Chapter 1 Medical Gas Supply Equipment

Chapter 1
Medical Gas Supply

Equipment
Measurement of Gas Pressure
(usually in cmH2o)
• Mercury Barometer
– Uses column of Hg as opposing force of atm
to measure atm P
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• Aneroid Barometer
– Uses evacuated metal container, spring, &
pointer

• Mechanical Manometer
– Similar to anaeroid barometer
– Uses diaphragm or evacuated container

• Bourdon Gauge
– Hollow coiled metal tube w/ elliptical cross
section
– Commonly found on medical gas cylinders

Physics of the Principles
• Kinetic Theory of Gases
– Gases are composed of discrete molecules
– Molecules are in random motion
– Molecular collisions are elastic
– Molecular activity depends on temp.
– No physical attraction b/t molecules

• Gas Pressure
– Force per unit area
– Caused by molecules colliding w/ other
molecules & walls of container
– Temp. influences velocity by level of kinetic
energy

• Pascal’s Law
– Fluid in a container transmits pressure equally
in all directions
– Pressure against wall of container is
transmitted to said wall

Physics of the Principles (continued)
• Gas Flow
– Occurs due to P difference b/t 2 points
– Flow from area of P to P
– Rate (velocity) depends on:
• Difference in P
• Size of opening

• Bernoulli’s Principle
– Gas flow through a tube
– As velocity of gas , lateral P (since total
energy is constant)

• Viscous Shearing, Vorticity, and Ejectors
– Viscous shearing: a high-velocity jet injected
into a quiescent (stationary) gas
– Vorticity: tendency of velocity of jet gas to
due to “swirling” mixture of 2 gases
– Ejectors (Ducted): use nozzle, viscous
shearing, & vorticity to total flow

Viscous Shearing

• Venturi’s Principle
– Expanded on Bernoulli
• Tube w/ radius (angle must be <150)
• High velocity of source gas causes ambient air
entrainment
• HAFOE (high air flow w/ O2 enrichment mask)
– a.k.a. venturi mask
– P downstream will decrease ambient air entrainment
resulting in a higher FiO2

• Ducted Ejectors
– Similar to Venturi except:
• Tube diameter does not Δ
• Purpose is to maintain high velocity (not restore
lateral pressure)
• Velocity remains high, P remains constant
• Advantage: P downstream has less effect on
entrainment
• Used in nebulizers

• Choked Flow or Compressible Flow
– Velocity of a gas with P upstream
– When head P is 1.893x that of atm, velocity
no longer , but is choked
– Nebulizers become choked @ 26 psi driving P

• Reynolds’ Number
– Determines if gas flow through a tube is
laminar or turbulent…
• Laminar: smooth, uniform flow; requires less
energy to sustain (<2,000)
• Turbulent: erratic, irregular flow; requires more
energy (>2000)
Formula: R = (velocity)(density)(diameter)
(viscosity)

• Poiseuille’s Law
– Describes resistance (R) when flow is laminar
(ΔP)(π)(r4)
8(L)(μ)
Simply stated: “as the radius of a tube

is halved, resistance to flow increases
by a factor of 16.”

Physics of the Principles (continued)
• Boyle’s Law
– w/ constant T0, volume varies inversely w/ P
– Formula:
P1V1=P2V2

• Charles’ Law
– w/ constant P, volume varies directly w/ T0(K)
– Formula:
V1 = V2
T1 T2

• Dalton’s Law
– The Law of Partial Pressures
– The P of a gas mixture = the sum of the
partial P of the component gases
– The partial P of each is proportional to its
volumetric percentage

• Gay-Lussac’s Law
• w/ volume constant, pressure will w/ T0
• Formula:
P1 = P2
T1 T2

• Combined Gas Law (a.k.a. general gas law)
– Combines Boyle’s, Charles’, & Gay-Lussac’s
– Formula:
P1 V1 = P2 V2
T1 T2

Gas Diffusion
• Fick’s Law
– Rate of diffusion of a gas into another is
proportional to its concentration
– As gradient , rate of diffusion

Gas Diffusion
• Henry’s Law
– Rate of gas diffusion into liquid is proportional
to partial P of gas @ given T0
– Example: opening a Coke (or beer.)
• CO2 diffuses out of liquid into atm, where partial P
of CO2 is less

Gas Diffusion
• Graham’s Law
– Rate of gas diffusion through liquid is
proportional to gas solubility & inversely to
gm. mol. wt.
• CO2 is 19x more diffusable in blood than O2
• But…Graham assumes = partial P
• In reality, alveolar PO2 > PCO2

