Class 4_Storage and Distribution Pt 2_BB_F 2024.pptx

Storage and Distribution of Medical Gases Part II Hess Chapter 13 & 14 Safety systems were designed by the Compressed Gas Association to: A. Prevent the delivery of the wrong gas having different connections. B. Insure that tanks are stored properly. C. Insure t...

Storage and Distribution of Medical Gases Part II Hess Chapter 13 & 14 Safety systems were designed by the Compressed Gas Association to: A. Prevent the delivery of the wrong gas having different connections. B. Insure that tanks are stored properly. C. Insure that tanks are mark with the proper label. D. Allow safe transport across state lines. Which answer below best describes the picture? A. E –cylinder with regulator B. E- cylinder with ASSS connection C. H – cylinder with PISS connection D. H- cylinder with ASSS regulator The tank color of He/Ox is? A. Grey B. Yellow C. White D. Brown & Green Working pressure on a full H-cylinder that has passed the elastic expansion test. A. 2015 psig B. 50 psig C. 2200 psig D. 10 psig What is the name of this safety system? A. ICCA B. PISS C. DISS D. ASSS An H-cylinder holds how many cubic ft of compressed gas? A. 22 cubic ft. B. 860 cubic ft. C. 244 cubic ft. D. 315 cubic ft. One cubic ft. of liquid Oxygen will expand? A. 22 times B. 860 times C. 244 times D. 120 times What is this safety system called? A. DISS B. ASSS C. PISS D. ICC/DOT What is the working pressure that comes out of this connection? A. 100 psig B. 10 psig C. 220 psig D. 50 psig Which of the below statements about tanks is FALSE? A. Controlled by the DOT B. Service pressure 2200 C. Tested every 5 to 10 years D. All gas cylinders are required to have specific markings permanently stamped onto the upper shoulder of the tank/cylinder What is this?  DISTRIBUTION AND REGULATION OF MEDICAL GASES Before you can administer a medical gas to a patient, it must be delivered to the bedside and reduced to a workable pressure. Modern hospital gas distribution systems deliver bulk oxygen and compressed air to patient rooms and special care areas via an elaborate piping network.  MEDICAL GAS PIPING SYSTEMS The National Fire Protection Association (NFPA) is the organization that recommends the standards for construction of medical gas piping systems. These piping systems may be supplied by a bulk liquid supply of gas, a manifold composed of two or more large medical gas cylinders, or both. Bulk Supply Manifold System  MEDICAL GAS PIPING SYSTEMS Should the bulk supply system run out, a safety system is provided. A piping system is required to have a reserve or backup supply of oxygen. As the pressure in the supply line drops after exhausting the main oxygen supply, the reserve system is automatically switched on.  The Reserve System (Back-Up) May consist of a liquid bulk supply, a manifold of two or more cylinders, or a combination of the two. Must be able to meet a facility’s oxygen needs for a minimum of 24 hours, according to NFPA regulations.  Reducing Valves High pressure must be reduced to a working pressure of 50 psi. Respiratory care equipment is designed to function at this lower working pressure. Operating equipment at the lower pressure has obvious safety advantages.  Reducing Valves The devices that reduce the pressure in the medical gas cylinder from 2200 psi to 50 psi are termed reducing valves. There are many types of reducing valves: single stage, modified single stage, and multistage.  Reducing Valves A single stage reducing valve has one chamber for the reduction of cylinder pressure to 50 psi. A modified single stage reducing valve is very similar in design to a single stage reducing valve. The only difference is the addition of a poppet closing spring.  Poppet Valve A Poppet Valve is used to control the timing and quantity of gas or vapor flow. Single Stage Reducing Valve  Reducing Valves A multistage reducing valve consists of two or more single stage reducing valves working in series. The first stage of the reducing valve is usually preset by the factory to a pressure of approx. 200 psi. The gas then enters the second stage and is reduced to the correct working pressure of 50 psi. Multi-Stage Reducing Valve  Reducing Valves The advantages of a multistage reducing valve are: More accurate regulation of pressure, Smoother operation, and Consistently higher flow rates.  PIPING SYSTEMS in a MEDICAL FACILITY Each floor of a building is divided into several zones. Each zone has a safety shutoff valve, termed a zone valve. In a multistoried building, each floor is provided oxygen by a pipe termed a riser. Each riser is required to have a safety shutoff valve in the event of a fire. Zone s and Riser s Zone Valves  Characteristics of Medical Gases In regard to fire risk, medical compressed gases are classified as either nonflammable (will not burn), non­flammable but will support combustion, or flammable (will burn readily, potentially explosive, and is sometimes termed inflammable).  Characteristics of Medical Gases Nonflammable: Nitrogen, Carbon Dioxide, Helium (will not burn) Support combustion: oxygen, nitrous oxide, air, oxygen-nitrogen, oxygen-carbon dioxide, helium­oxygen, nitric oxide Flammable: Cyclopropane, Ethylene  Oxygen (02) Characteristics A colorless, odorless, transparent, and tasteless gas Oxygen is nonflammable, but it GREATLY accelerates combustion. Burning speed increases with an increase in the oxygen percent or an increase in total pressure. Thus, both oxygen concentration and partial pressure influence the rate of burning.  Oxygen (02) Characteristics Patient Safety-- what would be the effect of a patient lighting a cigarette while being delivered O2 through the nose…. - AT HOME? - IN THE HOSPITAL? Intentionally Left Blank  Oxygen (02) Production Most medical oxygen is mass produced by fractional distillation of atmospheric air. Fractional distillation is the most common and least expensive method for producing oxygen.  