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Development of multi-parameter monitoring system

development OF MULTI-PARAMETER MONITORING SYSTEM

Aravind Rahul. D (15D205)

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Dissertation submitted in partial fulfillment of the requirements for the degree of

bachelor OF ENGINEERING

Branch: BIOMEDICAL ENGINEERING

Of Anna University, Chennai

[image: C:UsersSAMSUNGDesktopsanju kuttyusersPSG_College_of_Technology_logo.jpg]

OCTOBER 2018

DEPARTMENT OF BIOMEDICAL ENGINEERING

PSG COLLEGE OF TECHNOLOGY

(Autonomous Institution)

COIMBATORE-641004

PSG COLLEGE OF TECHNOLOGY

(Autonomous Institution)

COIMBATORE-641004

development OF MULTI-PARAMETER MONITORING SYSTEM

Aravind Rahul. D (15D205)

Dissertation submitted in partial fulfillment of the requirements for the degree of

bachelor OF ENGINEERING

Branch: BIOMEDICAL ENGINEERING

Of Anna University, Chennai

APRIL 2019

………………………… ………………………… …………………………

Dr. M.S.Sangeetha Nitin Chavan Dr. R. Vidhyapriya

Assistant Professor (Sr.gr) Patient Monitoring Team Lead Head of the Department

Faculty Guide BPL Medical Technologies Biomedical Engineering

Certified that the candidate was examined in the viva-voce examination held on ……………………..

…………………… ……………………..

(Internal Examiner) (External Examiner)

CONTENTS

CHAPTER PAGE NUMBER

ACKNOWLEDGEMENT………………………………………………………………….I

ABSTRACT…………………………………………………………….………………….II

LIST OF FIGURES………………………………………..………………………….….III

LIST OF TABLES…..……………………………………..………………………….….IV

1. INTRODUCTION………………………………………………………………………..1

1.1 History of Patient Monitor 1

1.2 Categories of Patients using Patient Monitors 2

1.3 Different Physiological Signals Monitored 3

1.3.1 Electrocardiogram 3

1.3.2 Peripheral Capillary Oxygen Saturation 3

1.3.3 Invasive Blood Pressure Measurement 4

1.3.4 Non-Invasive Blood Pressure Measurement 5

1.3.5 End-Tidal Capnography 5

2.LITERATURE SURVEY.………………………………………………………..………..6

3. METHODOLOGY……………………………………………………………………………….11

3.1 Block Diagram 11

3.2 Hardware 12

4. RESULTS AND DISCUSSION…………………………………………………………..14

5. CONCLUSION AND FUTURE WORK….…………………………………………….15

5.1 Conclusion 15

5.2 Future Work

BIBLIOGRAPHY…………………………………………………………………………………………………….16

ACKNOWLEDGEMENT

I wish to express our sincere gratitude to our beloved Principal Dr.R.Rudhramoorthy for providing an opportunity and necessary facilities in carrying out this dissertation work.

First of all I would like to thank my HoD, Dr.R.Vidhyapriya for her continuous support and guidance. I am grateful to her for giving me such a wonderful opportunity to work in this area of research.

I take this opportunity to express my profound gratitude to Ms.M.S.Sangeetha, Assistant Professor (Sr.Gr) for her exemplary guidance, monitoring and constant encouragement throughout the course of this project.

I would like to thank my Tutor, Ms.P.Prema, Assistant Professor (Sl.Gr) for her guidance and support.

I would like to thank my Lead Mr. Nitin Chavan and the whole of Patient Monitor team who helped me throughout my Internship in BPL Medical Technologies.

I thank all the Faculty members in the Department of Biomedical Engineering for their suggestions throughout the project work. I also thank the Lab assistants and our friends for rendering all possible helps whenever required.

I am also grateful for the encouragement and support from my Parents.

ABSTRACT

In today’s world of automation, the field of biomedical is no longer aloof. Application of engineering and technology has proved its significance in the field of biomedical. It not only made doctors more efficient but also helped them in improving total process of medication. The Patient monitoring system is also a step in the automation of supervision for doctors. This paper presents a current invention for monitoring the patient health by continuous observations. It continuously monitors the vital parameters of patients such as ECG, Blood Pressure, Respiration Rate, Oxygen Saturation, End-tidal Capnography and Body temperature. This system is used in hospital for a person who is not under the continuous observation of doctor, can check his/her vital signs using the sensors in this project if sensors output starts fluctuating above normal rate then immediately an indication will be sent to the doctor and the nurses in Hospital through Nurse Call. Multiple sensors and electrodes are used to measure these parameters. Patient Monitors developed at BPL are multi-parameter monitors which comes in three standard sizes 8, 10 and 12 (all in inches) comes with touch interface and all other High-end options optimized to provide precise reading with high accuracy. The main motive of proposed method is to provide an circuitry which would prevent the leakage current from Defibrillator which can possible damage the internal circuits of Patient Monitor and the compatibility between sensors used for SpO2 measurement has been added.

