Defective gas mixers, a cause of retro-pollution of medical gas distribution pipelines

Abstract

A defective Air/O2 mixer of a ventilator located downstream of the gas outlets of two pipelines is a potential cause of retropollution. Retropollution of O2 with Air or vice versa carries a risk of either a) a hypoxic gas mixture delivery during anaesthesia, including O2-N2O administration, when the O2 pipeline supplies Air instead of O2, or b) a hyperoxic gas mixture delivery in the intensive therapy unit for neonates during administration of a O2-Air mixture, when the Air pipeline supplies O2 instead of Air. A defective O2/N2O flowmeter-mixer of an anaesthesia machine, with N2O flow control by O2 through a differential pressure manometer, can cause retropollution of O2 supply pipeline with N2O or vice versa. The prerequisite for retropollution is the association of three events: build-up of a pressure difference between the two gas lines; defective or absent back-flow check value in the circuit of the gas at a lower pressure; one of the following defects: a) the pressure equilibrating valves of the mixer cannot amend the pressure difference and allow a gas reflow at the gas mixture outlet; b) leak in the diaphragm of a pressure equilibrating valve; c) defective bypass supply valve. The optimal means for the recognition of a pipeline contamination by another gas is the O2 analyzer, especially in anaesthetic areas where the presence of N2O and Air carries the risk of a hypoxic gas mixture delivery. The mixer or flowmeter-mixer responsible for retropollution can be recognized in plunging successively the various quick couplers underwater into a glass, while the others remain connected to their outlets and the mixer set at a O2 concentration of 50 vol% or the flowmeters set at a similar flow. In case of retropollution, the gas reflow produces bubbles. It is recommended: a) in anaesthetic areas to set the O2 pressure at about 0.2 bar above that of Air and the latter at a pressure of about 0.2 bar above that of N2O; b) in intensive therapy units for neonates, to set the Air pressure at about 0.2 bar above that of O2; c) in all areas to disconnect from the gas outlets the devices equipped with a mixer or a flowmeter-mixer when not in use.