Module 4

Instruments for clinical laboratory

1. Oximeters

2. pH meter

3. Blood cell counter

4. Flame photometer

5. spectrophotometer

Module 3 2
 1. Oximeters Kandpur 2nd edn, Page no.312

• Used to determine the percentage of oxygen saturation in

arterial blood.
• Measurement is mainly used in the diagnosis of cardio
respiratory functions.
• The oxygen is mainly carried by RBCs in the blood.

X 100 %

Where HbO2 : Conc. Of oxygenated hemoglobin

Hb : Conc. Of deoxygenated hemoglobin

Module 3 3
• The main application areas of oximetry are the
diagnosis of cardiac and vascular anomalies.

• Also, a major concern during anaesthesia is the

prevention of tissue hypoxia, necessitating
immediate and direct information about the level of
tissue oxygenation.

Module 3 4
Module 3 5
Module 3 6
 Two types:
a) In vitro oximetry:
The blood is taken out and oxygen content is
measured using some equipment

b) In Vivo Oximetry
The measurement is done without taking blood out. `

Module 3 7
In Vivo Oximetry

• Oxygen saturation is found without taking the blood out.

• Transmission and reflection methods can be used.
• Eg: Finger tip oximeter. Hemoreflector oximeter

Finger tip oximeter

Module 3 8
 Kandpur 2nd edn, Page no.421
2. pH Meters

• Measure the acidity or basicity of blood.

• pH is the measure of potential of Hydrogen ion

• Expressed in logarithm scale with base 10

• Equation for finding pH using the pH meter is given by;

OR

• Where
Vm is the potential measured by the meter,
C is a constant. Module 3 9
Vr

Vin
Vout

Vt

Module 3 10
Module 3 11
• For measuring pH, the solution is taken in a beaker.
• Two electrodes are immersed in the solution
• One act as reference and the other measures the pH.
• The voltage developed across the electrodes is applied to
an amplifier circuit.
• pH meter usually include a circuit for temperature sensing.
• This is for avoiding errors due to variation in temperature.
• The pH measuring electrode has a glass bulb at the tip.
• Which is a special type of glass membrane which senses
the pH.

Module 3 12
 3. Blood Cell Counter
Khandpur 2nd edn. Page 444
• Blood contains RBC, WBC and platelets.

• Erythrocytes (Red Blood Cells):

RBC contains hemoglobin and carries oxygen and carbon
dioxide.
The erythrocytes have no nucleus

If RBC count increases, it causes Polycythemia

If RBC count decreases, it causes Anemia

Normal hemoglobin value: 130-170 g/l (men)

120-160 g/l (women)

Module 3 13
Module 3 14
Module 3 15
 4. Spectrophotometer
Khandpur 2nd edn. Page 387,388, 390

• The study of the frequencies of the photons which are

absorbed would thus provide information about the nature
of the material.

• Also, the number of photons absorbed may provide

information about the number of atoms or molecules of the
material present in a particular state.

• It thus provides us with a method to have a qualitative and

quantitative analysis of a substance.

• This technique is used to find different components of

biological substances in a solution.
Module 3 17
• The light from the halogen lamp is allowed to fall on a
monochromator which isolate different wavelengths in to
different angles.

• The needed wavelength from the dispersed light is selected by

a movable aperture.

• The light beam is directed to the sample and a photodetector

gives an electrical output corresponding to the intensity of the
transmitted light.

• The amplifier amplifies the output from the detector and

finally indicator indicates the concentration of the substance.
 5. Flame Photometer

• A flame photometer is used to analyse urine or blood in order

to determine the concentration of potassium (K), sodium
(Na), calcium (Ca) and lithium (Li).

• When a metal salt solution is burned, the metal provides a

colored flame and each metal ion gives a different colored
flame.

• Flame tests, therefore, can be used to test for the absence or

presence of a metal ion.
Module 3 20
Module 3 21
Module 3 22
Module 3 23
 Biomedical Telemetry system

• Biotelemetry is the measurement of biological

parameters over distance, and transmitting the data
from point of generation to the point of reception.

