VBA News - November 1997

Mary Frye Coker

There were several changes to the Board of Directors during the annual meeting. Three members (Ben Clark, Rick Davis and James Anderson) rotated off the board after their maximum 2 term tenure. Mike Carlton stepped down due to other obligations.

Results of the election during the annual meeting were - Michael Reichenbach and Steve Germain were re-elected for a second term and four new members were elected.Jack Sykes (Va Beach Gen), Brian Blackwell (Centra Health), Andy Holden (Mary Washington Hosp) and Lee Gilley (Centra Health).

Thanks to those who are rotating off the board for all their time and efforts. All changes take effect with the new year ('98). New officers will be elected at the December 15th board meeting .

The 1997 Virginia Biomedical Association annual meeting made many successful changes this year in an effort to provide better educational opportunities, attract more attendees, increase vendor participation, and provide a fun environment for learning. Below are just some of the highlights attendees were treated to:

* A dynamic keynote address by Christopher Bailey of the Virginia Hospital Association addressing healthcare trends in the state of Virginia.
* Educational offerings sponsored by Comprehensive Monitoring Services, Ditec , Marquette Electronics, Precision Endoscopy of America, RSTI and Spacelabs.
* A roundtable discussion on SBET and its future lead by Steve Haupt of Carilion Health system.
* 28 manufacturer exhibitors displaying their latest in products and services.
* A golf tournament
* An exhibitor cocktail reception featuring a palm reader
* First class facilities, food and treatment from the Williamsburg Marriott

There was also time for networking and general discussion on relevant topics to the biomedical field. Total attendance was approximately 100 individuals who were treated to have a fun, learning experience. If you were unable to attend, please join us at future educational events.

Thank You

Coordinating a state wide meeting from scratch is a major undertaking. I would like to publicly acknowledge the grateful assistance of the following individuals for their unflagging assistance in making the Wiliamsburg meeting run smoothly -

Dave Guerry (Cadmet) - coordinated mailing and promotional literature.
Yogi Biggs (Graphic Controls) - coordinated the golf tournament.
Virgil Smoot (CHKD) - coordinating exhibitor door prizes.
Michael Reichenbach (Martha Jefferson Hospital) - coordination of
Educational offerings.
Steve Berlew (American I.V. Products) - (my boss) allowing me the time to work on behalf of the VBA.

Vendor Support - The VBA thanks the following vendors for their continued support at the Williamsburg annual meeting:

Physio Control
Comprehensive Monitoring Services
Spacelabs Medical
Medex
Hewlett Packard
Precision Endoscopy of America
Ditec
American IV Products
The Scale People
Protocol Systems
Endocare
IMS
Reimer Systems
Lee Hartman and Sons
Marquette Medical
Cadmet
Fibertech Medical
Dependable X-Ray
Bio-Tek Instruments
ECPI
Allied Medical
Medserv International
Specialties Services
Drager
Johnson and Johnson
Datascope
Graphic Controls

Educational Support - The following companies provided educational classes at the Williamsburg annual meeting. The VBA extends special thanks to the manufacturers for their support.

Precision Endoscopy of America - Christopher Hatcher
Spacelabs Medical - Manik Rane
Ditec - Manny Roman
RSTI - Larry Cornell
Marquette Electronics - Jeff Kabachinski
Comprehensive Monitoring Services - Gerhard Gerschwander

Golf Tournament Update - The first annual captain's choice VBA Golf Tournament was held at the Williamsburg National Golf Club on September 10^th. Thirty four players vied for the VBA green jacket. The winners were:
Lowest net score - Chong Kim (Carilion Health System), Paul Nelson (Riverside Hospital), Steve Berlew and Al Strickler (American IV Products)
Closest to Pin - Mike Hecht (HP)
Longest Drive - Michael Reichenbach (Martha Jefferson Hospital)
Special thanks to Graphic Controls for sponsoring beveraves during the day.

Al Strickler, American IV Products
Annual Meeting Coordinator

Are you the lucky one (or part of the team) designated to come up with the answers for Y2K (as year 2000 is being generically referred to) problems and issues? There is lots of information out there (both good and bad) dealing with it. One of the most comprehensive articles we've seen is in the November 1997 issue of "Materials Management" magazine. The article is titled "CODE BLUE 2000" (pages 16-22). It defines the basic issue at hand and goes into some of the fixes and possible future complications. It contains a list of websites (some shown in the "Connections" column) and a compliance questionaire sample.

This is a brief overview of some of the physiological considerations that come into play when using both a pulse oximeter and Index 2. Blood oxygen, hemoglobin and blood pressure are all discussed here, as are the workings of the pulse oximeter.

What Is Blood Pressure?

