AKHIL KUMAR S, AP, ECE

Therapeutic Equipments
AKHIL KUMAR S
ASSISTANT PROFESSOR
ECE
MLMCE
AKHIL KUMAR S, AP, ECE
 CARDIAC PACEMAKERS
AKHIL KUMAR S, AP, ECE

A device capable of generating artificial pacing impulses

and delivering them to the heart is known as a pacemaker
system(commonly called a pacemaker).
It consists of
pulse generator and appropriate electrodes.
By giving external electrical stimulation impulses to the
heart muscle, it is possible to regulate the heart rate. These
impulses are given by an electronic instrument called a
'pacemaker'.
AKHIL KUMAR S, AP, ECE
 The rhythmic beating of the heart is due to the triggering
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pulses that originate in an area of specialized tissue in the right

atrium of the heart. This area is known as the sino-atrial node.
In abnormal situations, 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 electrocardiogram (ECG)
waveform.
AKHIL KUMAR S, AP, ECE
 A pacemaker basically consists of two parts:
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1. An 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.
 Types of Pacemakers
AKHIL KUMAR S, AP, ECE

Internal Pacemakers:
In this entire system is inside the body.
Permanently implanted in the body whose SA node failed to
function properly.
The system is implanted with the pulse generator placed in a
surgically formed pocket below the right or left cavicle.
Internal leads connected to electrodes that directly contact
surface of myocardium
Pulse generator must be self contained with a power source
capable of continuously operating the unit for a period of
years.
AKHIL KUMAR S, AP, ECE
 External Pacemakers
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Employed to restart normal rhythm of heart in case of

cardiac standstill.
An external pacemaker usually consists of an externally worn
pulse generator connected to electrodes located on or
within the myocardium.
Used on patients with temporary heart irregularities.
In this the pulse generator located outside the body and
connected to ventricle using a long thin tube called catheter.
The pacing impulse(80 mA) is applied through metal
electrodes placed on the surface of the body.
 MODES OF OPERATION
AKHIL KUMAR S, AP, ECE

Two modes of operation are possible with both internal and

external pacemakers and they are,
 Asynchronous
 The fixed rate impulses occur along with natural pacing
impulses.
Synchronous:
They are programmed either in demand or synchronized
mode.
 Asynchronous Pacemaker(Competitive)
AKHIL KUMAR S, AP, ECE

An asynchronous pacemaker is a free running oscillator

type.
The electrical pulses are produced at uniform rate thereby
giving a fixed heart rate.
Asynchronous pacing is called competitive pacing because
the fixed-rate impulses may occur along with natural
pacing impulses generated by the heart and would therefore
be in competition with them in controlling the heartbeat.
 This competition is largely eliminated through use of
ventricular or atrial-programmed pulse generators.
AKHIL KUMAR S, AP, ECE

POWER SUPPLY:
It is required to supply energy to the pacemaker
Primary or secondary batteries are used as power source
For long life lithium batteries are used
Sometimes external power sources can be used for
implantable pacemakers.
 OSCILLATOR:
AKHIL KUMAR S, AP, ECE

The asynchronous pacemakers provide stimulus pulses at a

constant rate
It is either a free running blocking oscillator or a multi-
vibrator PULSE OUTPUT CIRCUIT:
It consists of a timing circuit to determine when a stimulus
should be applied to the heart.
It produces pulses at a fixed rate between 70 to 90 beats per
minute.
LEAD WIRES:
There should be appropriate connection to carry the electric
stimuli to the heart and to apply them in the appropriate place.
So simply lead wires are the connecting electrical wires
between the electrodes and the operating device.
 These lead wires being good electrical conductors must
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also be mechanically strong to with stand of movements and

must have a high grade of insulation.
ELECTRODES:
Electrodes must with stand flexing due to the pumping
action of the heart and must remain in place.
The material chosen is of great importance as it should not
have any electrolytic relations with heart tissue and must
not cause irritation to the myocardium.
Materials commonly used are platinum and silver-silver
chloride, carbon and titanium.
AKHIL KUMAR S, AP, ECE

Pacemaker electrodes
 Synchronous Pacemaker
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We have two forms of synchronous pacemakers:

1. Demand Pacemaker
2. Atrial Synchronous pacemaker
Most of the patients require pacing intermittently; this is
because the patients can establish normal cardiac rhythm
between periods of block.
 Demand Pacemaker
In this case it is not necessary to stimulate the ventricles
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continuously as it may cause ventricular fibrillation.

