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CL IN ICAL ENGIN E E R ING


quicker. Pressure at the terminal outlet may also drop. Expansion of critical care bed spaces into other clinical areas has meant adding additional pipe work and terminal units quickly and this has placed a further burden on the oxygen supply. There were also concerns that there may be a shortage of ventilators and that anaesthetic workstations would need to be used as ventilators. To complicate matters further, there were predicted shortages of medications for pain relief and it was envisaged that anaesthetic gases could provide an alternative. However, if these anaesthetic gases are employed outside of the operating theatre environment, there is the additional requirement for anaesthetic gas scavenging systems (AGSS). Scavenging systems traditionally are part of the medical gas pipeline system, but portable systems are available and can be rapidly deployed. From the above lesson, we can learn that we should consider installing some piped medical gases in areas that potentially could be used for future surge capacity. We are fortunate that medical gas pipeline installation companies have worked rapidly to meet the demands of hospitals in the UK and examples include installing a VIE system in a London hospital in a matter of days rather than weeks. Perhaps there is a further opportunity here, however, to review the guidance for the design of medical gas pipeline systems which is set out in Hospital Technical


Moving forward we must ensure there is a robust source of supply for all our equipment and medications. Suppliers we work with must have multiple manufacturing facilities, not co-located and no single route for transportation.


Memorandum 02-01. This document sets out the design requirements for medical gas pipeline systems in the UK. HTM 02-01 was published in 2006 and we have seen significant changes in medical technology since its publication, for example many patient ventilators now no longer require a medical air supply as they entrain air from atmosphere and some will also provide high flow oxygen, which needs to be considered in the pipeline design flow calculations. Turning to the operating theatres we are now seeing a much lower use of nitrous oxide (N2


O) so perhaps there is an opportunity to revisit the diversified flow calculations at this point. Should provision for pandemics, such as COVID-19, also be factored into pipeline design calculations?


Change of purpose


The need to rapidly change the use of clinical areas to meet predicted critical care patient numbers has identified that some of the infrastructure required has not been


in place. I have already mentioned the requirements for medical gases, however, the large number of medical devices used for patients in critical care will mean additional electrical sockets. Provision of additional sockets will also put an increased demand on the electrical infrastructure, and this will again need to be factored in. Is there an opportunity here, therefore, to plan our hospitals with the capacity to meet this potential demand? Critical care units would normally have all of their patients connected to a patient monitor measuring physiological parameters – such as ECG, blood pressure, temperature, oxygen saturation and for patients being ventilated expired carbon dioxide (EtCO2


).


The patient monitor at the bed head will be connected to a Central Monitoring Station at the nurse’s station, so that the parameters of multiple patients can be monitored at the same time and alarms warnings given when the parameter falls outside of the set limits. The bed head patient monitors are


28 l WWW.CLINICALSERVICESJOURNAL.COM


SEPTEMBER 2020


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