• The most widespread use of biotelemetry for

bioelectric potentials is in the transmission of ECG.
Biomedical Telemetry system
 Examples of ECG telemetry

• Transmission of ECGs from an ambulance or site of

emergency to a hospital.
• For exercise ECGs in the hospitals so that the patient can
run up and down steps, without any wires.

• The individuals with heart problems can wear ECG

telemetry units always and relay ECG data periodically to
the hospital for checking.
• Monitoring of athletes running a race for improving their
performance
• The figure shows the block diagram of a single channel
telemetry system suitable for transmission of ECG.
• There are two main parts - telemetry transmitter and
telemetry receiver.
 Requirements for a distortion-free transmission of
ECG

1. The subject should be able to carry the instruments,

without discomfort.

2. Motion artifacts and muscle potential interference

should be minimum.

3. Long battery life.

4. ECG telemetry systems operate in the 450 – 470MHz

band.
Therapeutic Equipments
a. Pacemakers
b. Cardiac Defibrillators
 I. Pacemakers: Khandpur 2nd edn : Page 687

Need of Cardiac Pacemaker:

• The rhythmic beating of the heart is due to the triggering
pulses that originate from the SA node.
• if this natural pacemaker ceases to function or becomes
unreliable or if the triggering pulse does not reach the heart
muscle because of blocking by the damaged tissues, the
natural and normal synchronization of the heart action gets
disturbed.
• When monitored, this manifests itself through a decrease in
the heart rate and changes in the ECG waveform.

• By giving external electrical stimulation impulses (Fig. 25.1) to

the heart muscle, it is possible to regulate the heart rate.
• These impulses are given by an electronic instrument called a
‘pacemaker’.
• A pacemaker basically consists of two parts:
1. Electronic unit which generates stimulating impulses of controlled
rate and amplitude, known as pulse generator
2. The lead which carries the electrical pulses from the pulse generator
to the heart. The lead includes the termination which connects to the
pulse generator and the insulated conductors, which interface with
electrodes and terminate within the heart.
• The waveforms used for pacing are round-topped rectangular pulses of 1–3
ms duration with rates adjustable from 50-150 pulses per minute.
• The electrode arrangements can be in two way
1. Bipolar system: two electrodes are placed on the heart
for myocardial stimulation
2. Unipolar system: one electrode is placed on the heart
and the other electrode is positioned elsewhere in the
body.

• The active electrode is connected to the negative

terminal of the pacemaker so as to resemble the
normal depolarization of the heart which occurs with
intrinsic negative stimulation.
Types of Pacemakers
• The classification of pacemakers is based on the mode
of application of the stimulating pulses to the heart.
• External pacemakers are used when the heart block
presents as an emergency and when it is expected to
be present for a short time.
• Internal pacemakers are used in cases requiring
long-term pacing because of permanent damage that
prevents normal self triggering of the heart. In it the
pacemaker itself may be implanted in the body.
• The patient is able to move about freely and is not tied
to any external apparatus.
1. External pacemakers:
• They are employed to restart the normal rhythm of the
heart in cases of cardiac standstill, in situations where
short-term pacing is considered adequate
• Frequently, external pacemakers are used for patients
recovering from cardiac surgery to correct temporary
conduction disturbances resulting from the surgery.
• As the patient recovers, normal conduction returns and
the use of pacemakers is discontinued.
• The pacing impulse is applied through metal electrodes
placed on the surface of the body.
• Electrode jelly is used for better contact and to avoid
burning of the skin underneath.
• An external pacemaker may apply up to 80-mA pulses
through 50-cm , 2 electrode on the chest.
• This procedure is painful and therefore is used only in
an emergency or a temporary situation.
• Pacing with external pacemakers through the chest
requires a maximum of 150 V pulses across an impedance
of the order 1 kW.

• External pacing has following disadvantages

– The electrodes eventually tend to burn the skin and
the electrical pulses become painful.
– Each impulse causes an uncomfortable contraction of
the thoracic muscles around the area of the
electrodes.
2. Internal pacemakers/ implantable pacemaker

• The stimulating pulses can be preferably applied to a heart

through a pacing catheter passing through a vein and connected
to the heart. This is called internal pacing.

