File - Respiratory Therapy Files
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Transcript File - Respiratory Therapy Files
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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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