HLTMS207C Handle Medical Gases Safely
FOREWORD This publication is one of a number of Learning Guides produced by The Australian Medical Association (WA) Inc as a resource for the health sector. It is utilised within AMA Training Services and Health Training Australia as a training resource and within the workplace as a support guide. The development of this workbook was undertaken by a number of trainers and developers within AMA and HTA, who have both industry knowledge and specific expertise in the course content. Although every effort has been made to present reliable and accurate information, the AMA will assume no responsibility for outcomes and actions resulting from the application of the information presented in this workbook. Users are encouraged to confirm application in conjunction with protocols within their specific work environment. This book is copyright. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the Copyright Act, no part may be reproduced by any process without written permission. Please forward all enquiries to: The Manager Health Training Australia PO Box 133 NEDLANDS WA 6909 Telephone: (08) 9273 3044 Facsimile: (08) 9273 3045
CONTENTS INFORMATION FOR LEARNERS...4 Training...4 On and Off-the-Job Training...5 Assessment...5 Learning Guide Aid...6 Tips for Learners...7 LEARNING OUTCOMES...8 INTRODUCTION...9 LEGISLATION AND MEDICAL GASES...10 TYPES OF MEDICAL GASES...11 CYLINDER IDENTIFICATION...12 Cylinder Colour Coding...12 Labelling...13 Cylinder Labelling...13 Material Safety Data Sheets (MSDS)...14 EMERGENCY AND PERSONAL PROTECTIVE EQUIPMENT...15 Emergency Situations Involving Cylinder or Pipelines...16 Personal Protective Equipment (PPE)...17 GAS CYLINDER AND FITTINGS...18 Cylinder Fitting...19 Manifolds...20 Regulators / Flowmeter...21 Bull-Nose regulator...21 Pin Index Regulator...21 TRANSPORT AND STORAGE...22 Storage of Cylinders...22 Types of equipment for transporting medical gases...23 Preparation for Use...24 GAS CYLINDER USE...25 Cylinders in Use...25 After Cylinder Use...25 MEDICAL OXYGEN CYLINDERS AND EQUIPMENT...26 Safe Manual Handling of Medical Oxygen...26 Cleaning...26 Operating Instructions...27 Fitting a regulator and flow-meter to an oxygen cylinder with a pin-index valve...28 After use...28 Fitting a regulator and flow-meter to an oxygen cylinder with a bull-nosed valve...29 After Use...29 MANAGEMENT OF MEDICAL CYLINDERS FOR PIPELINES...30 BIBLIOGRAPHY...31 GUIDE TO ASSESSMENT...33 Assessment Plan for Participant...34 Summary of Evidence Sources...35 Assessment Plan...36 WRITTEN ACTIVITIES...37 PRE-ASSESSMENT CHECKLIST...41
INFORMATION FOR LEARNERS This learning guide will assist you in developing skills and knowledge to work effectively in the health industry and to apply these skills to your workplace and daily tasks. Training Competence means that you have the required knowledge and skills to do your job. These are described in competency standards. Your training will be based on these to make sure it is relevant to the needs of your job and yourself. Your Participant Assessment Record and the Pre-Assessment Checklist in the Guide to Assessment (included at the back of this Learning Guide) state the standards of competence. The purpose of the training is to develop your workplace competence, so you will be expected to practise your skills whenever you can. This can be done through work experience, practical sessions in a training organisation or through your full time or parttime job. It is important that you have both theoretical and practical knowledge and skills. 4
INFORMATION FOR LEARNERS On and Off-the-Job Training Your training may consist of on-the-job coaching with your workplace supervisor and/or trainer on a one-to-one or small group basis. It may also involve formal training sessions conducted off-the-job in addition to working through your learning guide. Make sure you ask lots of questions, complete the activities, and do additional research to ensure you know everything listed in the Pre-Assessment Checklist. If you do not understand any part of the unit please contact your Trainer. Assessment Once you have completed your training and practised your skills, you will be ready to have your skills and knowledge assessed. The purpose of this is not to see if you can pass a test, but to determine if you can perform work tasks competently. Refer to the Guide to Assessment for detailed information on this unit s Assessment Plan. Complete the Pre-Assessment Checklist in the Guide to Assessment. This sets out the skills and knowledge you will need to demonstrate during your assessment to be deemed competent in this unit. 5
