medical gases Flashcards

1
Q

how is 02 manufactured?

A

fractional distilation - industrial O2
oxygen concentrators - field medicine, home O2

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2
Q

describe the process of fractional distilation..

A

liquidifies air

heats slowly, allowing different components with different boiling points to evapourate at diff temps

collects O2 at temp for 02 boiling point -183 degrees

99% pure

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3
Q

how do oxygen concentrators work

A

by pressure swing absorption

air is passed over a filter and then through 1 of 2 adsorbers made of zeolite (silica and aluminium)
as pressurised air passes over the zeolite, under pressure the zeolite adsorbs nitrogen and allows O2 to pass through.
this concentrates O2. there is also some argon present

the zeolite will eventually become saturated with nitrogen and to recycle this, it can be depressurised allowing nitrogen to escape.
there is 2 towers allowing one to pressurise while other depressurises allowing constant process of concentrating O2

95% O2 produced, some impurities and argon

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4
Q

what are the pros and cons of O2 concentrators?

A

pros
* allow portable method of concentrating O2. can be used as a back up on anaesthetic machine, for home O2 or field medicine
* relatively cheap
* reliable
* flows up to 10L/min

cons
* 95% and still has impurities
* needs power
* fire risk
* life span of zeolite is 10yrs
* requires routine maintainance - change of filters

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5
Q

define adsorption

A

the process of molecules adhering to a surface, without change in chemical structure / properties

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6
Q

define absorption

A

material bind materials and react with them to change their structure.

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7
Q

how is O2 stored?

A

cylinders e.g. cylinder manifolds, also as extra portable back up on wards and anaesthetic machine

vacuum insulated evaporator (VIE) - more practical i.e. stored as a liquid so takes up a lot less room

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8
Q

how much can a VIE hold? what are the pressures and temp

A

1500L of liquid O2
at -150 to -170 degrees C
at 5-10bar pressure

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9
Q

in a large hospital what is the main O2 supply?

A

VIE
cylinder mannifolds are only a backup

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10
Q

what is the recommended O2 storage capacity for a hospital ?

A

2 weeks

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11
Q

what are cylinder mannifolds?

A

group of size J cylinders and piping system that supplys N20, O2 and entanox for the hospital. O2 is mostly as a back up for the VIE.

these cylinders contain gases under pressure 137bar except N20 which is liquid + equilibrium with vapour.

they supply the pipelines at 4 bar

they are connected to a changeover control unit which measures pressure and allows a valve to switch between cyclinders when pressure is low. this will also alarm

each bank carries no less than 2 days supply

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12
Q

what are the pros and cons of cylinder manufolds?

A

Pros
* provide back up to VIE
* may be primary O2 supply in smaller hospitals
* cheap and simple
* have alarm system for low pressure
* automatic control unit to switch between them

Cons
* less storage capacity than VIE , so less practical as only O2 supply
* fire / explosion risk

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13
Q

how does a VIE work?

A

concentrated O2 is supplied to a VIE and cooled to -150 to -170 degrees and pressurised to 5-10bar.
this is below O2 critical temp and leads to liquidification of O2.

The liquid O2 is stored in a steel container with a vacuum insulation layer.

The O2 vapourisers and leaves the VIE via pipelines that go through a series of pressure regulating valves to reduce it to a pressure of 4bar. it also passes through a heat exchanger to warm the oxygen.

as the O2 vapourises, it cools the container via latent heat of vapourisation. this helps to maintain a low temp (as well as the vacuum shell)

there are 2 routes for vapourisation incase demand increases

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14
Q

how is the temperature of a VIE maintained?

A

vacuum insulated
latent heat of vapourisation
white reflective outer shell - reduces absorption of ambient heat.

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15
Q

what happens if no O2 is used in a VIE?

A

the temp rises (no latent heat) and more gas will vapourise and pressure will rise

if exceeds 15bar it will be released via pressure relief valve.

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16
Q

how is the content of VIE measured?

A

the VIE is placed on a scale so the mass can be weighed.
using moles = mass / mr
can work out the moles present and hence the volume of gas this could supply

new ones use a pressure transducer which compares pressure at bottom and top to determine how much liquid left.

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17
Q

pros and cons of VIE?

A

pros - large amount of O2 can be stored efficiently - most practical/ economical. no power

cons - explosion risk, expensive set up, if not used, O2 is wasted, needs thorough testing and checking for pressures/ contamination

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18
Q

how much O2 per L of liquid O2 in VIE?