The pacemaker should not compete with normal pacing of
the heart.
It is also known as Demand pacemaker.
 It consists of a timing circuit, an output circuit and
AKHIL KUMAR S, AP, ECE

electrodes along with a feedback path.

Timing circuit has a fixed rate of 60/80 beats per minute.
Timing circuit reset itself after each stimulus waits for
appropriate time and then generates the next pulse.
The feedback circuit detects the QRS complex of ECG
signal from electrodes and amplifies it.
The signal is used to reset the timing circuit. It waits for the
assigned interval before producing next stimulus.
If heart beats again, before the stimulus is produced the timing
circuit is reset and process repeats itself.
 Atrial Synchronous Pacemaker
AKHIL KUMAR S, AP, ECE
 The heart’s physiological pacemaker located at SA node,
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initiate the cardiac cycle by stimulating the atria to contract

and then providing stimulus to AV node, which after
appropriate delay stimulates ventricles.
If SA node is able to stimulate the atria, the electric signal
corresponding to atrial contraction can be detected by an
electrode implanted in atrium and used to trigger the
pacemaker in same way that it triggers AV node.
Voltage is a pulse that corresponds to each beat.
The atrial signal is then amplified and passed through a
gate to a monostable multivibrator giving a pulse V2 of
120ms duration, the approximate delay of AV node.
 Another monostable multivibrator giving pulse duration of
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500ms is also triggered by atrial pulse and it produce V4

which causes the gate block any signal from atrial
electrodes for a period of 500ms following contraction.
This eliminates any artifact caused by ventricular contraction
from stimulating additional ventricular contraction.
V2 is used to trigger a monostable multivibrator of 2ms
duration.
Pulse V2 acts as a delay allowing V3 to be produced which
follows atrial contraction.
Then V3 controls an output circuit that applies stimulus to
the appropriate ventricular electrodes.
AKHIL KUMAR S, AP, ECE

Types of Pacing Modes

 Non competitive method
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The noncompetitive method, which uses pulse generators

that are either ventricular programmed or programmed by
the atria, is more popular.
Ventricular-programmed pacemakers are designed to operate
either in a demand (R-wave-inhibited) or standby (R wave-
triggered) mode.
Atrial-programmed pacers are always synchronized with the
P wave of the ECG
 Ventricular Programmed
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Either type of ventricular-programmed pulse generator, when

connected to the ventricles via electrodes, is able to sense
the presence (or absence) of a naturally occurring R wave.
The pulse generator has two functions, pacing and sensing.
 Sensing is accomplished by picking up the ECG signal.
In the case of dual-chamber pacing, the P wave is also
sensed.
Once the signal enters the sensing circuit, it is passed
through a QRS bandpass filter.
This filter is design to pass signal components in the frequency
range of 5-100 Hz, with a centre frequency of 30 Hz.
 This is followed by an amplifier and threshold detector which
is designed to operate with a detection sensitivity of 1-2 mV.
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Sensitivity of this order ensures reliable detection of cardiac

signals sensed on the electrodes which typically have amplitudes
in the 1-30 mV range depending onto 1 electrode surface area and
the sensing circuit loading impedance.
Refractory period (T1) is necessarily incorporated to limit the
pulse delivery rate, particularly in the ' presence of
electromagnetic interference. It is meant to prevent multiple re-
triggering of the astable multivibrator following a sensed or
paced contraction.
The free-running multivibrator provides a fixed rate mode with
an interval of T2 via the output driver circuit.
The output pulses of a length T3 synchronous with input signals
that fall outside the sensing refractory period T1 are thus
delivered at the stimulating electrodes.
 Ventricular synchronous demand pacer.
AKHIL KUMAR S, AP, ECE
 R-wave-inhibited (demand):
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The output of an R-wave-inhibited (demand) unit is suppressed

