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For a long time now, medical professionals were straightforward in what they could provide to patients via an MRI. However, over the past several years, they began performing certain medical procedures within the MRI. This can create some confusion for design professionals in what to provide within the MRI room to support these procedures.
For example, we will look at a new outpatient clinic with a couple of MRIs and exam rooms. This clinic will be used for cancer treatments and biopsies.
From previous columns I have written, you know I want to see a risk assessment from the owner’s Risk Management Team before doing anything with the medical gas systems.
You need to send off your list of questions to the owner (risk management department) so the person(s) can respond via email. Below is a simple list of questions you can include in your next project:
1. What procedures will be performed in this outpatient facility (biopsies, invasive, non-invasive, etc.)?
2. What class will the MRI be considered (Class 1, 2, or 3)?
3. What level of sedation, if any, will be used (deep, general, moderate or minimal)?
4. Who will provide the risk assessment?
The risk assessment is the first item of critical information; it will provide most of the information to help you determine what will be required for the medical gas system.
The following is pulled from the 2018 NFPA 99 section 4.2, Risk Assessment:
“4.2.1 The health care facility’s governing body shall establish the processes and operations that are planned for the health care facility.
“220.127.116.11 The governing body shall conduct risk assessments and shall determine risk categories based on the character of the processes and operations conducted in the health care facility.
“4.2.2 Risk categories shall be classified by the health care facility’s governing body by following and documenting a defined risk assessment procedure.
“18.104.22.168 Where required by the authority having jurisdiction, the risk assessment shall be provided to the authority having jurisdiction for review based on the character of the processes and operations conducted in the health care facility.
“4.2.3 A documented risk assessment shall not be required where Category 1 is selected.”
We need to address the sedation levels so that the facility and architect understand the terminology we are referring to when we talk about sedation. I have seen facility personnel use the term “general anesthesia” when, in fact, they are not using general sedation. They will sometimes use general anesthesia loosely to describe minimal and moderate sedation, so we have to make sure what level they are talking about.
Below are the 2018 NFPA 99 definitions for each level of sedation you need to include in your questions so each party knows exactly what the other is asking:
“3.3.66* General Anesthesia and Levels of
“22.214.171.124 General Anesthesia. A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (MED)
“126.96.36.199 Deep Sedation/Analgesia. A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (MED)
“188.8.131.52 Moderate Sedation/Analgesia (Conscious Sedation). A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (MED)
“184.108.40.206 Minimal Sedation (Anxiolysis). A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. (MED)”
The risk assessment needs to come back with one of the four categories for sedation selected. Then the designer knows which medical gas systems will be needed, which may trigger additional requirements for mechanical and electrical.
If risk management says, “We will do minimal and moderate sedation,” then the medical gas systems will be classified as Class 2 or 3.
Over the years, it has been the norm to put in medical air, oxygen and vacuum in an MRI suite and not even think twice about it.
The addition of sedation levels to NFPA 99 has brought forth several questions the owner’s risk management team needs to answer. Hospitals have always been risk-based; outpatient clinics have become more risk-based with medical procedures being performed in them, requiring sedation for patients.
MRI Suite Classes
Per the Facility Guidelines Institute (FGI) guidelines, the MRI suites have three classes they will fall under:
• Class 1 — MRI Base, with O2 + Vac only
• Class 2 — MRI Procedure, with (2) O2 + Air +WAG (non-invasive)
• Class 3 — MRI Surgical, with (2) O2 + Air + WAG (invasive procedures)
Based on which classification of your outpatient MRI, you will know which medical gases to provide and how many outlets for the MRI and the holding bay/PACU.
2018 FGI Guidelines for Design and Construction of Outpatient Facilities
1. If MRI is considered a procedure room, then do they perform invasive procedures?
2. If they do invasive procedures, they will need to look at it as Class 3 imaging (when performing these procedures).
3. When doing these procedures, the room shall be designed to the more stringent code.
4. This goes for the mechanical ventilation being positive and negative depending on the procedure; electrical has additional requirements.
My recommendation will be to provide the holding bay to a Phase I recovery at one O2 and one Vac. The MRI shall have two O2, three Vac, one MA, and one WAGD when performing deep sedation. The WAGD is a recommendation from the FGI when invasive procedures are performed.
So, dig in and learn more about the types of facilities and procedures to be prepared for those odd projects.