There is two type depended on the situation:
1- Fixed ventilator
This type of ventilator includes a breath delivery unit (BDU) that controls ventilation, a graphic user interface (GUI) that monitors and displays ventilator and monitored data, and Backup power source (CPS) that include battery that work for 4 hours after charging and compressor that worked in case of emergency if you don’t have air source from wall (see Figure1.1.1).

Figure 2.1.1.1 fixed ventilator components 1
2- Portable ventilator
It has this same components and mission of fixed ventilator but it has a special advantage which is its size small can take to anywhere it used during transferring ICU patient to the radiology department.

Figure2.1.1.2 potable ventilator
The possible troubleshoots at ventilator:
1- Graphic User Interface (GUI): Break at a screen or at buttons.
2- Breath Delivery Unit (BDU): Oxygen sensor, leakage, block out at a patient circuit.
3- Backup Power Source (BBPS): Expiring of battery life, compressor.
PPM of ventilator
Checking of the ventilator setting by two steps
1-Extended Self-Test (EST)
This test used to check all part and units of ventilator like a battery, compressor, buttons,…….etc.
The biomedical engineer does it.
2-Short Self-Test (SST)
This test used to check the patient circuit if its work to deliver the oxygen to the patient or not.
Both users and engineers can do it.
PPM of ventilator it happens every 6 months.

2.1.2 Continues Renal Replacement Therapy (CRRT) (Class B)
It is a device designed to support the recovery of critically ill patients with acute kidney injury at ICU by using slowly process to prevent injury and pain.
The PRISMAFLEX control unit is designed to deliver continuous renal replacement therapy (CRRT) for a 24-hour period for:
1-Metabolic control 2- Fluid removal
3-Acid/base control 4- Electrolyte balance
Principle of CRRT
Therapy of CRRT is slowly dialysis by 250 ml per minute compare with regular its used for patients with a special condition its depended on a theory of diffusion in hemofilter. It has two gates one from patients carries blood without filtration and the other to patients carries filtered blood inside this hemofilter there is a small type of bristles that used to filter the blood the solution that used to filter the blood it is different depending on patient condition the solution will pass between bristles to filter the blood from wastes and balance the level of minerals between blood and the solution by apply diffusion principle that needed mineral from higher concentration region to lower region.

Figure2.1.2.1 Continues Renal Replacement Therapy components
The possible troubleshoots at CRRT
1- Block out at any pumps
2- Incorrect connection tubes lead to blocking the tubes then no fluid goes to a patient
3- Broken sensor or valves
4- Broken scales because put a heavy weight on it.

2.1.3 Defibrillator (DC Shocks) (Class C)
The defibrillator is considered as a life-saving device. It is designed for emergency situations. It is equipped with features and technologies which enable fast charging and shock delivery to the patient heart. It can be used also as monitors by adding multi parameters connectors such as ECG, SpO2, CO2, Invasive blood pressure (IBP), Non-Invasive blood pressure (NIBP), and temperature.

Figure2.1.3.1 defibrillator
The possible troubleshoot at the defibrillator:
The device cannot deliver shocks because the isolation on paddles it happened because misuse of the device.
Misusing it happen if not clean up the paddle well after use it.
PPM of defibrillator
Checking defibrillator by examines the amount of energy delivered by using a simulator (test equipment). When the reading is same the chosen value this means the device is working well. Instead of that, it needs to be calibrated.
2.1.4 Infusion Pump (Class C)
An infusion pump is a medical device used to deliver fluids into a patient’s body in a controlled manner.

Figure2. 1.4.1 infusion pump
2.1.5 Syringe Pump
(Class C)
A syringe pump is a type of infusion pump fluid is held in the reservoir of a syringe, and a moveable piston controls fluid delivery.