Fractional Distillation The process involves several related steps. First, atmospheric air is filtered to remove pollutants, water, and carbon dioxide. The purified air is then liquefied by compressing it to a high pressure, and then cooling it by rapid expansion (the Joule-Thompson effect).  Fractional Distillation The resulting mixture of liquid oxygen and nitrogen is heated slowly in a distillation tower. The remaining liquid oxygen is then transferred to a specially insulated cryogenic (low-temperature) storage cylinders. Food and Drug Administration (FDA) standards require an oxygen purity of at least  Oxygen (02) Production Physical Separation: Two methods are used to separate oxygen from air. The first method uses molecular “sieves” composed of inorganic sodium aluminum silicate pellets. These pellets absorb nitrogen and water vapor from the air, thus providing a concentrated mixture of over 90% oxygen for patient use. Molecular Sieve Concentrator  Oxygen (02) Production The second method uses a semi-permeable plastic membrane to filter nitrogen (but not water vapor) from ambient air. This system can produce an oxygen mixture of about 40%. These devices, called oxygen concentrators, are used primarily for oxygen supply in the home care setting.  Air A colorless, odorless, naturally occurring gas mixture consisting of 20.95% oxygen, 78.1% nitrogen, and about 1% “trace” gases, mainly argon. Medical-grade air is usually produced by filtering and compressing AIR COMPRESSOR  Carbon Dioxide (C02) At STPD, carbon dioxide is a colorless and odorless gas with a specific gravity of 1.53 (about 1.5 times heavier than air). Carbon dioxide does not support combustion or maintain animal life. Today, the therapeutic use of carbon dioxide mixtures is limited. CO2 mixtures are still used in membrane oxygenators (Heart Lung Machine aka ECMO).  Helium (He) Helium is second only to hydrogen as the lightest of all gases, with a density at STPD of 0.1785 g/L. Helium is odorless and tasteless and inert (thus nonflammable) Helium always must be mixed with at least 20% oxygen. Some clinical centers use heliox to treat severe cases of large airway obstruction, such as life-threatening asthma.  Nitrous Oxide (N20) A colorless gas with a slightly sweet odor and taste that is used clinically as an anesthetic agent and can support combustion Nitrous oxide’s use as an anesthetic agent is based on its CNS depressant effect. However, only dangerously high levels of N20 provide true anesthesia. AKA: Laughing Gas  Nitric Oxide (NO) A colorless, nonflammable, and toxic gas that supports combustion. In combination with air, nitric oxide forms brown fumes of nitrogen dioxide (NO2). Together, these two gases are strong respiratory irritants, which can cause chemical pneumonitis and a fatal form of pulmonary edema Delivered in part per million start point is 20ppm  Estimating the Duration of Cylinder Gas Flow When using a cylinder of therapeutic gas, you must be able to predict how long its contents will last at a given flow. You can estimate a cylinder’s duration of flow if you know: (1) the gas flow (2) the cylinder size (type) (3) the cylinder pressure at the start of therapy.  Estimating the Duration of Cylinder Gas Flow When full, the most common sizes of oxygen cylinders (“H” and “E”), contain 244 cubic feet and 22 cubic feet of oxygen, respectively. The gauge pressure of a full cylinder is also 2200 psi. These are constants for full cylinders.  Estimating the Duration of Cylinder Gas Flow A special constant termed a tank factor (Cylinder Factor) is used in the calculation for each cylinder size. Cylinder factors are derived for each common gas and cylinder size by using the following formula:  Cylinder Factors (CF) “H cylinder” 244 cubic ft (full cylinder) x 28.3 Cylinder factor 3.14 = 2200 psig “E cylinder” 22 cubic ft (full cylinder) x 28.3 Cylinder factor 0.28 = 2200 psig  Estimating the Duration of Cylinder Gas Flow Once the factor for a given gas and cylinder is known, calculating the duration of flow is a simple matter of applying the following equation:  Practice “E cylinder” has 1800 psig. You are required to walk a patient that requires an O2 flow of 4 liters per min (4 l/m). How long will this cylinder last in minutes? 1800 x.28 4 L/M Answer = 126 Minutes  Practice “H cylinder” has 1100 psig. You are required to use this cylinder in the hospital for a patient that requires an O2 flow of 8 liters per min (8 l/m). How long will this cylinder last in hours? 1100 X 3.14 8 L/M = 431.75 minutes Round Down to 431 divide by 60 (for minutes in an hour). =Answer 7.195 hours  Figuring For Transport When transporting outside a hospital you must figure in a buffer for each tank. This buffer is 500 psig (on the Bourdon Gauge - red area). A full “E cylinder” @ 2200 psig minus the 500 psig buffer equals 1700 psig for planning.  Practice Using “E cylinders,” you are required to transport a patient to Louisville. The patient requires 10 liters per minute flow (10 l/m) of O2. The trip is estimated to be 110 minutes. How many E cylinders are required? 1700 X.28 10 L/M =Answer 47.6 min / 1 tank, require full 3 tanks 110 minutes divided by 47 = 2.3 tanks. Since it requires more than 2 tanks you would need 3 tanks.  Liquid O2 Duration Formula Weight 2.5 lbs. per liquid liter. Liquid O2 expands 860 times to become gaseous O2. Exa: 1.25 lbs @ 4L/min. 1.25 lbs x 860 = 430 liters  Liquid O2 Duration Formula 430 liters 4 L/M 107.5 minutes or 1.79 hour (1hr 47 min) 60 min x.79 = 47.4 minutes Exa. 2: 1720 liters remaining and 2 liters per min required how long will it last?  Liquid O2 Duration Formula Liquid O2 weight 1.5 lbs. required liter flow is 4 l/m how long will the O2 last?  Study Study this PowerPoint I will post additional problems on tank duration in BlackBoard. Watch for another Study Guide in BlackBoard.