storage and handling of medical gases ret 2274 respiratory care theory 1 module 2.0

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Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

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Page 1: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

RET 2274

Respiratory Care Theory 1

Module 2.0

Page 2: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Medical Gases are stored in one of two ways: Portable high-pressure cylinders Large bulk reservoirs

Page 3: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Gas Cylinders High pressure cylinders used to store and ship

compressed or liquid medical gases Constructed from:

chrome molybdenum steel High strength aluminum alloy

Regulated by: Department of Transportation (DOT) Interstate Commerce Commission (ICC)

Page 4: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Gas Cylinders DOT classify cylinders according to their

fabrication Type 3A – made from carbon steel Type 3AA – made from steel alloy (tempered for

higher strength) Type 3AL – made from aluminum

Page 5: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Markings Cylinders are marked with metal stamping on

the shoulder

Page 6: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Cylinder Markings

If an asterisk (*) is present after the test date, the cylinder may go 10 years before being tested again

May be stamped with DOT or ICC (Interstate Commerce Commission)

A plus (+) means the cylinder is approved for filling to 10% above service pressure

Page 7: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color Coding Cylinders are color coded and labeled for

identification of their contents Code adopted by the Bureau of Standards of the

U.S. Department of Commerce

Note: Prior to initiating use of any gas, the contents of the cylinder must be verified by reading the label that is affixed to the tank

Page 8: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color CodingUnited States Canada

Oxygen Green White Carbon Dioxide Gray Gray Nitrous Oxide Blue Blue Cyclopropane Orange Orange Helium Brown Brown Ethylene Red Red CO2/O2 Gray/Green Gray/Green Helium/O2 Brown/Green Brown/Green Nitrogen Black Black Air Yellow Yellow Nitrogen/O2 Black/Green Black/Green

Page 9: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color Coding

Oxygen

Page 10: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color Coding

Air

Page 11: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color Coding

Helium

Page 12: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Color Coding

Nitrous Oxide

Page 13: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Labeling Name and chemical

symbol of the gas Purity of the gas Volume of the cylinder

in liters at a temperature

Specific hazards/precautions

Instructions in case of exposure

Name of manufacturer, packer, and shipper

Page 14: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Labeling

Page 15: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Sizes Sizes E and H

most common in medical facilities

Page 16: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Valves and Connections Small cylinders have a post valve for yoke connectors Large cylinders (F – K) have a treaded valve outlet

Post valve Threaded valve

Page 17: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Safety Relief Valves To prevent rupture due to high pressures, gas

cylinders are equipped with high-pressure relief valves

Frangible Ruptures at a specific pressure

Fusible plug Melts at a specific temperature

Spring-loaded Opens at a set high pressure

Page 18: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Valves Safety Systems Outlet connections of cylinder valves have

safety systems to prevent the interchange of regulating equipment between gases that are not compatible American Standard Safety System (ASSS)

Uses differing thread pitches, internal left- and right hand threads, and external threading to prevent the attachment of equipment not designed for the gas contained in large cylinders, e.g., prevents the attachment of an oxygen regulator to a nitrous oxide cylinder

Page 19: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Medical Gases

ASSS

Page 20: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Valves Safety Systems Pin Index Safety System (PISS)

PISS incorporates pins in the reducing valve yoke and holes on the cylinder valve at specific positions to prevent the attachment of equipment not designed for the gas contained in smaller cylinders, e.g., prevents the attachment of an oxygen regulator to a helium cylinder

Page 21: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

PISS

Page 22: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Moving Cylinders

Always leave protective valve caps in place when moving a cylinder

Do not lift a cylinder by its cap Do not drop a cylinder, strike two cylinders against one

another, or strike other surfaces Do not drag, slide, or roll cylinders; use a cart Use a cart whenever loading or unloading cylinders

Page 23: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Moving Cylinders

Page 24: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Storing Cylinders

Comply with local and state regulations for cylinder storage as well as with those established by the National Fire Protection Association

Post name of the gases stored Keep full and empty cylinders

separate. Place the full cylinders in a convenient spot to minimize handling of cylinders

Keep storage areas dry, cool, and well ventilated. Storage rooms should be fire-resistant

Page 25: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Storing Cylinders

Do not store cylinders close to flammable substances such as gasoline, grease, or petroleum products

Protect cylinders from damage. Keep cylinder valve caps on at all times

May be stored in the open; however, shading may be necessary

Protect cylinders from potential tampering by untrained, unauthorized individuals

Page 26: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Withdrawing Cylinder Contents

Only to be handled by experienced, trained individuals User must verify cylinder contents before use Leave protective cap in place until ready to use Make sure cylinder is supported and protected from

falling Always “crack” the cylinder prior to attaching a regulator Use appropriate regulator or reducing valve

