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The Definite Guide to Medical Gas Delaware Form

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it's a requirement medical gas.color-coding you notice we have two.different code references here with the.USA color coding and the is oh of course.we'll be addressing the USA the ones.that you often see in health care well.really pretty much most of these with.the exception of maybe oxygen helium.which you might see of an MRI but the.rest of them are pretty common so grey.cylinders you would see would be carbon.dioxide medical air yellow again that's.a pretty very common nitrogen black.nitrous oxide blue and then you get.oxygen skipping down the oxygen green in.the vacuum suction which is white and a.waste instead of gas is purple so these.are the common color codes you would see.in health care and it's good to memorize.these get to know these pretty much know.these like the back of your hand because.again you come into contact with these.weather pipes above the ceiling or.whether they're going to be cylinders in.your bulk storage area this is something.to become expert at here's an example of.a bulk liquid oxygen system you notice.obviously a big tank and a small tank.these are liquid oxygen the smaller tank.is there as a redundant backup system so.it's valves separately to the larger.take and again that's a fairly common.configuration you'll find in most.hospitals here's an example of a medical.air system and one thing to keep in mind.about medical air is that when you.deliver medical air it needs to be very.very clean obviously and it also needs.to be dry so on most medical air systems.you'll find either a center of.refrigeration system that dehumidifies.or you'll find desiccant filters that.are used to dry and of course both those.systems require a fair amount of.maintenance I think that's the one thing.that sometimes gets missed with these.medical air systems otherwise their.compressors and motors and just the.storage tank vacuum systems similar to.medical air.being that their pumps and motors and.storage tanks have one other very.interesting special consideration you.have to be very mindful of depending.upon what type you have and that is you.want to make sure that you have if you.have a water-cooled system obviously if.you were to lose water in your building.for any reason then you're you could.lose your vacuum system and sometimes.folks don't realize that that they could.lose vacuum and vacuum really is one of.the most critical systems especially we.look at for suction and for other.medical clinical applications it is used.very frequently in surgery or so vacuum.you know all medical gas systems are.critical but I think vacuum is one of.the ones that once you lose vacuum it.really creates a very quick reaction.typically out inside your Hospital.you'll have other redundant systems.little portable vacuum systems that are.used for emergencies for backup.something else I want to mention here.and I want to go back again to the I.won't go back but I want to mention is.that you know n plus-1 design n plus 1.which is really a requirement healthcare.means that you have the ability to have.at least one more unit or a backup unit.C to what's needed so then think of n is.being needed and the one is extra and.really n plus one can either be a second.system that sits there passively waiting.to be used the key something fails or it.can be you have the system design so.that you have enough capacity we're both.you may be say let's say have two to two.things that are two motors or two pumps.that are running and you have enough.capacity so that if one were to fail the.other one has more than enough capacity.to cover the load so it doesn't.necessarily mean that one isn't running.it could be both her running or it could.be that your alternating back and forth.but any case you have one extra and.that's and you'll hear n plus one quite.a bit we as we go through maintenance.and operations and even codes and.standards in design so I just wanted to.mention n plus one while we're at this.at this point as this at this point.here's an interesting diagram this.diagram here shows us pretty much kind.of a design of a basic medical gas.system here you.your oxygen storage your liquid tank and.you see of course there's your green.line coming through and going to.different places.here's tied it into a manifold maybe as.a backup to these stories these takes.here and then you have it going to a gas.supply monitor now this monitor here one.might call a master monitor and we'll.talk about that in just a minute.well you have another manifold over here.tied to n2 oh yeah our nitrous and.there's your blue going up and be.distributed here it is probably going up.to O R over 2 all the way to the right.you got your compressors and your vacuum.pumps and your tanks and this here could.be maybe some dehumidification to your.medical air and monitoring and.monitoring as well and over here of.course on the other side is your vacuum.system and you see again here goes your.here's your grey line going up and.probably up to the or and down here is.your yellow which is your medical air.and it's going up and out and being.distributed interesting too if you look.here these are kind of examples of like.a well here's an operating room and also.here's a gas pressure monitor one thing.I want to bring note to is if you look.at this line right here this is like the.room wall this grey line going up and.down and you'll notice that your gas.monitor is outside the room okay in your.shutoff valves as well as things you.will run into later as we talk about gas.and medical gases about location of.shutoff valves and monitors and you'll.see the same thing over here in your ICU.here's your outlets to your bed.here is your shutoff valve outside the.room there's your grey line and here's.your gas pressure monitor so a nice.basic design but when I was doing this I.also got to think of hmm I wonder