REPORT OF INTERNSHIP ACTIVITIESatMax Super Speciality Hospital, DehradunPRESENTED TOProf. VIDHYA S (SENSE)Submitted by: Internship started on – June 1, 2016 Muskan Rathi (14BMD0011) Internship ended on – June 28, 2016 Date of submission – October 23, 2016TABLE OF CONTENTSACKNOWLEDGEMENT……………………………………………..…….
.3SCANNED COPY OF CERTIFICATE……..………………………
.…..4INTRODUCTION……………………………………………………5 1.1 OF THE INSTITUTION………………………
..………5 1.2 OF DIFFERENT DEPARTMENTS..
…..7 1.3 OF BIOMEDICAL DEPARTMENT..
1 REPORT ON TRAINING…………………….…………..…….
11 2.2 LIST OF EQUIPMENTS…
…..11 2.3 DETAILS OF EQUIPMENT..
…24REFERENCES…………………………………………..…………….25ACKNOWLEDGEMENTI can’tpossibly thankeveryone whohas contributed to the completion of the internship. Every person who came across me during the internship period has played an important part.
I would like to thank Dr. S.Gunasekaran for writing letter of recommendation and guiding all through the pre internship phase. I would pay my special thanks to my internal guide Prof.
Vidhya S who provided her continuous support throughout the internship phase and to the school office SENSE.Mr. Piyush Chhabra Assistant Manager in Human Resources department of Max Super Speciality Hospital, Dehradun, HOD (Biomedical Department) Mr.Anil , Senior Biomedical Engineer Mr. Mayank Kumar and all other members of the biomedical staff.
They have been with me from the very first day of internship, provided me the opportunity of working in the renowned hospital, and provided me all the resources.Also, I am very much thankful to the whole staff of Max healthcare Dehradun.SCANNED COPY OF CERTIFICATE1. INTRODUCTION1.1 INTRODUCTION OF THE INSTITUTION1.1.1 HistoryMax India Limited was founded in 1985. The Institute is a wholly owned subsidiary company of Max India Limited.
Max India Limited is a Public Limited company listed on the Bombay Stock Exchange and National Stock Exchange of India with more than 37,000 shareholders.The first Max healthcare centre was opened as Max Multi Speciality Centre in Panchsheel Park, New Delhi with OPD facilities and day care surgeries in 2000. Dedicated to mother and child care, Max Hospital, Noida was opened in 2002 with services including non-invasive cardiology, orthopedics, ENT, ophthalmology, nephrology etc. Max Heart and Vascular Institute was established in 2004 with advanced cardiac life support and air evacuation service in Saket. Max Hospital in Patparganj was founded in 2005. In the same year, Max Eye and Dental Care centre was opened at Panchsheel Park, New Delhi. Max Super Specialty Hospital in Saket was founded in 2006 and Max Hospital, Gurgaon was opened in 2007.
In July 2014 the company formed a joint venture with LIFE Healthcare Group, the second largest private hospital operator in South Africa, with the two groups each holding a 46.4% equity stake in the new venture to be known as Max India1.1.2 General InformationWith over 2600 beds and 13 top hospitals in Delhi-NCR, Punjab and Uttarakhand, 2300 world-class doctors, Max Healthcare is one of the leading chain of hospitals in India. With over 500 ICU beds, the most advanced technology and state-of-the-art infrastructure, Max Healthcare is one of the best hospitals in India.
Headquarters: New DelhiCEO: Mr.Rajit MehtaChief information officer: Mr.Sumit PuriFounder: Mr. Analjit SinghManaging director: Rajit MehtaWebsite – www.maxhealthcare.in1.1.3 BranchesMax Super Speciality Hospital, SaketMax Multi Speciality Hospital, Greater NoidaMax Institute of Cancer Care, Lajpat Nagar Max Super Speciality Hospital, Patparganj Max Hospital, PitampuraMax Multi Speciality Hospital, NoidaMax Multi Speciality Centre, Panchsheel ParkMax Hospital, GurgaonMax Super Speciality Hospital, Shalimar Bagh, DelhiMax Super Speciality Hospital, Vaishali, GhaziabadMax Super Speciality Hospital, Mohali, PunjabMax Super Speciality Hospital, Bathinda, PunjabMax Super Specialty Hospital, Dehradun, Uttarakhand1.
