1. David Capal, CEM, CHFM, SASHE David Womack 1.5 Contact Hours /0.15 CEU AHA/ASHE

3. Oxygen Systems Medical Air Systems Medical Surgical Vacuum Systems Waste Aesthesia Gas Disposal Systems

4. 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

6. 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)

7. 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)

9. 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.

10. Nitrogen Tank Manifold Nitrous Oxide Tank Manifold

12. 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.

15. Area/room being supplied Who can shut valve

17. 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

20. 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

23. Oxygen Vacuum Medical Air

24. Vacuum Oxygen Air

26. 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)

27. 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

28. Thermos Bottle (One Cylinder inside another cylinder with a vacuum separating the tanks)

32. CSA=> DOT Compliance-Safety Accountability

33. 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 PPM Dew Point <39F @ 50 PSIG (Prevent freezing of airlines run outside the building) CO < 10 PPM CO2 <500 PPM

35. Source for Control Air Dental Air Surgical Pneumatic Air Devices

36. 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

37. 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

38. 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

44. A system consisting of central-vacuum producing equipment with pressure and operating controls, shutoff valves, alarm warning systems, gauges and a network of piping.

48. 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.

50. 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

51. 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 60 PSIG) Backup or Reserve tank in use Dew point for Medical air goes above 39 F

54. Local alarms are located next to the medical gas/vacuum equipment. CO2 monitoring Dew Point System pressures High water for water sealed vacuum pumps

55. 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.

58. E Cylinder 660Liters * 0.035 Ft 3/Liter => 23.1 Ft 3 H Cylinder 7100 Liters * 0.035 Ft 3/Liter = 249 Ft 3

60. MED GAS PM Frequency

61. 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

62. 12 E Size Cylinders per smoke compartment >500 PSIG Full Tank

63. 12 Full Cylinders Each Cabinet Smoke compartment within a smoke compartment 36 cylinders in This compartment

65. 3000 Cubic Feet 120 E-Cylinders @ 25 cubic feet each 12 H-Cylinders @ 250 cubic feet each

66. Unlimited storage Requires dedicated ventilation with return within 12 inches of floor All electrical switches/outlets at > 60 AFF

69. 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