Piped Medical Systems

Understanding the piped medical delivery systems in your facility is a great opportunity to familiarize yourself with all of the various components that create these "systems". Depending upon your frame of reference, the "start" and "end" of these systems will vary from the clinician's perspective and a contractors point of view. To a nurse, the system starts at the patient location. To an engineer or contractor, the mechanical room is the "starting" location.

As a rule, I try to organize my thinking around patient care being the driver of all needs. Therefore, I will discuss these systems as starting at the patient location and ending in the associated mechanical rooms or storage locations.

Piped Medical Systems Include:
Medical Gasses: Pressurized gasses distributed from a central location.
Vacuum/Suction: Centralized suction pump(s).

Depending upon the type of care and acuity level, the gas and suction requirements will vary from department to department and room to room. Some of these needs are driven by code, while others are staff preferences.


Medical Gasses:
Oxygen - Provides oxygen to patients.
Medical Air - Used to blend with oxygen or to power some devices.
Nitrous Oxide - Used in operating rooms to anesthetize a patient.
Nitrogen - Used in some rooms to power pneumatic instruments/brakes.
Compressed Air - Used to power pneumatic instruments/brakes or to clean instruments.

Vacuum/Suction:
Medical Suction - Provides a vacuum to draw fluids away from the patient into a collection canister.
Dental Suction - Provides a vacuum to draw fluids away from the patient into a central collection point.
Waste Anesthesia Gas - Provides a vacuum to remove exhausted anesthetic agents by the patient from the room.

Most gasses and suction outlets are provided with a flowmeter or regulator to regulate the flow or strength. Others are simply turned on or off.

Post #1: Oxygen and Medical Air at the patient side

Oxygen is delivered to the patient with a flowmeter controlling the volume of oxygen delivered to the patient. This is measured in LPM or liters per minute. For adults, the most common flowmeters are adjustable from 0 - 15 LPM. For infants, they use "low-flow" flowmeters that allow the flow to be regulated in much smaller increments. These can be commonly found in 0-3 LMP or 0-8 LMP. It is important to note that the flowmeter is controlling the flow volume, so the exact same gas system can deliver the oxygen to both adult and infant areas. The mechanical engineer is responsible for sizing the system to ensure there is proper capacity to support all locations and any anticipated future growth.

The flowmeters look almost identical, except this low flow offers increments of 0 - 3 LPM. (Increments of measure vary by manufacturer and model)




The more common "adult" version offers 0-15 LMP adjustment indicators:



From both of these types of flowmeters, plastic tubing will connect to either a nasal cannula or oxygen mask to provide the oxygen to the patient. Oxygen is expensive and flammable, so for both financial and safety reasons, the delivery of oxygen must be as efficient as possible.

Nasal Cannula:



Oxygen Mask:



Medical Air:
The system for medical air is identical, except medical air is less common. Today medical air is only used to blend air with oxygen for infants or in ventilators. Therefore, most patient locations that offer oxygen do not offer air.

An air flowmeter looks identical to an Oxygen flowmeter, except the color is standardized for easy differentiation. Oxygen is green and Air is yellow.





As a recap, the air and oxygen from a piped medical system is regulated at the patient location with a flowmeter and delivered using a mask or nasal cannula. A hose connects from the patient (Using a mask or nasal cannula) to the flowmeter. THe flowmeter attaches directly to a medical gas outlet. (More on this in my next post)

The tubing, masks and cannula are disposable. Therefore another consideration when designing the room is the convenient storage of these disposable products. It is common to see additional sets of tubing and nasal cannula wedged behind the flowmeter as a storage method.




While this is convenient, it can be unattractive and lead to items falling on the floor. Using a drawer in a bedside cabinet or wall mounted baskets are a better option in my opinion.

Wall mounted Storage Basket Option:



Bedside Cabinet for storing disposable supplies:





Our next post will discuss the medical gas outlets and all of the various configurations available.

A place for everything and everything in its place.

Every now and then an equipment planner will come across someone even more anal retentive than themselves. But not very often. We can rattle off: Water, steam, drain, vent, gas, vac, data, volts, watts, amps, BTU's like some frat boy reciting the Greek alphabet during pledge week.

So after months specifying the "perfect" compliment of equipment; identifying alcoves for every stretcher, wheelchair and C-arm; and coordinating the infrastructure requirements with the electrical and mechanical engineers, we expect everything to be perfect.

