MEDICAL GASES Manufacture, Storage, Transport + Delivery First Year Respiratory Therapy MJC RsCr 220

Composition of the Air We breathe earth’s atmosphere composed of: Nitrogen (78%) Oxygen (21%) Carbon Dioxide (0.03%) Argon and trace gases (0.93%) Neon, Xenon, Krypton and Deon RsCr 220

How Oxygen is produced Fractional Distillation Physical Separation Nitrogen Molecular sieve Semi-Permeable membrane

Fractional Distillation Large Manufacturing Facility

Fractional Distillation for liquid O2 RsCr 220

Fractional Distillation 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 RsCr 220

Molecular Sieve Semi-Permeable Plastic Membrane (in the home) Physical Separation Molecular Sieve Semi-Permeable Plastic Membrane (in the home)

Molecular Sieve Composed of inorganic sodium aluminum silicate pellets These pellets absorb the nitrogen and water vapor from the air Produces up to 90% mixture RsCr 220

Oxygen Concentrator RsCr 220

Semipermeable Membrane Pulls air through membrane Oxygen passes through faster than nitrogen Can produce 40% mixture Good for long-term low flow oxygen RsCr 220

Oxygen concentrator–Semi-permeable membrane RsCr 220

Physical Separators Will produce concentrations for nasal cannula but only at low flows Used in oxygen concentrators IN THE HOME RsCr 220

Home Concentrator RsCr 220

Medical Gases Oxygen, Carbon Dioxide, Helium, Nitrous Oxide, Nitric Oxide, Nitrogen, Carbon Monoxide

Properties of Common Gases Chemical symbol Molecular weight Color, odor, taste Physical state Critical temperature, boiling point Combustion characteristics RsCr 220

Oxygen 02 Molecular Weight 32 Colorless, odorless, tasteless Slightly heavier than air Density of 1.29 g/L Nonflammable but supports combustion RsCr 220

Compressed Air Is the same mixture of nitrogen, oxygen, carbon dioxide and argon. Is piped in to all modern hospitals Used to power pneumatically powered equipment Some situations (patients are C02 retainers) when oxygen is contraindicated RsCr 220

Carbon Dioxide C02 Colorless and Odorless Does not support combustion Used in fire extinguishers More soluble in liquids than oxygen Easier transporting in blood then oxygen Used to treat hiccups (singulation) RsCr 220

Helium He Odorless, tasteless, non-flammable Second lightest of gases Combined with oxygen (heliox) to reduce work of breathing with swollen upper airways RsCr 220

Nitrous Oxide N20 Nonflammable but supports combustion Used as an anesthesia in OR (laughing gas) Always mixed with oxygen (Entonox) and other anesthesia agents RsCr 220

Nitric Oxide N0 Is nonflammable but supports combustion Used experimentally in low concentrations (ppm) for pulmonary vasodilation Recently has had excellent results with premature babies RsCr 220

Nitrogen N2 Used as lab gas (liquid) for freezing tissue RsCr 220

Carbon Monoxide CO Used in Pulmonary Function Lab Very diffusible – used to test how easily gas will pass through the lung membranes RsCr 220

Cyclopropane Strictly an anesthesia gas RsCr 220

Ethylene Oxide Used to gas sterilize medical equipment Useful for equipment that can’t handle high temperatures or immersion in water RsCr 220

Tanks – Liquid Tanks - Gas Oxygen Storage Tanks – Liquid Tanks - Gas

Tank Sizes and Capacities Large Cylinders Small Cylinders

Oxygen Tank Sizes RsCr 220

H Cylinders 2200 psi A.S.S.S safety system Threaded connection Need to be safety chained and in a secured dolly for moving RsCr 220

E Cylinders Small and lightweight (15 pounds) PISS – Pin Index Yoke connection RsCr 220

Types and colors of cylinders 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 RsCr 220

Labels – The only sure way RsCr 220

Other Oxygen Tank Markings RsCr 220

Regulation of cylinders D.O.T O.S.H.A. F.D.A. B.M.D.

Recommending Agencies C.G.A. N.F. P.A. A.N.S.I. I.S.O RsCr 220

Bulk Supply Systems Liquid Oxygen

Bulk Oxygen Systems Large capacity Small system (or back up) Liquid oxygen Small system (or back up) Nitrous Oxide Bank of H cylinders RsCr 220

Large Oxygen Supply System RsCr 220

Small Bank of Cylinders RsCr 220

Liquid vs Gas Insulated – Liquid Solid metal - Gas Large continuous demand – Liquid Small portable – Liquid or tank Tanks act differently if they contain gas or liquid No accurate gauge on liquid tank content RsCr 220

Go figure RsCr 220

Liquid Oxygen 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 RsCr 220

Bulk Liquid Oxygen supply RsCr 220

Bulk Oxygen Supply System RsCr 220

Home Liquid Oxygen RsCr 220

Low Pressure Safety Systems Diameter Index Safety System Quick Connect

Wall (low pressure) systems D.I.S.S. 50 P.S.I The MJC lab has these Quick connect A newer “better system” RsCr 220

DISS (and Dat) RsCr 220

DISS Wall Outlet RsCr 220

Different Quick Connects RsCr 220

More Quick Connects RsCr 220

Flowmeters Thorpe Tube is most common Can use Bourdon Gauge RsCr 220

RsCr 220

Other Safety Features Zone Valves

Zone Valve System RsCr 220

Zone Valves for bulk O2 supply RsCr 220

Cylinder Connections (High Pressure) American Standard Safety System Pin Index Safety System Key Index Safety System

Regulators 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. RsCr 220

Cylinder connections A.S.S.S. (American Standard) P.I.S.S. (Pin Index) H cylinders High pressure, large tanks P.I.S.S. (Pin Index) E cylinders High pressure, small tanks RsCr 220

American Safety Standard System RsCr 220

Pin Index System RsCr 220

Pin Index System RsCr 220

Pin Index Numbering for small cylinders RsCr 220

Tank Duration How long will they last

Cylinder Duration Calculations 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 RsCr 220

Liquid Oxygen Duration 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 RsCr 220

Thanks for listening RsCr 220