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Medical Gases

Medical Gases. Lynn Morrison Regional QA Pharmacist NHS Greater Glasgow and Clyde. Medical Gases. Introduction and session objectives To describe the different medical gases found within a hospital To understand the design and construction of a medical gas pipeline system (MGPS)

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Medical Gases

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  1. Medical Gases Lynn Morrison Regional QA Pharmacist NHS Greater Glasgow and Clyde

  2. Medical Gases Introduction and session objectives • To describe the different medical gases found within a hospital • To understand the design and construction of a medical gas pipeline system (MGPS) • To be aware of the system of controls applied to facilitate the safe and secure operation of a medical gas pipeline system • To understand the roles and responsibilities of key personnel involved in medical gases • To understand the role of the Quality Controller (MGPS) • To have an awareness of medical gas testing • To appreciate the role of the EDC pharmacist in an emergency situation

  3. Medical Gases – what gases are found in hospitals? • Oxygen • Nitrous oxide • Medical Air • Surgical Air • Oxygen / Nitrous oxide mixture 50:50 “Equanox” or “Entonox” • Vacuum

  4. What are the medical gases used for? • Oxygen – used to sustain life • Medical air – used to drive ventilators • Surgical air – used to operate surgical tools • Nitrous oxide – used in theatres for anaesthetic purposes • Equanox / Entonox – used as an analgesic, home delivery • Vacuum - suction

  5. What other gases could you find? • Carbon dioxide • Helium / oxygen mixtures • Nitric oxide • What are these gases used for? • Carbon dioxide – clinical and physiological investigations • Helium/oxygen mixtures – respiratory assessment and treatment e.g. COAD • Nitric oxide – aids oxygen exchange in respiratory distress conditions

  6. How are the gases supplied to the hospital? • Oxygen – delivered as a liquid via a tanker to a liquid oxygen tank compound with vacuum insulated evaporators - VIE • Nitrous oxide – cylinders • Medical air – cylinders or compressors • Equanox / Entonox – cylinders • Other gases – cylinders • NHS Scotland - national contracts for supply of medical gases

  7. Where are the gases stored? • Liquid Storage Tank with VIE – oxygen • Cylinder store – various gases • Manifold rooms – e.g. medical air, nitrous oxide, Equanox/ Entonox • Medical and surgical air compressor systems and receiver tanks • Other locations – e.g. ready use stores ambulances patient transport

  8. Oxygen tank – VIE tank • “Duty” tank and a “stand by” tank • Vacuum insulated evaporator • Valve box (with test point) • Alarm panel • Copper pipework – medical gas pipeline system - connecting tanks to the hospital pipeline system

  9. Oxygen tank and VIE

  10. Oxygen tank – control panel

  11. Cylinder store • Visit the cylinder store on site • Cylinder stores should be :- separate from other buildings no “naked flames” clean, tidy, locked full cylinders should be stored separately from empty each gas type to be stored separately etc • Can you think of any other storage requirements? • separate cylinders by size • temperature control • log of issue and return

  12. Cylinders • Currently :- • Oxygen – black body / white shoulders • Nitrous oxide – blue • Medical air – grey body / black and white shoulders • Equanox / Entonox – blue body / blue and white shoulders • Heliox – black body / brown and white shoulders • Carbon dioxide - grey • Future :- • EU Directive – all cylinders will have white body and colour coded shoulders as above • Implementation to be completed by 2025

  13. Manifold rooms • A manifold is defined as a set of pipework to which a series of cylinders is attached. • “Duty” and “stand by” bulk supply to the hospital • Must be in date • Must be checked regularly

  14. Oxygen manifold

  15. Medical air manifold

  16. Medical / Surgical air compressors

  17. How do the gases get to the patient ? • Medical Gas Pipeline System (MGPS) • Copper pipelines • Pressure reducing valves • AVSU – area valve service unit • Terminal outlets • Flow meter and tubing • Mask / nasal canulae • Cylinders – valve and flowmeter

  18. Area Valve Service Units

  19. Terminal Units

  20. Safety issues • Medical gases • Oxygen – supports combustion – patient’s clothing and bedding can become saturated • Nitrous oxide – causes headaches, drowsiness, cumulative effects, teratogenic effects, can cause asphyxia in confined spaces also supports combustion • Equanox / Entonox – combination of the above

  21. Safety issues • Cylinder handling • Never carry a cylinder by its neck • Use correct trolleys • Protective equipment • Never roll cylinders!! • Never eat/smoke while handling cylinders • Etc!! • Training vital!!!

