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

Medical Gas Outlets

Medical Gas Systems

Oxygen Systems

Medical Air Systems

Medical Surgical Vacuum Systems

Waste Aesthesia Gas Disposal Systems

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 various respiratory disorders

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)

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)

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.

Nitrogen Tank Manifold Nitrous Oxide Tank Manifold

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.

Main Shutoff Valve

Area Shutoff Valves

Zone Valve Box

Area/room being supplied

Who can shut valve

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

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

Guidelines for Construction and Equipment of Medical and Hospital Facilities

Medical Gas Outlets

Oxygen Vacuum

Medical Air

Vacuum

Oxygen Oxygen

Air

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)

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

Dewar Tanks

Thermos Bottle (One Cylinder inside another cylinder with a vacuum separating the tanks)

CSA=> DOT Compliance-Safety Accountability

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 PPMDew Point <39’F @ 50 PSIG (Prevent freezing of airlines run outside the building)CO < 10 PPMCO2 <500 PPM

Medical Air CANNOT be used for

Source for Control Air

Dental Air

Surgical Pneumatic Air Devices

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

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

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

Medical Air Compressors

Medical Air Control Panel

Emergency Power

Dew Point Monitor

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.

Medical Vacuum System

Medical Vacuum Control

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.

OR Room

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

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

Master Alarm Panel

Area Alarm Panel

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

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.

Cylinder Information

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

MED GAS PM Frequency

MED GAS PM FrequencyMED GAS PM Frequency

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

Smoke Compartments12 E Size Cylinders per smoke compartment

>500 PSIG

Full Tank

Storage Cabinet

12 Full Cylinders Each Cabinet

Smoke compartment within a smoke compartment

36 cylinders inThis compartment

CMS requires signage on any door where 02 cylinders are stored

Half Hour Rated Room

3000 Cubic Feet

120 E-Cylinders @ 25 cubic feet each

12 H-Cylinders @ 250 cubic feet each

One Hour Rated Room

Unlimited storage Requires dedicated ventilation with return

within 12 inches of floor All electrical switches/outlets at > 60 AFF

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

Component Documentation

Deficiency List

Individual problem tracking

Questions?