File - Respiratory Therapy Files

Report
210a
 Oxygen
– O2
 Air
 Carbon
dioxide – CO2
 Helium
– He
 Nitrous
oxide – N2O
 Nitric
oxide - NO
 Oxygen
and air are life supportive because
these gases supports the metabolic
production of energy in the carbon-based
organisms found on earth.
 Atmospheric concentrations are given in
percentage values (%), which represent the
relative quantities of gases as they are
present in the earth’s atmosphere.
 Characteristics

Colorless, odorless, tasteless
 Non-flammable
 Supports
combustion
 Characteristics
 Critical

temperature
-118.6 °C (-181 °F)
 Makes
up approximately 21% of air
 Commercially
produced through
fractional distillation
 Physical
 Used
separation
in oxygen concentrators
 Atmospheric
air is filtered of pollutants,
carbon dioxide and water
 Air is compressed and cooled to a liquid
 Then it is slowly heated and the nitrogen
boils off.
 Liquid oxygen remains
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 Composed
of inorganic sodium aluminum
silicate pellets
 These pellets absorb the nitrogen and water
vapor from the air
 Produces up to 90% mixture
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 Pulls
air through membrane
 Oxygen passes through faster than nitrogen
 Can produce 40% mixture
 Good for long-term low flow oxygen
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 Will
produce concentrations for nasal
cannula but only at low flows
 Used in oxygen concentrators IN THE HOME
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 Characteristics
 Colorless,
odorless, tasteless
 Non-flammable
 Supports
combustion
 At
normal atmospheric conditions, air is an
odorless, colorless, transparent, tasteless
mixture of gases and water vapor that is
nonflammable and supports combustion.
 Air is composed of about 78% nitrogen and
21% oxygen by volume.
 Compressed air may be referred to in
medical settings as room air or ambient air.
 Compressed
air is supplied in cylinders that
are color coded yellow.
 Piped compressed air is commonly provided
in hospital medical gas systems for use in
areas such as the operating room and
intensive care units.
 Smaller, portable air compressors are
available for hospital or home use.
 Produced
by filtering and
compressing atmospheric air
 Must
be dry
 Must
be free of oil
 Carbon
dioxide (CO2) is a colorless,
transparent, odorless to pungent, and
tasteless or slightly acid-tasting gas with a
specific gravity of 1.522, making it heavier
than air.
 CO2 is nonflammable and does not support
combustion or animal life.
 CO2 is a by-product of animal metabolism
and the burning of carbonaceous fuels.
 Characteristics
 Colorless,
 Does
not support combustion
 Cannot
 Grey
odorless
support life
cylinder
 Produced
by heating limestone in
contact with water
 Critical
temperature above room
temperature; stored as liquid in
cylinder
 Used
in the past in mixtures with
oxygen (90% O2 with 10% CO2, 95% O2
with 5% CO2); current use is limited
 Current
CO2 mixtures used primarily
in membrane oxygenators and for
calibration of analyzers
 Characteristics
 Second
lightest of gases
 Odorless,
tasteless
 Non-flammable
 Brown
cylinder
 Characteristics
 Good
conductor of heat, sound, and
electricity
 Inert
 Cannot
support life
 Produced
 When
through liquefaction
used therapeutically, must be
mixed with at least 20% O2 (Heliox)
http://www.youtube.com
/watch?v=nripiMQt0ls
 Used
to manage severe airway
obstruction to decrease work of
breathing
 Nitric
oxide (NO) is a colorless, tasteless gas
with a slight metallic odor. This
nonflammable and non-life-supporting gas
supports combustion and is toxic.
 Nitrogen (N2) is the major component of the
atmosphere, 78% by volume.
 Nitrogen gas is responsible for the blue color
of the sky on earth.
 Characteristics
 Colorless
 Slightly
sweet odor and taste
 Supports
 Cannot
combustion
support life
 Produced
by thermal decomposition
of ammonium nitrate
 Critical
temperature above room
temperature; stored as liquid in
cylinder
 Used
as an anesthetic agent
 Characteristics
 Colorless
 Non-flammable
 Supports
combustion
 Produced
by oxidation of ammonia
at high temperature in the presence
of a catalyst
 Respiratory
irritant capable of
causing chemical pneumonia and
pulmonary edema
 High
concentrations can cause
methemoglobin to form
 Used
in term and near-term infants
for the treatment of persistent
pulmonary hypertension
 Markings
 Sizes/oxygen
contents
D
– 12.6 cu.ft./356 L
E
– 22 cu.ft./636 L
G
– 186 cu.ft./5260 L
 H/K
– 244 cu.ft./6900 L
 2200
psi
 A.S.S.S safety system
 Threaded connection
 Need to be safety chained and in a secured
dolly for moving
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 Small
and lightweight (15 pounds)
 PISS – Pin Index
 Yoke connection
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 Air
Yellow
 Oxygen
Green – Int’l (White)
 Helium
Brown
 CO2 Grey
 Nitrogen Black
 Nitrous Oxide-Blue
Do NOT trust the color of the tank as sole
indicator of it’s contents
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 Large