A

840L of gaseous O2 supplied per 1L of liquid

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19
Q

what are the safety features of a VIE?

A

pressure regulators - reduce pressure
heat exchanger - increases temp
pressure relief valve - 15bar - O2 can escape
stored away from hospital incase of explosion
back up cylinder manifolds.

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20
Q

what is the boiling point and critical temp of O2?

A

-185 degrees = BP
-118 = critical temp

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21
Q

outline the features of piped O2 supplies in hospitals

A

supplied from central supplies - either VIE or cylinder manifolds
gases flow through copper alloy pipelines - 4bar
delivered to outlet valves located at different points in the hospital - some connected via shrader valves and some via wall rotameters.

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22
Q

what other piped lines are there?

A

piped lines for O2, N20, air, suction, scavenging
O2 and N20 and medical air = 4 bar
air for driving tools - 7 bar
suctioning and scavenging - negative pressures

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23
Q

why is copper used in piped lines?

A

bacteriostatic
prevents degradation of gases

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24
Q

how should cylinders be stored?

A

size F, G and J - upright to prevent damage of valve
C, D ,E either horizontal or vertical
entanox - horizontal

empty cylinders stored away from full ones.
in fire proof, dry, well ventilated room, normal temp

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25
when are cylinders used?
piped O2 not available - transfer failure of piped supply for gases not frequently used - heliox
26
27
what sized cylinders do you know?
sizes C to J used in medicine C = 170L D = 340L - sometimes transport E = 680L - anaesthetic machine F = 1360L - ambulance G= 3400L - on wards J =6800L - cylinder manifolds there are also CD - these are made of aluminium so can withstand higher pressures so store more than conventional C CD = 460 L , 230bar - most common in transport
28
what are the medical gas cylinders made of?
traditional/ old ones = molybdenum steel newer light weight design = aluminium alloys - can withstand higher pressures.
29
what is this ..
CD oxygen cylinder modern alluminium alloy cylinder commonly used in transport
30
what are the advantages of aluminium vs molybdium steel cylinders?
new CD alluminium ones ... * stronger - higher pressures, store more O2 * MRI safe * lighter in weight * have built in pressure gauge and click stop flow meter * more practical - have a handle * integral valve * have a schrader valve connection the molibdenum steel need a special holder to stand them up as they are heavy with a round bottom. (new ones have a flat bottom)
31
what is this..
old type molibdenum steel cylinder looks like a size D
32
how is a cylidner connected to the anaesthetic machine/ wall?
cylinder yokes - solid block of stainless steal supporting the cylinder bodok seal - washer to provide airtight seal between valve and yoke pin index system
33
how are cylinders marked by manufacuteres?
engraved * unique serial number * chemical formula of gas * tare weight * test pressure * dates of tests performed label on cylinder * name of gas and chemical structure / proportion if its a mixture * serial number * hazards and safety instructions * size of cylinder, including volume and max pressure * directions for use including storage and handling plastic disc around the neck - date of endoscopic exam
34
what pressures are cylinders stored at?
most 137bar CD = 230 bar N20 - 52 bar at 20 degrees (44 bar at 16 degrees CO2 - 57 bar at 20 degrees
35
how can O2 contents in a cylidner be measured?
FOr gas cylinders * boyles law * gauge pressure * PV = PV * we know the volume when full e.g. size E = 680 L if pressure is now 100. can use ratios 100/137 x 680L for liquid * weigh cylinder and work out moles * 1 mole = 22.4 L of gas at 0 degrees and atm pressure.
36
outline the safety features present in medical gas supplies...
Not mixing up gases: * colour coding * schrader * pin index * NIST - prevents misconnection Detecting low/ high pressures: * pressure releif valves * gauge pressures * low pressure alarms detect failure in gas supply - at anaesthetic machine and cylinder manifolds * back up cylinders on anaesthetic machine other: * copper piping * flexible reinforced hosing - i.e. from wall supply to anaesthetic machine - cant be compressed * splitting ratios
37
what are the colours of medical gas cylidners?
shoulders have specific colour O2 - white (black body) N20 - french blue (blue body) entanox - french blue and white checked shoulder air - black body, white and black shoulders suction - yellow scavenging - colourless/ brown CO2 - grey helium - brown heliox - brown and white, brown body this was old colour in 2025 will be replaced. all bodies will be white and only shoulders will be different