1.4 Contact DetailsMr. Piyush Chhabra Assistant Manager – Human ResourcesMax Super Speciality Hospital, DehradunMalsi, Mussoorie Diversion Road, Dehradun – 248001+91-95826239730135-6673879 www.maxhealthcare.
in1.2 INTRODUCTION TO VARIOUS DEPARTMENTS1.2.1 ICUs – Intensive Care UnitsFollowing are the different types of ICUs that are functional in MAX hospital-NICU – Neonatal ICUCTVSICU – Cardiac Thoracic Ventricular System ICUNSICU – Neuro Surgery ICUMICU – Medical ICU Post Operative ICUThe ICUs provide constant, close monitoring and support from specialist equipments and medications in order to ensure normal bodily functions. They are staffed by highly trained doctors and nurses who specialise in caring for critically ill patients.All the ICUs are well equipped with the advanced instruments. Like NICU has Perfusor compact / Syringe Pump of Smiths medical, Cardiac monitor of Goldway, Radiant warmer.
CTVS ICU has monitor of Edvard life sciences – vigilance II, Cardiac monitor of Philips, Ventilators of MAQUET. MICU has nebulisation machine, clear cuff pressure infusor, mattress pump.1.2.
2 RADIOLOGYRadiology is a medical speciality that uses imaging to diagnose and treat diseases seen within the body. Variety of imaging techniques that are available in the hospital are-MRI- Magnetic Resonance ImagingX-rayCT – Computed TomographyFluoroscopyEndoscopyCath lab and nuclear medicine department (Gamma Camera) also uses radiations to detect the diseases.1.2.3 NEPHROLOGY AND UROLOGYThe hospital has a separate dialysis unit where 10 dialysis can be carried out simultaneously.
The dialysis unit is equipped with dialysis machine of Fresenius Medical care and dialyzers that can be reused. For kidney transplantation, there is a team of highly qualified doctors. MAX department of kidney transplant strives to provide the patients with expert treatment and care by merging two dialytic therapies to provide better kidney care. The department takes care of prostatitis, hematuria, over reactive bladder, kidney stones etc.1.2.4 CARDIOLOGYThe cardiology department carries out in – depth investigation of the patient condition taking into account patient’s complete medical history, therefore have a tailored treatment and cost effective plan for each.
There are advance ECG machines to record the electrical activity of heart, Treadmill test, and Holter test is also available 24 hours. The department takes care of arrhythmia, heart attack, cholesterol, diabetes, heart failure, hypertension and all the ailments related to the heart.1.2.5 NEUROSCIENCESEquipped with high-tech neurophysiology laboratory and a team of amazingly insightful and skilled surgeons, doctors and support staff, the institute gives through diagnosis, research, and treatment in all major disciplines of neurosciences/neurosurgery.
The department takes are of brain tumor, stroke, epilepsy, multiple sclerosis, Parkinson disease and all other disorders related to neurons.1.2.6 OTHERSThe other specialities include weight loss surgery, laparoscopic surgery, cancer care surgery and treatment, orthopaedics, aesthetic and reconstructive surgery, bone marrow transplant. Dental care, dermatology, ENT, eye care, gastroenterology, general surgery, IVF, gynaecology, physiotherapy, paediatric, laboratory, blood bank.1.3 INTRODUCTION TO THE BIOMEDICAL DEPARTMENT1.
3.1TYPES OF EQUIPMENTDiagnostic equipment includes medical imaging machines, used to aid in diagnosis. Examples are an ultrasound and MRI machines, PET and CT scanners, and x-ray machines. Treatment equipment includes infusion pumps, medical lasers and LASIK surgical machines. Life support equipment is used to maintain a patient’s bodily function.
This includes medical ventilators, anaesthetic machines, heart-lung machines, ECMO, and dialysis machines. Medical monitors allow medical staff to measure a patient’s medical state. Monitors may measure patient vital signs and other parameters including ECG, EEG, and blood pressure. Medical laboratory equipment automates or helps analyse blood, urine, genes, and dissolved gases in the blood.1.3.2 MAINTAINANCE OF THE RECORD OF EQUIPMENTS AND BREAKDOWNTRACKERThe record of all the medical equipments in the hospital is kept in separate files for each. That includes history sheet which has information about name of equipment, asset code, name of company/supplier, location, frequency of calibration, model, date of installation, serial no.
