Storage and Handling of Medical Gases

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Storage and Handling of Medical Gases

• RET 2274
• Respiratory Care Theory 1
• Module 2.0

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Storage and Handling of Medical Gases

• Medical Gases are stored in one of two ways
• Portable high-pressure cylinders
• Large bulk reservoirs

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Storage and Handling of Medical Gases

• Gas Cylinders
• High pressure cylinders used to store and ship
  compressed or liquid medical gases
• Constructed from
• chrome molybdenum steel
• High strength aluminum alloy
• Regulated by
• Department of Transportation (DOT)
• Interstate Commerce Commission (ICC)

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Storage and Handling of Medical Gases

• Gas Cylinders
• DOT classify cylinders according to their
  fabrication
• Type 3A made from carbon steel
• Type 3AA made from steel alloy (tempered for
  higher strength)
• Type 3AL made from aluminum

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Storage and Handling of Medical Gases

• Cylinder Markings
• Cylinders are marked with metal stamping on the
  shoulder

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Cylinder Markings
May be stamped with DOT or ICC (Interstate
Commerce Commission)
A plus () means the cylinder is approved for
filling to 10 above service pressure
If an asterisk () is present after the test
date, the cylinder may go 10 years before being
tested again
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Storage and Handling of Medical Gases

• Cylinder Color Coding
• Cylinders are color coded and labeled for
  identification of their contents
• Code adopted by the Bureau of Standards of the
  U.S. Department of Commerce
• Note Prior to initiating use of any gas, the
  contents of the cylinder must be verified by
  reading the label that is affixed to the tank

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Storage and Handling of Medical Gases

• Cylinder Color Coding
• United States Canada
• Oxygen Green White
• Carbon Dioxide Gray Gray
• Nitrous Oxide Blue Blue
• Cyclopropane Orange Orange
• Helium Brown Brown
• Ethylene Red Red
• CO2/O2 Gray/Green Gray/Green
• Helium/O2 Brown/Green Brown/Green
• Nitrogen Black Black
• Air Yellow Yellow
• Nitrogen/O2 Black/Green Black/Green

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Storage and Handling of Medical Gases

• Cylinder Color Coding

Oxygen
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Storage and Handling of Medical Gases

• Cylinder Color Coding

Air
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Storage and Handling of Medical Gases

• Cylinder Color Coding

Helium
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Storage and Handling of Medical Gases

• Cylinder Color Coding

Nitrous Oxide
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Storage and Handling of Medical Gases

• Cylinder Labeling
• Name and chemical symbol of the gas
• Purity of the gas
• Volume of the cylinder in liters at a temperature
• Specific hazards/precautions
• Instructions in case of exposure
• Name of manufacturer, packer, and shipper

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Storage and Handling of Medical Gases

• Cylinder Labeling

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Storage and Handling of Medical Gases

• Cylinder Sizes
• Sizes E and H most common in medical facilities

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Storage and Handling of Medical Gases

• Valves and Connections
• Small cylinders have a post valve for yoke
  connectors
• Large cylinders (F K) have a treaded valve
  outlet

Post valve Threaded valve
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Storage and Handling of Medical Gases

• Cylinder Safety Relief Valves
• To prevent rupture due to high pressures, gas
  cylinders are equipped with high-pressure relief
  valves
• Frangible
• Ruptures at a specific pressure
• Fusible plug
• Melts at a specific temperature
• Spring-loaded
• Opens at a set high pressure

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Storage and Handling of Medical Gases

• Cylinder Valves Safety Systems
• Outlet connections of cylinder valves have safety
  systems to prevent the interchange of regulating
  equipment between gases that are not compatible
• American Standard Safety System (ASSS)
• Uses differing thread pitches, internal left- and
  right hand threads, and external threading to
  prevent the attachment of equipment not designed
  for the gas contained in large cylinders, e.g.,
  prevents the attachment of an oxygen regulator to
  a nitrous oxide cylinder

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Medical Gases

• ASSS

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Storage and Handling of Medical Gases

• Cylinder Valves Safety Systems
• Pin Index Safety System (PISS)
• PISS incorporates pins in the reducing valve yoke
  and holes on the cylinder valve at specific
  positions to prevent the attachment of equipment
  not designed for the gas contained in smaller
  cylinders, e.g., prevents the attachment of an
  oxygen regulator to a helium cylinder

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Storage and Handling of Medical Gases

• PISS

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Moving Cylinders
• Always leave protective valve caps in place when
  moving a cylinder
• Do not lift a cylinder by its cap
• Do not drop a cylinder, strike two cylinders
  against one another, or strike other surfaces
• Do not drag, slide, or roll cylinders use a cart
• Use a cart whenever loading or unloading
  cylinders

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Moving Cylinders

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Storing Cylinders
• Comply with local and state regulations for
  cylinder storage as well as with those
  established by the National Fire Protection
  Association
• Post name of the gases stored
• Keep full and empty cylinders separate. Place
  the full cylinders in a convenient spot to
  minimize handling of cylinders
• Keep storage areas dry, cool, and well
  ventilated. Storage rooms should be
  fire-resistant

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Storing Cylinders
• Do not store cylinders close to flammable
  substances such as gasoline, grease, or petroleum
  products
• Protect cylinders from damage. Keep cylinder
  valve caps on at all times
• May be stored in the open however, shading may
  be necessary
• Protect cylinders from potential tampering by
  untrained, unauthorized individuals

