Medical Gas Safety

1. Medical Gas Safety January 2010

2. Contents 1 Medical gas systems in your area 2 Suction and oxygen therapy equipment 3 Storage of cylinders 4 Clinical uses of medical gases 5 Policy and Contacts 6 Assessment

3. Medical gas systems in your area

4. Medical Gas Can be piped or in cylinders 4 bar (T4) is used for patient needs 7 bar used to drive medical equipment Used in the delivery of nebuliser medications (anaesthetic machines)

5. Area Valve Service Unit AVSU Emergency isolation valve for piped gas in your area AVSU should be clearly labelled identifying the gas, the areas served and the number of outlets

6. Area Valve Service Unit AVSU You should be aware of the location of each AVSU in your area The AVSU can only be accessed by engineering staff but only with a permit to work

7. Quick Quiz What does AVSU stand for? Multi choice What does an AVSU do? Free text with correct answer pop up

8. Quick Quiz Where are the AVSUs located in your area? Which areas do they serve? In a Fire, whose responsibility would it be to switch off the gas at the AVSU?

9. Before isolation check which area it serves Check that patients are on an alternative gas supply

10. Local Alarms Could be installed near the AVSU or at the nurse station Should indicate the area covered Provide information on the condition of the piped medical gas systems in the area covered

11. Local Alarms Characterised by two fault conditions High pressure Low pressure The display should be checked daily (by whom?) to ensure normal is illuminated

12. Local alarms � if activated If the alarm sounds, you are already in an emergency situation Check display to see if high or low pressure If low pressure, this could mean that you have run out of gas

13. Local alarms � if activated�next steps Assess which patients are using gas Make alternative supply arrangements (Use cylinders or move patient to another area)

14. Quick Quiz Where are the local alarms located in your area? How often should the display be checked for �normal�? By whom? If alarm sounds, what steps should you take?

15. Piped gas outlet points Quick connect device Wall or pendant mounted Connection ensures correct gas to fitting � NEVER attempt to force wrong connection Never attempt to use when �Do not use� devices are fitted as the unit could potentially deliver the wrong gas

16. Piped gas outlet points � how to use Ensure anti-swivel notch (on flowmeter/suction pump?) is at 12 o�clock Engage by pushing probe squarely into outlet until it clicks into place Release by depressing index ring on outlet

17. Order of outlet points on terminal unit Oxygen Nitrous Oxide 50% Oxygen / 50% Nitrous Oxide Medical Air (4 bar) Surgical Air (7 bar) Vacuum AGSS

18. Cleaning terminal units No cleaner or solvent to be used Use damp cloth only Follow infection control policy

19. Quick Quiz If you go to fit a medical gas probe into the outlet point and it doesn�t fit, what should you do? What cleaning product should you use to clean the medical gas terminal units?

20. Suction and Oxygen therapy Equipment

21. Flow and Suction Regulators Designed to control the level of gas or vacuum to a patient Pics needed

22. Flowmeters - Gas Ensure hands and equipment are clean and free from dirt, grease or alcohol gel Inspect for damage before use Insert the flowmeter probe directly into the outlet until it clicks into position Check it is upright with no leaks, before adjusting the flow Ensure flowmeter has been shut off after use

23. Methods of oxygen delivery Nasal Cannula Simple mask Venturi mask Non rebreather masks

24. Oxygen in use Are these cards used in our Trust?

25. Oxygen Wastage 3 flowmeters left running at 5 l/m will use a full tanker of liquid oxygen over the course of a year

26. Suction equipment - vacuum Suction regulator and bacterial trap Suction and transfer hoses Collection jar

27. Suction regulators Controller to adjust level of vacuum On-Off switch Vacuum level gauge Bacterial trap Transfer tubing

28. Hoses Colour coded Inspect before use Be careful not to run over them with heavy equipment as could cause damage

29. Frequency of Checks It is compulsory that suction checks are carried out daily and signed for daily using Trust Resuscitation and Suction checklist Pic of checklist / link to policy

30. Responsibility Person in charge is responsible to ensure that daily checks are done and.. All suction is working and fit for purpose Checklist is signed and kept on Resus trolley, using Trust Resuscitation and Suction checklist. Ward managers are ultimately responsible for ensuring suction is working, checked and signed by the nurse in charge

31. Quick Quiz What should you check for before adjusting the flow on a flowmeter? How often should suction checks be carried out? Whose responsibility is this? Where should the Trust Resuscitation and Suction Checklist be kept?

32. Storage of Cylinders

33. Designated Cylinder Parking Area Cylinders on Wards should be kept to a minimum They should be secured in trolleys in defined storage or cylinder parking areas. Cylinders for immediate use should already be fitted with regulators turned off at the valve.

34. Ready to use stores In theatres or A&E a small number of cylinders may be held for immediate use The number of cylinders should be kept to 24 hours usage

35. Ready to use stores No combustible material or non medical gases to be stored in the same area They should be stored in racks, with sufficient space to manoeuvre on and off trolleys. Room must be clearly labelled with prohibition and warning signs

36. Quick Quiz True or false� Every Ward should keep a 24 hour supply of oxygen cylinders in case of emergency Cylinders for immediate use should be fitted with regulators Cylinders in theatres or A&E should be kept in a room with other non medical gases (eg??)

37. Clinical use of medical gases

38. Oxygen (O2) Essential for life in humans and animals Widespread use in hospital and home Mostly used in critical care areas, operating theatres, A&E, Respiratory and Surgical wards

39. Uses of Oxygen (O2) Used to treat hypoxia - reduced or inadequate supply of oxygen to tissues and cells Hypoxia can be caused by respiratory disease, circulatory disease or anaemia. Oxygen also used to increase margin of safety in other conditions such as low blood pressure, reduced conscious level and trauma.

40. Prescribing Oxygen Oxygen must always be prescribed by a Doctor, except in an emergency situation In an emergency, the prescription must be then completed retrospectively by a Doctor(?)

41. Oxygen Usage One small cylinder (15 litres) of oxygen will last a patient approximately 30 minutes

42. Entonox Analgesic (stem and acute pain relief) primarily used in: Midwifery Ambulances Wound cleaning or suturing Minor surgery Dressing changes Physiotherapy

43. Quick Quiz What is hypoxia? Name 3 conditions that Oxygen may be prescribed for Name 2 situations where Entonox may be used If you are asked to deliver oxygen therapy without a Doctor�s prescription what would you do?

44. Policy and Contacts

45. Assessment