Medical Gases 2024.pptx

Medical Gas Supply Vicente Gonzalez, DNP, CRNA, APRN Florida International University Department of Nurse Anesthesiology Storage and Supply of Medical Gases Cylinder Hazards 0.83% of cylinders had irregularities Emphasizes the need for proper inspection Guidelines for Use of...

Medical Gas Supply Vicente Gonzalez, DNP, CRNA, APRN Florida International University Department of Nurse Anesthesiology Storage and Supply of Medical Gases Cylinder Hazards 0.83% of cylinders had irregularities Emphasizes the need for proper inspection Guidelines for Use of Medical Gas Cylinders Purchase from reputable suppliers Avoid transfilling Follow safety rules Understanding Basic Facts and Safety Principles Importance of Proper Knowledge and Safety Principles for Medical Gas Use Ensures patient safety Prevents accidents and mishandling Promotes efficient use of medical gases Anesthesia Providers' Responsibility Guide gas handling in healthcare settings Ensure proper training for staff Monitor and manage gas usage Common Medical Gases in Anesthesiology Common Medical Gases in Anesthesiology Oxygen (O2) Nitrous oxide (N2O) Medical air Nitrogen Helium Rarely Nitric Oxide and Heliox (a mixture of Helium and Oxygen) Gas cylinders are considered part of the high-pressure system Uncommon Gases in Clinical Situations Helium in Laryngeal Surgery Used for its low density Enhances airflow properties Carbon Dioxide in Anesthesia Management Occasionally used for specific congenital heart defects Nitric Oxide as a Pulmonary Vasodilator Available in clinical settings Used to dilate pulmonary vessels Regulations and Inspections for Medical Gas Manufacturers Stringent Regulations Government and industry regulations for medical gas manufacturers have become more stringent. These regulations aim to ensure the highest safety standards. Increased Inspections There has been an increase in inspections to ensure compliance with safety standards. Regular inspections help identify and rectify potential safety issues. Reduction in Accidents Enhanced regulations and inspections have led to a reduction in accidents. The focus on safety has significantly improved overall safety records. Characteristics and Safety of Medical Gas Cylinders Cylinder Characteristics Various cylinder sizes available (e.g., B, D, E, M, G, H or K) Each with specific dimensions and nominal volumes. Color Coding Different gases are color-coded for identification Green for oxygen Blue for nitrous oxide. Guidelines for Medical Gas Cylinder Use Check Label and Color Coding Identify gas by checking the label and color coding. Do not use cylinders with illegible labels. Use Diameter Index Safety System (DISS) Ensure gas-specific fittings using DISS. Prevents incorrect gas connections. Inspect Cylinders for Damage Check cylinders for any damage before use. Do not use damaged cylinders. Medical Gas Pipeline Systems Overview Importance of Central Vacuum Systems in Healthcare Crucial for healthcare facilities Requires detailed attention similar to medical gas systems Standards for Central Vacuum Systems Adequate suction Multiple vacuum pumps Emergency power connections Hazards of Medical Gas Delivery Systems Underreporting of Accidents Accidents involving medical gas delivery systems are often underreported. Lack of awareness and fear of legal consequences contribute to underreporting. Importance of Maintenance and Monitoring Proper maintenance and monitoring are crucial to prevent accidents. Regular checks can identify potential issues before they become serious problems. Deaths and Complications Errors in gas supply or anesthetic apparatus can lead to deaths. Complications from these errors can have long-lasting effects on patients. Gas Cylinders Oxygen Most commonly used size is E cylinder and are usually stored in the rear of the anesthesia machine Total volume of cylinder is 5L Color is green (white in other countries) Pressure is 1900 psi (for this class and for calculation we will use 2000 psi) Contains 660L of oxygen It is a gas at room temperature critical temperature -118 C The pressure gauge reading is proportional to the amount of gas in tank Gas Cylinders Nitrous Oxide 5 L tank capacity A full tank contains 1590L of gaseous N2O tank color is blue Tank pressure is 745 psi (equal to standard vapor pressure SVP of N2O) It is a liquid at room temperature (critical temperature 36.5 C) Since it is a liquid at room temperature the gauge cannot be used to estimate tank volume. Pressure in N20 cylinder will remain constant until 75% of cylinder is exhausted or 400L remain. Gas Cylinders Air 5 L volume color is yellow (black and white in other countries) Pressure 1900 psi Volume of air in tank 625L State in cylinder- gas Nitrogen Usually stored in H cylinders used to power pneumatic equipment Gas Cylinder Markings Codes are stamped near the neck on all medical gas tanks Regulated by DOT Date of inspection (must be inspected every 10 years) Most common sizes E and H  