INFORMATION FOR LEARNERS Learning Guide Aid You will see the following icons throughout your Learning Guide. They will help you with your learning by telling you what type of information that is being presented in the Learning Guide. The icons are listed below with explanations on the use of each one. REMEMBER - used for specific points to note or helpful tips to remember. THINK / IDEA when asking you to think about your response to a statement or situation. What do you do in your workplace? INFORMATION when providing additional information or giving links to further information e.g. website, reference book, workplace policies and procedures. IMPORTANT for any information that is considered important and critical to demonstrating competence in the unit, or in relation to an occupational health and safety issue. ACTIVITY may form part of the evidence of competency for this unit. The activities are designed to make the theory practical to your individual situations and you are encouraged to complete them all. 6
INFORMATION FOR LEARNERS Tips for Learners Read through the information in the Learning Guide carefully. Make sure you understand the material. If you come across anything you do not understand: Discuss your training with your trainer and make sure you understand what is required and how the training will be organised. Ask for feedback on your progress as you work through the activities. Ask for help when you need it. Talk to more experienced colleagues or your trainer and ask for their guidance. Listen, take notes, ask questions and practise your new skills as often as possible. This way you will improve your speed, memory, and also your confidence. During your training, you should seek other sources of information as well e.g. reference books, the Internet. Some of these are suggested in the guide. Try to relate the information presented in this Learning Guide to your own experiences and to what you already know. Work through the activities. They are there for a reason and even if you already have the knowledge or skills relating to a particular activity, doing them will help to reinforce what you already know. If you do not understand an activity, think carefully about the way the question or instructions are phrased. 7
LEARNING OUTCOMES This Learning Guide will provide you with information that will assist in your knowledge and application of safe practice for medical gases in a health care environment. Completing this work book aims to provide you with a greater understanding of the principles and techniques associated with: Identifying and preparing medical gas equipment for use. Appropriate methods for handling and transporting medical gas equipment. Effective and appropriate methods for storing medical gas cylinders and equipment. Operating medical gas equipment. Emergency response procedures in relation to medical gases. Relevant legislation, industry standards and workplace requirements necessary for handling and storing medical gases. In order to be competent in this unit you will be able to: Read and interpret all work requirements. Methodically organise your work area and equipment. Be able to identify the type of medical gas and its characteristics. Identify cylinder, regulator and valve types. Organise equipment availability. Use emergency and personal protective equipment. Identify when gas handling procedures do not conform to work practice. Safely operate medical gas equipment. Use safe and efficient work practices whilst handling medical gases. Communicate effectively when handling medical gases to ensure safety. Handle and transport medical gases and equipment appropriately. 8
INTRODUCTION This unit is provided as a collective unit for Health Support Workers who have a multifunctional role within a heath care facility but can also be adapted for workers who have a more specific support role in relation to providing quality health care services. In reading through the Learning Guide you may well come across information and tasks that are not your everyday responsibility. However, by completing this unit you will gain a better understanding of your role and responsibilities in a health care setting and thereby improve your existing skills and knowledge in your current work role. In health care facilities the use of medical gas cylinders is common practice. Therefore it is important for you to have skills and knowledge in safe handling of them. Use a trolley to move cylinders and secure correctly when not in use. In this unit examples are given from Western Australian Legislation. Each State and Territory has adapted Legislation according to their needs and requirements. To look at Legislation that governs your State or Territory go to: Australian Government website www.australia.gov.au/legislation 9
