Medical Equipment Module

Track PAP device assignments, mask interfaces, and equipment serial numbers

Overview

The Medical Equipment module manages the assignment and tracking of PAP (Positive Airway Pressure) devices and mask interfaces provided to patients for home therapy. It serves as an inventory system and ensures proper equipment accountability.

Model: EquipoMedico
Location: apps/exams/models.py:293-352

This module tracks equipment dispensed to patients, not facility inventory. Each record represents a device and mask combination assigned to a specific patient admission.

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Equipment Data Fields

PAP Device Information

marca_equipo · CharField · required

Device Brand - Manufacturer of the PAP device

Available Choices:

• BMC - BMC Medical
• RESMED - ResMed
• PHILIPS RESPIRONICS - Philips Respironics
• SEFAN - Sefan
• RESVENT - Resvent
• CURATIVE - Curative Medical
• PRISMA - Prisma
• DEVILBIS - DeVilbiss

Form Label: “Marca del Equipo”
Display Labels: Formatted brand names (e.g., “Philips RespiroNics”)

serial_equipo · CharField · required

Device Serial Number - Unique identifier for the specific PAP device

• Max Length: 100 characters
• Format: Text field (alphanumeric)
• Form Label: “Serial del Equipo”
• Purpose: Equipment tracking, warranty management, recall identification
• Example: “RMD19A12345678”

Always record the complete serial number exactly as printed on the device label. This is critical for:

• Equipment recalls and safety alerts
• Warranty claims and technical support
• Theft recovery and loss prevention
• Insurance documentation

modo_ventilatorio · CharField · required

Ventilatory Mode - Type of positive airway pressure therapy the device provides

Available Choices:

• CPAP - Continuous Positive Airway Pressure
• BiPAP - Bilevel Positive Airway Pressure
• BiPAP ST - BiPAP with Spontaneous/Timed backup rate

Form Label: “Modo de Ventilación”

Mode Descriptions:

Mode	Description	Typical Use Cases
CPAP	Single continuous pressure throughout breathing cycle	Standard obstructive sleep apnea
BiPAP	Two pressure levels (higher on inhale, lower on exhale)	High pressure needs, pressure intolerance, COPD overlap
BiPAP ST	BiPAP + backup respiratory rate if patient stops breathing	Obesity hypoventilation syndrome, central apnea, neuromuscular disease

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Mask Interface Data

Mask Type

tipo_mascara_eq_medico · CharField · required

Mask Type - Style of interface connecting patient to PAP device

Available Choices:

• PILLOW NASAL - Nasal pillow (minimalist interface inserted into nostrils)
• NASAL - Nasal mask (covers nose only)
• ORONASAL - Full face mask (covers both nose and mouth)

Form Label: “Tipo de Mascara”
Display Labels:

• PILLOW NASAL → “Pillow nasal”
• NASAL → “Nasal”
• ORONASAL → “Oronasal”

Mask Type Selection Guide:

Nasal Pillow (Pillow Nasal)

Design: Soft silicone plugs inserted into nostrils

Advantages:

• Minimal contact (best for claustrophobia)
• Unobstructed field of vision
• Ideal for people who wear glasses or read in bed
• Lightweight and comfortable

Disadvantages:

• Requires nasal breathing (not for mouth breathers)
• Can cause nostril irritation at high pressures
• May dislodge more easily with movement
• Not suitable for CPAP >15 cmH₂O typically

Best For: Mild-moderate OSA, pressure-sensitive patients, active sleepers

Nasal Mask (Nasal)

Design: Cushion that seals around the nose

Advantages:

• Stable seal for most pressure levels
• Comfortable for most patients
• Good for side sleepers
• Wide variety of models and sizes

Disadvantages:

• Requires nasal breathing
• Mouth leak if patient opens mouth during sleep
• Pressure on nasal bridge

Best For: Most patients with nasal breathing, standard OSA treatment

Full Face Mask (Oronasal)