Blood pressure readings provide us with valuable information about the condition of our bodies, indicating health or the lack of it. With our fingertips, we can feel the waves of blood pressure (our pulse) most perceptibly at the pulse points in our wrists and neck, but blood pressure is actually (and naturally) the strongest in our aorta, where the blood leaves our heart. As the heart contracts (systole) and relaxes (diastole), the volume of freshly oxygenated blood increases and decreases measurably within the artery walls. This action causes the artery walls to expand and contract in rhythm with the heart. The force of the blood exerted upon the artery walls is what is called blood pressure. Contraction produces the highest pressure, and relaxation the lowest. When our blood pressure is taken, it is measured at the brachial artery in the forearm in millimeters of mercury (mmHg). If our blood pressure reading is at or near 120 mmHg (systolic) over 80 mmHg (diastolic), we are considered to be in peak health, all else being normal.

Gasses In Blood

But blood pressure is not the whole story, since the exact concentration of gases such as carbon dioxide and especially oxygen in your blood cannot be determined by a simple blood pressure test. To determine gas concentrations accurately, specifically of saturated oxygen, a blood-gas sensing device must be used, and must be capable of detecting the wide range of nominal values for these gases. Gas concentrations in blood, specifically oxygen (O2) and carbon dioxide (CO2), can be expressed as milliliters of gas per liter of blood, and can be indicated by the partial pressure that the gases exert in your blood at a given temperature.

Pulse Oximeters

Because of their ease of use in many hospital- and critical-care situations, pulse oximeters have greatly increased in popularity since their introduction a little over a decade ago. Today, pulse oximeters are virtually required equipment in situations where the monitoring of arterial oxygen saturation (SaO2) is essential, such as when anesthesia is in use, both during an operation and in post-operative recovery, intensive care, transport, and patient home care. Pulse oximeters have proven to be capable and reliable, being highly accurate in measuring blood SaO2 in the range of 80-100%, while at the same time needing little, if any, calibration. No patient preparation is required before using the pulse oximeter; in addition, the devices are so simple to operate that specialized training is unnecessary.

How Pulse Oximeters Work

Pulse oximeters are defined as non-invasive, arterial, oxygen-saturation monitors which measure the ratio of two principal forms of hemoglobin in the blood: saturated arterial hemoglobin (also called oxyhemoglobin), HbO2/SAT, to unsaturated (or reduced) hemoglobin, Hb. The oxygen saturation, SaO2, is defined as the ratio of the concentration of oxyhemoglobin (cHbO2) to the concentration of HbO2 + Hb (cHbO2 + cHb). Oxygen saturation is commonly expressed as a percentage and is calculated. Using this information, a correctly calibrated and operating pulse oximeter can accurately predict the level of oxygen in the blood, which in turn provides valuable data about the health of a patient, and in the case of anesthesia and post-operative recovery, the status of the patient. Pulse oximeters operate on the principle known as spectrophotometry, using wavelengths of light to determine the concentration of oxygen in the blood. Because we already know the wavelengths for the light absorption of blood hemo-globin, we can mathematically determine the arterial oxygen saturation in a patient's blood. The light emitting diodes (LED's) of a pulse oximeters shine two types of light-near infrared light (at 940 nanometers) and red light (at 660 nanometers)-wavelengths that pass through the skin and which are absorbed by both the oxyhemoglobin and the reduced hemoglobin. These light beams pass through the index finger of a patient to photo detectors on the opposite side of the pulse oximeter.

Using this dual light emitting and sensing technology, the pulse oximeter determines the amount of light absorbed by the blood and calculates the percent of oxygen saturation (SaO2). But it's not quite that simple. Pulse oximeters must also calculate out the effect of absorption caused by the presence of venous and capillary blood and soft tissue in order to obtain the true SaO2 figure. To do so, pulse oximeters use a system that distinguishes between "AC" components (the pulsating arterial blood) and "DC" components (the non-pulsating components mentioned just above). The pulse oximeter determines the AC component of absorbency at each wavelength and divides this by the corresponding DC (amplitude) component. This results in a "pulse-added" absorbency that is independent of the light intensity. The ratio (R) of these pulse-added absorbances is calculated using a .formula: When the ratio of red-to-infrared absorbance equals 1.00, the saturation is approximately 81%.

REFERENCES

Accuracy and Precision of Fourteen Pulse Oximeters, B. Hannhart, et al, Neonatal Intensive Care, Nov./Dec. 1991.
Clinical Pulse Oximetry, Thomas L. Petty, MD, Anesthesiology, v. 70, no. 1,Jan. 1989
Oximetry/Blood Gas, --- , Medical Electronics, Oct. 1989
The Concise Columbia Encyclopedia, (Columbia University Press, 1991), Microsoft Bookshelf, 1992

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This article was contributed by and printed with the permission of: BIO-TEK Instruments, Inc
(another BioTek article will appear in the next newsletter)

Apathy and a man on the Street

I don't know what the problem is with BMET's, but I sense a growing cancer of apathy. The fire that burned in the bellies of those creating a new profession (Clinical Engineering) is gone. We seem to think, "what can I get" not "what can I give". No wonder third party service vendors find opportunity everywhere, from hospitals to large equipment manufacturers. People looking for new work are hungry.

