A Biomedical Technician/Technologist is an indirect patient care provider. The medical devices that are maintained by the biomed are used by healthcare professionals to diagnose/treat patients. If the medical device is not operating as per the manufacturer’s specifications, the patient diagnosis/treatment may be incorrect and the biomed “may” be negligent! The vast majority of biomeds perform their job with outstanding ethics and ensure the medical devices they maintain are operating as per the manufacturer’s specifications, prior to use, after a PM (Preventative Maintenance) and/or repair.
What does the term PM mean? PM involves the biomed performing two distinct tasks plus electrical safety:
* Preventative Maintenance: doing something on a medical device to avoid future issues.
* Performance Checks: ensuring the medical device is working as designed.
* Electrical Safety: ensuring the device poses no electrical hazard to the patient or user.
I have three medical device incidences I would like to share, for the purposes of discussing ethics in the profession:
1. An Infant Incubator that caused a skin burn: A nurse pulled a neonate out of an incubator due to excessive crying and realized the neonate received skin burns. After the incident, I did a reviewed of this incubator by running full performance tests. I found the primary heating circuit failed and allowed the heating element to stay on fully. I also found the secondary over temperature safety circuit was bypassed which allowed the internal temperature to rise high enough to cause the skin burns. In this situation, the biomed who maintained this medical device had questionable ethics because the safety was bypassed (negligence) and his prior PM results stated he tested and passed the over temperature safety circuit numerous times. An ethical biomed would never bypass a safety circuit and/or falsify PM results.
2. Defibrillator with pacing failed while on battery: A patient presented to an Emergency Department (ER) with chest pain. The ER physician determined the patient’s heart needed to be externally paced and then transferred to the Operating Room (OR) for surgery. In this situation a Defibrillator with a pacer ability was used to pace the patient’s heart for transport to the OR. Unfortunately, when they unplugged the defibrillator and proceeded down the hallway towards OR, the battery failed within a few minutes. They quickly returned to ER to re-establish pacing and again stabilize the patient. Another device was used for external pacing via battery power so they patient could be safely transported to OR. After this incident, I did a reviewed of the defibrillator by running full performance tests and determined the defibrillator’s battery was not maintained or tested properly for quite some time. The battery was over 7-years old although the manufacturer recommends replacement every 5-years. Secondly, the defibrillator had a PM performed 1-week prior which stated the battery passed full capacity tests, highly suspicious? Feedback from the ER staff proved the battery operation was questionable months prior to the incident. In my opinion this biomed had very questionable ethics and was clearly negligent on maintaining this life-saving medical device! An ethical biomed would never place a life-saving medical device into service, such as a defibrillator, if it is not fully functional.
3. Electrosurgery unit (ESU) caused a skin burn: In this situation, the return electrode plate (REP) burned the patient’s back. I personally maintained this ESU so I was on the hot-seat! After this incident, I did a reviewed of the ESU by running full performance tests but found no issues. The head nurse eventually showed me the REP which was covered with skin and hair in two corners of the patient plate. This occurred many years ago on an ESU that had no Return Electrode Monitor (REM) safety circuit (yup feeling old!). Prior to REM, an ESU would still operate with a high patient/plate contact resistance. The nurse did not properly clean/remove hair from the patient’s back and ensure the REP fully contacted the patient’s back. As a result, large amount of heat (I2R) existed at the REP, burning the patient’s back. In this situation the nurse had questionable ethics as she dropped the plate prior to use, did not perform proper preparation of the back and failed to ensure the REP was fully in contact with the patient’s back. The nurse stated she was not trained properly and was re-trained after the incident.