So when I get a call that the lead apron racks are pulling out from the walls in two locations on a recent project, I'm not too happy.

We'll it turns our that the "perfect" location that was planned for them was changed to a new location. (This can happen when you're not on-site to supervise the installation.) So now I'm standing in the sub-sterile room looking at 4 holes in the wall, a dusting of drywall powder on the floor and about 80 pounds of lead aprons clumped together like a 5th graders laundry pile. The lead apron rack has been neatly leaned up against a wall, clearly identifying it as the culprit to this mess.

"Why didn't you put the bracket where it was shown on the plans? Where all of the backing is?" I ask. "We wanted it over here." Is the response...

I can feel the urge for sarcasm growing in me. But, instead I take a few dimensions and go order a custom wall plate. It spans two studs and allows the apron rack to be installed in the new location with ample wall support to keep it from ripping through the drywall again.

My take-away from this little exercise is a mental note to start having the contractor provide wall backing in both a primary AND a secondary location when there is the potential to have more than 1 mounting location. In addition, I'll start suggesting that wall backing span 4 studs. The additional construction cost is minimal and will allow for much greater flexibility when the staff who actually occupies the space wants to give their personal touch to the configuration.

For items such as ice makers and televisions, there are several utilities that help to identify the mounting location. (Electrical, data, plumbing, etc.) But, there are some items that will offer no clear indication of where they are to be mounted without looking at a layout drawing. (Like lead apron racks for example.)

When you are planning your project, make certain you take into account the opportunity for flexibility. An artificial sense of needing to have only 1 "correct" way to do things can come back to haunt you when other opinions enter the picture.

For Example:

A wall like this, with many utility connections, the opportunities are limited for placing wall backing.



But, if you have a large empty wall, go ahead and put backing in a large enough area to allow for some flexibility. The larger the area with backing, the more opportunity to allow alternative configurations.



Don't go crazy with it, but certainly consider the benefit of allowing the facility staff to configure to their liking. As an architect or planner, we are typically only around until the ribbon cutting ceremony. Give those that get to use the space in years 2 - 30 some options for using it the way they want to. Even if your way really is better : )

What to do when construction slows down

I read an article today that mentioned an interesting (If not a bit scary) statistic. According to the American Hospital Association, 56 percent of recently surveyed hospitals were reconsidering or postponing large construction projects. In the short-term that is bad for architects, contractors and equipment vendors. When the economy recovers, it means that there will be the need to re-confirm the planning assumptions used. What changed in terms of population, competition and technology?

The medical equipment list will need to be reviewed for the same reasons as the design of the space. Here are a few areas to focus your review:

1) Save money by not spending it. Re-examine opportunities to re-use existing items. If your new project was delayed, the Doc's likely kept on begging for that new ultrasound, laser, or OR tables. You might find that this year's annual budget was spent reducing the need for purchases on your new project.

2) Commit early for better pricing. As we all know, equipment vendors are focused on hitting their quarterly numbers. This slow down will have a very negative effect on them. When your project is back on the front burner, vendors will be looking to get revenues flowing again. If you have a high confidence level in your project completion date, you should be able to negotiate a better price if you commit in an earlier quarter than you would have otherwise. Ask for the deal. Any VP of Sales knows that locking out the competition is worth a few points. Even better, call your GPO and push them to organize a group buy for the big ticket items you need. As a side bonus, the contractor will love you because there won't be any last minute change orders. (Or at least fewer!).

3) Sit down with the architect. Go through the plans and get an understanding of what changed and why. Sometimes changes that meant little to the architect my offer an opportunity to alter the equipment list. For example, many clients will shell some spaces to allow for future expansion. You can easily eliminate the equipment from those rooms. But if you drop from ten LDR's to 4, can you still justify a dedicated ultrasound? Maybe they share with Imaging for another year.


Worried you won't be around when the project is re-started? Suggest new ways for your expertise to be used. In any downturn, the focus turns to cost-cutting. If you have enough experience to know what is broken in the system, do you have the expertise to fix it? Submit a proposal to improve the utilization of equipment, streamline the capital purchasing process, develop facility standards or move a paper process into an electronic process. If the facility is not spending capital dollars, the C-suite might be willing to spend operational dollars to effect cost-savings when the spigot opens again.

If you have other suggestions, or a comment on these first few suggestions, we'd like to hear from you.