I. Subject: Medical Gas Systems Utility Failure Interim Procedure III. Purpose:

Transcription

1 I. Subject: Medical Gas Systems Utility Failure Interim Procedure II. Purpose: To provide a systematic response to medical gas system failure and restoration of this critical utility. III. Procedure: Systems or Services Affected: Oxygen Medical/ Surgical Care Units Emergency Care Hyperbaric Medicine Diagnostic Imaging Services Medical Air Critical Care Units Special Care Nursery Open Heart Surgical Suites Pediatrics Hyperbaric Medicine Nitrous Oxide Labor and Delivery Nitrogen Pathology (liquid) Carbon Dioxide Laboratory Specialty Gases Cardiopulmonary Diagnostics Hyperbaric Medicine Mitral Valve Prolapse Clinic Vacuum Medical/ Surgical Care Units Emergency Care 1

2 Redundancy: Oxygen Primary and Secondary bulk liquid systems Large and small gas cylinders Medical Air 3 large rotating air compressors 3 portable medical air compressors Large and small gas cylinders ventilators with internal compressors ventilators and oxygen blenders without internal compressors will continue operating with remaining gas source Nitrous Oxide Primary and Secondary cylinder banks Small gas cylinders Nitrogen Primary and Secondary cylinder banks Small gas cylinders Carbon Dioxide Primary and Secondary cylinder banks Small gas cylinders Specialty Gases Reserve cylinders in par inventory Vacuum Redundant vacuum pumps Dual systems in hospital and heart center are interconnected Portable electric vacuum generators 4 gas powered suction units Hand powered manual aspirators Operational & Interim Contingency Plans: Oxygen Oxygen Shutdown During Fire Emergencies Patient care staff will immediately activate the R-A-C-E Fire Plan, removing patients from the area where the fire is located. Patient care staff will disconnect any oxygen administration device to discontinue oxygen flow into the effected room. If the flow of oxygen can not be shut off in the effected room, or if the fire is widespread, the patient care staff member will shut off the appropriate zone valve for unit. 2

3 Patients requiring oxygen will be provided small cylinders of oxygen and/or moved to a safe area where oxygen is available Piped Medical Oxygen System Loss Medical oxygen alarm will activate at switchboard and on nursing unit panels Ventilators, anesthesia machines, and oxygen blenders alarm but continue to operate with remaining gas(es) Anesthesia personnel will switch to reserve oxygen cylinders on anesthesia machine and hand ventilate patient. Perfusionist will connect reserve oxygen cylinder to gas blender on bypass pump. Engineering department personnel will be notified immediately of failure. Respiratory Therapy department personnel to be notified immediately of failure Respiratory Therapy personnel will prepare and deliver large oxygen cylinder systems for back feed to critical care zones. Hyperbaric treatments will be discontinued and the patients brought to surface breathing room air. In the event that decompression is required for an inside attendant, the attendant will be moved into the smaller access lock and decompress as required. Engineering personnel will identify location and reason for failure Primary bulk liquid line failure will require engineering personnel to turn off the primary line at the storage pad and the opening of the secondary line Primary and secondary bulk liquid oxygen system failure will require turning off the line outside the 1200 unit near outpatient surgery. Engineering personnel will then instruct Respiratory Therapy personnel to connect the large oxygen cylinders to outlets in the ICUs to back feed the entire hospital. Oxygen piped gas line interruption occurring at the nursing unit level will require shutting off the zone valve for that unit. Patients on that unit will be furnished with small oxygen cylinders or moved to a location where piped oxygen is available until the system is repaired. In the event that the location of the failure cannot be quickly established, Respiratory Therapy and Engineering department personnel will begin delivering large oxygen cylinders to selected high use patient care units for back feed supply. Each unit will be isolated by turning off its zone valve once the large cylinder is connected. Patients requiring oxygen on those units not selected for back feeding will be supplied with small oxygen cylinders or moved to an area with oxygen supply. 3

4 Following restoration of piped oxygen gas pressure, an inventory of liquid oxygen tank volume and oxygen cylinders will be undertaken and additional supply(ies) obtained as necessary (see Contact umbers). Medical Air Compressor failure, line failure, or failure due to loss of primary and backup electricity Medical air alarm will activate at switchboard and on nursing unit panels Ventilators, anesthesia machines, and oxygen blenders alarm but continue to operate with remaining gas(es) Ventilators with internal air compressors will automatically switch to internal systems. Anesthesia personnel in the open heart surgical suites will switch to reserve air cylinders on anesthesia machine and hand ventilate patient. Perfusionists will connect reserve air cylinder to gas blender on bypass pump. Hyperbaric treatments will be discontinued and patients brought to surface breathing oxygen. In the event that decompression is required for an inside attendant, the attendant will be moved to the smaller access lock and decompress as required utilizing reserves from the air volume tanks. Engineering department personnel to be notified immediately of failure Respiratory Therapy department personnel to be notified immediately of failure. If interruption of a medical air line is detected at the unit level, the zone valve for that unit will be closed. Respiratory therapy personnel will prepare and deliver portable air compressors to the effected area(s), especially critical care, nursery, and pediatrics areas following restoration of piped air gas pressure, an inventory of air cylinders will be undertaken and additional supply(ies) obtained as necessary (see Contact umbers). itrous Oxide Alarm will activate on the console at the Surgery department desk. Anesthesia machine alarm will activate. Anesthesia personnel will switch to reserve nitrous oxide cylinders on anesthesia machines. Engineering department personnel to be notified immediately of failure department personnel will check gas supply on primary bank and switch to secondary bank if necessary. Non-emergency surgical cases will be held as necessary. itrogen Alarm will activate on the console at the Surgery department desk. 4

5 personnel will switch to small nitrogen E cylinders Engineering department personnel to be notified immediately of failure department personnel will check gas supply on primary bank and switch to secondary bank if necessary. Non-emergency surgical cases will be held as necessary. Pathology will contact vendor for additional liquid nitrogen. If refill time > 1 hr., specimens will be transported to another accredited facility for processing. Carbon Dioxide Alarm will activate on the console at the Surgery department desk. Perfusionist and surgery personnel will switch to small carbon dioxide E cylinders. Engineering department personnel to be notified immediately of failure. department personnel will check gas supply on primary bank and switch to secondary bank if necessary. Non-emergency surgical cases will be held as necessary. Small cylinders of CO2 will be obtained from OR for microbiology until large cylinders are replenished Specialty Gases Notify Department manager of effected system Diagnostic testing will be rescheduled as necessary Vacuum Alarm will sound at each nursing unit zone. Engineering will be notified immediately. Zone valve will be turned off if leak is present at a specific area to isolate zone. Each nursing unit will utilize portable electric suction units available on the crash carts. If electric power is unavailable, pneumatic suction devices and hand suction devices will be obtained from the Respiratory Therapy department and stationed in the critical care units. Gastric evacuation may be performed with low pressure settings on portable suction units, or by use of large volume catheter tipped syringes. 5

6 CO TACT UMBERS: Liquid Oxygen: Linde (national) Chemtrek (emergency) 1-(800) Air Products Medical Gas Cylinders: Airgas (local) Respiratory Therapy: ext Engineering: ext