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
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.) = 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.) = 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) = 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

51. 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.