LEGISLATION AND MEDICAL GASES Handling and moving medical gases is a hazardous task and therefore it is controlled very strictly by the use of state and federal legislation. In terms of safety there are various aspects to consider and the majority of issues are covered under: Occupational Safety and Health Act. Dangerous Goods Safety Act. Dangerous Goods Regulation. Code of Practice for the storage and handling of dangerous goods. Australian Standards. It is also essential that you have full understanding of your organisations policies and procedures in relation to handling, identifying and reporting risk in relation to medical gases and adhere to them at all times. These documents should reflect current legislation. Outline your organisations policies and procedures for handling medical gases. If you are unsure about any aspect of the procedures for safe handling and storage of medical gases ask your supervisor for further information before you undertake the task. 10
TYPES OF MEDICAL GASES There are various types of medical gas used in health facilities. They maybe delivered via a cylinder or through pipelines direct to the patient/client. The most commonly used in a hospital are: Medical Air This gas is clean compressed air which is a mixture of 21% Oxygen and 78% Nitrogen and other inert gases. It is used for patient ventilation. Oxygen Oxygen makes up 21% of the atmosphere and is essential to life. It is tasteless, colourless and has no odour. It can react strongly in the presence of other chemicals and so care should be taken during its use. It is commonly used with clients who have respiratory disorders or in cases where a patient/client needs to be resuscitated. Carbon Dioxide Carbon Dioxide is made up of two elements: carbon and oxygen. It is colourless, has a slightly irritating odour and is heavier than air. It is found in small amounts in the atmosphere but cannot sustain life. It freezes at -78.5 C to form carbon dioxide snow which is used in fire extinguishers. It may also be used in some surgical procedures. Nitrous Oxide Nitrous Oxide or laughing gas is mainly used in operating theatres as part of the anaesthetic process. It is a colourless gas with a slightly sweet taste and smell. Entonox Entonox is a mixture of 50% Nitrous Oxide and 50% Oxygen. Due to the percentage of oxygen it doesn t produce unconsciousness. It is colourless and has a slightly sweet smell and taste. It is used for patients who need to be given a quick acting pain reliever that only lasts for a short duration. In hospitals it is most commonly used in Obstetric and Emergency Departments. 11
CYLINDER IDENTIFICATION Medical Gas cylinders are identified in a number of ways: By the cylinder valve outlet. By the pattern on the cylinder. By the colour on the cylinders. By the name of the gases on the cylinder label. Cylinder sizes are identified by a letter code G, E, D, and C shown on the label. The nominal capacity is shown in litres. The empty weight of the cylinder (or tare ) is stamped on the aluminium ring located under the valve on all cylinders containing liquefiable gases (e.g. carbon dioxide, and nitrous oxide). Colour Each gas has a specific cylinder colour for ease of identification. These colours are indicated on the Medical Gas cylinder chart or pocket guide. Cylinder Colour Coding Table 1: SHOULDER BODY OF CYLINDER OXYGEN White Black NITROUS OXIDE Ultramarine Ultramarine ENTONOX Ultramarine and white Ultramarine 50% Nitrous Oxide 50% Oxygen CARBON DIOXIDE Green Grey Green Grey 12
CYLINDER IDENTIFICATION Labelling In accordance with the Dangerous Goods legislation, a label is attached to each cylinder. The label contains the following details: 1. Shipping name, product name, identifying number (for safe handling, transport and storage) and class diamond. 2. Product code (gas code) and cylinder size, identified by letter code. 3. Indicated major hazards or prescription drug warning notice. 4. Quality of product (grade of gas). 5. Specific product and cylinder handling information (content, filling pressures). 6. Instructions for use. Cylinder Labelling Figure 1: 13
CYLINDER IDENTIFICATION Material Safety Data Sheets (MSDS) In order to comply with Occupational Health and Safety Act in addition to the information on the cylinder labels, a current MSDS (sometimes referred to Product Information Sheets) should be available for all staff members that come into contact with medical gases. These sheets will give precise and detailed information on the company supplying the gas, the ingredients/physical characteristics, uses, administration, contraindications, precautions, first aid advice and emergency information. Before you handle any medical gases you need to have read and understood the information on the MSDS. Find a copy of the MSDS for one of the medical gases you handle. Record below any important safety information you should be aware of before handling it. 14
