Storage and Handling of Medical Gases

1. Storage and Handling of Medical Gases RET 2274 Respiratory Care Theory 1 Module 2.0

2. Storage and Handling of Medical Gases • Medical Gases are stored in one of two ways: • Portable high-pressure cylinders • Large bulk reservoirs

3. 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)

4. 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

5. Storage and Handling of Medical Gases • Cylinder Markings • Cylinders are marked with metal stamping on the shoulder

6. 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

7. 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

8. 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

9. Storage and Handling of Medical Gases • Cylinder Color Coding Oxygen

10. Storage and Handling of Medical Gases • Cylinder Color Coding Air

11. Storage and Handling of Medical Gases • Cylinder Color Coding Helium

12. Storage and Handling of Medical Gases • Cylinder Color Coding Nitrous Oxide

13. 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

14. Storage and Handling of Medical Gases • Cylinder Labeling

15. Storage and Handling of Medical Gases • Cylinder Sizes • Sizes E and H most common in medical facilities

16. 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

17. 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

18. 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

19. Medical Gases • ASSS

20. 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

21. Storage and Handling of Medical Gases • PISS

22. 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

23. Storage and Handling of Medical Gases • Safety Rules for Cylinder Use • Moving Cylinders

24. 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

25. 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

26. 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

27. 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

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

29. Cylinder Explosion

30. 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

31. 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

32. 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

33. 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

34. 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

35. Storage and Handling of Medical Gases • Bulk Liquid Oxygen

36. 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

37. Storage and Handling of Medical Gases • Bulk Liquid Oxygen (Hospital Piping System)

38. Storage and Handling of Medical Gases • Bulk Liquid Oxygen (Hospital Piping System)

39. Storage and Handling of Medical Gases • Bulk Liquid Oxygen • Hospital Piping System • Zone Shutoff Valves

40. Storage and Handling of Medical Gases • Bulk Liquid Oxygen • Hospital Piping System • Zone Shutoff Valves

41. 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

42. 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

43. Storage and Handling of Medical Gases • Cylinder Manifold System • AKA – “Alternating Supply”

44. 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

45. Storage and Handling of Medical Gases • Bulk Air Supply Systems

46. Storage and Handling of Medical Gases • Bulk Air Supply Systems

47. Storage and Handling of Medical Gases • Station Outlets • High-pressure, bulk oxygen supply is reduced to a 50 psi working pressure in the patient’s room where it can be used to operate respiratory equipment

48. 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 device’s (flowmeter) adaptor is inserted into it

49. 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

50. Storage and Handling of Medical Gases • Station Outlets • Safety Systems • DISS