As hospital service departments and service organizations look to improve quality and the bottom line, BMET's must change their work practice to survive. Innovative equipment manufactures have figured it out. New and improved technologies like remote diagnostics and on-line troubleshooting software make the traditional BMET obsolete. Technology is making BMET's less technical. As technical skill levels drop, so does the value of a BMET to an employer. A pathetic discussion of the good old days means nothing. Employers owe us nothing for all the great work done in the past and people looking to take your job don't care.

Non-traditional work with fewer technicians is the norm. Stressed and overworked BMET's are not the hero of electrical safety days as service contracts, maintenance insurance, and asset management programs can often outperform apathetic in-hospital or overpriced OEM service. Fixing equipment is not as important as fixing the people that use the equipment. Operator error and training issues are equal to hard equipment failure in total numbers. BMET's are giving away the future to people embracing this idea. Anyone willing to work hard and not hide behind some self imposed rule of conduct is a BMET candidate. A stubborn refusal to change means replacement or retirement. Too many reading this today are looking for rocking chairs not service opportunities. People looking for opportunity are finding new work. I applaud the Third Party vendors entering our profession in greater numbers. Most of you will not find jobs with them. They want professionals unafraid to work, willing to self motivate, and communicate. So is the future that dark? Actually, I think it's what you, the individual, want to make. Here are three suggestions to dust off your old drive and dismiss the apathy that is crushing opportunity.

1) Education: Who says education stops with high school or college? And who said your employer is re quired to give all continuing ed uca tion. Your personal continu ing education is your greatest tool for the future. Personal continu ing education in computers or public speaking is a must. Set a goal to really study one service manual per week outside your place of employment. Rest as sured, waiting for your em ployer to educate is a certain way to find early, unwanted retirement.

2) Communication: People skills are equally as important as technical. There is no such thing as a bench tech, hiding behind a smoking sol dering iron and oscilloscope. How often in the last year have you used either? To get your point across to nurses, physicians, administrators and technicians requires training and knowledge. Knowledge of the subject (education) and knowledge of communicating ideas. The BMET must become a great com municator. Communication is visual and verbal which means dress appropri ately.

3) Interfacing: BMET's should be the lead interface between clinical equipment and Information Man agement systems. If not, the MIS department will assume this role and BMET's will be relegated to fixing BP cuffs and stethoscopes.

Do you agree? Disagree? Tell me why Ben.Clark@CentraHealth.com

In looking around on the I'net and reading thru some of the journals I've come up on some interesting sites. Some of these you may have seen some not. Some are useable info and reference information and some are just for fun. If you have or know of any sites you think would be useable to others send them in to me and I'll list them in the future.

lee.gilley@centrahealth.com

First up: Have you checked out our own site lately. Well, you should. Mark Freeman is continuously adding to and upgrading it. Take a look - check it out - "www.vabiomed.org"

There's a new biomed email bulletin board out there if you haven't seen it. It's called BIOMEDTALK. To subscribe email to "BIOMEDTALK-L @listserv.aol.com" and in the body (message) just type - "subscribe BIOMEDTALK-L" and your name. There's been some pretty lively discussions from around the world on it lately.

For those that deal with your facilities radio communications check out "www.fcc.gov" for the latest info.

Anyone starting or already tackling the "Y2K" (year 2000) issue needs to look at the "www.y2k.gov.au/biomed" site. They're already done a lot of your work there.

Year 2000 Information Center. The largest of all Y2K sites. 246K hits in September alone. By Peter De jager "www.Year 2000.com"

Y2K gloom and doom prophet Gary North has some impressive links if you scroll past his personal apocalyptic vision to find them. "www.garynorth.com/y2k/search_.cfm"

The VBA and I would like to thank all vendors for participating in our annual symposium. A special THANK YOU goes out to the vendors donating door prizes to our event. The vendors donating the wonderful door prizes are as follows:

DITEC Ruth and Manny Roman

Color Pocket LCD TV

Ditec Hat

Ditec Thermos Mug

ECPI Jennifer Brown and Jim Dozier

Two ECPI Mugs

ECPI Tee Shirt

ECPI Hat

MEDSERV INT. Mike Schmidt

Golfshirt

FIBERTECH Cortes Pauls

Nikon "Funtouch" 35mm Camera

HEWLETT PACKARD Larry Gasparini

Two HP 10B Financial Calculators

MARQUETTE Ms. Dale Monroe

Two "Affinity" Reference Guides for Biomedical Technicians

LEE HARTMAN & SONS Cyril Hollland

Four packages of Video Tapes

CADMET David Guerry

Cordless Screwdriver Versapak

PHYSIO CONTROL George Buchanan

Physio Notebook

SPACELABS Manik Rane Ms. Andi Shick

Volume Set of "Clinical Information & Technology Series" books

In addition once again Spacelabs sponsored the "BMET of the YEAR" award. The lucky winner was TOM YUSAVAGE. He is from Mary Washington Hospital in Fredricksburg, Va. Manik Rane presented Tom with a very nice Plaque and a $100.00 check.

Virgil Smoot, CBET
CHKD, Norfolk, Va