Table of Contents 1. Scope 2 2. Objective 2 3. Definitions 2 4. Responsibility 2 5. Procedure 2 6. Precautions 8 7. References 8 8. Appendices 8 9. Revision History 8 Page Original Authorised Copy for: Reading Copy Written by: Reviewed by: Approved by: Signature/Date: Signature/Date: Signature/Date: Page 1 of 8
1. Scope This Standard Operating Procedure (SOP) applies to the staff and students using the Littmann Classic II S.E. in the Pharmacy Practice Resource Unit (PPRU) at the Pharmacy Department, University of Malta. 2. Objective To describe the procedure for the operation and maintenance of the Littmann Classic II S.E. 3. Definitions 3.1. Littmann Classic II S.E.: A stethoscope with a two-sided chest piece consisting of a traditional bell together with a patented tunable diaphragm. 3.2. Patented Tunable Diaphragm: The part of the chest piece that enables the user to listen to both low and high frequency sounds without the need to turn over the chest piece. 4. Responsibility 4.1. The members of the Department of Pharmacy (staff and students) are responsible for following this SOP. 4.2. The designated Laboratory Officer or Laboratory Assistant is responsible for ensuring that this SOP is followed. 5. Procedure 5.1. Operation 5.1.1. Push each ear tip onto the end of each ear tube until they snap firmly into place. 5.1.2. Insert the ear tubes inside the ear canals ensuring that the ear tips are pointing in a forward direction as they are being inserted. 5.1.3. Hold the chest piece stem in one hand. 5.1.4. Rotate the chest piece with the other hand until a click is heard to adjust the side of the chest piece that needs to be used. 5.1.5. Use the open bell part of the chest piece to listen to low frequency sounds. Page 2 of 8
5.1.6. Use the tunable diaphragm part of the chest piece and apply firm pressure, to listen to high frequency sounds. 5.1.7. Use the tunable diaphragm part of the chest piece and apply light pressure, to listen to low frequency sounds. 5.2. Maintenance 5.2.1. Adjusting spring tension in headset 5.2.1.1. Hold each ear tube at the bend near each ear tip. 5.2.1.2. Gradually pull them apart until fully extended to reduce the spring tension in the headset. 5.2.1.3. Repeat 5.2.1.2 as necessary. 5.2.1.4. Grasp the headset with one hand, where the ear tubes enter the tubing. 5.2.1.5. Squeeze until the tubing on one ear touches the other to increase spring tension in the headset. 5.2.1.6. Repeat 5.2.1.4 and 5.2.1.5 as necessary. 5.2.2. Assembly and replacement of tunable diaphragm 5.2.2.1. Apply a small amount of talc using the finger tip to the inside surface of the flexible edge of the diaphragm to facilitate assembly and to maintain smooth and quiet low and high frequency alternation. 5.2.2.2. Snap the diaphragm with finger to remove excess talc. 5.2.2.3. Insert the flexible edge of the diaphragm into the groove of the rim by starting with the rim positioned above the legible side of the diaphragm. 5.2.2.4. Visually examine the ring to ensure that the flexible edge is smoothly engaged inside the rim. 5.2.2.5. Flex the assembly by pinching the outer rim edge between the thumb and fingers. 5.2.2.6. Attach the rim/diaphragm assembly to the chest piece by engaging the groove of the rim, with the diaphragm attached, around the chest piece at one point and holding it in place with both thumbs. 5.2.2.7. Slowly roll the rim around and over the chest piece edge using both thumbs, moving in opposite directions around the chest piece. Page 3 of 8
5.2.2.8. Visually inspect the edge where the diaphragm engages the rim for uniform containment. 5.2.2.9. Make minor adjustments by slightly pulling and rolling the rim away from the diaphragm ensuring that the diaphragm slips into position. 5.2.3. Cleaning For general cleaning: 5.2.3.1. Remove ear tips from the ear tubes for thorough cleaning. 5.2.3.2. Clean the entire stethoscope by wiping it with alcohol or soapy water. For chest piece cleaning: 5.2.3.3. Grasp the rim with the thumbs and index fingers of both hands with the diaphragm side-up. 5.2.3.4. Roll the rim off the edge of the chest piece. 5.2.3.5. Remove the diaphragm from the rim and clean the parts in soapy water or wipe with alcohol. 5.2.3.6. Dry all the parts and surfaces thoroughly before reassembly. Page 4 of 8
5.3. Flow Charts 5.3.1. Operation Start Push each ear tip onto the end of each ear tube until they snap firmly into place Insert ear tubes inside ear canals ensuring that ear tips are pointing in a forward direction as they are being inserted Hold chest piece stem in one hand Rotate chest piece with other hand until a click is heard to adjust side of chest piece that needs to be used Need to hear high frequency sounds Use open bell or else the tunable diaphragm and apply light pressure to listen to low frequency sounds Use tunable diaphragm and apply firm pressure End Page 5 of 8
5.3.2. Maintenance Start 1 Need to adjust spring tension in headset Need to assemble or replace tunable diaphragm 2 Need to reduce spring tension Hold each ear tube at bend near each ear tip and gradually pull them apart until fully extended. Repeat as necessary Grasp headset with one hand, where ear tubes enter the tubing, and squeeze until tubing on one ear touches the other to increase spring tension Apply a small amount of talc using finger tip to the inside surface of the flexible edge of the diaphragm Snap diaphragm with finger to remove excess talc Insert flexible edge of diaphragm into groove of rim, starting with the rim positioned above the legible side of the diaphragm 1 Flexible edge smoothly engaged inside rim Adjust accordingly Flex the assembly by pinching outer rim edge between the thumbs and fingers Attach rim/diaphragm to chest piece by engaging the groove of the rim around chest piece at one point and holding it in place with both thumbs Slowly roll rim around and over chest piece using both thumbs, moving in opposite directions around chest piece Visually inspect edge where diaphragm engages rim for uniform containment 3 Page 6 of 8
3 Minor adjustments necessary Slightly pull and roll rim away from diaphragm until it slips into position 2 General cleaning required Chest piece cleaning required Remove ear tips from ear tubes for thorough cleaning Grasp rim with thumbs and index fingers of both hands with the diaphragm side up Clean entire stethoscope by wiping with alcohol or soapy water Roll rim off edge of chest piece Remove diaphragm from rim and clean with soapy water or wipe with alcohol Dry all parts and surfaces prior to reassembly End Page 7 of 8
6. Precautions 6.1. Do not expose the stethoscope to extreme heat, cold, solvents and oils. 6.2. Do not immerse the stethoscope in any liquid or subject it to steam sterilisation. 6.3. Wipe the stethoscope with 70% isopropyl alcohol solution only if disinfection is required. 7. References 3M. Littmann Classic II S.E. Stethscope Instruction Manual. Neuss: 3M Health Care. 8. Appendices N/A 9. Revision History Version Number Amendments/ Reasons for change 01 Initial Release Page 8 of 8