, warranty expiry date. The file also includes maintainance record that has information about the date of complaint, date when the issue is resolved, breakdown time, fault, action taken.Analysis of the equipment is done on the regular basis and a chit is placed on the equipment displaying the last analysis date and the upcoming analysis date. If a equipment gets damaged than the engineer first checks whether the equipment is under warranty, if it is than the biomedical staff calls the engineer from the company and the enginner comes and repairs the instrument.
If the device is not in the warranty period than only the biomedical enginner appointed by the hospital take over the instument.For any breakdown the biomedical enginner need to prepare a breakdown racker in Excel. This breakdown tracker sheet includes- complain no.
, date on which complain is registered, name of the department that registered complain, name of the equipment, company of the equipment, attended by, asset code, type of complain, complain details, log time, attended time, closure time, corrective action details, part name (if any), cost involvve, whether internal assistance or external assistance is needed, resolution time, down time, service time, resolving date and remarks.1.3.
3 TYPES AND APPROACHES TO MAINTENANCE OF MEDICAL EQUIPMENT There are two types of maintenance: Corrective Maintenance (or Repair) – This is done to take corrective action in the event of a breakdown of the equipment. The equipment is returned repaired and calibrated. Planned (or Scheduled) Preventive Maintenance – This work is done in a planned way before repair is required and the scheduled time for the work circulated well in advance. It involves cleaning, regular function / safety tests and makes sure that any problems are picked up while they are still small. The choice of approach for Preventive and Corrective Maintenance depends on the complexity of equipment Maintenance by in-house trained technicians – The majority of the problems are relatively simple and can be corrected by a trained technician.
Simple repairs and inspections are less costly when done this way. Workshop requirements for in-house medical equipment maintenance are described in references in chapter 11. Vendors should provide training to in-house technicians at the time of installation and commissioning. Maintenance by manufacturer or third party – For specialized and advanced equipment, the vendor should provide maintenance services through a combination of on-call services and a maintenance contract negotiated at the time of the purchase. It will rarely be economical to provide this level of service in-house.
1.3.4 PRECAUTIONS THAT NEED TO BE TAKEN WHILE REPAIRING A EQUIPMENTUnplug the appliance under repair: You must unplug the appliance under repair before you disassemble any electronic device. Turning off the source of ac line voltage is not enough.Work dry: It is dangerous to work with wet hands or clothing. Ensure that you do not work in wet or moist environment. Remember that life has no duplicate.Replace the entire power supply unit with similar type: It is absolutely safer for you if the power supply unit can be totally replaced as in the case of computer system.
Go ahead and replace it with a new power supply unit of similar power rating.Always wear insulator in your hands: It is a good idea to wear rubber gloves while carrying out repairs on electronic devices. Rubber glove is an insulator that will prevent shock.Do not work with any metallic jewellery: Under no reason should you work on electronic device with your metallic jewelleries on your hand. Jewelleries are metallic in nature and hence good conductor of electricity. 2.
TRAINING2.1 REPORT ON TRAININGThe internship training was done for a period of 28 days from July 1, 2016 to July 28, 2016 in MAX healthcare hospital Dehradun, under the guidance of HOD of biomedical department Mr. Anil. The working hours were from 9:30 AM to 5:30 PM.Starting from the working of the Gas manifold plant they showed and explained me the functioning of almost all the equipments available there.2.2 LIST OF EQUIPMENTS STUDIEDSyringe pump – Smiths Medical Graseby TM 2000Monitors – Philips Intellivue (MP20)Ventilator – Maquet Getinge groupHaemodialysis machine – Fresinus Medical Care 4008sAnaesthesia machine – Drager Fabius PlusMRI patient monitor – InvivoPlatelet agitator – HelmerUltrasound machine – Philips HD7Radiant WarmerDefibrilator – PhilipsECG machine – Philips Page writer20Study of Gas Manifold PlantNebulisation machine- Nuneb Pro piston typeBipap A40 – Philips RespironicsMattress pump – Arjohuntleigh Alpha Trancell Deluxe Autoclave and sterilizers2.3 DETAILS OF EQUIPMENTS2.
3.1 ANAESTHESIA MACHINETable 2.1 Troubleshooting Anaesthesia MachinesFAULT POSSIBLE CAUSE SOLUTIONEquipment 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 presentRefer to electrician for repairNo 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 pressureO2 failure alarm not working Alarm battery is low. Alarm device is not working Call biomedical technician to fix the problemMachine 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. Flowmeter fault Over tightening of the needle valve or sticking of the float / ball Refer to biomedical technicianElectrical shocks Wiring fault Refer to electrician immediatelyFig.