Liquid oxygen
 Small


capacity
system (or back up)
Nitrous Oxide
Bank of H cylinders
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 Insulated
– Liquid
 Solid metal - Gas
 Large continuous demand – Liquid
 Small portable – Liquid or tank
 Tanks
liquid

act differently if they contain gas or
No accurate gauge on liquid tank content
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 Constantly
losing oxygen despite insulation
 Needs pressure and insulation for cold
temperature (-118oC)
 Low pressure (200 psi)
 Large system has vaporizers fins to help with
heat transfer when liquid turns to gas (frozen
year round)
 Small system is great for mall shopping
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44
 D.I.S.S.


50 P.S.I
The MJC lab has these
 Quick

connect
A newer “better system”
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 Thorpe
Tube is most common
 Can use Bourdon Gauge
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


They decrease internal tank pressure down
to a working pressure (50psi)
They read and display the internal tank
pressure
They meter out the precise flow for
patient use.
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 A.S.S.S.


H cylinders
High pressure, large tanks
 P.I.S.S.


(American Standard)
(Pin Index)
E cylinders
High pressure, small tanks
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 You
can memorize size of tank then calculate
how long it will last
Or use:
 Conversion factors


3.14 for H cylinders
0.28 for E cylinders
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



Convert pounds to liters
Multiply by 860 to get volume of gaseous
oxygen (Liters)
Divide by the liter flow (L/min)
Convert minutes to hours and minutes
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 Steel
cylinders are used to store compressed
oxygen and other gases.
 Medical gases can be stored and transported
in the gaseous state or as liquefied gas in
various-sized cylinders and cryogenic bulk
containers.
 Filling
cylinders
 Compressed
gas cylinders filled to
service pressure plus 10%
 Measuring
contents
 Compressed