Medical Gas Supply Equipment

Compressors
• Provide compressed air to power

equipment & mix w/ O2
• Air must be oil-free (oil + O2 = FIRE!)
FIRE!
– No vaseline in a O2 rich environment!
• P must be reduced to 50psi for use!
• 3 types:
– Piston
– Diaphragm
– Centrifugal
Piston Compressor
• Uses a piston driven by an electric motor

Diaphragm Compressor
• Uses flexible diaphragm driven by electric
motor
• Typically used in small nebulizers

Centrifugal Compressor
• Uses electrically powered impeller
• May produce large volumes of air (power
an entire hospital)

Concentrators
• Molecular sieve
– Most effective
– Uses Zeolite to adsorb the N
– 50-90% FiO2
• Membrane enricher
– Uses semipermeable polymer to allow O2
through (N molecules > O2 molecules)
– 40% FiO2 @ 1-10 LPM

Liquid Reservoir Systems
• Bulk supply systems
– large amounts of gas
– -1830 C
– 1 ft3 liquid O2 = 861 ft3 gas
• Portable reservoirs
– Portable reservoir duration based on liquid
weight (342.8 L gas/lb of liquid)
– Stationary home models = 20-43 L
– Ambulatory versions = 0.6-1.23 L
Piping Systems
• Construction of piping systems
– Supply
• Manifold, bulk liquid, or both
• 24hr reserve supply required
• Copper pipes tested to 1.5x working P
– Safety features
• Alarms- alert to drop in system P
• Zone valves- emergency shutoffs (fire)
• Pressure sensors- ensure 50psi
– Station outlets
• DISS: gas-specific threading & diameter (<200psi)
• Quick-connect

Zone Valves

Cylinders
• Cylinder construction
– Regulated by DOT
– Chrome molybdenum steel
– Aluminum alloy
– Lightweight aluminum w/ carbon fiber wrap
• 70% < steel
• 30% < aluminum
• Fill to 3,000 psi

• Cylinder markings
– Date tested
– Inspector’s mark
– Passed inspection (+)
– Next inspection in 10yrs (*)
– Construction material (DOT 3AA or DOT 3AL)
– Approved fill P (up to 10% > working P)
– Serial #
– Owner’s stamp
Cylinder Markings
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Cylinder Markings

Cylinder Markings (cont’d.)

• Hydrostatic testing
– Q 5 or 10yrs
– Filled to 5/3 working P
– Difficult w/ carbon fiber tanks

• Cylinder sizes
– H, G, M, E, D, B
– H & E most common in hospital
• H = 244 ft3 of O2
• E = 22 ft3 of O2
– D most common on ambulance

• Color coding
– O2 green (or white)
– CO2 gray
– N2O light blue
– C3H6 orange (extremely reactive)
– He brown
– CO2 + O2 gray & green
– He + O2 brown & green
– Air yellow
• Although label is most reliable indicatory of
contents, if label & color code do not
match…
DO NOT USE THE

CYLINDER!!!
• Safety rules for cylinder use
– Mostly common sense
– Review table 1-4 (page 31)

• Duration of gas flow
– 4 key factors
• Full H contains 244 ft3 O2
• Full E contains 22 ft3 O2
• Full cylinder = 2200 psi
• 1 ft3 = 28.3L O2

Tank Factor Calculation
Tank Factor =
Size (ft3) x 28.3L/ft3

Pressure when full
H = 3.14L/psi E = 0.28L/psi

Let’s Try One…
• You are asked to transport an intubated
patient to CT scan for a procedure. Travel
time to radiology is approximately 20
minutes. Your E cylinder currently reads
2100 psi, and your patient is utilizing 15
LPM for manual ventilation. Do you have
enough O2? (Hint: Don’t forget about the
return trip!)

