Beruflich Dokumente
Kultur Dokumente
Presented By: Ed Tinsley, PE, CEM, CHFM, HFDP, LEEDTM AP TME, Inc.
Agenda
Introduction to Medical Gas Systems Applicable Codes and Regulations Designing Medical Gas Systems Installing Medical Gas Systems Maintaining Medical Gas Systems Summary Further Study
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Medical Gas System An assembly of equipment and piping for the distribution of nonflammable medical gasses such as oxygen, nitrous oxide, compressed air, carbon dioxide, and nitrogen.
* NFPA 99C, Chapter 3, Definitions
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Oxygen (O2)
An element that at atmospheric temperatures and pressures exists as a colorless, odorless, tasteless gas. Primarily used for respiratory therapy and anesthesia. Has the ability to support life and to support combustion. Although oxygen is non-flammable, materials that burn in air will burn much more vigorously and create higher temperatures in oxygen or oxygen-enriched atmospheres.
Oxygen (O2)
Comprises approximately 21% of the earths atmosphere. Liquid oxygen exists at cryogenic temperature, -300F at atmospheric pressure. When warmed to room temperature, it will expand to fill a volume 860 times its liquid volume. 50 to 60 psig
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vacuum producing equipment and a network of piping for patient suction in medical, medical-surgical, and waste anesthetic gas disposal (WAGD) applications. Primarily used for patient treatment in surgery, recovery, and ICU to remove fluids and aid in drainage. 15 to 25 Hg
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Nitrogen (N2)
Exists as a gas at atmospheric temperatures and pressures. Clear, colorless, and tasteless gas. Comprises approximately 78% of the earths atmosphere. Used for pipe joining and pressure testing purposes. Used to power instruments. 160 psig
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AIA Guidelines for the Design and Construction of Hospital and Health Care Facilities NFPA 99, Health Care Facilities Other Codes and Regulations Other Guidelines State and Local Codes and Regulations
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AIA Guidelines
American Institute of Architects Academy of Architecture for Health, Facilities Guideline Institute and U. S. Department of Health and Human Services 2006 Edition Establishes minimum standards for constructing and equipping health care facility projects Basis for many state codes and regulations Addresses all types of health care facilities including general hospitals, nursing facilities, outpatient facilities, rehabilitation facilities, psychiatric hospitals, mobile units, hospice, assisted living, etc.
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AIA Guidelines
7.31.E5 The installation, testing, and certification of nonflammable medical gas and air systems shall comply with the NFPA 99. (See table 7.5 for rooms requiring station outlets.) 7.31.E6 Clinical vacuum system installations shall be in accordance with NFPA 99.
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Location
Patient rooms (medical and surgical) Examination/treatment (medical, surgical, and postpartum care) Isolationinfectious and protective (medical and surgical) Critical care (general) Isolation (critical) Coronary critical care Pediatric critical care Newborn intensive care
Oxygen
1/bed 1/room 1/bed 3/bed 3/bed 3/bed 3/bed 3/bassinet
Vacuum
1/bed 1/room 1/bed 3/bed 3/bed 2/bed 3/bed 3/bassinet
Medical Air
---------1/bed 1/bed 1/bed 1/bed 3/bassinet
1 For any area or room not described above, the facility clinical staff shall determine outlet
Chapter 5 addresses gas and vacuum systems. 2002 Edition or 2005 Edition Chapters 13, 14, 17, 18, 19, 20, and 21 contain facility specific requirements.
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Potential Hazards
Fire hazard O2 and N2O support and enhance combustion Potential service interruption Build-up of potentially hazardous concentrations Suffocation due to O2 displacement (N2, CO2, and N2O) Contamination Mix-up of gases
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ANSI American National Standards Institute ASME American Society of Mechanical Engineers ASSE American Society of Sanitary Engineering ASTM American Society for Testing and Materials AWS American Welding Society CGA Compressed Gas Association Pamphlets: G-4 Oxygen Systems, G-4.1 Cleaning Equipment for Oxygen Service, 02-DIR Directory of Cleaning Agents for Oxygen Service, etc.