if.there aren't some maybe some issues with.this base with this basic design and so.I didn't mention a couple things that I.kind of saw and this this is really this.kind of for those of you who work in.health care for those of you who you.know look at things like this know this.code a little bit better then the folks.have not seen this before here a couple.things that you might find could be an.issue with that little basic design we.didn't see a backup oxygen tank okay.there should have been a little tank.there the master.monitor there was a put a question hmm I.wonder if it's in a rated room and we'll.talk about that in a minute and then and.is the master monitor in a monitored.room and then also are the smaller tanks.secured so let's go back and look at.this again and look at those things so.here's the room again okay we got one.tank okay it's just a picture but there.should be a second tank the thing about.the monitor is this here's the gas.monitor okay and interestingly enough.it's in a room that appears to be with.all the manifolds and all these other.tanks you know is this a radio room well.it almost certainly would have to be a.rate of room because you know here's our.wall and when you have these tanks like.this and all this this has got to be a.rated room however there's some things.about this room which is interesting one.is that this gas monitor needs to be.protected I'm not so sure that I would.put a gas monitor in the room with all.the oxygen tanks if there's gonna be a.fire or something like that this whole.thing's gonna be engulfed and this thing.is really gonna work so I probably put.this in a separate room the other thing.is it monitored well not very likely.there's probably a very good chance that.this gas monitor is not monitored 24 by.7 as is required or in the location.where can be monitored this is obviously.a storage room and there probably aren't.two people in here might be an.engineering or something like that but.even then is that monitored 24 by 7.that's what those code requirements so.just a couple of things when you when.you look at when you look at you know.these these things like this again this.was it this picture wasn't designed to.be perfect I know that but as you start.getting a trained eye you'll start.seeing these things they'll start.jumping out at you as you look at it.designs of things like this now here is.a master alarm example and you'll know.this one thing that's very important.here this goes back we were just talking.about this master alarm is located at.the telephone operator well why is it.located there well because more than.likely the telephone operator is there.24 by 7 365 so it's monitored very.important well you also gotta make sure.that that's in a protected room so that.has to be a 1 hour rated room so if.you're gonna put that in there.it needs to be in a rated room now.here's the other one here's the master.alarm located at the engineering.departments you have a second backup.master alarm but it's an engineering ok.so here's an example of master alarms.may have you different gases this.happens to say medical air medical air.is fed into here a lot of other oxygen.is gonna be fed into here vacuum is.gonna be fed into here your nitrous if.you have a bulk system it's gonna be fed.into here then you have the various.alarms for the system so this would be.kind of a typical master alarm image.here's an aerial alarm again it's a.little more basic this also I think.could combo as a master alarm but this.is another type of LARM system that you.might see out there and then you get.another armed system and this is what we.call a zone I call local or zone alarm.again this becomes even more basic you.each one of these will have the amount.of pressure and they will alarm if those.pressures go out of range and these are.typically again located outside of rooms.sometimes they might be inside of rooms.but it's important to note too that if.they're going to be located in the room.there's going to be valves outside the.room as well typically these are all.located outside the room here are some.zone area valves again this is often.found outside of spaces or areas if it's.surgery it would be outside it found off.to outside the surgery suite altogether.and then you would have the different.again this has obviously gauges on it.telling you the pressures it also has.the different valves here this is one of.those things where we've talked about.over the years about exercising these.you know do we exercise these like we.should what happens is if you don't.exercise these you know some of these.valves to put them all kind of valve.they are you know gate valve or.depending upon if it's a needle valve.otherwise they they can get the ride out.inside and then when they go to use them.you can get all kinds of problems so I.know I've had problems with some our.older buildings where we did not.exercise them and then when we went to.test them either they.they were leaking very badly and we had.to have some kind of emergent.to take care of it or for that matter in.some cases we physically could not turn.them they were just frozen in place so.it's definitely something to keep mine.or I'll putting these on schedules and.and checking them and testing them with.some some frequency here's a classic.oxygen outlet or outlets of medical gas.outlets pretty typical there are.different styles well it's one thing to.keep in mind about outlets and this is.something that ran into with one of my.facilities as we had different revisions.of buildings added onto each other we.have a situation we lost standardization.of outlets and we ended up with several.style of outlets some outlets require.different ways to connect them and where.they created problems for us was is that.certain equipment particularly equipment.used by respiratory therapy if they were.to take a crash cart and they would have.to go to a different unit they would.have to keep multiple adapters or.different type hoses to connect