Figure2.1.5.1 syringe pump
2.2 OPERATION ROOM (OR)
Operation room is a special department that needs special Circumstances to keep patient safe from outside area or infection state.
The most important instrumentation at OR:
2.2.1 Anesthesia Gas Machine
The anesthesia gas machine is a medical equipment which delivers different types of gases including anesthetizing and life-sustaining gases that used to induce sleep and prevent pain during surgical procedures.
The basic anesthetic gas machine delivery system consists of a source of oxygen (O2) from wall, an O2 flow- meter, a source of anesthetizing gas (N2O) from wall, a source of a medical area from wall, and a patient breathing circuit (connectors, sensors (oxygen sensor and flow sensor, tubing, and valves such as APL used to limit maximum pressure and exhaust excess gases to scavenging system), and a scavenging system that removes any excess anesthetic gases. This is critical, since room pollution with anesthetic gases may lead to health problems.

Figure2. 2.1.1anesthesia gas machine
The possible troubleshoot at the anesthesia gas machine:
1- Damage at flow sensor or oxygen sensor.
2- Leaking at tubing or patient circuit.
3- Leaking at scavenging system.
4- Damage to APL valves.

PPM of anesthesia gas machine:
Checking anesthesia gas machine by run self- test to check each basic parts of it such as O2 flow-meter, APL valves, source of anesthetizing gas (N2O),…etc.
2.2.2 Monitors (Class B)
It is a medical device used to surveillance patient data during or after surgery by using multi parameters connectors such as ECG, SpO2, Invasive blood pressure (IBP) is a catheter in either the facial artery or the metatarsal artery, Non-Invasive blood pressure (NIBP) is a cuff placed over either the ventral coccygeal artery or the metacarpal artery, and temperature. It also can be used as portable monitors.

Figure2.2.2.1 monitors
The possible troubleshoot of monitors:
The damage can be at cables or SO2 sensor or connection.
2.2.3 Suction Machine (Class C)
It is a medical device designed for aspiration bodily fluids or gases of the patient during or after surgery.
The suction machine contains liquid Jars with overflow valve system, silicone Tubes + Conical Connector, antibacterial & hydrophobic Filter (to prevent the fluid back to motors) and pump.

Figure2.2.3.1 suction machine

The possible troubleshoot of the suction machine:
1- Damage at filter led to damage at motors because of fluid back to motors.
2- Damage to the pump.
4- Leakage in silicon tubes.
2.2.4 Endoscopy
it a medical device used rather than some surgical procedures to take tissue samples from the body and to perform certain endoscopic procedures like bone and tissue preparation and suture management.
Each endoscopy consists of the camera that goes inside the body to do the procedure, microphone, printer, and suction device.

Figure2. 2.4.1 Endoscopy machine
The possible troubleshoot of endoscopy machine:
1- Broken at the button.
2- Focusing on the camera.
3- Suction device.
2.3 RADIOLOGY
Radiology is a department help doctors to discover and diagnose diseases and it consists of many sections like x-ray, CT scans, MRI, and fluoroscopy.
2.3.1 X-Ray
X-Ray is the oldest and most common form of medical imaging used for anatomy images such as bone, chest, and abdomen.
It has an X-ray tube, table, and a detector. Images actually are a shadow difference between many regions. This type includes Digital X-ray, Dental, and Portable X-ray.

Figure2.3.1.1 X-Ray machine
2.3.2 Fluoroscopy
Fluoroscopy is an imaging technique that uses X-rays to get real-time moving images of the interior of an object. It used during Invasive Procedures and Endoscopy.
This type of radiology as X-ray contests of an X-Ray tube, table, and detector but the image is dynamic “real time”. Usually for procedures like endoscopy or some procedures in OR.

Figure2.3.2.1 fluoroscopy machine

2.3.3 Computed Tomography (CT)
It type of X-ray used of computer-processed to produce cross-sectional images of specific areas from different angles of a scanned object, allowing the user to see inside the body without cutting.
It has an X-ray tube and a detector. The X-ray tube in CT is rotated around the patient. It’s the most machine used in the hospital for Cancer, Cardiac, Chest, and Head.

