1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 12 Oxygen Supply Systems

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Medical Gas Cylinders Cylinders are constructed in accordance with regulations –In compliance with DOT regulations, they are required to have specific markings permanently stamped onto the shoulder. –Hydrostatic testing every 5 or 10 years is required for all cylinders in service.

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Gas Cylinder Coding GASCOLOR CODE United StatesInternational OxygenGreenWhite Carbon dioxideGray Nitrous oxideLight blue CyclopropaneOrange HeliumBrown Carbon dioxide and oxygenGray and greenGray and white Helium and oxygenBrown and greenBrown and white AirYellowWhite and black

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Cylinder Valves and Cylinder Valve Safety Systems Cylinder valves are needed to contain the gas and provide a point of attachment for equipment. –Direct-acting –Diaphragm

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Safety Precautions with Use of Medical Gas Cylinders Oxygen supports combustion. – If anything is burning in close proximity, combustion will occur at a greatly accelerated rate. –Spontaneous combustion Certain substances, when exposed to oxygen, may ignite with great force without the addition of heat. The CGA has published recommended safe practices for handling medical gases.

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Calculation of Cylinder Contents Tank factor –Special constant used in the calculation for each cylinder size When full, the most common sizes of oxygen cylinders —H/K and –E contain 244 cubic feet and 22 cubic feet of oxygen. –Gauge pressure for a full cylinder is 2200 psi.

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Transfilling of Medical Gas Cylinders Transfilling medical gas cylinders involves the connection of an empty cylinder to one that contains gas under pressure. –Controversial topic in respiratory care Safety hazards

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Medical Gas Piping Systems Main Supply and Reserve Supply –Bulk liquid supply or manifold supply Reserve must be able to support a facility’s oxygen needs for 24 hours Gas supply pressure must be reduced to 50psi by a regulator Riser – pipe that provides oxygen Zone valve – safety shutoff Station outlet –Diameter indexed safety systems (DISS)

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Reducing Valves A device that reduces the pressure in the medical gas cylinder from 2200 psi to 50 psi –Single-Stage Reducing Valve –Modified Single-Stage Reducing Valve –Multistage Reducing Valve

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Flowmeters Bourdon Gauge Flowmeter Thorpe Tube Flowmeter Uncompensated Thorpe Tube Flowmeter Back Pressure–Compensated Flowmeter

12. 12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Liquid Oxygen Systems Popular in home care Able to power –Humidifier –Nebulizer –Positive-pressure breathing device Large reservoir –Small reservoir for portable use

13. 13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Oxygen Concentrators Take air from the atmosphere and separate the oxygen from the other gases in the air –Membrane –Molecular sieve Oxygen concentration of between 87 – 94%

14. 14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Air/Oxygen Blenders Devices that provide a precise oxygen concentration by mixing air and oxygen –Any value from room air to 100% oxygen –50 ‑ psi outlet Some also have a Thorpe tube flowmeter –50 ‑ psi inlet

15. 15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Using Medical Gas Cylinders Obtain the cylinder from storage. –Identify the cylinder. Maneuver the cylinder. –Exercise care. Transport the cylinder and cart. Crack the cylinder. Attach a reducing valve.

16. 16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of Portable Liquid Oxygen Systems Transfill from primary liquid oxygen reservoir Connect oxygen delivery device to nipple outlet Adjust flow control valve

17. 17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Determining Liquid Oxygen Duration Weigh the reservoir. Subtract the empty weight of the reservoir from its current weight. Multiply the liquid oxygen weight by 342.8 L/lb and multiply by 0.8. Divide the result by the liter flow rate being used.

18. 18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of an Oxygen Concentrator Convenient method for the delivery of oxygen for home or subacute use –Less expensive than cylinders or liquid systems –Oxygen is separated from atmospheric air

19. 19 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of Air/Oxygen Blenders Attach the inlet gases. Secure to a stand or wall-mount Attach to the 50 ‑ psi outlet or a flowmeter attached to the outlet. Adjust desired oxygen concentration and confirm oxygen concentration with an oxygen analyzer.