Presentation Transcript

1. Medical Gas SystemsPosted on: TSHE-OKI.ORG (Power point tab)

   David Capal, CEM, CHFM, SASHE David Womack 1.5 Contact Hours /0.15 CEU AHA/ASHE
2. Medical Gas Outlets
3. Medical Gas Systems Oxygen Systems Medical Air Systems Medical Surgical Vacuum Systems Waste Aesthesia Gas Disposal Systems
4. Medical Gases Oxygen most widely used of medical gases, composing 21% of the atmosphere, oxygen represents 65% of all the elements in the body Compressed Air used by respiratory therapy to blend various percentages of Oxygen Nitrous Oxide used for anesthesia applications Nitrogen used to power pneumatic type devices such as surgical drills Carbon Dioxide used by respiratory therapy for artificial respiration as a continuation of resuscitation Helium mixed with air or oxygen and used in the treatment of variousrespiratory disorders
5. Medical Gas System Levels Level 1 Patients served are dependent on mechanical ventilation or assisted mechanical ventilation at any time including during the administration of anesthesia. Level 2 Intended for facilities treating patients who may require gases occasionally but ordinarily would not. (examples Clinics-ED-OP Surgery) Level 3 Patient population during or after treatment are not dependent for life on the gases or vacuum, the treatment the facility will perform can be completed without detrimental effects on patient outcomes in the event of a sudden loss of gas or vacuum (example Doctors Office)
6. Agencies that Oversee Medical Gas Systems U.S. Department of Transportation (DOT) Compressed Gas Association (CGA) National Fire Protection Association (NFPA) Occupational Safety and Health Administration (OSHA) Center for Medicaid/Medicare Services (CMS) Joint Commission (JC) U.S. Pharmacopeia (USP) American Society for Testing Materials (ASTM)
7. Manifold A device for connecting the outlets of one or more gas cylinders to a central piping system The manifold system connects two banks of cylinders that alternately supplies the medical gas system Each bank of cylinders shares a common header, with enough cylinders to provide at least 1 days use.
8. Nitrogen Tank Manifold Nitrous Oxide Tank Manifold
9. Shutoff Valves To ensure the flow of medical gases can be turned off to select locations for maintenance or emergencies. A (source) valve just downstream of the supply components (driers-regulators-filters) A (main) shutoff, downstream of the source for the entire system One valve at each riser Between each riser and patient outlet Each special care area (OR-delivery-ICU etc.) Other valves to isolate portions of the system, must be locked open and labeled.
10. Main Shutoff Valve
11. Area Shutoff Valves
12. Zone Valve Box Area/room being supplied Who can shut valve
13. Medical Gas Piping Hard-drawn seamless Type K or L copper Marked OXY, MED, OXY/MED, ACR/OXY, ACR/MED (ACR (Refrigeration type Tubing) tubing special internal cleanliness) Braised connections Changes to the piping system must be certified/documented by a qualified technician
14. Medical Gas Outlets Each outlet must be labeled legibly which gas is being supplied Must prevent the insertion of any connectors other than those designed for that gas Must be capable of supporting medical devices such as flow devices and regulators
15. Guidelines for Construction and Equipment of Medical and Hospital Facilities
16. Medical Gas Outlets Oxygen Vacuum Medical Air
17. Vacuum Oxygen Oxygen Air
18. Oxygen Oxygen an element that, at atmospheric temperature and pressure exits as a colorless odorous tasteless gas that can sustain life and support combustion. Gaseous form a colorless odorless and tasteless gas at atmospheric temperature and pressure. Liquid exits at -300’ F atmospheric pressure expands 860 times when allowed to revert back to a gas 99+% pure, 50 PSIG +/- 5 PSI main line pressure Minimum outlet 3.5 SCFM @ STP- with <5psig drop (New Outlets)
19. Bulk Oxygen A assembly of equipment such as storage containers, pressure regulators, relief valves, vaporizers, manifolds and piping that has a storage capacity of greater than 20,000 cubic feet, including unconnected reserves. Oxygen can be stored in both a liquid and/or gas Dewar Tanks are one tank inside another with a vacuum seal used for extreme temperature variations
20. Dewar Tanks Thermos Bottle (One Cylinder inside another cylinder with a vacuum separating the tanks)
21. CSA=> DOT Compliance-Safety Accountability
22. Medical Compressed Air Air that is supplied from cylinders, bulk containers, medical air compressors or has been reconstituted from Oxygen Total Hydrocarbons (liquid undetectable, gas <25 PPM) Halogenated Hydrocarbons < 2 PPM Dew Point <39’F @ 50 PSIG (Prevent freezing of airlines run outside the building) CO < 10 PPM CO2 <500 PPM
23. Medical Air CANNOT be used for Source for Control Air Dental Air Surgical Pneumatic Air Devices
24. Medical Air System Components Intake Line – Inlet turned down Non-corrosive screen Located outside above roof level, 20 feet above ground 10 feet from building openings Compressors 2 or more compressors each sized to supply the entire system demand Designed to exclude oil from the main air stream Connected to emergency power
25. Medical Air System Components Receiver Tank Pressure relief valve set at 100 psig Automatic water drain Pressure gage and sight glass Air dryers Ensure the dew point does not exceed 39 F @ 50psig Filters Duplex filters rated 98% efficient at 1 micron Include visual indicators that show status of element
26. Medical Air System Components Regulators/Relief Devices Pressure Relief Valve set at 75 to 100 PSIG prior to the main source shut off valve Line pressure is maintained between 50-55 PSIG
27. Medical Air Compressors
28. Medical Air Control Panel
29. Emergency Power
30. Dew Point Monitor
31. Medical Surgical Vacuum System A system consisting of central-vacuum producing equipment with pressure and operating controls, shutoff valves, alarm warning systems, gauges and a network of piping.