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Thoracic OR Major OR Minor OR Special Procedures Delivery Rooms Recovery Beds Outpatient Revcovery Beds Intensive Care Beds Emergency Beds Pat. Surgical Beds Pat. Medical Beds Nurseries Beds LDRP Beds Labor Beds Treatment Rooms Exam Rooms Autopsy Respiratory Therapy Radiology Rooms Nuclear Medicine Cardiac Stress Anesthesia Workrm. Total Average Load (cfm)
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Diversity charts yield erratic flow calculations. Many designers prefer to use diversity graphs.
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Selecting Equipment
Altitude is important! 100 SCFM = 107 ACFM in Los Angeles 100 SCFM = 130 ACFM in Denver Consider worst case ambient conditions. ACFM requirements are at their highest on hot and humid days. ACFM approaches infinity at higher vacuums 10 SCFM = 17 ACFM @ 12 Hg 10 SCFM = 50 ACFM @ 24 Hg 10 SCFM = 153 ACFM @ 28 Hg
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Space Requirements
Cylinder and Manifold Rooms Dedicated room Close to loading dock Ventilated Heated by indirect means (steam or heating water) 1 hour fire resistance rating Electrical devices located at or above 5 AFF All relief valves vented to outside 20 deg. F minimum temperature for N2O and CO2 Each cylinder must be individually secured (2002 edition)
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Space Requirements
Bulk Systems NFPA 50 & 99 Outside Secure Illuminated Accessible Vacuum Pumps and Medical Air Compressors Can be located in same room as chillers, air handlers, etc. Ventilated to prevent accumulation of heat 41
NFPA 50
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Pipe Sizing
Flow Rate (considering diversity) Allowable friction loss Equivalent length of pipe Minimum pipe sizes
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*Allowable pressure drop is approximately 10% of the source pressure. Approximately 5 psig for O2, CO2, MA, and N2O, 15 20 psig for IA and N2, and 3 Hg for vacuum.
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Valves
Zone Valves
Must be a wall between the zone valve and the outlets served. All outlets must be served through a zone valve. A zone valve cannot serve outlets on more than one story.
Future Valves
Optional Must be locked closed Must be located in a restricted area Must be properly identified
Service Valves
Must be located behind a locked access door or locked open above a ceiling or in a secure area Minimum of 1 per floor per riser
Riser Valves
Required at each riser
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Critical care areas include ICU, CCU, PACU, Cath Labs, Emergency, and Delivery.
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Electrical Service
Medical air compressor and medical vacuum pumps must be served by the equipment branch of the essential power system for a delayed automatic connection. Connection to critical branch is permitted. (Recommended when generator paralleling systems with load shed circuits are used.)
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Electrical Service
Medical gas alarms must be connected to the life safety branch of the essential power system. Manifolds must be connected to the essential power system. Cylinder room ventilation equipment must be connected to the essential power system.
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Coordination of Work Labeling Installer Qualifications Brazing, Soldering, and Purging Materials Acceptance Testing
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Coordination of Work
Communication and Coordination are essential! Establish who has authority to shut off medical gas or vacuum valves (facility personnel either perform shut down or witness). Recognize the different systems. In renovations, multiple shutdowns and verifications/certifications may be required.
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Installer Qualifications
Installers of medical gas and vacuum systems shall meet the requirements of ANSI/ASSE Standard 6010 Professional Qualifications Standard for Medical Gas and Vacuum System Installers. Prior to any installation work, the installer of medical gas and piping shall provide and maintain documentation on the job site for the qualification of brazing procedures and individual brazers . . . .