• The pacing current required is much less than when it is applied

through the chest.

• The voltage output of internal pacemakers is about 0–15 V and

the available output current ranges from 1–20 mA.

• For long-term pacing by this method, the electrodes can be

inserted percutaneously into the myocardium of the left
ventricle.
• implantable pacemaker, along with its electrodes, is
designed to be entirely implanted beneath the skin.
• Its output leads are connected directly to the heart
muscle
• The pacemaker is a miniaturized pulse generator and is
powered by small batteries.
• The circuit is so designed that the batteries supply
sufficient power for a long period.
• Since the pacemaker is located just beneath the skin,
the replacement of the pacemaker unit involving
relatively minor surgery has become a routine
procedure.
 • There are three types of pacemakers based on the type of
output waveform
a) Voltage Pacemakers:
– Voltage pacemakers are those in which the current in the circuit is
determined by the available voltage during the entire duration of
the impulse.
– The voltage output from the pacemaker remains constant and
changes of resistance in the circuit will influence only the current.
b) Current Pacemaker:
– In current pacemakers, throughout the impulse, the current in the
circuit is determined by the internal resistance of the pacemaker.
c) Current Limited Voltage Pacemakers:
– This is primarily a voltage circuit, but the maximum current in the
circuit is limited, preventing too large a current impulse to circulate
when there is a low resistance in the electrode circuit.
– With these pacemakers, during the first part of the impulse, the
current in the circuit is determined by the internal resistance of the
pacemaker (constant current type) but during the second part of the
impulse, the current in the circuit is determined by the voltage
available (constant voltage version).
 Types of implantable pacemaker
Fixed Rate Pacemaker:
• This type of pacemaker is intended for patients having
permanent heart blocks.

• The rate is pre-set, say at 70 bpm.

• The rate can be varied externally in implanted units by

magnetically actuating a built-in relay.

• Since the fixed rate pacemaker functions regardless of

the patients’ natural heart rhythm, it poses a potential
danger because of competition between the patients’
rhythm and that of the pacemaker.
Demand Pacemaker :
• These pacemakers have gradually almost replaced
the fixed rate pacemakers because they avoid
competition between the heart’s natural rhythm and
the pacemaker rhythm.

• The demand unit functions only when the R-R

intervals of the natural rhythm exceed a pre-set limit.
R wave Triggered Pacemaker:
• The ventricular synchronized demand type (R wave
triggered) pacemaker is meant for patients who are
generally in heart block with occasional sinus rhythm.
• The pacemaker detects ventricular activity (R wave of
ECG) and stimulates the ventricles after a very short delay
time of some milliseconds.
• If there is sinus rhythm, the stimulating impulse will occur
in the ventricular de-polarization.
• If there is a systole, the unit will stimulate the heart after
a pre-set time.
Atrial Triggered Pacemaker:
• This is a R wave triggered or atrial triggered
pacemaker.

• The pacemaker detects the atrial de-polarization and

starts the pulse forming circuits after a delay so that
the impulse to the ventricles is delivered after a
suitable PR interval.

• The major advantage of this pacemaker is its ability to

provide maximum augmentation of cardiac output at
changing atrial rates to meet various physiological
requirements.
 II. Cardiac Defibrillators
Khandpur 2nd edn : Page 714
Fibrillation:
• Ventricular fibrillation is a serious cardiac emergency resulting from
asynchronous contraction of the heart muscles.
• This uncoordinated movement of the ventricle walls of the heart
may result from coronary occlusion, from electric shock or from
abnormalities of body chemistry.
• Because of this irregular contraction of the muscle fibres, the
ventricles simply quiver rather than pumping the blood effectively.
• This results in a steep fall of cardiac output and can prove fatal if
adequate steps are not taken promptly.
 Cardiac Defibrillators
Fibrillation:

• Fabrillation is the rapid, irregular, and asynchronize contraction of

heart muscle fibers.
• During fibrillation, the heart muscle fibers are continuously
stimulated by adjacent cells so that there is no synchronization in
the heart beat.
• This may lead in arrhythmia (Irregular heart beat) and later in a
systole (Flat line).