1 Anaesthesia machine Table 2.2 User maintenance checklist for Anaesthesia Machines – DailyCleaning Remove any dust / dirt with dry cloth Remove water and waste matter from inside 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 use, depressurize system and replace all caps / covers 2.3.
2 GAS MANIFOLD PLANTLiquid medical oxygen Company – Inox air product limited MAWP 15kg/cm^2License should be taken plus SRV tests need to be done on the regular basis. Two meters are mounted on the tank one is for measuring the amount of oxygen in mmwp or in litre and other is for measuring the oxygen pressure in kg/cm^2. In this the pressure displayed was 10kg/cm^2.The tank is manufactured by Inox india limited vadodra in technical colabration with NIPPON SASO corporation Japan .The following information is displayed on the tank.Equipment name – LIN/LOX cold convertor Model no.
– V-0515Capacity – 5040lTotal weight empty – 1350kgJob no. – 936011Year of manufacturing – 1994Design manufacturing code – ASME SEC VIII DIV 11992Operating fluid – oxygen Maximum working Pressure – 15.0 kg/cm^2Design pressure – 16.5 kg/cm^2Operating temperature – (-) 196?C Air test pressure – 16.5 kgcm^2To pass the gas to the required area from the plant a pressure of 4 kg/cm^2 is required.Liquid medical oxygen tank is the first and the economical option for supplying medical oxygen in the hospital to the patient. In case there is some problem in the tank and is not able to supply oxygen tank. An oxygen control panel is used in this system, the control panel measures the right bank pressure, left bank pressure and line pressure in kg/cm^2.
All 3 meters shows use no oil indication. In case this system also fails oxygen cylinders are used directly called emergency oxygen. This is used for patients requiring supplemental oxygen via mask.
ii. Nitrous oxide – 2 sources Left and right nitrous oxide( N?0) bank. A nitrous oxide control panel is there having 3 meters measuring pressure of nitrous oxide and measures pressure gauge in kg/cm^2. In case the system fails cylinders of nitrous oxide are used, labelled as nitrous oxide emergency. Cylinders of bharat oxygen traders are used in the hospital.
This gas is supplied to surgical suites for its anaesthetic functions during pre operative procedure.iii.carbondioxide supply – 2 sourcesLeft bank, right bank and CO? emergency cylinders are used. CO? control panel is there which has 3 meters for measuring the pressure of CO? in kg/cm^2. ‘Use no oil’ indication is there in two meters.
A pressure of 4 kg/cm^2 is required for supplying the CO? to the required area in the hospital from the gas plant.This gas is used for insufflation during surgery, and also used in laser surgery, also used for certain respiratory disorders. Insufflation is the act of blowing something such as a gas, powder, or vapour into body cavity. Used as a route of administration for various drugs.
iv. vacuum pump and air compressortwo vacuum pumps and two air compressors are used in the gas plant, only one works other is used in case the first one fails. Medical vacuum supports suction equipment and evacuation procedure supplied by vacuum pump system exhausting to the atmosphere. v. air tank and vacuum tankAn air tank and a vacuum tank is there both have meters for measuring the air and vacuum pressure.
Air tank is used for the temporary storage of compressed air, allows the system to perform more efficiently, because of the immense pressure they contain.vi. air dryerAn air dryer is used of trident company (dryspell).vii. air filtersAir filters are also used of trident company (clean sweep).Model is G 100P, element type is G100P, maximum pressure is 16 bar and maximum temperature is 80?C.there is a filter in this and a meter is there which shows the condition of the filter whether it is clean (green), or we need to change it (yellow) or it is dirty (red).
fig.3 Air dryer fig.4 air filtersviii. AGSS pump – Anaesthetic Gas Scavenging SystemIt is used to remove anaesthetic gases directly from the patient connection of anaesthetic machine by means of air mixer, AGS outlet pipeline and AGS exhauster to provide clean and an environment free from anaesthetic gases.Anaesthetic gases- nitrous oxide, xenon ix.PRV Station – Pressure Reducing Valve Station A PRV station is there for supplying medical air which is supplied in most of the part of the hospital wherever required.