Design: Cushion that seals around both nose and mouth

Advantages:

• Works for mouth breathers
• Tolerates higher pressures
• No mouth leak issues
• Essential for BiPAP ST (prevents CO₂ rebreathing)

Disadvantages:

• More claustrophobic feeling
• Higher leak rates
• More difficult to fit properly
• Obstructs field of vision
• Associated with higher AHI (increases dead space)

Best For: Mouth breathers, nasal obstruction, high pressures, BiPAP ST

Mask Specifications

talla_mascara · CharField · required

Mask Size - Size of the mask fitted to the patient

Available Choices:

• SMALL - Small
• MEDIUM - Medium
• LARGE - Large

Form Label: “Talla de la Máscara”

Proper mask sizing is critical for therapy success:

• Too small: Excessive pressure points, skin breakdown, pain
• Too large: Air leaks, ineffective therapy, noise
• Incorrect size is the #1 cause of CPAP abandonment

Always use manufacturer sizing guides and verify fit before dispensing equipment.

referencia_mascara · CharField · required

Mask Model/Reference - Specific product model or reference number

• Max Length: 100 characters
• Form Label: “Referencia Mascara”
• Default: “No especificado”
• Purpose: Track specific mask models for reordering, troubleshooting
• Examples: “AirFit N20”, “Amara View”, “Mirage Quattro”

Recording the specific mask model (referencia_mascara) helps when:

• Patient needs replacement parts (cushions, headgear)
• Different models within same type/size have different characteristics
• Tracking which models have highest satisfaction/lowest leak rates
• Documenting mask trials if first model unsuccessful

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Relationships

ingreso · ForeignKey

Links to the patient’s active admission record

Related Name: equipos_medicos
On Delete: CASCADE

registrado_por · ForeignKey

User who registered this equipment assignment

Related Name: equipos_medicos_registrados
On Delete: SET_NULL

created_at · DateTimeField

Timestamp when this equipment record was created

Auto-generated: Automatically set on record creation
Represents: Date equipment was dispensed/assigned to patient

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Registration Workflow

View: register_equipo_medico (apps/exams/views.py:276-300)

def register_equipo_medico(request, patient_id):
    patient = get_object_or_404(Patient, id=patient_id)
    
    # Find patient's active admission
    ingreso_actual = patient.ingresos.filter(estado='ACTIVO').first()
    
    if request.method == 'POST':
        form = EquipoMedicoForm(request.POST)
        if form.is_valid():
            equipo_medico = form.save(commit=False)
            
            # Link to active admission
            equipo_medico.ingreso = ingreso_actual
            equipo_medico.registrado_por = request.user
            
            equipo_medico.save()
            
            messages.success(
                request,
                f'Equipo Médico registrado para {patient.nombre} exitosamente'
            )
            return redirect('patient_clinical', patient_id=patient.id)
    else:
        form = EquipoMedicoForm()
    
    return render(request, 'exams/register_equipo_medico.html', {
        'patient': patient,
        'form': form
    })

Equipment Assignment Process

Typical Workflow:

1. Titration Study Completed (see Polysomnography)
   • Determines optimal pressure settings
   • Identifies best mask type and size
2. Equipment Selection
   • Choose device brand and model based on:
     • Ventilatory mode needed (CPAP vs BiPAP vs BiPAP ST)
     • Pressure requirements
     • Available inventory
     • Insurance coverage
   • Select mask type and size from titration results
3. Patient Education
   • Demonstrate device operation
   • Teach mask application and adjustment
   • Explain cleaning and maintenance
   • Set expectations for adaptation period
4. Equipment Dispensing
   • Record device serial number
   • Document mask specifications
   • Create equipment record in system (this module)
   • Provide user manual and contact information
5. Follow-up Planning
   • Schedule follow-up visit (typically 1-2 weeks)
   • Explain how to access usage data
   • Provide troubleshooting resources

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Equipment Inventory Management

Tracking Considerations

Device Accountability

Per Record:

