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?