• To prevent this condition, we use defibrillators.

• Defibrillators usually give a high electric shock to the heart to

re-establish a more regular cardiac rhythm.
• Using defibrillator, a high voltage electric shock is given to
heart muscles.

• This sudden shock will cause all heart muscle fibres to contract
simultaneously.

• Electric shock is given mainly by using direct electrodes placed

on the heart, or trans-thoracically, using large area electrodes
placed across the chest

Types. a. A.C. defibrillator

1. Internal defibrillator b. D.C. defibrillator
2. External defibrillator c. Synchronized defibrillator
d. Square wave defibrillator
1. Internal Defibrillator

• It is used directly on the heart walls by opening the chest

• In the DC defibrillator, a shock of about 50V to 1000V will be
applied.
• The direct contact resistance of the heart is about 50 Ω, so the
current passing through the heart will be 1 to 20 Ampere.
• This electric shock is applied for a very short duration of about
2.5 to 5 milliseconds.
• Different types if electrodes can be used.

Spoon shaped electrode Paddle shaped electrode

2. External Defibrillator

• Paddle shaped electrodes are used.

• Required voltage is in the range of 1000V to 6000V
• Electrode gels are placed on the electrode to reduce the
contact resistance
• The resistance is about 100 Ω
Anterior- Anterior placement Anterior Posterior placement
AC Defibrillator

• It can be used for providing voltage for both internal and

external defibrillation.
• Consist of a Step-up transformer with various taping on the
secondary.
• A timer circuit will be connected to the primary for
controlling the duration of electric shock.
• Disadv: Causes occasional burning of skin.
May cause atrium fibrillation
DC Defibrillator
• Consist of a auto transformer connected to the primary of a step up
transformer.
• Rectifier is used to convert the signal to DC.
• At position 1 of switch, the capacitor will get charged using this
current.
• For providing the shock, manually the switch is moved to position 2
and the capacitor discharges rapidly through the body.
• The inductor is used to reduce the speed of discharging of
capacitor.

• The success of defibrillation depends on the energy stored in

the capacitor.

• Typical energy requirement: External: 400 joules

Internal : 100 joules
 Implantable Defibrillator
• The use of automatic implantable defibrillators (AID) is
recommended for patients who are at high risk for ventricular
fibrillation.
• The AID was commercially introduced by Cardiac Pacemakers (CPI),
USA in 1985
• An implantable defibrillator is continuously monitors a patient’s
heart rhythm.
• If the device detects fibrillation, the capacitors with in the device are
charged up to 750 V.
• The capacitors are then discharged into the heart which mostly
represents a resistive load of 50 W and to bring the heart into
normal rhythm.
 Implantable Defibrillator
• This may require delivery of more than one high energy pulse.
• most devices limit the number of high energy shocks to 4 or 5
during any single arrhythmic episode.
• The shock duration for efficient defibrillation is approximately
4-8 ms which results in the delivery of approximately 30 –35 J at
750 volts.
• Biphasic waveforms are more efficient and probably safer than
monophasic waveforms and produce successful defibrillation at
lower energies.
a) Heart-lung machine
b) Surgical diathermy equipment
c) ventilators
d) Dialyzers
 a) Heart Lung Machine
Ref: Dr. M Shanmugam-Biomedical
Instrumentation (Pg:5.35-5.43)
• Machine to support the cardio-vascular system in heart surgery.
• During open heart surgery, it is necessary to have blood less field
under direct vision.
• So the heart functioning will be temporarily stopped and all the
blood vessels will be connected to the ‘Heart Lung machine’.
Symbolic Representation of Heart lung Machine.
Block Diagram of Heart Lung Machine
• The lungs and Heart are replaced by Oxygenator and Blood
pumps respectively.
• The collected venous blood is directed into a receiving reservoir.
• Then the blood is passed to settling reservoir/ de-bubbling
reservoir and then to Oxygenator.