Contents directly proportional to pressure
 Liquid

gas cylinders
gas cylinders
Contents determined by weight of cylinder
 Duration
 Duration
of flow
of flow = Contents
Flow
 Factors
for determination of duration
 “E” cylinder = 0.28
 “H/K”
cylinder = 3.14
Duration of flow = Pressure x Cylinder factor
Flow
 Cylinder
cap in place when not in
use
 Segregate
full and empty cylinders
 Factors
 Liquid
for determination of duration
system = 860
Amount of gas in liquid = Weight of liquid x 860
2.5
 Must
 No
be in racks or chained to wall
combustible material in the
vicinity
 Flammable
gases stored separately
from gases that support combustion
 Always
use “No Smoking” signs when
oxidizing gas is present
 Liquid
oxygen containers must be in
a cool, well-vented area
 Use
approved carts for transporting
cylinders
 Keep
protective cap in place during
transport
 Cylinders
must always be secured
either with a chain to the wall, or
an approved cart or stand
 Cylinders
 “Crack”
 Storing
must be uncovered
a cylinder valve before use
cylinders:
 http://www.youtube.com/watch?v=
AtyUn0aBYiw&feature=related
 Do
not position cylinders near
sources of heat
 Do
not alter the safety system for
the cylinder
 Defined
as containing at least 20,000
cubic feet of gas
 May
be in either gaseous or liquid
form
 More
economical over the long term
 More
dependable; less prone to
interruption
 Eliminates
need to transport large
numbers of cylinders
 Delivery
pressure uniform
 Operating
pressure is lower (50 psig)
 Expensive
 Failure
to construct
may affect large numbers of
patients
 Supply
systems
 Cylinder
manifold system
 Cylinder
supply system with reserve
supply
 Supply
 Bulk
systems
gas system with reserve
 Shut-off
valves, zone valves
 Food
And Drug Administration (FDA)
 Oversees
purity of gases produced
 Department
 Oversees
of Transportation (DOT)
construction of cylinders and
transportation of medical gases
 National
Fire Prevention Association
(NFPA)
 Oversees
construction of bulk systems
and sets standards for storage of
medical gases
 Compressed

Gas Association (CGA)
Regulates handling, storage, fittings,
and markings
 American
Standard Safety System
(ASSS)

Standardizes threaded high-pressure
connections for cylinder sizes “F” to “H/K”

http://www.youtube.com/watch?v=9uQzTA
XZ59c&feature=related
 26
connections total within the
system
 Thread
diameter
 Threads
per inch
 26
connections total within the
system
 Right-handed
 External
vs. left-handed
vs. internal
 Sub-system
 Applies
of ASSS
only to cylinders up to size “E”
 System
of two pins aligning with holes
in cylinder valve face; six possible
positions
 Pin
Positions
 Oxygen
– 2-5
 Oxygen/Carbon
dioxide – 2-6
 Helium/Oxygen
– 2-4
 Nitrous
 Air
oxide – 3-5
– 1-5
 Used
For low pressure (<200 psig)
medical gas connectors
 Consists
of an externally threaded
body and mated nipple with a nut
 Twelve
standardized connections
 Made
 Each
by various manufacturers
connector has distinct shape so
it cannot be used with a different gas
 Two
types of high pressure reducing
regulators
 Single
stage – Reduces cylinder pressure to
working pressure in one stage
 Two
types of high pressure reducing
regulators
 Multiple
stage – reduces cylinder pressure
to working pressure in two or more stages
 Pre-Set
pressure
reducing regulator

Delivers fixed, preset outlet pressure
 Adjustable
reducing regulator

Delivers outlet
pressure adjusted to
specific need
 Used
to set and control the flow of
gas to the patient from a 50 psig
source
 Three
types
 Bourdon
 Thorpe
 Flow
gauge
tube
restrictor
 Measures
pressure within the
flowmeter; calibrated to read as flow
 Unaffected
by gravity; can be used in
any position
 Inaccurate
when pressure distal to
the orifice increases, causing back
pressure to increase; causes
flowmeter to read high
Figure 15-15: DISS safety systems: flow meter and 50-psig outlet.
Courtesy of Western/Scott Fetzer Company
 Measures
 Must
true flow
be used in the upright position
 http://www.youtube.com/watch?v=
6UwXKXS9Xao
Figure 15-11A: ASSS, PISS, and DISS connections.
Courtesy of Western/Scott Fetzer Company
 Pressure
 Flow
compensated
control valve distal to the meter;
Prevents changes in downstream
resistance from affecting accuracy of
reading
 Uncompensated
 Flow
control valve proximal to the
meter; records less than actual flow
Compensated
 Has
a fixed orifice capable of
delivering one specific flow
 Need
variety of restrictors in the
event of patient needs changing
 Cannot
 Unable
be used during resuscitation
to increase flow for CPR

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