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Health care workers' exposures to nitric oxide, nitrogen dioxide, and nitric acid during inhaled nitric oxide therapy.

American Industrial Hygiene Conference and Exposition, June 2-7, 2001, New Orleans, Louisiana. Fairfax, VA: American Industrial Hygiene Association, 2001 Jun; :68
Background: In December 1999, the U.S. Food and Drug Administration approved the use of inhaled nitric oxide (INO) therapy to treat respiratory failure in infants and young children. Few studies have been conducted to evaluate the potential for exposure to nitric oxide (NO) in health care workers treating these patients. The drug consists of a mixture of 0.8% NO and 99.2% nitrogen (N2) and is stored as a compressed gas in an aluminum cylinder. It is administered via a delivery system, which attaches to an oxygen supplying ventilator. The delivery system is equipped with an in-line analyzer, which measures NO, nitrogen dioxide (NO2), and oxygen supplied to the patient. System set up requires respiratory therapists to first purge the high pressure line in the cylinder to rid it of NO2 and then attach it to the ventilator. The dosage is set between 0 - 80 parts per million (ppm), with a typical dose averaging 20 ppm. Methods: Full-shift personal breathing zone (PBZ) samples were collected for NO, NO2, and nitric acid (HNO3) on employees caring for a child receiving INO treatment. Full-shift general area (GA) samples were also collected for NO, NO2 and HNO3 by the patient's bedside. Short term PBZ samples for NO2 and HNO3 were collected during line purging in the NO cylinder storage closets. Samples were analyzed using both laboratory and direct reading instrumentation methods. Results and Conclusions: All of the PBZ and GA samples collected for NO, NO2 and HNO3 were well below the relevant evaluation criteria for occupational exposures. However, there was a potential for higher exposures during training sessions for health care workers. A need for ventilation was identified in a compressed gas storage closet. Emergency plans, controls, and warning systems were not in place in case of an N2 leak, which could displace oxygen in the ambient air.
Respiration; Humans; Children; Health-care-personnel; Gases; Gas-mixtures; Therapeutic-agents; Ventilation; Ventilation-systems; Age-groups; Air-quality; Exposure-levels
10102-43-9; 7697-37-2; 10102-44-0; 7782-44-7
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American Industrial Hygiene Conference and Exposition, June 2-7, 2001, New Orleans, Louisiana