• Oxygenator will increase the oxygen saturation in the blood and

will be given to Arterial heat exchanger.

• The arterial pump is used to provide required pressure to the

blood.
• Arterial heat exchanger is used when low temperature
operations are required.
• This lowering of temperature is for reducing body metabolism
and thereby reducing the oxygen consumption and to increase
the operation time.
• This will also help to prevent brain damage.
• In the heat exchanger, the blood is maintained at the body
temperature of about 37oC.
• This blood is given to major artery through a filter.
• This filter will prevent possibility of particles or bubbles in the
blood.
• In addition, for providing blood to coronary arteries and heart
itself, separate blood supply is used.
Oxygenator:

• Oxygenator is the artificial lung in the Heart lung machine.

• Used for maintaining oxygen saturation in the blood.
• Mixture of Oxygen and 2-5% CO2 is mixed with blood.
• Oxygenator will oxygenate around 5litres/min of blood.

• Types:
a. Bubble Oxygenator
b. Film oxygenator
c. Membrane oxygenator
d. Liquid-Liquid oxygenator
 Bubble Oxygenator:

• Oxygenation is done by bubbling the oxygen through a large column

of blood.
• After mixing, the extra air bubbles will be removed using a filter.
 Blood Pumps:

• Used to pump blood at required pressure and volume to

different regions of the machine.
• It typically pumps 6litres/min of blood.
• The pumping action should not cause any damage to the cellular
components of the blood.

• Types:
a. Pulsatile pump
b. Non Pulsatile pump
 b) Diathermy Khandpur 2nd edn : Page 728

• It is a treatment process in which, cutting, coagulation, healing of

tissue damage, muscle pain relief are possible.

• The term Diathermy means ‘ through heating ’.

• The treatment is done by heating the tissues by passing high
frequency current.

• The high frequency current can heat up tissues which are at 2

inches from the skin surface

• The diathermy machine does not apply heat directly, instead the
heat is developed within the tissue itself.
Uses of diathermy

a. Destruction of tissue/Fulguration: By passing electric sparks,

heat will be developed and lead to destruction of unwanted skin
surface cells.
b. Desiccation/ Healing of wounds: Electric current passed at a
particular frequency can be used for drying the tissues.
c. Electrotomy: Division of tissues by high frequency current
applied locally with an electrode. This can be used for cutting the
tissues.
d. Coagulation: by keeping electrode near the skin and passing high
frequency current in the form of bursts causes coagulation of
tissues.
e. Hemostasis: Continuous cutting of tissues and its coagulation
using the RF current.
f. Blending: Welding or joining of tissues can be done using the
high frequency current.
Waveform shapes and pattern for different
applications of diathermy
General Block diagram of a Surgical Diathermy unit
• Logic board generates the required High frequency signal.

• It contains a Astable multivibrator along with some binary

counters.

• Astable MV generates 500kHz square wave.

• The counters are used for dividing the frequencies.

• Eg: Continuous supply of 250kHz current is used for cutting the

tissues. If the same frequency is given as a burst with 12µs
pulse width, it can coagulate the tissue.

• A push pull amplifier and step-up transformer are used to

increase the power of the signal.
For cutting:400W in 500Ω load at 2000V
For Coagulation: 150W of burst with duartion 10-15µs
• Audio tone generator act as an indicator of frequency of the
current.

• The foot switch and isolated switch boards are used for
isolation of the user from device and thereby reducing the
accidents.

• The control panel controls all the operations of the diathermy

unit by monitoring the requirement of the doctor.
 Types of Diathermy

1. Short Wave Diathermy:

• Frequency= 27.12 MHz with wavelength 11m.

• Required power = 500W
• Used for healing of wounds and inflammations.

• Two types: (a) Capacitor method/ condenser method

(b) Inductor method.