(no output pulses are produced) as long as natural (intrinsic) R
waves are present.
Thus, its output is held back or inhibited when the heart is able
to pace itself.
However, should standstill occur, or should the intrinsic rate fall
below the preset rate of the pacer (around 70 BPM), the unit will
automatically provide an output to pace the heart after an escape
interval at the designated rate.
In this way, ventricular-inhibited pacers are able to pace on demand.
A demand pacer, in the absence of R waves, automatically
reverts to a fixed-rate mode of operation.
 R-wave- triggered :
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R-wave-triggered pulse generators, like the inhibited units,

sense each intrinsic R wave.
However, this pacer emits an impulse with the occurrence of
each sensed R wave. Thus, the unit triggered rather than
inhibited by each R wave.
The pacing impulses are transmitted to the myocardium
during its absolute refractory period, so they will have no
effect on normal heart activity.
 Atrial Programmed
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In cases of complete heart block where the atria are able to
depolarize but the impulse fails to depolarize the ventricles,
atrial synchronous pacing may be used.
Here the pulse generator is connected through wires and
electrodes to both the atria and the Ventricles.
The atrial electrode couples atrial impulses to the pulse
generator, which then emits impulses to stimulate the
ventricles via the ventricular electrode.
In this way, the heart is paced at the same rate as the
natural pacemaker.
When the SA node rate changes because of sympathetic
neuronal control, the ventricle will change its rate accordingly
but not above some maximum rate (about 125 per minute).
 CARDIAC DEFIBRILLATORS
AKHIL KUMAR S, AP, ECE

NEED FOR A DEFIBRILLATOR

Cardiac Fibrillation is a serious cardiac emergency
resulting from asynchronous contraction of the heart
muscles.
The fibrillation of atrial muscle is called atrial fibrillation
and that of the ventricles is called ventricular fibrillation.
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.
AKHIL KUMAR S, AP, ECE

This results in a steep fall of cardiac output and can prove

fatal if adequate steps are not taken promptly.
In fibrillation, the main problem is that the heart muscle
fibres are continuously stimulated by adjacent cells so
that there is no synchronized succession of events that
follow the heart action.
Consequently, control over the normal sequence of cell
action cannot be captured by ordinary stimuli.
 DEFIBRILLATOR
AKHIL KUMAR S, AP, ECE

Cardiac Fibrillation can be converted into a more efficient

rhythm by applying a high energy shock to the heart.
This sudden surge across the heart causes all muscle fibres
to contract simultaneously.
Possibly, the fibres may then respond to normal physiological
pacemaking pulses.
The instrument for administering the shock is called a
Defibrillator.
The shock can be delivered to the heart by means of electrodes
placed on the chest of the patient (external defibrillation) or
the electrodes may be held directly against the heart when
the chest is open (internal defibrillation).
 Defibrillator consists of an electric supply unit and two
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metal electrodes called “Paddles” that are pressed very

firmly to the patient’s chest using insulating plastic handles.
So the person using them does not get a shock too.
The important thing is that current should flow through the
heart so where the paddles are applied is crucial.
 For getting good electrical contact solid or liquid
conducting gel is used.
 Higher voltages are required for external defibrillation
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than for internal defibrillation.

Restoration of normal rhythm in fibrillating heart
 There are two basic type:
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1. AC Defibrillator
2. Capacitive Discharge DC Defibrillator

Defibrillation by electric shock is carried out either by passing

current through electrodes placed directly on heart or by
using large area electrodes placed against the anterior
thorax.
 AC DEFIBRILLATOR
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By construction it consists of a step up transformer with

various tapping on the secondary side.
An electronic timer circuit is connected to the primary of the
transformer
This timer device is a simple capacitor and resistor or mono-
stable multivibrator.
 Applying brief 0.25 -1 second burst of 60 Hz AC act as
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intensity of around 6A.

It acts as counter shock for resynchronization and repeats
until defibrillation occurs.
It is constructed in such a way that appropriate voltages for
internal and external defibrillation are available.
External defibrillation voltage range: 250 – 750V
Internal defibrillation voltage range: 60 – 250V
Large currents are required in external defibrillation to
produce uniform and simultaneous contraction of the heart
muscle fibers.
 DC DEFIBRILLATOR
AKHIL KUMAR S, AP, ECE

In this an energy storage capacitor is charged at a relatively

slow rate (in the order of seconds) from the AC line by
means of a step-up transformer and rectifier arrangement
or from a battery and a DC to DC converter arrangement.
During Defibrillation, the energy stored in the capacitor is
then delivered at a relatively rapid rate (in the order of
milliseconds) to the chest of the subject.
The simplest arrangement involves the discharge of capacitor
energy through the patient's own resistance (R).
The capacitor is discharged through electrodes and patient
is represented by a resistive load and inductor L.
 For effective defibrillation, it is advantageous to adopt some
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shaping of the discharge current pulse.