32. Medical Vacuum System
33. Medical Vacuum Control
34. WAGD Waste Anesthesia Gas Disposal System WAGD system is a scavenging system used to remove anesthesia gas from the operating area. It is considered an environmental system with occupational safety implications. A WAGD system can be part of the Medical Surgical Vacuum System. A Medical Surgical Vacuum system cannot be part of a WAGD system.
35. OR Room
36. Alarm Panels and Systems Purpose is to signal when system pressure or vacuum variations exceed a predetermined limit and to indicate when “Reserve” bank or tank is in use. There are three types of alarms: Master Alarms Local Alarms Area alarms
37. Master Alarm Panel Located in two separate locations Working area (Maintenance or tech office) In an area that is constantly supervised, One area must be a 24/7 operation An alarm whenever pressure exceeds of drops below 20% (50 PSIG alarm <40 or > 60 PSIG) Backup or Reserve tank in use Dew point for Medical air goes above 39 F
38. Master Alarm Panel
39. Area Alarm Panel
40. Local Alarm Panel Local alarms are located next to the medical gas/vacuum equipment. CO2 monitoring Dew Point System pressures High water for water sealed vacuum pumps
41. Area Alarms Special Care Units in which in anesthesia locations where patients are subjected to invasive procedures and connected to electo-mechanical devices. These alarms must indicate deviations of more than 20% from the nominal operating pressure. The panels located where they are visible to area staff such as nurses station System test buttons are also provided to verify that all visual and audible alarm indicators are working properly.
42. Cylinder Information
43. Tank Capacities E Cylinder 660Liters * 0.035 Ft 3/Liter => 23.1 Ft 3 H Cylinder 7100 Liters * 0.035 Ft 3/Liter = 249 Ft 3
44. MED GAS PM Frequency
45. MED GAS PM Frequency MED GAS PM Frequency
46. Storage Full Cylinder (>500 PSIG) not in use (In-use examples- wheel chair-portable (1-2 cylinder carts) CMS requires signage on all doors storing 02 Full/Empty Signage E-Cylinder 25 cubic feet (STP) H Cylinder 250 cubic feet (STP) Smoke Compartment <300 cubic feet Oxygen Cabinet <300 Cubic feet ½ hour enclosure <3000 Cubic Feet 1 Hour with ventilation >3000
47. Smoke Compartments 12 E Size Cylinders per smoke compartment Full Tank >500 PSIG
48. Storage Cabinet Smoke compartment within a smoke compartment 12 Full Cylinders Each Cabinet 36 cylinders in This compartment
49. CMS requires signage on any door where 02 cylinders are stored
50. Half Hour Rated Room 3000 Cubic Feet 120 E-Cylinders @ 25 cubic feet each 12 H-Cylinders @ 250 cubic feet each
51. One Hour Rated Room Unlimited storage Requires dedicated ventilation with return within 12 inches of floor All electrical switches/outlets at > 60 AFF
52. JC/CMS Med Gas Inspections All testing is preformed according to manufacturers/regulatory requirements unless a risk assessment has been completed All testing has pass fail criteria All repairs are completed and documented in a timely manner
53. Component Documentation
54. Deficiency List
55. Individual problem tracking
56. Questions?