Medical gases are being used in a variety of clinical settings, and their piped administration is a significant step forward in patient care. In the design, installation, commissioning, and operation of medical gas pipeline systems (MGPS), patient safety is paramount. The system must be operational 24 hours a day, with virtually no downtime, and its failure can be hazardous if not restored as soon as possible. There is a lack of knowledge among practitioners about the medico-legal implications of the MGPS. It is a highly technical sector; therefore, in-depth expertise is required to assure system safety.
According to an article published by the Journal of Anesthesiology Clinical Pharmacology, gas pipeline breakdowns have been documented several times in the anesthesiology literature. Petty looked at pipeline-related mortality in the United States from 1972 to 1993 and found 26 deaths caused by crossed pipes, faulty connections, and supply errors.
The Anesthesia Patient Safety Foundation conducted a study that revealed a large knowledge gap among anesthesiologists about medical gas pipeline systems (MGPS), and a thorough grasp of information is required to ensure the system's safety. Several medico-legal cases over the last decade have compelled doctors to turn their attention to the system's practical direction. As a result, upholding safety requirements is critical from the main source in the manifold room through the final distribution point.
National Fire Protection Association 99 (US) and HTM 02-01 are the two main MGPS standards (UK). The International Standards Organization, the Compressed Gas Association, the Canadian Standards Association, and the British Standards EN 737 (BS EN 737) are among the others. Pipes should have Lloyd's certification according to BS 2871 and cylinders should fulfill American Society for Testing and Materials requirements.
The manifold room, which should be manned by qualified workers 24 hours a day, is the heart of the entire system. It should have an appropriate acoustic containment, as well as 100% generator backup and fire protection. In the case of an emergency, the site should be prominently marked for easy identification. It holds the control panel, which permits a flow rate of 3000 L/min at 4.1 bar from the vacuum insulated evaporator (VIE) and sends alarms to secondary panels positioned throughout the hospital.
Any medical unit's basic requirement is a constant supply of oxygen. There should be three separate supply sources, according to BS EN 737-3:2000. Primary, secondary, and a reserve source sufficient to fulfill demand if primary and secondary sources fail.
Two banks of D-type cylinders, each carrying a minimum of two days' supply, should be connected to a fully automated changeover control panel in the manifold room. As a fallback option, three days' worth of consumption should be maintained on hand.
Higher filling pressure is possible with aluminum or steel cylinders with a Kevlar or Carbon fiber outer shell, allowing for more storage. Cylinders should be checked every 5 years by the manufacturer. Furthermore, oxygen concentrators or pressure swing adsorber systems can provide FiO2 levels ranging from 0.95 to 0.97, with a paramagnetic oxygen analyser monitoring the levels.
Liquid oxygen is a cost-effective and simple way to store oxygen. The cryogenic liquid is kept in a VIE, which is generally 5 or 10 liters in size, though smaller Cryospeed™ vessels are also available. After receiving regulatory permission from Nagpur's Fires and Explosives Act office, VIE should be installed in a high-security and fire-safe zone.
It's utilised as a driving power for pneumatic drills (surgical air) as well as an inhalational gas (medical air). The plant must maintain a 3 KL/min flow at 8 bar, then lower the flow as needed. A flow rate of 80 L/min at 4 bar is required for medical air, while 350 L/min at 7 bar is required for surgical air.
The medical air quality should satisfy the European Pharmacopoeia's guidelines, which limit carbon monoxide levels to 5 ml/m3. Integral dryers, filters, and a dew point sensor keep the humidity below the 67 ml/m3 standard.
Vacuum and Anesthetic Gas Scavenging System
According to the Control of Chemicals Dangerous to Health Regulations 2002, anesthetic gases are substances hazardous to health unless they are provided to a patient in the course of therapy. A vacuum pressure of 300 mmHg is required at the terminal unit, with a flow rate of 40 L/min.
Both systems' exhausts should be carefully positioned away from windows and air compressor and ventilator intake. Anesthetic gas scavenging systems should include a canister system that catches wasted gases, filters them, and recycles them to reduce the greenhouse effect of anesthetic gases.