inhalation sedation equipment

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Cylinders

3/8-inch-thick steel although some cylinders of N2O have been made of aluminum Tested every 5 years to ensure integrity with internal hydrostatic pressure, the pressure depending on the size of the cylinder

regulators delivery pressure

45 to 55 psig Located between cylinders of gas and flowmeters on yoke on portable units Located usually on cylinder in central systems

major advantage demand flow unit

economy obtained from the decreased volume of compressed gases used

scavenging system

with N2O sedation equipment is desirable because it removes any potentially toxic waste gas from the environment

minimum oxygen liter flow

- inhalation sedation units are designed so that once turned on the unit delivers a preset minimum liter flow of O2 through the flowmeter. In most units this minimum flow is 2.5 or 3 L/min of O2. The flow of N2O cannot start until a flow of O2 has been established.

Nitronox

A type of demand-flow used in hospital and ambulatory settings Unique in that percentage is not adjustable, is fixed at 50/50, O2 and N2O and is extremely accurate

ratio of use

About 2.5 cylinders of O2 are used for every N2O cylinder

flowmeter adjustment

Adjustment of gas flow is accomplished by a fine-needle valve for each flowmeter, the knobs are both touch-coded and color-coded (in U.S. O2 control knob is green and fluted, N2O knob is blue and not fluted) Also O2 flowmeter is positioned on the right side of the flowmeters

bag tee flowmeter

Anesthetic gases leave the tops of their respective flowmeters and are combined in the mixing chamber, found in the head of the sedation unit From this point, a combination of gases flows through the machine and now exit the sedation unit through the outflow tube, known as a bag-tee and carried to the patient

yokes (portable system only)

Assembly holds cylinder of compressed gas tightly in contact with portable sedation unit Circuit of gases - from cylinder through yoke and into reducing valve - "the high-pressure system"; from reducing valve to patient - "the low-pressure system" From reducing valve, the gas enters low-pressure tubing, color-coded for specific gases, that conducts gas to attachments at the rear of sedation unit

Reservoir bag

Bladder-type bags, with the 3-L used most commonly in dentistry Attaches to base of bag-tee, usually immediately below emergency air inlet valve A portion of the gases may be diverted into the reservoir bag

Diameter Index Safety System (DISS)

Designed to ensure correct gas enters the correct part of the sedation machine Makes it physically impossible to inadvertently attach wrong tubing to wrong inlet of machine

safety features of cylinders

Color coded: N2O blue; O2 green Pin index safety system makes it physically impossible tor a N2O cylinder to be inadvertently attached to O2 portion

types of inhalation units

Continuous flow machine Intermittent-or demand-flow unit

cylinders handle

Cylinders are designed to handle 1.66 times the usual pressure Marked with a metal stamp indicating the date the cylinder was commissioned, dates of testing, the pressure for which the cylinder was designed, insignia of testing facility, and identification of manufacturer

demand flow dial

Dial provides a direct indication of the percentage of O2 delivered in the mixture; the remainder of the gas is N2O Units only show what was set, not what was actually delivered

Demand Flow Units

Does not deliver gas continuously to the patient Varies rate and flow of delivered gas according to patient's respiratory demands and requirements

demand flow disadvantage

Flow of anesthetic gases per minute is not visible or registered anywhere on the machine (cannot be visibly monitiored) Instead there is a dial on which percentages of gases are recorded and another on which the pressure at which they are delivered is visible

regulator function

Function to reduce high-pressure gas from cylinder to a pressure safe for patient and sedation unit maintain constant gas pressure to flowmeters and to patient regardless of gas pressure contained within the cylinder, important to minimize potential for damage

flowmeter instruction

Gas enters a taper tube, grows wider from bottom to top A float is inside the flowmeter for measuring volume When flow of gas begins, the gas forces the float up into the tube Calibrations on the tube indicate flow of gas in liters per minute (L/min)

Compressed gas cylinders

Gases dispensed at a pressure greater than 25 lb per square / 25 psig - pounds per square inch gauge pressure at 25 degree C or 70 degrees F are considered compressed gases according to hazardous materials regulations of the U. S. Department of Transportation (DOT) Because of potential for serious injury from improper handing of these cylinders, DOT has regulations

Regulator (temperature)

It is in the reducing valve that recompression of gases produces the tremendous increase in temperature to 815 - 1093 degrees C (1500 - 2000 degrees F). temp increase can ignite oil, grease, or Teflon if found in this area, leading to explosion and fire.

ratings

It is recommended that a sedation unit should have received an acceptable rating from the ADAs Council on Scientific Affairs This listing is published in the Journal of the American Dental Association, the Dentist's Desk Reference, and on the ADA website (www.ada.org)

manifolds (central system only)

Joins multiple compressed-gas cylinders Also found on manifold is a safety pressure relief valve and an alarm that activates when pressure is too high or low

Emergency air intake valve

Located on bag-tee above reservoir bag In the event the sedation unit ceases to function and gas flow from the machine is terminated, it provides a supply of atmospheric air all equipment latex free

nitrous oxide cylinder and contents

N2O is present in both liquid and gaseous states presence of liquid N2O in the cylinder, the gas pressure gauge will record "full" as long as any liquid remains in the cylinder

color code of cylinders

N2O: light blue O2: green

oxygen cylinder contents

O2 cylinder contains only gas Pressure gauge on machine yoke reflects actual contents of cylinder

flowmeters

Permits administrator to deliver a precise volume of either gas to patient Flowmeters measure actual quantity of gas in motion not cylinder pressure; if flow is interrupted, flowmeter will read zero