Gas Cylinders Pressure Relief Valves 3 types Fusible- temperature Frangible disk- pressure Safety relief valve- pressure spring loaded Typical E-cylinder valve Outlet port in larger cylinders is threaded and different for every gas Pin Index Safety System for Gas Cylinders Pin Index Safety System for Gas Cylinders Two 5-mm stainless steel pins on cylinder yoke connector Seven different pin positions based on gas type Prevents incorrect gas cylinder connections Essential for anesthesia gas delivery safety Ensures gas-specific fittings for each cylinder Gas Cylinders Safety considerations PISS system DISS system On E-cylinders, every gas has a different Pin combination Pin Index Safety System Air N2 N2O O2 CO2 1–5 1–4 3–5 2–5 1–6 Pin position numbering Typical O2 cylinder Outlet port Pin holes Proper Handling of Gas Cylinders Inspection of Cylinders Upon Delivery Check for visible damage or leaks Verify cylinder labels and contents Ensure proper documentation and certification Prevention of Incorrect Gas Cylinder Connections Use color-coded and labeled connections Follow manufacturer guidelines Train staff on proper connection procedures Safe Cylinder Practices Hazards of cylinders Although rare, cylinders pose safety hazards Incorrect gas Incorrect valve Damaged Contaminated contents Other hazards Improper handling Improper storage  Connectors DISS Diameter and threads are different for every gas Most commonly used to connect hospital supply to devices (anesthesia machine, ventilators) Other safety connector systems Quick connect- Similar to PISS commonly used to connect hospital supply to equipment Reputable Suppliers and Cylinder Safety Source Medical Gases Responsibly Obtain medical gases only from reputable commercial suppliers Ensure suppliers meet safety and quality standards Inspect and Test Cylinders Inspect and test cylinders upon delivery for safety Check for any signs of damage or irregularities Be Aware of Potential Hazards Be cautious of potential hazards like irregularities in cylinders Report any issues immediately to the supplier Central Supply Systems for Medical Gases Overview of Central Supply Systems Central supply systems distribute medical gases throughout the hospital. They ensure a reliable and continuous source of medical gases in healthcare facilities. Oxygen Central Supply Consists of standard cylinders connected by a manifold system or pressure vessels with vaporizers for larger installations. Small hospitals may use a series of standard H-cylinders connected by a manifold or high-pressure header system for oxygen storage. Medical Air Supply May involve compressed air cylinders, oxygen and nitrogen cylinders mixed by a regulator, or air compressors. Oxygen Supply Systems in Healthcare Importance of Oxygen Supply Systems in Healthcare Oxygen supply systems are crucial in healthcare facilities. Proper design and monitoring of oxygen supply systems are essential for safe oxygen delivery. Standards and Regulations Standards for bulk oxygen systems are outlined in NFPA Publication 55. Liquid Oxygen Storage Liquid oxygen storage allows for a large oxygen reservoir in a small space. Oxygen Generation Technology Oxygen concentrators use molecular sieve technology to generate oxygen. Bulk Oxygen Systems in Hospitals NFPA Standards for Bulk Oxygen Systems NFPA Publication 55 NFPA Publication 99 Liquid Oxygen Storage Suitable for large facilities Requires special containers to maintain temperature Redundancy in Oxygen Supply Primary and secondary supplies Ensures continuous availability Cylinder Supply System Components Cylinder Supply System Components Pressure regulators to maintain normal outlet pressure. Pressure relief devices to vent gas if pressure exceeds normal levels. High- and low-pressure alarms and shut-off valves at various locations. Connectors at pipeline termination points for interfacing with medical equipment. Quick connectors and Diameter Index Safety System (DISS) fittings for gas- specific connections. Liquid Oxygen Systems in Hospitals Importance of Liquid Oxygen Systems in Hospitals Essential for providing oxygen to patients Crucial for patient safety Maintenance of Liquid Oxygen Systems Prevents accidents Ensures patient safety Storage of Liquid Oxygen Stored in special containers Kept under pressure to maintain effectiveness Maintenance of Oxygen Supply Systems Importance of Regular Maintenance Crucial for oxygen supply systems Ensures system reliability and safety Pressure Regulation and Safety Pressure regulators maintain outlet pressure Pressure relief devices vent gas if pressure exceeds normal levels High and low-pressure alarms, shut-off valves required for safety Medical Air and Nitrous Oxide Systems Medical Air Cylinders Typically provided in E-size cylinders Color coded yellow Pressure of 1900 psig Contains about 625 L Nitrous Oxide Cylinders Can become cold due to latent heat of vaporization Moisture or frost may form on the outside surface Indicates when the