If the discharge is truncated, so that the ratio of the duration
of the shock to the time constant of decay of the exponential
waveform is small, the pulse of current delivered to the chest
has a nearly rectangular shape.
For a somewhat larger ratio, the pulse of current appears
nearly trapezoidal.
Rectangular and trapezoidal waveforms have also been
found to be effective in the trans-thoracic defibrillation and
such waveforms have been employed in defibrillators designed
for clinical use
 Circuit diagram of a DC defibrillator
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 A variable auto-transformer T1 forms the primary of a high
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voltage transformer T2.

The output voltage of the transformer is rectified by a diode
rectifier and is connected to a vacuum type high voltage change-
over switch.
In position A, the switch is connected to one end of an oil-filled 16
micro-farad capacitor.
In this position, the capacitor charges to a voltage set by the
positioning of the autotransformer.
When the shock is to be delivered to the patient, a foot switch or a
push button mounted on the handle of the electrode is operated.
The high voltage switch changes over to position 'B' and the
capacitor is discharged across the heart through the electrodes.
In a defibrillator, an enormous voltage (approx. 4000 V) is initially
applied to the patient.
 Discharging Pulse of a DC defibrillator
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The most common waveform utilized in the RLC circuit

employs an under-damped response with a damping factor
less than unity.
This particular waveform is called a Lown' waveform.
This waveform is more or less of an oscillatory character, with
both positive and negative portion.
The pulse width in this waveform is defined as the time that
elapses between the start of the impulse and the moment that
the current intensity passes the zero line for the first time and
changes direction.
The pulse duration is usually kept as 5 ms or 2.5 ms.
AKHIL KUMAR S, AP, ECE
 Area under the curve is proportional to energy delivered.
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Once the discharge is completed, the switch automatically

returns to position 1 and process can be repeated if necessary.
Energy stored in capacitor is given by,
𝑊=1/2𝐶𝑉2
C= Capacitance
V= Voltage to which capacitor is discharged
 IMPLANTABLE DEFIBRILLATORS
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An implantable defibrillator is continuously monitors a

patient's heart rhythm.
If the device detects fibrillation, the capacitors within the
device are charged up to 750 V.
The capacitors then discharged into the heart which mostly
represents a resistive load of 50 ohm and to bring heart into
normal rhythm.
This may require delivery of more than one high energy pulse.
AKHIL KUMAR S, AP, ECE
 Implantable defibrillator systems have three main system
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components:
The defibrillator itself (AID), the lead system, and the
programmer recorder/monitor (PRM).
The AID houses the power source, sensing, defibrillation,
pacing, and telemetric communication system.
The leads system provides physical and electrical connection
between the defibrillator and the heart tissue.
The PRM communicates with the implanted AID and allows
the physician to view status information and modify the
function of the device as needed
 Programmer Recorder/Monitor (PRM)
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The PRM is an external device that provides a

bidirectional communications link to an implanted AID.
This telemetry link is established from a coil which is
contained within the wand of the PRM, to a coil which is
contained within the implanted device.
This telemetry channel may be used to retrieve real-time
and stored intra cardiac ECG, therapy history, battery status,
and other information pertaining to device function.
A number of combinations of programmable therapy and
detection options are available and it is not unusual to alter
these prescriptions dozens of times over the life of the
implant.
 Leads
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The defibrillating high energy pulse was delivered to the

heart via a 6 cm x 9 cm titanium mesh patch with
electrodes placed directly on the external surface of the
heart.
Sensing was provided through leads screwed in the
heart.
This approach required an invasive surgical approach to
provide access to the heart.
The modern implantable defibrillators make use of a single
transvenous lead with the multiple electrodes inserted into
the right ventricle for ventricular pacing and defibrillation.
 Pulse Generator:
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Major sub-systems of the implanted pulse generator