• The tissue will act as a dielectric

• The two electrodes will act
as the two plates of the capacitor
• A flexible wire will be wound over
the body part
• This will act as an inductor.
• Due to the flow of high frequency
current, eddy current will be
generated in the tissue and will
cause heat generation.
2. Microwave Diathermy

• Frequency: 2450 MHz with a wavelength of 12.25cm

• No electrode pads are used in this method.
• Direct transmission of the current from the generator.
• Magnetrons are used for generating microwaves.
3. Ultrasonic Diathermy
• Frequency = 800kHz to 1MHz.
• used mainly in the treatment of peripheral nervous
system, skeletal muscle and skin.
• The device consist of a High frequency signal generator,
timer and Piezo electric transducer.

• The RF signal is given Piezo electric transducer and cause mechanical vibration
of the sensor.
• This sensor will be in contact with body art and the vibrations will be
transferred to the tissues.
Effect of Different Diathermy Techniques Muscle
Skin
Bone
 c) Ventilators Khandpur 2nd edn : Page 837

• A medical ventilator is a machine designed to move breathable air in

and out of the lungs, to provide breathing for a patient who is
physically unable to breath properly.
• Used when a Lung injury or Respiratory failure occurs and in all
Thoracic surgery cases.

Ref: Dr. M Shanmugam-Biomedical Instrumentation (Pg:6.8)

• It provide oxygen enriched, medicated air to a patient at a
controlled temperature and remove carbon dioxide.
 Types of ventilators
A. Classification Based on Modes of operation/Initiating
respiratory phase:

1. Controlled: Automatic mechanism in which breathing is

controlled by a timing circuit. This is used in patients
who cannot breath on their own.

2. Assisted/ Patient Initiated: Used when the patient is

able to breath himself but has difficulties in breathing.

3. Assist-Control: By this mode, the patient controls his

own breathing as long as he can and switch to
automatic mode when the patient fails to control it
B. Classification Based on Power Transmission

1. Direct Power Transmission: A ventilator which delivers

the gas directly from the source of compressed gas to
the patient

2. Indirect Power Transmission: A ventilator which has

separate patient and power systems. The pressure in
the power system determines the flow rate.
C. Classification Based on Pressure pattern

1. Positive-Atmosphere: A ventilator which produces a positive

pressure in the patient’s lungs during inspiration, with an end
expiratory pressure that is equal to the atmospheric pressure. In
this mode, the mean airway pressure is always higher than the
atmospheric pressure and the patient normally breathes
spontaneously with this mode of operation

2. Positive-Negative: A ventilator which produces a positive

pressure in the patient’s lungs during inspiration and below
atmospheric pressure in the airway during part of expiratory
phase
D. Based on Safety limit:

1. Pressure limited Ventilators: A ventilator designed in such

a way that predetermined pressure cannot be exceeded during
inspiration.

2. Volume Limited Ventilators: A ventilator in which

pre-determined volume cannot be exceeded during inspiration.
Volume limit normally refers to tidal volume.

3. Time Limited: A ventilator in which predetermined phase

time cannot be exceeded. It limits the expiratory phase time if
the patient does not initiate the inspiratory phase and is
common to ventilators used for assisted ventilation.
1. Pressure limited Ventilators:

5 6

3
2

1
11 12

10
9 7

8
Inspiration process:
1. During inspiration, the air compressor draws room air through an air
filter and passes it the main solenoid.
2. Main solenoid forces the bottom inlet valve of the internal bellows
chamber to open and lower outlet valve to close.
3. Oxygen is passed into bellows through a controlled manner by
means of a control valve.
4. The high pressure in the bellow chamber compresses the bellow
and forces the upper outlet valve to open.
5. The compressed oxygen enriched air is passed through main
solenoid into external tube (6) and to bacterial filter (7), humidifier
(8), nebulizer (9) and finally to patient lung (10).
• During Expiration, air is sucked into the spirometer chamber (11)
through a valve.
• Volume of the chamber is varied by means of a light weight piston.
• The spirometer alarm indicates the correct volume of the exhaled
air.
 Volume Limited Ventilators
•It is based on the volume of air goes in and out of the lung.
• During inspiration, constant volume of air is delivered to the
lung.
• The expired air volume is monitored to control the expiration
process.
Microprocessor based / Servo Controlled Ventillator
d) Dialyzer / Hemodialysis Machine