Oxygen Regulation Devices
• Cylinder valves
– Direct acting cylinder valve
• Opens & closes valve directly
• D & E cylinders
– Diaphragm cylinder valve
• a.k.a. “indirect acting”
• Diaphragm opens & closes valve
• H cylinder

Cylinder Valve Safety Features
• American Standard Safety System (ASSS)
– Uses variants in threading to prevent
attachment of wrong equipment
– Found on larger cylinders (H)
• Pin Index Safety System (PISS)
– Uses variants in pin placement to prevent
attachment of wrong equipment
– Found on smaller cylinders (D & E)

Cylinder Valve Safety Features (cont’d.)
• Pressure release devices

– Frangible disk
• Thin metal disk that ruptures if P is too
– Fusible plug
• Melts @ T0 > 208-220 0F

Oxygen Regulation Devices (continued)
• Reducing valves
– Single-stage reducing valve
– Modified single-stage reducing valve
– Multistage reducing valves

• Single-stage reducing valve
– Reduces P to 50 psi in single step
– Uses 2 opposing forces
• Spring tension
• Gas pressure

• Modified single-stage reducing valve
– Has an additional spring
– Allows > flow rates

• Multistage reducing valves
– Allows > flow & more precise P
– 2 or more single-stage combined
• 1st drops to 200 psi
• 2nd drops to 50 psi

• Reducing valve safety features
– Pressure relief valves
• Safety, or pop-off valves
• 1 per stage
– Indexing of inlet & outlet
• Inlet utilizes ASSS or PISS
• Outlet utilizes DISS

• Regulators
– A reducing valve & a flowmeter combined
– 2 types of flowmeters
• Bourdon-type
• Thorpe tube

Oxygen Flowmeters
• Fixed orifice flowmeter
• Bourdon gauge flowmeter
• Uncompensated thorpe tube flowmeter
• Compensated thorpe tube flowmeter

Fixed orifice flowmeters
• Sets flow by adjusting size of outlet orifice
• Very common E cylinder flowmeter:
. 63
Bourdon gauge flowmeter
• Bourdon gauge + adjustable reducing

valve
• Reads P, but indicates flow
• Accurate only @ ambient P
• Back pressure causes flow to appear >
actual
• Can’t tell if O2 is flowing by looking @
gauge!!!
• Lightweight & not gravity-dependent
Bourdon Flowmeter
65
Bourdon Gauge Flowmeter
FIGURE 4-8 A, Bourdon gauge operating under normal conditions. The

actual flow delivered equals the flow registered on the flowmeter. B,
The effect when resistance is added downstream of the flowmeter at
the outlet. Notice that the flow registered on the flowmeter is higher
than the actual flow. C, Complete occlusion of the outlet has a similar
66
effect; that is, the flow registered on the flowmeter is erroneously high.
Uncompensated thorpe tube
flowmeter
• Needle valve is proximal to tube
• Not compensated for back P
– P downstream may cause flow
to appear < delivered

Compensated thorpe tube
flowmeter
• Needle valve is distal to Thorpe tube
• Back P has no effect
• Ball “jumps” when attached
to gas source

Uncompensated VS
Noncompensated
69
Flowmeter Range
• Typically 0-15 LPM
• Low-range = 0-3 LPM
– Peds/neonates
– COPD
• High-range = 0-75 LPM
– CPAP
– Vapotherm®

Other Medical Gas Supply
Equipment
• Proportioners (Air-Oxygen Blenders)
– Mix air & O2 to precise concentrations
– Provide 50 psi
– Proportioning valve
controls concentration
– Built-in alarm
• Senses gas P

• Demand Pulse Flow O2 Delivery Devices
– Deliver O2 only during inspiration
• Reduces oxygenation of anatomical dead space
• Sense inspiration via P transducer
• No need for humidity (???)
– a.k.a. O2 conserving device (OCD)
– Requires exercise oximetry study

Water Content in Gas
• @ 370C gas may hold 44 mg of H2O per L
• @ 760mmHg (1 atm), 47 mmHg is due to
water vapor pressure

Production of O2
• Fractional Distillation
– Air is liquefied & cooled
– Slowly heated
– N & trace gases have lower boiling point
– Result is 99.5% pure O2
• Physical Separation (Concentrators)
– Molecular sieves
– Semi-permeable plastic membrane
Gas Densities
• O2: 1.429 g/L
• Air: 1.29 g/L
• CO2: 1.98 g/L
• He: 0.1785 g/L
• N2O: 1.98 g/L
• NO: 1.34 g/L

What do gas densities tell us
about the layering effect?

Chapter 1 Medical Gas Supply Equipment

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Chapter 1 Medical Gas Supply Equipment

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Chapter 1

Medical Gas Supply

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Simply stated: “as the radius of a tube

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• Provide compressed air to power

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DO NOT USE THE

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Size (ft3) x 28.3L/ft3

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• Pressure release devices

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• Bourdon gauge + adjustable reducing

FIGURE 4-8 A, Bourdon gauge operating under normal conditions. The

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