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LIST OF FIGURES

FIGURE PAGE NUMBER

1.1 Burdick CS625 Patient Monitor 2

1.3.1 Normal ECG Waveform 3

1.3.2 SpO2 Sensor 4

1.3.3 Invasive Blood Pressure Measurement 4

1.3.5 Normal End-tidal EtCO2 Waveform 5

2.1 Correlation of measured SpO2 against standard SaO2 7

2.2 Mean blood pressures, SD, bias, precision, upper and lower 95% limits 9

of agreement, and percentage error measures on 43 Anaesthetized horses

3.1 Block Diagram of Multi-Parameter Patient Monitoring System 11

3.2 Patient Monitor Screen Displaying all Vital Parameters 12

3.2.1 SpO2 Sensor 13

3.2.4 AC to DC SMPS circuit 14

3.2.5 DC-DC Board Block Diagram 15

3.2.6 Side Panel 15

4.1 Live Testing of the system 16

4.4 Pace Pulse detection cicuit 18

LIST OF FIGURES

TABLE PAGE NUMBER

Temperature reading displayed on the monitor before averaging 24

Temperature reading displayed on the monitor after averaging 24

CHAPTER 1

INTRODUCTION

Patient Monitor is an device used in critical care units, and operation theatres. This broad category of devices fall into two categories single-parameter monitoring and multi-parameter monitoring. As name says, single parameter monitors can monitor only one parameter while the multi-parameter monitors gives us the freedom to monitor multiple parameters. There are seven vital signs to be monitored for a patient, that are Electrocardiogram (ECG), SpO2, Body temperature, Invasive Blood Pressure (IBP), Non-Invasive Blood Pressure (NIBP), EtCO2 and Heart Rate (HR). These parameters can either be monitored in real time or can be stored for viewing later.

1.1 HISTORY OF PATIENT MONITOR

It was back in 1625 when Santorio of Venice, with help from his good friend Galileo, published methods for measuring body temperature with a spirit thermometer, and timing the pulse rate with a pendulum. However, their findings were largely ignored. It was only with the publication of “Pulse-Watch” by Sir John Floyer in 1707 that the first scientific report pertaining to the pulse rate came to light. Ludwig Taube published the first-ever plotted course of fever in a patient circa 1852, adding respiratory rate to the list of human vital signs trackable at the time. Subsequent improvements in the thermometer and clock solidified the heart rate, respiratory rate and body temperature as the standard vital signs monitored by medical professionals of the time.

In 1896 the first ever ‘sphygmomanometer’ (blood-pressure cuff) was introduced to the medical world, which added a fourth vital sign, arterial blood pressures, to patient monitoring procedures. Seven years later, in 1903, Willem Einthoven invented the string galvanometer for measuring the ECG – and invention that won him the 1924 Nobel Peace Prize in physiology.

The next logical step in patient monitoring was to devise a system that allowed medical professionals to monitor all four vital signs (heart rate, respiratory rate, temperature, and blood pressure) at once, and over an indefinite period of time. With Himmelstein and Scheiner’s invention of the ‘cardiotachoscope’ in 1952, and advances in physiological monitoring system technologies by electronics companies in the 1960s, meant that patient monitoring systems were improving almost year on year.

[image: ]

Figure 1.1 Burdick CS625 Patient Monitor

1.2 CATEGORIES OF PEOPLE USING PATIENT MONITORS

There are four categories of patients who need physiological monitoring:

1] Patients with unstable physiological regulatory systems; for example, patient whose respiratory system is suppressed.

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2] Patients with a suspected life-threatening condition; for example, a patient who has findings indicating an acute myocardial infarction (heart attack) or patients immediately after open-heart surgery.

3] Patients in a critical physiological state; for example, patients with multiple trauma.

4] Mother and baby during the labor and delivery process.

1.3 DIFFERENT PHYSIOLOGICAL SIGNALS MONITORED

1.3.1 ELECTROCARDIOGRAM

An electrocardiogram abbreviated as EKG or ECG is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers. The right and left atria or upper chambers make the first wave called a “P wave” following a flat line when the electrical impulse goes to the bottom chambers. The right and left bottom chambers or ventricles make the next wave called a “QRS complex”. The final wave or “T wave” represents electrical recovery or return to a resting state for the ventricles. An ECG gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked.