HLTMS207C HANDLE MEDICAL GASES SAFELY GUIDE TO ASSESSMENT 33
GUIDE TO ASSESSMENT Assessment Plan for Participant Unit of Competency: HLTMS207C Handle medical gases safely Unit Description: This unit describes the skills and knowledge required to handle medical gas equipment in a safe manner within the health care environment Work will be within a prescribed range of functions involving known routines and procedures with some accountability for the quality of outcomes. The workplace context may be: Specific community. Community or regional service. Department of a large institution or organisation. Specialised service or organisation. Plan: Assessment Training, mentoring and support in relation to each unit of competency will be provided to participants on a regular basis in person, on the phone or via email. More intensive training will be provided to participants if required, as identified by the trainer/assessor (this may include off-the-job training). Participants on the job performance is discussed with the coach/supervisor (through the use of the Participant Assessment Record) forming the Third Party Report. Verbal and written instructions will be given to all participants prior to assessment. Ask your trainer/assessor for additional support if there are particular cultural and language needs. Alternative assessment methods are available these are outlined in the Participant Assessment Record The assessment report is discussed with participant providing feedback on the outcomes of assessment and guidance on future options. Participant receives a copy of the final assessment report. 34
GUIDE TO ASSESSMENT 35 Summary of Evidence Sources ASSESSMENT ON-THE-JOB OFF-THE-JOB Elements / Performance Criteria Demonstration / Simulation Oral Questions Direct Observation Third Party Report Written Activites Case Studies /Projects Workplace documents Diary / Journal Other 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 3.1 3.2 3.3 3.4 3.5 3.6
GUIDE TO ASSESSMENT Assessment Plan Verbal and written instructions will be given to all participants prior to assessment. Ask your trainer for additional support if there are particular cultural, language, literacy or numeracy needs. Assessment Type 1 Written Assessment 2 Direct Observation 3 Oral Questions 4 Third Party Report Assessment Task Knowledgebased assessment. Workplace assessment. Workplace assessment. Workplace performance. Brief Description of Task Directed activities and written questions in Learning Guide and Guide to Assessment. Direct observation of skills/performance in the workplace or simulated environment relating to handling medical gases safely. These questions will accompany observation of the workplace tasks relating to handling medical gases safely. Consultation with supervisor by assessor as to ongoing work performance of participant. Resources required Learning Guide. Workplace. Organisation policies/procedures. Assessment Tool. Organisation policies/procedures. Assessment Tool. Participants Record Book. Date of Assessment 36
WRITTEN ACTIVITIES 5. What are the two best ways to move medical gas cylinders around the health care facility? (Circle correct answer/s, there may be more than one answer) a. Use a trolley designed for moving cylinder and if there is no other means then roll on end of cylinder as last resort, using the correct posture and safety equipment e.g. gloves b. Lay the cylinder down and roll along the floor using your foot c. Use a trolley designed for moving cylinders or roll on end using the valve as a steady 6. What should be done before connecting a regulator? (Circle correct answer/s, there may be more than one answer) a. Wash the outside down so it is clean ready for use b. Check that it is the correct gas cylinder and regulator, secure to holding chains c. Crack the valve and check that there is no foreign body in the valve and it is free of oil etc 7. Why are medical gas cylinders colour coded? (Circle correct answer/s, there may be more than one answer) a. So we can identify by the international colour code for different gases b. Makes them look good in public c. Protects the steel cylinder from rust 8. What colour is an oxygen cylinder? (Circle correct answer) PINK BLACK YELLOW GREY WHITE BLUE 9. Some of the valves on medical cylinders are "Pin Index type". What are these? (Circle correct answer) a. They are put on special cylinders used for air driven surgical tools b. They are a higher-pressure valve for hospital use only, made from bright stainless steel and stand vertical. c. They are special medical valves for medical use only. Each valve has different locating holes so we don t get incorrect gases connected to equipment d. They are easier to turn on/off and use a hand wheel instead of a key 38