Figure2.3.3.1 CT machine

2.3.4 Magnetic Resonance Imaging (MRI)
MRI is a non-invasive imaging technology that produces three-dimensional detailed anatomical images without the use of damaging radiation used for soft tissue. It has Magnet – Radiofrequency (RF) Coils. To obtain an MRI image, a patient is placed inside a large magnet and must remain very still during the imaging process in order not to blur the image. Contrast agents (often containing the element Gadolinium) may be given to a patient intravenously before or during the MRI to increase the speed at which protons realign with the magnetic field. The best machine for soft tissue contrast. Has a lot of application from head to abdomen- cardiac.

Figure2.3.4.1 MRI machine
The possible troubleshoot of radiology machines:
1- Radiation tube
2- Detector
3- Batteries
2.3.5 Ultrasound
This type of radiology depends on the sound frequency by using the sound to produce live 3-D images of the internal organs. The ultrasound pulse travels through the body and echoes off the internal organs. These ultrasound echoes are then recorded and displayed as a live image. It is used across a wide range of medical specialties including obstetrics, gynecology, cardiology, abdomen.

Figure2.3.5.1 ultrasound machine

The possible troubleshoot of ultrasound machine:
1- Broken mouse
2- Cables
3- Probes
4- Display unit
2.4 LABORATORY (Lab)
The laboratory is one of the most important departments at the hospital for checking on patients and ensures that everything on them in normal level not more or less. It contains many sections such as hematology section for analyzing blood and its contents, histopathology for studying tissue, clinical chemistry for check minerals in the blood and blood bank for keeping blood.

The most important and popular at laboratory:

2.4.1 Centrifuge (Class C)
A centrifuge is a laboratory device that is used for the separation of fluids, gas or liquid, based on density by applies centrifugal force to its contents, typically to separate fluids of different densities used for separate blood contents such as plasma, blood component, serum, and urine. The most important we need to know is about centrifuge is the right size of the centrifuge tube and is the tube must be balanced.

Figure 2.4.1.1 Centrifuge
The possible troubleshoot of the centrifuge
The most troubleshoot it will be on a rotation system.

2.4.2 Microscope (Class B)
A microscope is an instrument used to see objects that are too small to be seen by the naked eye.it used for count blood cell, studying tissues or other things related with cells and blood.

Figure 2.4.2.1 microscope
The possible troubleshoot of the microscope
Always at the light or focusing Knobs

2.4.3 ANALYZER BLOOD GASES (ABG) (Class B)
It is a fully automatic machine to analyze blood gases. Essential Measured parameters are pH, pCO2, pO2, Hematocrit Lactate, glucose, Na, K, Ca. All these parameters should be measured simultaneously. It is almost found everywhere at the hospital. In this machine, there is a specific solution to test every parameter called membrane and sensor called electrode. During any test, the blood mixed with a solution of each parameter to give a result.

Figure 2.4.3.1 ABG machine
The possible troubleshoot of ABG machine:
It can be on
1- Tubes connection.
2- Sensors
3- Membrane
4- Electrodes
5- Solution
2.4.4 Count Blood Cells Machine (CBC) (Class B)
It a medical device used widely in patients to characterize and count the number of different kind of blood cells for disease detection and monitoring. It measures cell morphology and can detect small cell populations to diagnose rare blood conditions.
The three main physical technologies used in it are electrical impedance, flow cytometry, and fluorescent flow cytometry. These are used in combination with chemical reagents that lyse or alter blood cells to extend the measurable parameters.

It contains three basic components:
1- Hydraulics includes mixing chambers, diluters, aperture baths; hemoglobin meter.
2- Pneumatics vacuums; pressure for operating valves
3- Electronics Analyzer; computing circuit

Figure 2.4.4.1 CBC machine
The possible troubleshoot of CBC machine:
Always-on software or valves.
2.5 OUTPATIENT CLINICS (OPD)

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