1. Are medical gases necessary?
Yes, always, at the very least, you will need oxygen, of course.
Other gases, maybe, depending on circumstances.
2. Is a permanent, piped medical gas system required in order to use medical gases?
No it is not. Not for Medicare, not for the Joint Commission, not Quad-A, not Triple-A, not nobody.
Medical gases, such as Medical Oxygen (NF), Nitrous Oxide (NF), Medical Nitrogen (NF) are all listed products in the National Formulary, as are all prescription drugs and cover-the-counter medicines, dietary supplements and other healthcare devices. Medical gases are to be used at the direction of a physician and so if he chooses to employ a piped system, then that is his business. If, instead, the physician chooses to bring the oxygen cylinders into the OR, that is the choice and responsibility of the physician, as long as relevant fire and safety codes for cylinder restraint, etc. are being followed, in so doing.
That having been said, a permanent, piped medical gas system provides redundancies and safeguards, such as electronic monitoring and alarms, that do not exist otherwise, to aid the physician. A permanent, piped medical gas system provides a higher standard of care, cleanliness and safety to the patient and is to be strongly recommended. It’s just better.
3. Is Nitrous Oxide mandatory?
Nitrous oxide (Nitrous), an anesthetic, was once very common in facilities. It was sometimes assumed to be required by Code in a Medgas systems.
(It wasn’t) Its use has diminished over the years and it is often not used much except as a dental anesthetic and by oral surgeons. Some anesthetists in some circumstances still favor its use. Nitrous has the potential to be a workplace hazard unless handled properly..
If your facility is piped to provide Nitrous in the OR’s, do not automatically assume that it will be used. Do not automatically order Nitrous. Check first with your anesthetists to learn whether or not they plan to use it. If they will not be using it, have your Medgas service tech take the Nitrous system out- of-service, and label the system so. Don’t rip it out, just mothball it. It can always be restored to service later, if need be. It also could be repurposed, if you need to provide some other gas, like Medical Air, Nitrogen, or CO2.
4. A Note About Anesthesia Machines
Anesthesia machine have brackets on their backsides to receive and hold small portable gas cylinders whose size designation, in the industry, is known as an “E” cylinder. These small cylinders will operate the anesthesia machine, if the normal source of gas were to fail. Brackets for oxygen cylinders are always present on all machines. Brackets for Nitrous and Medical Air cylinders may also be present.
In older anesthesia machines, the machine will function whether or not E cylinders are installed in these brackets. However, late model anesthesia machines are now equipped with lock-out systems that will prevent the machine from functioning if the cylinder is not in place or has become empty. To learn if your machine(s) fall within this type, check with your anesthesia machine service provider. If your machines have this feature, you will need to stock E cylinders of gases to satisfy this need. Don’t forget to also keep a spare E cylinder of each gas type, “just in case”.
5. What about other gases?
Medical Air – Medical air is a gas with a few specific purposes. It is used in pediatric surgery and in some surgeries requiring the use of lasers. It is also finding use in the prevention of patient airway irritation caused by long duration cases.
Nitrogen, N2 – Nitrogen gas is used in orthopedic procedures and by oral surgeons to operate pneumatically driven power tools such as drills, wire drivers and saws.
Carbon Dioxide, CO2 – CO2 is used in insufflation of patients in GI cases.
Helium and Nitrogen gas mixtures – These gas mixtures are used for In Vitro Fertilization (IVF) work to provide a specific atmosphere in the laboratory incubators.
6. Haven’t you forgotten about Surgical Vacuum?
Well, technically, Surgical Vacuum isn’t really a gas. It is the absence of any gas. It is – vacuum. Vacuum is used for two purposes mainly, Surgical Suction and Waste Anesthesia Gas Scavenging (WAGS).
Vacuum systems are complicated and confusing to discuss and WAGS is worse, so we will save the rest about those for later, in a blog post specifically on the subject of vacuum. Check back after a bit.
7. Gas Cylinder Caps
It would be derelict not to mention the gas cylinder screw-on safety caps that come with each of the large gas cylinders. These caps are mega-important. They protect the valve at the top of the cylinder from being damaged, if the cylinder were to fall over. You must unscrew and remove the safety cap to be able to connect the cylinder to your Medgas system equipment.
These cylinders, if not properly handled and stored can be very dangerous.
If the safety cap is screwed on in place, as it should be, and the cylinder falls or gets knocked over, the valve is entirely protected from any damage.
If the safety cap has been removed from a cylinder, and the cylinder falls over and hits something on the way down, the valve can break completely off. And then you have a rocket on your hands. And I am not joking or exaggerating in this.
The high-pressure gas in a damaged cylinder can propel that cylinder, just like a rocket, for a mile or more, destroying whatever/whoever is in its path.
Keep the safety cap in place until the cylinder is safely chained to a wall. If you lose a safety cap, lay any uncapped cylinder on its side on the floor, out of the way. A cylinder laying on its side on the floor can’t fall far, can it?
You are not going to do anything today that is more important than this.