Page 27: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Safety Rules for Cylinder Use Withdrawing Cylinder Contents

Do not force any threaded connections. Verify that that the threads are designed for the same gas in accordance with the American Standard Safety System

Open valves slowly. Never use a hammer or wrench to force a valve open

Keep all connections tight to prevent leakage Before removing a regulator, turn off the valve and bleed

the pressure Never use a flame to detect leaks with flammable gases Do not store flammable gases with oxygen. Keep all

flammable anesthetic gases stored in a separate area

Page 28: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

This truck was carrying oxygen cylinders. The driver braked to stop at an intersection. The truck stopped ... but the cylinders kept on moving. 

Page 29: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Cylinder Explosion

Page 30: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Duration of Gas Flow H Cylinders contains 244 cubic feet of oxygen when

full (2200 psi pressure)

One cubic foot of oxygen equals 28.3 liters

Tank Factor

244 cu ft (28.3 liters/cu ft.) = 3.14 liters/psi

2200 psi

Page 31: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Duration of Gas Flow E Cylinders contains 22 cubic feet of oxygen when full

(2200 psi pressure)

One cubic foot of oxygen equals 28.3 liters

Tank Factor

22 cu ft (28.3 liters/cu ft.) = 0.28 liters/psi

2200 psi

Page 32: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Duration of Gas Flow An E cylinder of oxygen contains 1500 psi. How

long will the tank last while running a resuscitation bag at 15 liters/min and leaving 500 psi in the cylinder?

Tank factor (gauge pressure – 500) = Duration in minutes

Liter flow

0.28 liters/psi (1500 psi – 500 psi) = 18.67 minutes 15 Liters/min

Page 33: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Duration of Gas Flow You have an H cylinder of oxygen with 800 psi left

in the tank. How long with the oxygen last while running an oxygen mask at 12 liters/min, leaving 500 psi in the cylinder?

Tank factor (gauge pressure – 500 psi) = Duration in minutes

Liter flow

3.14 liters/psi (800 psi – 500 psi) = 78.5 minutes 12 Liters/min

Page 34: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Gas Systems Used to supply large amounts of medical gas to

a hospital or other institution

Bulk Liquid Oxygen

Cylinder Manifold Systems

Bulk Air Supply Systems

Page 35: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen

Page 36: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen NFPA defines a bulk

oxygen system as more than 20,000 cubic ft. of oxygen (at atmospheric temperature and pressure)

Major components Insulated reservoir

-183 Celsius Vaporizer/tubing

Warms liquid O2 Pressure reducing valve

50 psi for hospitals Pressure release valve

Page 37: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen (Hospital Piping System)

Page 38: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen (Hospital Piping System)

Page 39: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen Hospital Piping

System Zone Shutoff

Valves

Page 40: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen Hospital Piping

System Zone Shutoff

Valves

Page 41: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Liquid Oxygen NFPA requires hospitals to

maintain a backup gas supply to equal the average daily gas usage of the

facility Second, smaller liquid

stand tank Cylinder gas manifold

(smaller facilities) Contingency plan for

system failure is imperative

Page 42: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Manifold System Gas cylinders banked

together in series Two sides – primary bank

and a reserve bank Control valve switches over

to the reserve bank when pressure decreases to a set level Equipped with low

pressure alarms Empty cylinders are replaced

and become the reserve bank

Page 43: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Cylinder Manifold System AKA – “Alternating Supply”

Page 44: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Air Supply Systems Most systems use two compressors that work

independently, or in tandem if need arises Each must have the capacity to supply 100% of

average peek demand Dryer removes humidity from air entering piping

system Reducing valve reduces pressure to 50 psi or the

desired working pressure

Page 45: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Air Supply Systems

Page 46: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Bulk Air Supply Systems

Page 47: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Station Outlets High-pressure, bulk oxygen supply is reduced to a 50

psi working pressure in the patient’s room where it can be used to operate respiratory equipment

Page 48: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Station Outlets Station outlets provide connections for gas-

delivery devices such as flowmeters and mechanical ventilators

These outlets contain check valves that open when a delivery device’s (flowmeter) adaptor is inserted into it

Page 49: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Station Outlets Safety Systems

Diameter Index Safety System (DISS) DISS use

noninterchange-able, threaded fittings to connect gas-powered devices to station outlets

Page 50: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Station Outlets Safety Systems

DISS

Page 51: Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

Storage and Handling of Medical Gases

Station Outlets Safety Systems

Quick connect adaptors Inserting the

appropriate adaptor into the outlet pushes a plunger backward allowing gas to flow into the equipment, eg., flowmeter, mechanical ventilator, etc.