MEDICAL OXYGEN SUPPLY
Flow monitoring proves key as oxygen demand peaks
During the early days of the COVID-19 pandemic last Spring, many NHS hospitals found themselves struggling for oxygen capacity, as the number of patients with the virus – and in particular those needing to be connected to ventilators or high-flow oxygen equipment – surged. To help healthcare estates and clinicians manage the situation, and ensure a sufficient ongoing oxygen supply, SHJ Medical Gas Specialists (‘SHJ’) developed a new monitoring and alerting system, FLO2
, which works in tandem with ultrasonic or integral
flowmeters to continuously monitor oxygen flow rate and line pressure. This key data is then accessible in ‘real time’ via SHJ’s customer portal, with alerts sent by email and SMS, enabling rapid decisions to be taken when oxygen flow is approaching maximum capacity. HEJ editor, Jonathan Baillie, reports.
To find out more about SHJ’s recently launched FLO2
oxygen flow rate and line
pressure monitoring system, I spoke to the MD at the specialist in the supply, installation, and maintenance of complete medical gas pipeline systems, Stafford Scopes. He explained the background to the system’s development, how the hardware is installed on a hospital oxygen pipeline system, and the fundamentals of its operation. He began: “During the first and second ‘waves’ of the pandemic last year particularly, there was exceptional – in fact unprecedented – demand for oxygen as coronavirus case numbers rose, and many of the Vacuum Insulated Evaporators (VIEs) delivering oxygen at large hospitals across the UK were approaching their maximum flow capacity. Once they reach this point, oxygen supply could be compromised – an unthinkable scenario for the NHS. Many Trusts were thus keen to know accurately – and this desire continues today – how much oxygen they were using, and to be made aware if they were approaching the pinch point which could affect the supply of oxygen to their patients.”
NHSE/NHSI oxygen alert issued Indeed, in the light of the unprecedented oxygen demand, NHSE/I issued an Estates and Facilities Alert, NHSE/I – 2020/0002, on 6 April last year, entitled ‘Oxygen Usage’. Sent to Trust CEOs, Medical directors, Critical Care directors, Respiratory and acute medicine directors, Estates and Facilities directors, directors of Nursing, EPRR leads, and chief pharmacists, this warned that with hospitals now treating a large proportion of their inpatients for COVID-19 infection, the draw on oxygen was ‘exceptionally high’. As a result, some hospitals were drawing more oxygen from their VIE systems than the maximum flow for which they were designed. This, in the
compromising patient safety and the whole hospital.’ The Alert went on: ‘Please action oxygen alarms if they are triggered, ensure that there are cylinders available to replace piped oxygen supply in emergency, and ensure that you plan ahead – including as regards the potential for moving patients out of your hospital, if your system is nearing capacity.’
An exceptional case SHJ FLO2 oxygen flow monitoring
equipment installed at London’s Royal Brompton Hospital.
words of the NHSE/I Alert, ‘carries the risk of icing, that could cause flow to drop unexpectedly, compromising supply to patients, and/or permanent damage to the system’. The Alert said: ‘It is thus critical that only approved guidance is followed to achieve maximum sustainable flow from existing installations.’ It also emphasised that it was critical that clinicians and managers ‘engage with their engineers in order to safely look after their patients and plan their surge capacity’, adding: ‘Regional leads should manage the location of care for patients that require oxygen demand through close collaboration with individual hospitals, and ensuring that this is considered when planning mutual aid (i.e. transfers between hospitals to increase capacity for patient care). This will help to ensure that critical oxygen systems are not damaged,
Returning to my discussion with Stafford Scopes, and touching again on the exceptional circumstances those responsible for maintaining hospital oxygen supply faced at the pandemic’s ‘peaks’, the SHJ MD said: “Hospitals with large piped medical gas have always monitored their oxygen pressure, but rarely the oxygen flow, simply because few have ever had to worry about reaching their maximum flow rates. As an analogy, a VIE could be compared to a thermos flask, full of liquid oxygen, and it is the capacity of the flask that hospitals will measure. As the liquid oxygen level depletes, a hospital Estates team will know the oxygen needs refilling. Measurement of flow, however,” he added, “relates to how fast the gas is flowing out of the VIE, and, prior to the pandemic, this flow rate hasn’t really been measured. We at SHJ have, in fact, measured flow in a couple of London hospitals – the Royal Brompton and Royal Marsden Hospitals – for some years. These hospitals share a BOC VIE, which we installed in 2000, and we put in two flowmeters even before 2000, which enables us to see the oxygen flow rates at each hospital day to day.”
Oxygen flow rates
Stafford Scopes explained that SHJ had also installed similar flowmeters at the National Hospital for Neurology, and at Great Ormond Street Hospital, both in
June 2021 Health Estate Journal 33
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