Authorised by:
Charge Nurse - Newborn

June 2007

Safety and Emergency Precautions Signs of Toxicity of NO and NO2 Suspected minor gas leak Major Leak

Safety and Emergency Precautions

Hospital Transport and Storage

Transport Between Hospitals

Should be kept to a minimum to prevent accidents.

CCNs will arrange as per current policy.

Cylinder Regulator

To be changed only by:

Leakage Testing

This will be carried out:

The test will be carried out using "SNOOP" Liquid Leak Detector

Recommended Extra Precautions

SCAVENGING:
- Where possible Nitric Oxide is scavenged from the ventilator system.
TAMPER-PROOFING:
- The flow-meter is modified to prevent accidental adjustments to flow rates.

Signs of Toxicity NO & NO₂

A large cylinder of nitric oxide contains 800ppm NO. A full cylinder completely emptying into a room would give 80ppm.
Air conditioning clearance in NICU is 15-20mins. Air is cleaned to outside the building, i.e., is not recycled to other areas of the Hospital.
Recommended maximum environmental exposure is 5ppm for 8 hours.

Early Signs	Respiratory discomfort. Headache. Dizziness. Lassitude. Nausea and vomiting.
Signs After 5-8 hours	Cyanosis. Increased difficulty in breathing (choking). Dizziness. Chest tightness. Palpitations. Physical examination shows signs of pulmonary oedema.

Minor leak is when staff are developing symptoms as above or become aware of a leak that is not major.

Process

The Nurse in charge will assess the nature and extent of the leak and do the following.

Step	Action
1	Check the cylinder pressure.
2	Check the cylinder connections. Use "snoop liquid leak detector".
3	Note the symptoms and conditions and exposure of any staff (see previous page re signs of Toxicity NO and NO₂).
4	Notify Duty Manager who will contact the Occupational Physician on call for appropriate assistance.
5	Change the cylinder and connections, if available. (Call shift engineer to do this).
6	All non essential people to leave the pod for at least 15 mins. (Air conditioning clearance in NICU is 15-20 min).
7	Rotate the staff to a non contaminated pod.
8	Take baseline observations of affected staff including pulse rate, respiratory rate and blood pressure. Adult cuff kept on shelf in CCN's office. Use Dinamap located on adult resuscitation trolley.
9	Repeat these measurements hourly for a total of 6 hours or on a change of symptoms. (Occupational Health will advise where monitoring to occur).
10	Refer the staff members for assessment if concerned.
11	Provided the leak is assessed as minor and the staff exposed to the suspected leak are well, they should continue working provided the environment has been corrected.
12	An on-line risk monitor form should be completed.

Step	Action
1	Close the regulator tap.
2	Dial 777 state ‘Hazmat Alert’. State Fire Service required, but fire alarm activation not required. The following people will attend: Duty Manager who will contact the Occupational Health Physician on call for appropriate assistance. Shift Engineer. Orderly Supervisor. Fire and Ambulance Services. Security. Clinical Directors and Newborn Service Manager (will need to be contacted).
3	Inform medical staff immediately.
4	Contain gas by closing all nursery doors. The air-conditioning is to remain on. (In NICU this ensures a complete change of air every 15 minutes).
5	All parents and staff to leave the pod, closing doors.
6	Non-ventilated babies on heat tables should be removed from the pod.
7	Non ventilated babies in incubators should have air directed into their incubator from wall outlet.
8	Occupational Health Physician must be notified immediately (day or night, via the Duty Manager) and will come in and assess the situation.
9	All staff/parents who have been exposed to Nitric Oxide must go to an Accident and Emergency Dept to be examined and monitored as per advice from Occupational Health Physician. (Signs of toxicity may be delayed).
10	An on-line risk monitor form should be completed.

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