[image: ]

Figure 1.3.1 Normal ECG Waveform

1.3.2 PERIPHERAL CAPILLARY OXYGEN SATURATION (SpO2)

SpO2, also known as blood oxygen saturation, is a measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen. The body needs there to be a certain level of oxygen in the blood or it will not function as efficiently. In fact, very low levels of SpO2 can result in very serious symptoms. This condition is known as hypoxemia. There is a visible effect on the skin, known as cyanosis due to the blue (cyan) tint it takes on. Hypoxemia (low levels of oxygen in the blood) can turn into hypoxia (low levels of oxygen in the tissue). This progression and the difference between the two conditions is important to understand.

There are many ways that the blood can be tested to ensure it contains normal oxygen levels. The most common way is to use a pulse oximeter to measure the SpO2 levels in the blood. Pulse oximeters are relatively easy to use, and are common in health care facilities and at home. They are very accurate despite their low price point.

[image: ]

Figure 1.3.2 SpO2 Sensor

1.3.3 INVASIVE BLOOD PRESSURE

Invasive (intra-arterial) blood pressure (IBP) monitoring is a commonly used technique in the Intensive Care Unit (ICU) and is also often used in the operation theatre. This technique involves direct measurement of arterial pressure by inserting a cannula needle in a suitable artery. The cannula must be connected to a sterile, fluid-filled system, which is connected to an electronic patient monitor. The advantage of this system is that a patient’s blood pressure is constantly monitored beat-by-beat, and a waveform (a graph of pressure against time) can be displayed.

[image: ]

1.3.3 Invasive Blood Pressure Measurement

1.3.4 NON-INVASIVE BLOOD PRESSURE MEASUREMENT

Non-Invasive blood pressure measurement is the commonly used method in the clinical setup. This method is highly comfortable for patients, gives the precise blood pressure reading and both Systolic and Diastolic pressures can be monitored. There are different methods of Non-Invasive blood pressure measurement they are, Auscultatory Method, Oscillometric Metric and Cuff Method.

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1.3.5 END-TIDAL CAPNOGRAPHY

End-tidal capnography refers to the graphical measurement of the partial pressure of carbon dioxide (in mm Hg) during expiration (i.e., end-tidal carbon dioxide [EtCO2, PetCO2]). First established in the 1930s, clinical use of EtCO2measurement became accessible in the 1950s with the production and distribution of capnograph monitors. With continuous technologic advancements, EtCO2 monitoring has become a key component in the advancement of patient safety within anaesthesiology, and the American Society of Anaesthesiologists (ASA) has endorsed end-tidal capnography as a standard of care for general anaesthesia and moderate or deep procedural sedation.

[image: Image result for what is end tidal co2]

Figure 1.3.4 Normal End Tidal EtCO2 Waveform

CHAPTER 2

LITERATURE SURVEY

2.1 LITERATURE SURVEY

1. “ECG Monitoring leads and Special leads” Fransis Johnson

DESCRIPTION: There are different types of lead placements depending on the condition that is monitored, or the dynamic nature of subject, and much more. The most common lead placement is the Einthoven’s lead placement system, in which 3 electrodes are placed two on chest while the other one on the lower limb which acts as ground. In this type of ECG measurement bipolar signal acquisition is done, where the data received by two electrodes are processed to give waveform like Lead I, II or III. The most popular lead placement in critical care are the 5 lead system, in which 4 electrodes are placed on the torso region of upper limb while the 5th electrode in the lower left limb acts as ground. This type of lead placement have given best results in detection of tachycardia and deviations in ST segment. Next is the standard 12 lead ECG measurement which has 12 leads. Six of the leads are considered “limb leads” because they are placed on the arms and/or legs of the individual. The other six leads are considered “precordial leads” because they are placed on the torso (precordium).The six limb leads are called lead I, II, III, aVL, aVR and aVF. The letter “a” stands for “augmented”,” as these leads are calculated as a combination of leads I, II and III. The six precordial leads are called leads V1, V2, V3, V4, V5 and V6. Apart from this there are few other lead placement methods are available which are not much popularly used.

INFERENCE: As the information given in this paper, different lead placements can detect different physiological conditions. For example: Using a 5 lead ECG placement can detect tachycardia comparatively better the other two standard lead placements. As result of this, different lead types are being tested to provide an ECG measurement circuit which provides optimal results in all given conditions.

2. “The precisin and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in new born lambs” Jawson JA, Bastrenta P, Cavigioli F, et al

DESCRIPTION: Prospective observational study in ventilated anaesthetised new born lambs with an indwelling carotid artery catheter. Ventilation was adjusted to achieve hypoxaemia (condition in which SpO2 level is relatively lower than normal range). Nellcor (Oxi-Max 600 with Max-N sensor) and Masimo (Rad 4 with low noise optical probe (LNOP) sensor) sensors were applied to the right forelimb of the lamb. An arterial blood sample was collected at 1–5 min intervals when the animal was hypoxic. The displayed SpO2 was recorded. Bland–Altman analysis was used to determine precision and accuracy of each oximeter when SaO2

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