Class 3_Storage and Distribution Pt 1_BB_F 2024.pptx

Storage and Distribution of Medical Gases Hess Chapter 13  Infection Control: Review Questions You are treating a patient with well-controlled asthma. What level of precautions should a respiratory therapist observe? A. Airborne B. Contact C. Standard D. Universal...

Storage and Distribution of Medical Gases Hess Chapter 13  Infection Control: Review Questions You are treating a patient with well-controlled asthma. What level of precautions should a respiratory therapist observe? A. Airborne B. Contact C. Standard D. Universal E. None since asthma is a non-infectious disease.  Infection Control: Review Questions A respiratory therapist is about to enter the room of a patient who has MRSA. What personal protective equipment should the therapist put on first? A. Gloves B. Goggles C. Gown D. Mask  Infection Control: Review Questions A 10-year-old boy has been brought into the hospital with measles. To avoid airborne transmission of the disease to other children on the ward, where should the patient be placed? A. In an airborne infection isolation room B. In a private room C. In a multi-patient ward D. In quarantine at home  Infection Control: Review Questions According to the Centers for Disease Control and Prevention, how often should ventilator circuits be changed? A. Daily B. After a week C. Every 2 weeks D. Once a month E. When there is visual or known contamination  Infection Control: Review Questions All of the following are common routes of disease transmission, except: A. Walking and talking. B. Droplet and airborne. C. Vehicle and indirect. D. Vector and direct.  Infection Control: Review Questions Airborne transmission occurs by the spread of evaporated droplet nuclei smaller than: A. 0.5 µm. B. 5 µm. C. 1 µm. D. 3 µm. What do you think this is?  Storage and Distribution As a respiratory care practitioner, you will be expected to know how to safely utilize the various medical gas supply systems available in your institution. With the main focus on Oxygen Delivery Systems.  Storage and Distribution When used appropriately, these systems are safe and effective. If mishandled, they can be potentially lethal.  Storage and Distribution These supply systems include medical gas cylinders, medical gas piping systems, liquid systems, and oxygen concentrators.  MEDICAL GAS CYLINDERS Cylinders manufactured for the transport of medical gases are constructed in accordance with regulations specifically established by the Department of Transportation (D.O.T.).  MEDICAL GAS CYLINDERS Medical Gas Cylinders are generally constructed from seamless steel meeting chemical and physical requirements. Cylinders are constructed by either spinning or stamping a flat sheet into the proper shape. Following construction, cylinders are heat treated to retain the steel’s tensile strength.  Cylinder Markings To be in compliance with D.O.T. regulations, all gas cylinders are required to have specific markings permanently stamped onto the upper shoulder of the tank/cylinder. The first marking stamped on the shoulder of a medical gas cylinder is “DOT 3AA.” This indicates that the cylinder meets the D.O.T. standards for 3AA-type compressed gas cylinders.  Markings and Identification The letters DOT (or ICC if prior to 1968) are followed by the cylinder classification and the normal filling pressure in pounds per square inch. Information about the original safety test and subsequent test.  Markings and Identification Safety test must occur every 5 to 10 years according to DOT Regulations During safety test, Cylinders are pressurized to 5/3’s of their service pressure.  Markings and Identification EE followed by a number indicates the cylinder’s elastic expansion in cubic meters under the 5/3’s test condition. The star symbol next to the test date indicates DOT approval for 10-year testing and approved for filling 10% above service pressure of 2015 psi. Markings and Identificatio n  Common Medical Gas Cylinder Sizes The two most common medical gas cylinder sizes encountered in the clinical setting are the “E” and “H.” Size E through AA are referred to as small cylinders. Sizes G and above are large Cylinders. CYLINDER SIZES H E H COLOR CODES Table 37 -2  Compressed Gas Cylinders For gas-filled cylinders, the volume of gas in the cylinder is directly proportional to its pressure at a constant temperature. If a cylinder is full at 2200 psig, it will be half full when the pressure drops to 1100 psig. Thus, in order to know how much gas is contained in a compressed gas cylinder, you need only measure its pressure.  Pressurized Cylinders Temperature of 70F or 21.11C H cylinder 244 cubic ft., 6,900 liters, weight of O2 20lbs. 2200psig E cylinder 22 cubic ft., 622 liters, weight of O2 2 lbs. 2200psig (pressure square  Liquid Gas Cylinders The measured pressure is the vapor pressure above the liquid. This pressure bears no relationship to the amount of liquid remaining in the cylinder. The only accurate method to determine the contents of a liquid-filled cylinder is to weigh it.  