gas will run out Medical Gas Pipeline Other gases Helium is usually provided in tanks that attach to specially designed anesthesia machines Nitrogen used only to power OR equipment. It has its own regulator Vacuum systems Although not a gas it is important in anesthesia for suctioning and removing waste anesthetic gases (WAG). In modern hospitals, there is a separate vacuum line for WAG Gases and Ventilation in Medical Facilities Importance of Central Vacuum Systems in Medical Facilities Crucial for maintaining adequate suction during surgical or anesthetic procedures. Ensures a sterile and safe environment for patients and medical staff. Standards and Requirements Larger operating rooms must have sufficient suction to remove 99 L/min of air. Two independent vacuum pumps are required for peak loads. Emergency Power Connections Essential for uninterrupted vacuum system operation. Traps needed to dispose of any contaminants safely. Medical Gas Pipeline Other gases Helium is usually provided in tanks that attach to specially designed anesthesia machines Nitrogen used only to power OR equipment. It has its own regulator Vacuum systems Although not a gas it is important in anesthesia for suctioning and removing waste anesthetic gases (WAG). In modern hospitals, there is a separate vacuum line for WAG Challenges in Adding to Gas Pipeline Systems Planning and Coordination Proper planning crucial for adding to existing gas pipeline systems Involvement of various departments essential in the planning process Integration and Expansion Consideration needed for interaction between old and new facilities Expansion of central supply system may be necessary for new pipelines Shutdown of existing pipeline system may be required for expansion Incident Reporting and Prevention Importance of Reporting Encourage timely and accurate reporting of incidents involving medical gas systems. Underreporting Concerns Address the issue of underreporting accidents hindering prevention efforts. Preventable Mishaps Emphasize that most mishaps related to medical gases are preventable with proper attention and adherence to safety protocols. Need for Awareness Highlight the importance of raising awareness about incidents to prevent future accidents. Medical Gas Hazards Hard to obtain data Most accidents not reported No recent data an old study 1975 showed Most common problem low O2 pressure Crossed lines Central supply depletion Physical damage to pipes Gas Purity Testing in Hospitals Importance of Gas Purity Testing Ensures patient safety Prevents contamination Maintains equipment functionality Study Conducted on Gas Outlets in Hospitals Analyzed gas purity Tested multiple outlets Assessed compliance with standards Hazards of Medical Gas Delivery Systems Underreporting of Accidents Hinders dissemination of prevention information Impacts learning and prevention efforts Consequences of Errors Deaths and complications Errors in gas supply or anesthetic apparatus Preventability of Accidents Largely preventable Proper maintenance and monitoring are crucial Standards and Guidelines for Gas Systems Importance of Standards and Guidelines Standards and guidelines are crucial for gas systems Rigorous standards prevent contamination Testing and Verification Testing procedures ensure system integrity Verification by competent parties is essential Anesthesiologists play a key role in verifying gas supplies Cylinder Calculations You can only calculate Oxygen and Air cylinder use (Why?) A full tank of oxygen has 660L of oxygen at a PSI of 1900 ( we will use 2000 for ease) Setting up a proportion equation will allow you to calculate how much is remaining in the tank and, therefore, how long it will last given the rate of use. Therefore, given either the Liters or the psi, you should be able to calculate how much is left in the tank Cylinder Calculations How much oxygen is used per minute depends on two factors Fresh gas flow (from the flowmeter) and if you are using a ventilator or not. Anesthesia ventilators are powered by oxygen. Therefore, if your patient is receiving 600 ml/breath at a rate of 10 breaths a minute, the total minute consumption is 600x10= 6L/min Adding the two numbers will give you the TOTAL consumption/minute, which you can then use to calculate how much time you have left in the cylinder based on your previous calculations Cylinder Calculations The pressure on an E cylinder reads 1600 psi. How long will the tank last if it is used at a rate of 2L/min? The pressure on an E cylinder reads 800 psi. The patient is on the ventilator with a tidal volume of 500 mls at a rate of 10 breaths/ minute. The gas flow is 2 L/minute; how long will the tank last? Questions??? References Anesthesia Equipment 3rd edition- chapter 1 Miller’s Anesthesia 9th edition chapter- 22 Some images may come from other sources for illustration purposes only. Sources are not used for lecture material Useful links: https://healthprofessions.udmercy.edu/academics/na/agm/10.htm