It has a microprocessor which controls overall system
functions.
An 8-bit device is sufficient for most systems.
ROM provides non-volatile memory for system start-up
tasks and some program space, whereas RAM is required
for storage of operating parameters, and storage of electro-
cardiogram data.
The system control part includes support circuitry for the
microprocessor like a telemetry interface, typically
implemented with a UART-like (universal asynchronous
receiver/transmitter) interface and general purpose timers.
 The power supply to the circuit comes from lithium Silver
Vanadium oxide (Li SVO) batteries.
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Separate voltage supplies are generated for pacing (approx 5V)

and control of the charging circuit (10-15 V),
High power circuits convert the 3-6 V battery voltage to the
750 V necessary for a defibrillation pulse, store the energy in
high voltage capacitors for timed delivery, and finally switch
the high voltage to cardiac tissue or discharge the high voltage
internally if the cardiac arrhythmia self- terminates.
The major components of these circuits are the battery, the
DC to DC converter, the output storage capacitors, and the
high power output switches.
 VENTILATORS
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 Respiration is the process of supplying oxygen to tissues

and removing carbon dioxide from the tissues.
These gases are carried in blood, oxygen from lungs to the
tissues and carbon dioxide from the tissues to the lung.
Respiration process:
Inspiration – breathing in (air to lungs)
Expiration – breathing out (air out from lungs)
Inspiration results from contraction of the diaphragm whereas
expiration results from their relaxation.
For reduced or respiratory failure, mechanical ventilators or
artificial respirators are used in hospitals.
 A mechanical ventilator is a machine that makes it easier
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for patients to breath, until they are able to breathe

completely on their own.
It gives breath in various modes in order to maintain the
level of oxygen in the blood.
These devices provide artificial ventilation, supply
enough oxygen and eliminate right amount of CO2.
It maintains desired arterial partial pressure of O2 and
CO2.
An intensive care patient often requires assistance with
breathing.
When artificial ventilation needs to be maintained for a long
time, a ventilator is used to provide oxygen enriched
medicated air to a patient at a controlled temperature.
 Ventilators can operate in different modes
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Controlled mode
In this mode the breathing is controlled by an automatically
timing system which is usually provided for patients who
cannot breath on their own.
 Pressure control (PC)
 Volume control (VC)
Assisted mode/Supported mode
In this mode patients own spontaneous attempt to breath in,
causes ventilator to cycle on during inspiration
Continuous positive airway pressure (CPAP)
Pressure support
 Assist Control mode/ Combined mode
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In this mode, patient controls his own breathing as long as

he can, but if he should fail to do so, control mode is able to
take over from him.
AKHIL KUMAR S, AP, ECE
 A tube (endocardial tube) is inserted in the patient‘s nose, mouth
or through a trachy tube into the lungs, (this is called intubation)
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and is hooked up to the ventilator.

Trachy tube provides an alternative airway for breathing.
The ventilator pumps air and oxygen into the patient‘s wind
pipe through the tube.
In ventilator system, humidifier is used to prevent inspissation.
Inspissation the act of thickening or condensing as by
evaporation or absorption of fluid.
The HME (Heat and Moisture Exchange) is used to help to
prevent complications due to drying of the respiratory mucosa.
The ventilator can provide a pressure which helps hold the
patient‘s lungs open to prevent the sacs from collapsing.
The goal of mechanical ventilation is to reproduce the body‘s
normal breathing mechanism.
 Parameters used in ventilator
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Inspiration
It is an active movement
The diaphragm moves downwards
The outside air goes into lungs
Expiration
It is a passive movement
Return of the diaphragm to normal
Air (more CO2 goes out from lung
Tidal volume/lung volume
The volume of air/O2 for one breath.
Unit is ml
Breath rate
Number of breaths for one minute.