Liquid Oxygen Systems 1 cubic foot of liquid oxygen equals 860 cubic feet of gas, enabling liquid oxygen systems to store large quantities of oxygen in small spaces. To keep oxygen in liquid form, it is stored in large stand tanks at relatively low pressure (less than 250 psig). These stand tanks are like a giant thermos bottle, consisting of inner and outer steel shells separated by an insulated vacuum chamber. Liquid O2 Storage Tanks Liquid Oxygen Systems Liquid O2 System for Home Use  Liquid Oxygen Systems Liquid oxygen must continually be stored below -181.1 F or -118.8 C When the liquid oxygen flows through vaporizer coils exposed to ambient temperature, it quickly converts back to a gas to the standard working pressure of 50 psi by a pressure reducing valves. A safety vent allows vaporized liquid oxygen to escape  Cylinder Valves and Cylinder Valve Safety Systems Due to the high pressure contained in a medical gas cylinder, a device is required to contain the gas and to provide a point of attachment for equipment. These devices are termed cylinder valves. The cylinder valves are located at the top of the cylinder and are of two types: direct-acting or diaphragm. Cylinder Valves  Safety Systems In a closed cylinder, any rise in gas temperature will increase gas pressure. Should the temperature increase too much (as in a fire), the high gas pressure could rupture and explode the cylinder To prevent this type of accident, all cylinders incorporate high-pressure relief valves.  Relief Valves There are three basic designs: frangible disk, fusible plug, and spring loaded.  Relief Valves The fusible plug is made from a metal with a low melting point. If the temperature rises beyond the melting point of the metal plug, the plug melts and releases the pressure in the cylinder. Intentionally Left Blank  Safety System One of the greatest risks in medical gas therapy is giving the wrong gas to a patient. Careful reading of cylinder or outlet labels is the best way to avoid these accidents. A safety system was designed by the Compressed Gas Association to prevent the interchange of cylinders and possibly delivering the wrong gas.  Safety System There are two safety systems designed to prevent the interchange of cylinders containing different gases: one for large cylinders and one for “E” cylinders and other small cylinder sizes.  Safety System This system was formally adopted by the American Standards Association and called American Standard Indexing, or American Standard Safety System (ASSS)  ASSS American Safety Standard System  Safety System Large Cylinders The large cylinder safety system consists of different thread sizes and pitches and both internal and external threading. In addition to the safety system described above, large medical gas cylinders have a protective cap that covers the cylinder valve. This cap is threaded and matches threads on the cylinder shoulder just below the valve.  Safety System Small Cylinders Small cylinders valves utilize a yoke connection rather than a threaded connection for equipment attachment. The face of the cylinder valve has two holes drilled in two of six specific positions. This system is commonly known as the Pin Index Safety System (PISS).  Safety Indexed Connector Systems Three basic indexed safety systems involved in the delivery and regulation of medical gases: (1) American Safety Standard System - ASSS for short; (2) Pin-Index Safety System (PISS); (3) Diameter-Index Safety System (DISS)  Diameter Index Safety System The PISS and ASSS systems are designed for use on high-pressure cylinders. In contrast, the Diameter Index Safety System (DISS) was designed by the CGA for low-pressure (0 - 200 psig) connections and fittings. (CGA = Compressed Gas Association). DISS utilizes specific diameter-threaded male outlets that mate with a corresponding female nut and nipple. Different diameters, thread pitch, and nipple configurations are assigned to various gases and gas mixtures. Diameter-Index Safety System (DISS) Oxygen – Always Green. Air – Always Yellow. Pin-Index Safety System (PISS) If it has threads it is ASSS ASSS Flow Meter with a 50 psig Outlet.  Obtaining the Cylinder from Storage Large medical gas cylinders are stored along a wall where, for optimal safety, chains or straps are provided to secure the cylinders to the wall. The safety chains will prevent the cylinders from accidentally falling from the upright position  Maneuvering Large Medical Gas Cylinders An oxygen “H” cylinder weighs approximately 126 pounds when full. Care must be exercised when handling this much weight concentrated in a relatively small package. Besides the weight factor, the pressure in a full cylinder, if mistreated, could cause serious injury.  Transporting the Cylinder and Cart To transport the cylinder and cart, place one hand on the safety cap over the cylinder valve and the other hand on the handle of the cart. Push the cylinder and cart in front of you while keeping a sharp eye out for other personnel, objects, or hazards.  Cracking the Cylinder Before attachment of any equipment to a cylinder, the cylinder valve must be cracked. Cracking the cylinder removes any dust, or particulate matter, from the outlet of the cylinder valve.  Cracking the Cylinder When a cylinder is cracked, 2200 psi exiting through the narrow opening of the cylinder valve makes a very loud hissing noise. The sudden noise is enough to sufficiently startle anyone. Give Warning, “Cracking.” And wear Safety Googles to avoid getting debris in your eyes.  Cracking the Cylinder Respiratory care practitioners must ensure that any oil or dust is cleared from high-pressure medical-gas delivery systems before pressurization. Why is this action needed? Adiabatic compression could ignite the oil or dust.  E ! T I M AB L