The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

AUXILIARY OXYGEN DISTRIBUTION SYSTEMS IN THE HOSPITAL SETTING

Anthony L. Bilenki MA, RRT, Joseph G. Dwyer MAED, RRT The Johns Hopkins Hospital, Baltimore Maryland

Introduction: Knowledge and experience with bulk oxygen systems, bulk compressed gas systems and alternative gas sources needs to be encouraged and strengthened in Respiratory Care Practitioners (RCP). Experience demonstrates that the bedside practitioner has little experience in how to activate or utilize an alternative oxygen source in the event of a failure of a bulk medical oxygen system.

In the past 20 years there have been 2 failures of the main hospital liquid oxygen system at the Johns Hopkins East Baltimore campus. One, a construction accident, the other, a weather related failure when snow and ice froze a temperature sensitive valve closed during a blizzard. This resulted in the reserve system being depleted during a time when the hospital was in a lock down.

There are a number of reasons to consider competency training on this topic.

  1. The potential for mayhem.
  2. Construction accidents
  3. The need for new construction and renovation of oxygen systems in existing buildings
  4. Act of God

In both instances mentioned, tragedy was avoided by maintaining the training and competence of the RCP staff in providing safe oxygen delivery practices.

Equipment: Potential secondary oxygen systems may include:

· Cylinder(s) with flow or pressure regulating device connected directly to the patient/medical device

· Gas Cylinder(s) with pressure regulating device(s) connected via manifold to a fixed area controlled by a zone valve

· Liquid cylinder with portable vaporizing columns to provide source gas to a fixed area or an entire building controlled by a valve system

· Liquid oxygen tanker truck with a vaporizer docked to an external bulk system connection

Methods: Competency and proficiency training for oxygen back up systems should be incorporated in annual staff reviews. Competency training should include the following:

  1. How to recognize a failure of the oxygen system
  2. Know the departmental procedure for loss of oxygen pressure
  3. Be competent in how to back feed an oxygen system from a remote location

4. Recognizing the difference between a main system and a reserve system

  1. Be aware of the location of remote feed ports in the event of a main oxygen system failure.
  2. Understanding the function of redundant oxygen systems and lobbying for their construction.

Conclusions: The need to be aware of the processes and practices required to deal with this emergency procedure has always been a responsibility of the RCP. An article by Stoller, Stefanak, Orens & Burkhart reported that 63% of institutions surveyed reported having an external connection for tanker docking (Respiratory Care, 2000). Facilities and Maintenance staff may understand the mechanical applications of these systems but it is the RCP who assures that the system is functional and delivering the necessary support to the patient.

References:
Stoller, J., Stefanak, M., Orens, D., Burkhart, J. (2000). The Hospital Oxygen Supply: An O2K Problem. Respiratory Care, 45(3). 300.

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