  Minute volume
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Number of breaths in one minute multiplied by tidal volume

ie, Breath rate X Tidal volume. Unit is ml/minute
Airway pressure
The pressure in the airway or in the tube.
 Inspiration peak flow
The maximum flow of air/O2 during inspiration
 I:E ratio
The ratio between inspiration and expiration
Percentage of Oxygen
The oxygen concentration in the air during inspiration
Compliance
Measurement of the elasticity of the lungs and chest wall
 Positive End Expiratory Pressure (PEEP)
The pressure maintained in the airway or lung even after the
 MICROPROCESSOR BASED VENTILATOR
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 Microprocessor based automatic feedback control of a
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mechanical ventilator.
It consists of a microprocessor with RAM, EPROM, A/D
converter and a CRT controller.
The input signals to the microprocessor are obtained from a
CO2 analyser, a lung machine, gas analyser, oxygen
consumption monitor and a servo ventilator.
The proper controlling signals are delivered to the servo
ventilator so as to get correct ventilation adjustment in
response to a patient‘s metabolism.
 HEART-LUNG MACHINE
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During open heart surgery, the heart cannot maintain the

circulation.
It is then necessary to provide extra corporeal (outside the
body) circulation with a special machine called heart lung
machine.
Heart-Lung Machine is a blood pumping machine that takes
over the functions of the heart and lungs during surgery (i.e.
open-heart surgery).
It is most commonly used to perform a cardiopulmonary
bypass (CPB), which is the technique whereby blood is totally
or partially diverted from the heart into a machine with the
gas exchange capacity and subsequently returned to the
arterial circulation at appropriate pressures & flow rates.
 CPB allows for the heart to stop beating as its function is
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taken over by Heart Lung Machine, which makes it easier

to operate on, and surgeons can operate in a blood-free
area.

Functions of a Heart Lung Machine

RESPIRATION
Within which it includes Ventilation and Oxygenation.
CIRCULATION
 Maintaining circulation at appropriate pressures and flow
rates.
TEMPERATURE REGULATION
 It involves controlled hypothermia.
AKHIL KUMAR S, AP, ECE
 The Components of Heart Lung Machine
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Pumps:
The pumps are designed to minimize the damage to blood
cells and effective in pumping within physiological range.
Membrane Oxygenator
It imitates the function of lungs.
Membrane oxygenator are more common now a days.
Here O2 & CO2 Exchange takes place.
Gas exchange take place by the process of diffusion across a
thin membrane separating blood and gas made of highly
permeable silicon rubber or microporous polypropylene,
Teflon & polyacrylamide.
 Heat Exchanger
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Heat exchangers control body temperature by heating or

cooling blood passing through the perfusion circuit.
Arterial filter/bubble trap
It is used to filter small air bubbles that may have
entered, or been generated by the machine.
Aortic/atrial/vena caval cannulae
 Through which blood is taken and returned to body.
 The work flow of Heart Lung Machine
AKHIL KUMAR S, AP, ECE
 It Composed of a chamber that receives all the blood from
the body (right atrium of the heart), pumps that move the
AKHIL KUMAR S, AP, ECE

blood through an oxygenator (that mimic function right

ventricle),
Oxygenator removes the carbon dioxide and adds oxygen
to the blood (mimic lungs).
Machine continues by pumping the oxygenated blood back
to the body (that mimic function of left atrium and ventricle)
using a series of tubes.
Advantage of using Heart Lung machine:
The ability of a surgeon to perform an open-heart surgery
in a blood-free zone while the heart is not beating.
It also allows for medications and anesthetics to be
administered directly into the blood, adding them to the
blood in the heart-lung reservoir, arriving immediately to
 DIATHERMY
AKHIL KUMAR S, AP, ECE

High frequency currents used in operating rooms for surgical

purposes involving cutting and coagulation.
The frequency of currents used in surgical diathermy units is in
the range of 1-3 MHz in contrast with much higher frequencies
employed in short wave therapeutic diathermy machines.
This frequency is quite high in comparison with that of the 50Hz
mains supply.
This is necessary to avoid the intense muscle activity and the
electrocution (death caused by electric current passing through the
body) hazards which occur if lower frequencies are employed.
For their action, surgical diathermy machines depend on the
heating effect of electric current.
AKHIL KUMAR S, AP, ECE
 When high frequency current flows through the sharp edge
AKHIL KUMAR S, AP, ECE

of a wire loop or band loop or the point of a needle into the

tissue , there is high concentration of current at this point.
The tissue is heated to such an extent that the cells which are
immediately under the electrode, are torn apart by the boiling
of the cell fluid.
The indifferent electrode establishes a large area contact
with the patient and the RF current is therefore, dispersed
so that very little heat is developed at this electrode.
This type of tissue separation forms the basis of electro-
surgical cutting.
There are various electro-surgery techniques using diathermy
unit.
 Various types of electro surgery techniques
AKHIL KUMAR S, AP, ECE
 ELECTROTOMY
When the electrode is kept above the skin, an electrical arc
AKHIL KUMAR S, AP, ECE