The required pressure is 4 bar. Medical air is compressed air supplied by a special air compressor through a air dryer and distributed to patient care areas .Some patients have extremely delicate respiratory system which rely on pure and accurate concentration of medical air ex.
neonates, patients with adult respiratory depression syndrome.This air is manufactured as required using compressor. It is used in driving ventilators and incubators where it provides uncontaminated ad controlled air flow helping to reduce high concentration of oxygen exposure, as a carrier gas for anaesthetic agents. Many patients are sensitive to oxygen toxicity, for such patients medical air is supplied to reduce oxygen exposure. It also supplies surgical air. The required pressure is 7 bar. This air is supplied to operation theatres only, used in driving pneumatic tools in OT.
x. total of 7 pipes are passed on to the hospital building. Pipe colour coding i) oxygen supply ii) nitrous oxide supplyiii) medical air supplyiv) surgical air supplyv) Vacuum vi) Carbondioxide supply vii) This one is connected to the AGSS pump Light yellow fig.5 pipeline in gas manifold plant fig.6 Medical oxygen tank2.3.3 ECG MACHINETable 2.3Troubleshooting ECG MachinesFAULT POSSIBLE CAUSE SOLUTIONECG traces have artifacts or base line drift Improper grounding Try with battery power only.
If the recording improves then problem is with grounding. Check the grounding Power the machine from another outlet with proper electrical ground 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 Check limb electrodes and chest electrodes for damage, replace if necessaryPaper feed not advancing Incorrect paper loading Use instructions to reload paperPrinting 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 smoothThe 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 still no improvement, refer to technicianFig.7 ECG machineUser Maintenance Checklist ECG Machines – Daily Cleaning – Clean off dust with dry cloth and replace dust cover Visual check – Check that battery charge indicator, power indicator and patient cable connector indicators are working Function checks – Check the calibration of machine before use using 1mV pulse Check the baseline of the ECG recording is steady Check the printing is clear 2.
3.4 DEFIBRILATORAED OPERATIONIf rhythm monitoring activeIf needed press pause and begin CPRPress shockIf no shock advised check patientIf shock advisedIf patient is UnresponsiveNot breathingPulse lessConnect pads patient cableApply padsInsert data card (optional)Turn energy select to AED on Press analyseIf shock series is set to greater than oneManual operation preparation Insert data card (optional)Turn energy select knob to MANUAL ONUsing paddlesApply conductive matterApply paddles to patient’s chest, using anterior apex placementUsing padsApply pads as directd by packaging instructionsConnect the pads to the pads patient cable1DEFIBRILLATION SELECT ENERGY Move the energy select knob to the desired level2 CHARGE Press charge or yellow charge button on apex paddle3 SHOCK Press shock. If using external paddles, or switched internal paddles, simultaneously press shock buttons on pad. To disarm press disarmfig.8 pads used in defibrillatorPACING Select manual on Apply pads and electrodesPress pacer -adjust rate – press start fig. 9 Defibrillator – adjust output if needed ECG MONITORINGApply monitoring electrodesSelect lead (optional)Press lead select to choose desired leadSet HR alarm optionalPress HR alarm to set alarm limitsTo disable alarm press HR alarm2.3.5 ULTRASOUND MACHINETable 2.
4 Troubleshooting – Ultrasound MachineFAULT POSSIBLE CAUSE SOLUTIONEquipment 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 requiredFuse keeps blowing Power supply or cable fault Refer to electricianProbe head damaged or noisy Possible internal fault Exchange probe Send for testing and repair 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 technicianDisplay / computer error Software fault Turn machine off and restart. If problem persists, refer to biomedical technician Electrical shocks Wiring fault Refer to electricianUser Maintenance 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 clinicFig. 10 ultrasound machineCONCLUSIONThrough this internship I got the real time idea about how my branch of engineering is applicable in practical world.
I understood for what a biomedical engineer is appointed in a hospital and the importance of a biomedical engineer in the hospital. A biomedical engineer reduces the down time of the equipment and saves money and time of the hospital. In case of emergency if the critical instruments like ventilator and defibrillator breaks down than only the biomedical engineer comes to rescue and helps in saving the patient’s life.The role of a biomedical engineer is very critical in a hospital.
He/ she Install, adjust, maintain, repair, or provide technical support for biomedical equipment. Evaluate the safety and efficiency and effectiveness of biomedical equipment and also prevents damage.REFERENCEShttp://www.maxhealthcare.in/our-specialitieshttps://en.wikipedia.org/wiki/Max_Healthcarehttps://www.google.co.in/?gfe_rd=cr&ei=HaELWLaWMYHy8Afu0Y_ICg&gws_rd=ssl#q=max+healthcare