Central Storage System with mobile heads

Permits the use of larger compressed-gas cylinders with mobile heads but the inhalation sedation unit sits on a portable stand without a yoke apparatus It may be moved from treatment room to treatment room Quick connect tubing attaches the unit to O2 and N2O outlets on the wall

continuous flow subgroups

Portable systems Central storage system Central storage system with mobile heads

portable systems

Rolling stand compressed-gas cylinders attach at the yoke assembly Used when frequency of use is low or expense of central storage system is prohibitive Primary drawback: because they require use of smaller cylinders, they require replacement more frequently and cause a higher cost

nitrous oxide cylinder pressure full tank

The pressure in a full tank of N2O is 650 - 900 psi

pressure in full tank of o2 is

The pressure in a full tank of O2 is 1800 - 2100 psi

nitrous cylinder half tank pressure

The pressure in a half-full tank of N2O is 650 - 900 psi This is because the contents of a tank of N2O contains both liquid and gas

the pressure in a half full tank of o2 is

The pressure in a half-full tank of O2 is 900 - 1100 psi This is because the contents of a tank of O2 contains only gas

Central Storage System

The supply of N2O and O2 is located a distance from the area where the gases are delivered Large cylinders are used Multiple treatment areas may be connected by copper piping If inhalation sedation is used regularly, there is a savings using the larger gas cylinders

considerations for handling compressed gas cylinders

Use no grease, oil, or lubricant of any type to lubricate cylinder valves, gauges, regulators, or other fittings that may come into contact with gases - extremely dangerous 2. Store full cylinders in vertical position 3. Store cylinders in an area where temperatures do not fluctuate - avoid heat in particular handle with care, open valve slow counterclockwise , valves must fully be open to prevent gas leak. close cylinders tight to prevent contamination cylinders should be cracked before attached to machine.

Color Coding Safety System

all parts of the sedation unit that carry or operate O2 are colored green in the U.S., whereas tubes, knobs, and other parts handling N2O are colored light blue

automatic manifolds

automatically activates a new full reserve cylinder of gas when cylinder in use empties

oxygen fail safe

automatically terminates the flow of N2O whenever the delivery pressure of O2 falls below a predetermined level, approximately 50 psig. When the delivery pressure of O2 through the reducing valve can no longer be maintained at 50 psig, the O2 fail-safe mechanism is activated and the flow of N2O gas is terminated.

demand flow falls below standard

because it prevents the important practice of titration from occurring

conducting tubes

breathing tube, connects bag-tee to nasal hood Large diameter and corrugated, minimizes resistance to flow of gases and prevents kinking

continuous flow units

characterized by continuous flow of gases regardless of respiratory pattern of patient Gas continues to be delivered through the machine even as patient exhales These units use greater volume of gas over a given period of time Greater accuracy and safety compared to demand-flow

Size of cylinders

classified by letters "A" the smallest, "HH" the largest "E" cylinders are used for both N2O and O2 in portable units "G" cylinders for N2O and "H" for O2 use in central storage systems

Nasal Hood

device designed to fit comfortably and securely over the patient's nose Tubes deliver gases from sedation unit, 2 tubes deliver gases, two tubes carry away exhaled gases

emergency air inlet

located on top of the bag-tee outlet, the emergency air inlet is maintained in a closed position as long as O2 or N2O - O2 is being delivered. When the flow of gases ceases, the emergency air inlet valve opens, permitting the patient to continue to breathe, now atmospheric air.

gas cylinders

maintained in a storage area and gases are delivered to treatment area through copper pipes

nonautomatic manifolds

most common. When a cylinder is empty, it must be physically turned off and new one opened

digital electronic flow control devices

now available on N2O - O2 sedation devices

disadvantage of continuous flow

of the demand-flow unit are eliminated Eliminated is the inability to visualize flow of gases and inaccuracy of the mixer valve

central storage systems with mobile heads are recommended for?

offices in which economics of central storage warrant its instillation but frequency of use of inhalation sedation does not justify purchase of heads for all treatment areas

demand flow unit parts

one dial which changes the percentages of gases delivered

Oxygen flush button

permits rapid delivery of high flows of O2 to the patient. N2O delivery is automatically stopped when the oxygen flush button is pressed. The button is ideally located on the front of the sedation unit.

importance of keeping greese and oil away from compressed gas

potentially explosive mixture Once the grease or oil ignites, either N2O or O2, although nonflammable, will support combustion. Temperature and pressure within the cylinder increase even further producing: 1. an explosion 2. a melting of the valve stem of the cylinder, releasing the contents of the cylinder Death and serious injuries have occurred

Regulators

reducing valves Located between compressed-gas cylinder and flowmeter

minimum oxygen percentage

sets a minimum of 30% O2 on sedation units - this is a safety feature of the units. HOWEVER, remember that the minimum amount of O2 that must be used when administering N2O must be 20% O2.

Second disadvantage for demand flow

the lack of accuracy of the mixer valve Percentage of gas delivered is not accurate over the full range of delivery (0% to 100% N2O)

Pin index system

the safety system used to ensure that the proper regulator is used for a specific gas, such as oxygen makes it physically impossible to attach an N2O cylinder to the yoke attachment for O2. Consists of a series of pins, the configuration that differs for each compressed gas and matching series of holes on the cylinders.

alarm

there is a shutting off of gas flows on the unit, the alarm system is activated

Reservoir bag function

to provide a reservoir if respiratory demands of patient exceed gas flow, as when a patient draws a deep breath Second use - serves as a monitoring device for respiration, will inflate and deflate with exhalations and inhalations Third potential use - can provide O2 during assisted ventilation but usually only practical with full-face mask


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