to the.outlets and you could imagine you know.different different a new personnel or.maybe somebody didn't put the adapter.back and so they get to a code and they.need to connect something and guess what.they can't connect.so they scramble to find you know an.adapter or a connector in that delay.obviously could create an issue for.patients and we had a situation like.that when we end up going through and.standardizing your outlets and it took.took quite a while that's a bit.expensive but again you gotta be careful.when you when you go from one.construction project to the extraction.project that you standardize your.outlets and in some cases upgrade them.because some of these older style let's.do have some inherent issues and some of.the newer style let's obviously having.we have more safety features in them.just another picture of different.accessories as it relates to medical gas.I just saw this image and you saw all.kinds of different things here one of.the things you see is down here you see.some Springs and some ol rings and some.other pieces of parts you know these are.just different things you know rebuild.kits that you might have to rebuild an.outlet just thought this image was.would be something that would be.interesting for you to see cylinders.okay well when it comes to cylinders in.health care the two most common.cylinders that you will see in.healthcare are the H cylinder and this.is usually what you'll see brought in.for bulk manifolds and and for bulk.systems typically you might see this for.nitrogen or nitrous oxygen - you might.have this in a medical office building.you might also see that and maybe a.remote area that's not necessary tied to.the hospital so it's really common to.see the H tanks and their big the other.one that's very common is the e cylinder.and most of us are familiar with this.because of oxygen this is the one that.you often see on the on the bed or on.the crash cart.or you might see it on the wheelchair.there's one of things about each.cylinders is is that when it comes to e.cylinders there's a certain number of.Eastland those you're allowed to keep.outside of a bulk area and typically.that number is 12 and what's interesting.is you get yourself into a situation.sometimes because that's 12 full.cylinders.what about empties well that's that's it.one of the things that causes problems.is separating empties and foals but the.answer is twelve full and you can have.the empty cylinders in addition to that.but they got to be considered empty and.they have to be in a separate holding.area that says empty now are they truly.always empty not necessarily but that is.sort of the line that you walk and that.gets us into lots and lots of trouble in.lots of areas the other thing about.these cylinders which is very critical.to understand is securing them they have.to be secured they cannot be laying on.their sides they have to be properly.secured we're gonna look at a couple.images on that and here in a minute you.know here's a good example right here so.here's a manifold system with a bunch of.green or oxygen tanks connected to it.but I wonder when I look at it I mean.you look at this you see this sort of.you know what is.this stuff here is this holding this and.securing it to that wall my assessment.is it's not these are actually it seems.like these are just freestanding with.nothing holding them up at all in fact.over here you see similar if I can you.see them kind of here they're kind of.like a bowling pins but there's nothing.holding this so this would be a clear.issue having these cylinders just.standing on their own like that and.could be quite quite dangerous we hate.to think what would happen if one of.these syllabus would have fall over and.and crack its valve it would just be it.could almost be catastrophic to be.honest with you now this next day here.we go again.again a little concerned here you know.we see a manifold system we see all.these black tanks this year could be.nitrous I suppose and it's all tied in.this both manifold system but are they.secure you know again I would question.whether these are secured now typically.when they're secured you're gonna see a.chain around them it'll be very very.obvious that they're secure so it's.something that these are marketing.images I found but they're not showing.that they're very secure the last.recording I wanted to or the last slide.has to do with secure tanks just why did.you see a couple examples you'll see how.you have one chain here across all the.tanks and then this other kind of design.special designed you know figure shows.chains around each one either one of.these are acceptable obviously the point.is that they are secured.there's certainly is some common sense.to where you locate the chain but this.is an example I just want you to see a.good example of securing option tanks.something else keep mine too is when.you're transporting tanks there is a.tendency to want to lay eggs down like.in the back of a van well technically.not allowed to do that you need to.secure them in an upright position when.you transport them I think that's.another common practice that people do.that they don't realize that they're.violating US codes when they do that.so that's it for the medical gas and our.overview again this is a nice light.touch there's lots of codes lots of.standards behind a lot of this it will.touch as we go forward and other courses.but again this should give you a good.idea about medical gas systems in health.care a couple more slides that I wanted.to put in here as I did this.presentation was medical gas pipe.labeling medical gas pipe living again.this is one of those areas where I don't.believe the accreditation agencies have.scrutinized organizations maybe as.closely as they could and all the.surveys I've been to I have yet to have.a surveyor actually take a tepee 99 and.apply that code and concentrate on.medical gas pipe lately it is very.

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