38
describe the schrader system...
one way outlet valve consists of a socket with tapering that fits specific shape of a probe such that the correct pipeline is attached. these pipelines are secured via non-interchangable screw threads (NIST) on the anaesthetic machine
39
what is the pin index system?
a system for attaching the correct gas cylinder to the anaesthetic machine - for safery Air - 1 5 O2 - 2 5 N20 3 5 CO2 1 6 entanox 7
40
how are cylinders tested?
internal endoscopic exam - every 5 years - looks for cracks and defects tested against 220 bar pressure 1 in 100 cylinders are tested for effects of impact, pressure, tensile strength
41
how are the hoses maintained and tested?
tug test - correct connection at schrader replace every 2-5 years hoses are reinforced and non-compressible
42
what is the filling ratio?
the weight of cylidner when full of N20 / weight when filled completely with water in UK this is 0.75 gives room for vapour to exist and prevents extremely high pressures and explosion if ambient temp is to rise in hotter climates 0.67
43
can you describe a cylinder valve block?
larger cylinder dont have a pin index and instead have a bull nose valve
44
how is nitrous manufactured?
ammonium nitrate is heated to 250 degrees NH4NO3 --> N20 + 2H20 thermal decomposition impurities - ammonium, nitric acid, N2, NO2 these are removed by chelating and washing with acidic/ alkaline washes important to remove these due to pulmonary oedema and fibrosis.
45
how is nitrous oxide stored...
french blue cylinders as a liquid in equilibrium with vapour phase filled to 75%
46
why may a nitrous oxide cylinder be cold ?
latent heat of vapourisation
47
how much L of N20 do size E cylinders provide?
1800L
48
draw a graph to show the emptying of O2 and N20 cylinders..
O2 - linear, boyles N20 initially constant P as liquid vapourises, then boyles when all liquid has gone. - This is actually a simplification; in reality the initial pressure is not perfectly constant because as the n2o vaporises from the liquid phase it cools slightly (latent heat of vaporisation), and therefore gauge pressure does fall slightly.
49
what is entanox?
50:50 mix of O2 and N20
50
how is entanox sotred?
as a compressed gas into cylinders with white and blue checked shouldered at 137 bar should be kept above 5 degrees and horizontally to reduce risk of liquidifcation.
51
how is entanox produced?
liquid nitrous is carried into O2 gas to create a 50:50 mixture by the poynting effect the mix has its own properties - i.e. critical temp -7 degrees = pseudocritical temp therefore above this temp, the mix is gas, below this there is risk of liquidification.
52
what is meant by the poynting effect..
when 2 gases are mixed, the critical temp and pressure will be between that of the 2 individual gases alone. This is now called the pseudocritical temperature. Hence liquid nitrous oxide becomes gaseous when mixed with oxygen gas. - Critical temp of O2 alone = -118 - Critical temp N20 alone = 36.5 degrees - When mixed = pseudocritical temperature = -7 degree
53
what are the risks of liquidification of entanox? how is this risk minimised?
if the mixture separates it will consist of O2 gas above liquid N20 initially O2 rich mixture delivered then hypoxic mixture horizontal storage, above 5 degrees C a dip tube that reaches bottom of cylinder to siphon nitrous oxide first
54
why is risk of liquidification not important in pipelines?
the pressure is only 4 bar so even below pseudocritical temp not enough pressure to liquidify
55
how is CO2 manufactured?
heating Ca/ Mg carbonate (limestone) to 850 degrees CaCO3 --> CaO + CO2
56
what is the boiling point and critical temp of CO2?
-78degrees boiling point -30degrees critical temp
57
how is CO2 stored?
grey cylinders as liquid with in equilibtium with vapour phase. 57 bar at 20 degrees
58
what are the uses of CO2?
fire extinguishes inflation of the abdomen cryotherapy
59
what are the effects of CO2 on the body?
CVS - vasodilation, increase HR, arrhythmias resp - hyperventilation neuro - narcosis above 10kpa
60
tell me about the medical uses of helium
- Helium (He) is an inert gas with a molecular weight of 4 - Available as heliox = 79% helium, 21% O2 - Lower density than nitrogen - Therefore, when turbulent flow is present, a helium-oxygen mixture will increase flow compared to a nitrogen-oxygen mixture. - This has significant clinical application and is used to treat upper airway obstruction where flow is mainly turbulent. - Helium is also used in the measurement of lung volumes because it has very low solubility and so does not transfer.