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Withdrawing Cylinder Contents
• Only to be handled by experienced, trained
  individuals
• User must verify cylinder contents before use
• Leave protective cap in place until ready to use
• Make sure cylinder is supported and protected
  from falling
• Always crack the cylinder prior to attaching a
  regulator
• Use appropriate regulator or reducing valve

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Storage and Handling of Medical Gases

• Safety Rules for Cylinder Use
• Withdrawing Cylinder Contents
• Do not force any threaded connections. Verify
  that that the threads are designed for the same
  gas in accordance with the American Standard
  Safety System
• Open valves slowly. Never use a hammer or wrench
  to force a valve open
• Keep all connections tight to prevent leakage
• Before removing a regulator, turn off the valve
  and bleed the pressure
• Never use a flame to detect leaks with flammable
  gases
• Do not store flammable gases with oxygen. Keep
  all flammable anesthetic gases stored in a
  separate area

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• This truck was carrying oxygen cylinders. The
  driver braked to stop at an intersection. The
  truck stopped ... but the cylinders kept on
  moving. 

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• Cylinder Explosion

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Storage and Handling of Medical Gases

• Duration of Gas Flow
• H Cylinders contains 244 cubic feet of oxygen
  when full (2200 psi pressure)
• One cubic foot of oxygen equals 28.3 liters
• Tank Factor
• 244 cu ft (28.3 liters/cu ft.) 3.14
  liters/psi
• 2200 psi

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Storage and Handling of Medical Gases

• Duration of Gas Flow
• E Cylinders contains 22 cubic feet of oxygen when
  full (2200 psi pressure)
• One cubic foot of oxygen equals 28.3 liters
• Tank Factor
• 22 cu ft (28.3 liters/cu ft.) 0.28 liters/psi
• 2200 psi

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Storage and Handling of Medical Gases

• Duration of Gas Flow
• An E cylinder of oxygen contains 1500 psi. How
  long will the tank last while running a
  resuscitation bag at 15 liters/min and leaving
  500 psi in the cylinder?
• Tank factor (gauge pressure 500) Duration in
  minutes
• Liter flow

0.28 liters/psi (1500 psi 500 psi) 18.67
minutes 15 Liters/min
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Storage and Handling of Medical Gases

• Duration of Gas Flow
• You have an H cylinder of oxygen with 800 psi
  left in the tank. How long with the oxygen last
  while running an oxygen mask at 12 liters/min,
  leaving 500 psi in the cylinder?
• Tank factor (gauge pressure 500 psi)
  Duration in minutes
• Liter flow

3.14 liters/psi (800 psi 500 psi) 78.5
minutes 12 Liters/min
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Storage and Handling of Medical Gases

• Bulk Gas Systems
• Used to supply large amounts of medical gas to a
  hospital or other institution
• Bulk Liquid Oxygen
• Cylinder Manifold Systems
• Bulk Air Supply Systems

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen
• NFPA defines a bulk oxygen system as more than
  20,000 cubic ft. of oxygen (at atmospheric
  temperature and pressure)
• Major components
• Insulated reservoir
• -183? Celsius
• Vaporizer/tubing
• Warms liquid O2
• Pressure reducing valve
• 50 psi for hospitals
• Pressure release valve

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen (Hospital Piping System)

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen (Hospital Piping System)

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen
• Hospital Piping System
• Zone Shutoff Valves

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen
• Hospital Piping System
• Zone Shutoff Valves

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Storage and Handling of Medical Gases

• Bulk Liquid Oxygen
• NFPA requires hospitals to maintain a backup gas
  supply to equal the average daily gas usage of
  the facility
• Second, smaller liquid stand tank
• Cylinder gas manifold (smaller facilities)
• Contingency plan for system failure is imperative

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Storage and Handling of Medical Gases

• Cylinder Manifold System
• Gas cylinders banked together in series
• Two sides primary bank and a reserve bank
• Control valve switches over to the reserve bank
  when pressure decreases to a set level
• Equipped with low pressure alarms
• Empty cylinders are replaced and become the
  reserve bank

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Storage and Handling of Medical Gases

• Cylinder Manifold System
• AKA Alternating Supply

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Storage and Handling of Medical Gases

• Bulk Air Supply Systems
• Most systems use two compressors that work
  independently, or in tandem if need arises
• Each must have the capacity to supply 100 of
  average peek demand
• Dryer removes humidity from air entering piping
  system
• Reducing valve reduces pressure to 50 psi or the
  desired working pressure

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Storage and Handling of Medical Gases

• Bulk Air Supply Systems

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Storage and Handling of Medical Gases

• Bulk Air Supply Systems

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Storage and Handling of Medical Gases

• Station Outlets
• High-pressure, bulk oxygen supply is reduced to a
  50 psi working pressure in the patients room
  where it can be used to operate respiratory
  equipment

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Storage and Handling of Medical Gases

• Station Outlets
• Station outlets provide connections for
  gas-delivery devices such as flowmeters and
  mechanical ventilators
• These outlets contain check valves that open when
  a delivery devices (flowmeter) adaptor is
  inserted into it

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Storage and Handling of Medical Gases

• Station Outlets
• Safety Systems
• Diameter Index Safety System (DISS)
• DISS use noninterchange-able, threaded fittings
  to connect gas-powered devices to station outlets

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Storage and Handling of Medical Gases

• Station Outlets
• Safety Systems
• DISS

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Storage and Handling of Medical Gases

• Station Outlets
• Safety Systems
• Quick connect adaptors
• Inserting the appropriate adaptor into the outlet
  pushes a plunger backward allowing gas to flow
  into the equipment, eg., flowmeter, mechanical
  ventilator, etc.