is sent.
The developed heat produces a wedge shaped narrow
cutting of the tissue on the surface.
By increasing the current level, deeper level cutting of
the tissue takes place.
Normally continuous RF current is used for cutting
COAGULATION
When the electrode is kept near the skin, high frequency
current is sent through the tissue in the form of bursts
and heating it locally so that it coagulates from inside.
The concurrent use of continuous RF current for cutting and
a RF wave burst for coagulation is called Haemostasis.
 FULGURATION
This is called Fulguration‘ in which the electrode is held near
AKHIL KUMAR S, AP, ECE

the tissue without touching it and due to the passage of the

electric arc, the destruction of superficial tissue takes place.
Thus it is related to the localized surface level destruction of
the tissues.
DESICCATION
The needle point electrodes are stuck into the tissue and
kept steady while passing electric current.
This is called desiccation‘ which produces dehydration in the
tissues.
BLENDING
When the electrode is kept above the skin, the separated
tissues or nerves can be welded or combined together by an
electric arc. This is called blending.
 Kidney
Main function of the kidney is to form urine out of blood
AKHIL KUMAR S, AP, ECE

plasma, which basically consists of two process:

1. The removal of waste products from blood plasma
2. The regulation of the composition of blood plasma
Kidney performs these functions through a process involving
filtration, reabsorption, excretion.
Human body has two kidneys.
 Each kidney consists of about a million individual units which
AKHIL KUMAR S, AP, ECE

are all having similar structure and function.

These tiny units are called nephrons.
Its main functions include regulating the concentration of
sodium salts and water by filtering the kidney's blood,
excreting any excess in the urine and reabsorbing the
necessary amounts.
Healthy kidneys clean your blood and remove extra fluid in
the form of urine.
One of the most important prosthetic (artificial body part)
device in modern is the artificial kidney, which is
periodically connected to the circulatory systems of uremic
patients to remove metabolic waste products from their
body.
 Hemodialysis
AKHIL KUMAR S, AP, ECE

Dialysis replaces some of these functions when your kidneys

no longer work.
Hemodialysis is a therapy that filters waste, removes extra
fluid and balances electrolytes (sodium, potassium,
bicarbonate, chloride, calcium, magnesium and phosphate).
In hemodialysis, blood is removed from the body and
filtered through a man-made membrane called a dialyzer,
or artificial kidney, and then the filtered blood is returned to
the body.
AKHIL KUMAR S, AP, ECE
 Hemodialysis working
AKHIL KUMAR S, AP, ECE

The dialysis machine is like a big computer and a pump.

It keeps track of blood flow, blood pressure, how much fluid
is removed and other vital information.
The dialyzer is called the artificial kidney because it filters
the blood.
The dialyzer is a hollow plastic tube about a foot long and
three inches in diameter that contains many tiny filters.
There are two sections in the dialyzer
 the section for dialysate.
 the section for the blood.
The two sections are divided by a semi permeable
membrane so that they don‘t mix together.
 A semi permeable membrane has microscopic holes that
AKHIL KUMAR S, AP, ECE

allow only some substances to cross the membrane.

Semi permeable membrane allows water and waste to pass
through, but does not allow blood cells to pass through.
Dialysate, also called dialysis fluid, dialysis solution or both, is
a solution of pure water, electrolytes and salts, such as
bicarbonate and sodium.
The purpose of dialysate is to pull toxins from the blood into
the dialysate.
The way this works is through a process called diffusion.
In the blood of the hemodialysis patient, there is a high
concentration of waste, while the dialysate has a low
concentration of waste.
 Due to the difference in concentration, the waste will move
AKHIL KUMAR S, AP, ECE

through the semipermeable membrane to create an equal

amount on both sides.
The dialysis solution is then flushed down the drain along
with the waste.
The dialysis machine has a blood pump that keeps the
blood flowing by creating a pumping action on the blood
tubes that carry the blood from the body to the dialyzer
and back to the body.
AKHIL KUMAR S, AP, ECE