• Which specific device (serial number)
• Assigned to which patient (ingreso)
• Dispensed by whom (registrado_por)
• When dispensed (created_at)

Enables audit trail for expensive medical equipment

Replacement Tracking

Multiple Records Per Patient:

• Device malfunction replacement
• Mask size change (initial fitting error)
• Mask type change (intolerance)
• Mode upgrade (CPAP → BiPAP)

Each assignment creates new record with timestamp

Analytics Queries

# Example queries (not in source code, but useful)

# Current equipment inventory assigned to active patients
from django.db.models import Count
active_devices = EquipoMedico.objects.filter(
    ingreso__estado='ACTIVO'
).values('marca_equipo', 'modo_ventilatorio').annotate(
    count=Count('id')
)

# Most common mask type by ventilatory mode
mask_usage = EquipoMedico.objects.values(
    'modo_ventilatorio', 'tipo_mascara_eq_medico'
).annotate(count=Count('id')).order_by('-count')

# Devices due for recall (specific serial number pattern)
recall_devices = EquipoMedico.objects.filter(
    marca_equipo='PHILIPS RESPIRONICS',
    serial_equipo__startswith='PH5XX'  # Example recall pattern
)

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Clinical Workflow Integration

Equipment Assignment Timeline

┌─────────────────────┐
│  Basal Study        │ → Diagnose OSA severity
│  (PolisomnografiaBasal)
└──────────┬──────────┘
           ↓
┌─────────────────────┐
│  Titration Study    │ → Determine optimal pressures & mask
│  (PolisomnografiaTitulacion)
└──────────┬──────────┘
           ↓
┌─────────────────────┐
│  Equipment Assignment│ ← THIS MODULE
│  (EquipoMedico)     │ → Dispense device with specific serial #
└──────────┬──────────┘
           ↓
┌─────────────────────┐
│  Monitoring         │ → Track adherence & effectiveness
│  (Monitoreo)        │
└─────────────────────┘

Connection to Other Modules

From Titration to Equipment

Data Flow: PolisomnografiaTitulacion → EquipoMedico

Titration Study Determines:

• tipo_titulacion → modo_ventilatorio (CPAP/BiPAP/BiPAP ST)
• tipo_mascara → tipo_mascara_eq_medico (mask type)
• talla_mascara → talla_mascara (mask size)
• presion_ipap/presion_epap → Device programmed with these settings

Equipment Assignment Adds:

• marca_equipo (brand selection based on availability)
• serial_equipo (specific device accountability)
• referencia_mascara (specific mask model)

Note: Pressure settings from titration are programmed into the device but not redundantly stored in this model (avoid data duplication).

Equipment to Monitoring

Data Flow: EquipoMedico → Monitoreo

Equipment Record Establishes:

• Device capabilities (CPAP can’t deliver BiPAP pressures)
• Expected mask interface (leak detection baseline)
• Serial number for data download

Monitoring Tracks:

• Device usage data (adherence metrics)
• Mask leak rates (may indicate sizing issue)
• Pressure settings actually used (vs. prescribed)
• Equipment malfunction indicators

Feedback Loop: High leak rates in Monitoring → May need mask size change → New EquipoMedico record with different talla_mascara

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Equipment Troubleshooting

Common Issues

Excessive Mask Leak

Symptoms: High leak rate on device data download, whistling noise, low residual AHI improvement

Possible Causes:

• Wrong size: talla_mascara Small when Medium needed
• Wrong type: Pillow nasal with mouth breathing
• Worn cushion: Needs replacement (typically every 3-6 months)
• Facial hair: Beard prevents proper seal
• Over-tightening: Paradoxically increases leak

Solutions:

• Re-fit mask using manufacturer sizing template
• Try different tipo_mascara_eq_medico (e.g., nasal → full face)
• Replace cushion
• Adjust headgear tension
• Consider mask with seal designed for facial hair
• Document new assignment in EquipoMedico if equipment changed