  22. Control systems - Documentation • HTM 02-01 • Part A ; • Design, installation, validation and verification • Part B ; • Operational Management • In Scotland (s)HTM 02-01

  23. Control systems - Documentation • Permit to work system controls any engineering work to be carried out on the MGPS safeguards the integrity of the MGPS and patient safety 4 part documentation signed by all those involved in the work activity • Operational policies • Controlled document • Scope • Responsibilities and training for staff • Record drawings and accompanying documentation • Description of MGPS, valves, alarms etc • Medical gas committee • Emergency procedures

  24. Control systems - Documentation • Health and Safety at Work legislation • Manufacturer / supplier product material safety data sheets • C11 • CHIP • SPQAG testing protocols

  25. Control systems – defined roles and responsibilities • Designated Medical Officer or Nursing Officer • Authorised Person • Competent Person • QUALITY CONTROLLER (MGPS)

  26. Control systems – defined roles and responsibilities • QUALITY CONTROLLER (MGPS) • responsible for the quality control of medical gases as terminal units and plant • accepts professional responsibility for the last independent check of a MGPS • must be able to provide evidence of training, competence • registered - QC (MGPS) register

  27. Your involvement with medical gases • Clinical function • Clinical need • Equipment • Understand operation of MGPS • Understand safety considerations for cylinders • Regulators, flowmeters and associated tubing etc

  28. Emergency situations • Must be aware of day to day operational aspects of MGPS / cylinder management to ensure have fundamental knowledge to cope with emergency situation • Examples • Procedure to be followed • Operational policy documents and emergency information cards

  29. Emergency situations • YOUR ROLE • to ensure back up supply is made available and additional cylinders sourced as required • to contact suppliers and arrange delivery • Must ensure you know :- • where back up supply (cylinders / tank) stored on site • how to contact suppliers (cylinders or liquid supply) • how many cylinders to ask for • the size of cylinder to ask for • the delivery location • BEFORE AN EMERGENCY OCCURS !!

  30. Medical gases Testing

  31. Medical gas testing • RQAS Med Gas test team • Tests carried out – commissioning new installations modifications to existing systems de-commissioning of systems routine compressor testing

  32. Medical gas testing • Tests completed • Identity / purity • Particulate contamination • Non specific contamination • Water vapour • Carbon Dioxide • Carbon Monoxide • Oil • Sulphur dioxide • Nitrous fumes • Line pressure • Vacuum pressure

  33. Acceptance criteria (Ph. Eur.) • Identity and purity – acceptance criteria oxygen - > or equal to 99.5% (absence of nitrous oxide) oxygen in medical / surgical air – 20.4% to 21.4% nitrous oxide - >98% (absence of oxygen) oxygen / nitrous oxide mixture 48% to 52% of each component • Particles – absence of particles e.g. copper oxide, copper, “verdigris” • Non- specific contamination – polytest tube – absence of colour change in crystals • Water vapour – not more than 0.05mg/L / 67vpm

  34. Acceptance criteria (Ph. Eur.) • CO2 – not more than 500ppm / 300ppm • CO – not more than 5ppm • Oil – not more than 0.1mg/L – medical / surgical air to ensure no carry over from compressor motors • Sulphur dioxide – not more than 1ppm • Nitrous fumes – not more than 2ppm • Vacuum – not less than 400mmHg

  35. Visit to Medical Gas storage facilities and wards/ departments Visit the following :- • Oxygen tank and VIE plant • Medical air compressor plant • Nitrous oxide manifold • Visit a ward :- • What gases are supplied via a piped system? - look out for terminal units, area valve service units (AVSU) • What gases are supplied in cylinder form?

  36. Quiz • Please complete multiple choice questions

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