* NFPA 99, Chapter 5
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Brazing
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Soldering
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Purging
Continuous, oil-free, dry nitrogen purge required during all work on medical gas systems Required to eliminate oxidation Less than1% oxygen prior to brazing (2005 edition)
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Purging
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Materials
Tubes, valves, fittings, station outlets, and other piping components in medical gas systems shall have been cleaned for oxygen service by the manufacturer prior to installation. Each length of tube shall be delivered plugged or capped by the manufacturer and kept sealed until prepared for installation. Pressure gas tubes shall be hard-drawn seamless copper ASTM B 819 medical gas tube. Vacuum tubes shall be hard-drawn seamless copper. The use of roll grooved and gasketed joining methods is permitted for vacuum only (2002). Plastic pipe is permitted for Level III vacuum only.
Materials
Medical gas branches shall take off at an angle of 45 degrees or more above the pipe.
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Materials
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Materials
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Materials
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Materials
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Acceptance Testing
NFPA 99C, Chapter 5, requires separate installer and third party testing. Installer performs initial, non-certified tests Third-party performs verification and testing System Verifier - Individual who actually conducts required tests; pressure/flow readings, purity, etc. Inspector - Individual verifies physical aspects of installation; connections, labeling, materials, etc.; reviews verifier tests reports and installer certifications.
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System Verification
Test gas shall be oil-free, dry N2 (small projects affecting a limited number of areas may use the source gas). Standing Pressure Test (10 minutes) Cross-Connection Test Individual pressurization Pressure differential Valve Test Alarm Test Piping Purge Test
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System Verification
Piping Purge Test Piping Particulate Test Final Tie-In Test Operational Pressure Test Medical Gas Concentration Test Medical Air Purity Test Labeling Source Equipment Verification
Note: Be sure to specify the appropriate edition of NFPA 99 to the Third Party!
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Summary
Proceed with caution. Medical gas systems present many hazards. Know the codes. Medical gas systems are tightly regulated. AIA Guidelines NFPA 99 There are 3 types of systems. Level 1 (Imminent Danger) Level 2 (Manageable Risk) Level 3 (Little or No Risk)
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Summary
Flow rates depend on quantity of outlets, type of outlets, and diversity of use. Medical air compressors and vacuum pumps capacities are based on ACFM not SCFM. Refer to NFPA 50 for work related to bulk O2 systems. Medical air compressors and medical vacuum pumps require N + 1 redundancy for all components except the receiver. Although common, connecting WAGD to MSVS is discouraged.
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Summary
More cylinders are better. Cylinders and manifolds must be in a dedicated room. Piping and equipment should be sized to accommodate future growth. Numerous requirements for valves and alarms. Medical vacuum pumps, medical air compressors and alarms must be connected to the essential power system.
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Summary
Service interruptions must be carefully coordinated and scheduled. Installers must be qualified. Brazing is required for Level I and Level 2 systems. Tubing must be delivered cleaned and capped. Pressure gas tubing must be ASTM B 819 hard drawn copper. Materials must be stored in a suitable manner. Everything must be labeled. All systems must be tested by the installer.
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Summary
All systems must be thoroughly tested by a third party prior to use. Documentation is critical. Maintenance staff must be properly trained. Special precautions are necessary. Preventative maintenance is required. Alarms must be periodically tested.
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Further Study
NFPA 99, Health Care Facilities Handbook (2005 Edition available on 4/1/05) AIA Guidelines for Design and Construction of Health Care Facilities ASPE Data Book, Special Plumbing Systems, Chapter 2 FDA Public Health Advisory, Guidelines for Hospitals, Nursing Homes, and Other Health Care Facilities Healthcare Plumbing and Piping: New Designs for WAGD Systems by Mark Allen, Beacon Medical Products
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Further Study
The Human Factors of Medical Gas Systems by Ed Lyczko, the Cleveland Clinic Foundation Medical Gas Distribution System: Lifeline of a Modern Hospital by Prabir Kumar Hag ACFM vs. SCFM vs. ICFM by Squire-Cogswell Sizing Medical Gas Piping by Mike Frankel, Utility Systems Consultants NFPA 99, A Preview of the Changes by Mark Allen, Beacon Medical Products.
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