Device Malfunction

Symptoms: Device won’t turn on, error messages, unusual noise, pressure fluctuations

Troubleshooting Steps:

1. Check power connection and outlet
2. Verify filter is clean (replace monthly)
3. Ensure water chamber properly seated (if humidifier)
4. Review user manual for specific error codes
5. Check warranty status using serial_equipo and created_at

If Replacement Needed:

• Check if under warranty (typically 2-3 years)
• Contact manufacturer using marca_equipo and serial_equipo
• Dispense replacement device
• Create new EquipoMedico record with new serial number
• Keep old record for audit trail (don’t delete)

Patient Requests Different Equipment

Scenarios:

• Prefers different brand (quieter, smaller, etc.)
• Wants different mask type (claustrophobia with full face)
• Needs different mode (CPAP intolerable, requests BiPAP)

Clinical Approach:

1. Validate complaint: Is it preference or actual clinical issue?
2. Review data: Check adherence and residual AHI first
3. Education: Many issues resolve with adaptation (1-2 weeks)
4. Legitimate change: If clinical indication or persistent intolerance
   • Document reason for change
   • Obtain prior authorization if insurance required
   • Create new EquipoMedico record
   • Note this is a replacement in clinical documentation

Red Flag: Frequent equipment changes may indicate psychological barriers to therapy (see Psychology Module)

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Compliance and Regulatory Considerations

Insurance Documentation

PAP devices are expensive durable medical equipment (DME). Most insurance plans require:

• Documented diagnosis (polysomnography with AHI ≥5)
• Medical necessity (typically AHI ≥15 or AHI 5-14 with symptoms)
• Compliance demonstration (≥4 hours/night for 70% of nights during first 90 days)
• Serial number documentation for reimbursement

The EquipoMedico record provides essential documentation for insurance claims.

Recall Management

Critical Safety Function:

1. Manufacturer recalls (e.g., Philips Respironics foam degradation recall 2021)
2. Serial number tracking enables rapid patient identification
3. Query affected devices: Filter by marca_equipo and serial_equipo pattern
4. Contact patients: Retrieve via ingreso.paciente relationship
5. Replace devices: Create new EquipoMedico records for replacements

Example Query:

# Identify patients affected by recall
affected = EquipoMedico.objects.filter(
    marca_equipo='PHILIPS RESPIRONICS',
    serial_equipo__regex=r'^[serial pattern]$',
    ingreso__estado='ACTIVO'
).select_related('ingreso__paciente')

for equipment in affected:
    patient = equipment.ingreso.paciente
    # Contact patient for device replacement

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Data Retrieval

View: patient_clinical (apps/exams/views.py:34)

# Get all medical equipment assigned to active admission
equipos_medicos = EquipoMedico.objects.filter(
    ingreso=ingreso_actual
).order_by('-id')

Equipment records are filtered by the patient’s active admission and ordered by ID (most recent first). Multiple records indicate equipment changes during the treatment cycle (e.g., mask size adjustment, device replacement).

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Best Practices

Serial Number Accuracy

Critical:

• Double-check serial number entry
• Photograph device label as backup
• Verify against manufacturer database
• Essential for recalls and warranty

Mask Fit Verification

Essential:

• Use manufacturer sizing guides
• Have patient wear mask 10-15 minutes
• Check for red marks (too tight)
• Verify seal with device running
• Document specific model reference

Patient Education

Required:

• Demonstrate assembly/disassembly
• Explain cleaning procedures
• Set realistic expectations (adaptation)
• Provide written instructions
• Emphasize replacement schedule

Follow-up Planning

Important:

• Schedule 1-2 week check-in
• Plan data download at 30 days
• Mask cushion replacement at 3 months
• Full mask replacement at 6 months
• Device servicing per manufacturer

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Related Modules

Polysomnography

Titration study determines equipment needs

Monitoring

Track device usage and effectiveness

Pulmonology

Specialist prescribes advanced device modes