2003 OPEN FORUM Abstracts
TERTIARY BACKUP OXYGEN SYSTEM.
John Newhart RCP, Rick Ford RRT BS FAARC, Timothy Morris MD., UCSD Medical Center San Diego CA.
Background: At our 425 bed acute care medical facility, clinical oxygen is supplied by an external liquid oxygen system (LOX). Our LOX system includes two liquid vessels and redundant pressure reduction valves and supply lines to the facility. A failure of these components could result in patient compromise, particularly those in the ICUs who are reliant on mechanical ventilation. It was generally accepted throughout the medical center that this typical LOX system is relatively foolproof in the event of various possible catastrophes. We experienced a "near fracture" in the main O2 line from the external LOX during construction at the medical center, which directed us to look at other internal sources of oxygen. We formed a team of respiratory therapists, nurses and facilities personnel to evaluate options. Our objective was to insure that in the event of such a failure internal sources of gas in proper quantities were always available.
Methods: To establish the adequacy of the supply of cylinder gas, we surveyed four of our ICUs at random times and dates. We documented: 1) number of ventilators running, 2) number of oxygen cylinders with regulators and transport ventilators available in that ICU. From this we determined if a shortage of portable oxygen systems existed.
RESULTS: There were 5 observations in which there were not adequate supplies of cylinder oxygen to accommodate the number of ventilator patients. In addition any other patients requiring oxygen would not have oxygen available immediately. In addition the supply of portable cylinders in the ICUs varies greatly and capacity inspections of tanks is only once per shift. The team developed three possible backup systems 1) a system connected to each ICU that would activate automatically if oxygen pressure is lost, 2) a system whereby carts with large cylinders would be kept near each ICU would be manually moved into place and connected if oxygen pressure is lost, 3) individual dedicated small oxygen cylinders at each bedside for administrating supplemental oxygen or for manual bagging of patients. All three systems were presented to our patient care review committee and administration. System #3 was chosen as being the least expensive and simplest. Individual "E" cylinders of oxygen are kept at or near each ICU bedside. They are clearly marked "emergency use only," have a tamper evident seal, have instructions and a unique color-coding on the regulator.
Discussion: Each day a therapist is assigned to each ICU to inspect the tamper evident seal on each cylinder and replace any that are missing or have been opened. Each month a technician checks each cylinder's content by opening the valve and noting the pressure.
CONCLUSION: Subsequent surveys since implementation of the backup cylinders show there is at least one dedicated cylinder of oxygen per patient with a regulator immediately available for an oxygen outage. These cylinders can also be used in the event that ICU patients need to be evacuated from the premises.