Medical Gas Systems

Presented By:
Ed Tinsley, PE, CEM, CHFM, HFDP, LEEDTM AP
TME, Inc.

Agenda
Introduction to Medical Gas Systems
Applicable Codes and Regulations
Designing Medical Gas Systems
Installing Medical Gas Systems
Maintaining Medical Gas Systems
Summary
Further Study
2

Medical Gas System

An assembly of equipment and
piping for the distribution of
nonflammable medical gasses such
as oxygen, nitrous oxide,
compressed air, carbon dioxide, and
nitrogen.
* NFPA 99C, Chapter 3, Definitions
3

Common Medical Gas Systems

Oxygen (O2)
Medical Air (MA)
Medical Vacuum (MV)
Nitrous Oxide (N2O)
Nitrogen (N2)
Instrumental Air (IA)
Carbon Dioxide (CO2)
Waste Anesthesia Gas
Disposal (WAGD or
EVAC)
4

Oxygen (O2)
An element that at atmospheric
temperatures and pressures
exists as a colorless, odorless,
tasteless gas.
Primarily used for respiratory
therapy and anesthesia.
Has the ability to support life and
to support combustion. Although
oxygen is non-flammable,
materials that burn in air will burn
much more vigorously and
create higher temperatures in
oxygen or oxygen-enriched
atmospheres.

Oxygen (O2)
Comprises approximately
21% of the earths
atmosphere.
Liquid oxygen exists at
cryogenic temperature,
-300F at atmospheric
pressure. When warmed
to room temperature, it will
expand to fill a volume 860
times its liquid volume.
50 to 60 psig
6

Nitrous Oxide (N2O)

An oxide of Nitrogen
Exists as a gas at atmospheric
conditions.
Possesses a sweetish smell.
Capable of producing the first and
second stages of anesthesia when
inhaled.
Oxygen is released under conditions
of combustion, creating an oxygenenriched atmosphere.
Primarily used as an anesthetic.
50 to 60 psig
7

Medical Air (MA)

Medical air is supplied from cylinders,
bulk containers, medical air
compressors and treatment
equipment, or has been reconstituted
from oxygen and nitrogen.
Exclusively used for human
respiration or calibration of devices for
respiratory application.
Primarily used for respiratory therapy.
Hydrocarbon carryover from the
compressor poses a threat to the end
user and increases the risk of fire
especially when mixed with oxygen.

Medical Air (MA)

The quality of the local ambient
air should be considered prior to
its selection for compressors and
treatment equipment.
A medical air compressor is
designed to exclude oil from the
airstream and compression
chamber and that does not under
normal operating conditions, or
any single fault, add any toxic or
flammable contaminants to the
compressed air.
50 to 60 psig

Medical Vacuum (MV)

An assembly of central

vacuum producing equipment

and a network of piping for
patient suction in medical,
medical-surgical, and waste
anesthetic gas disposal
(WAGD) applications.
Primarily used for patient
treatment in surgery,
recovery, and ICU to remove
fluids and aid in drainage.
15 to 25 Hg
10

Nitrogen (N2)
Exists as a gas at atmospheric
temperatures and pressures.
Clear, colorless, and tasteless
gas.
Comprises approximately 78%
of the earths atmosphere.
Used for pipe joining and
pressure testing purposes.
Used to power instruments.
160 psig
11

Instrument Air (IA)

Substitute for nitrogen for
powering instruments
unrelated to human
respiration (surgical tools,
ceiling arms, etc.).
Medical air and instrument
air are distinct systems for
mutually exclusive
applications.
200 psig
12

Carbon Dioxide (CO2)

Occasionally used for

surgical procedures and
laboratory applications.

13

Waste Anesthesia Gas Disposal (WAGD)

Also referred to as scavenging or
evacuation.
Used to capture and carry away gases
vented from the patient breathing
circuit during the normal operation of
gas anesthesia or analgesia
equipment.
Can be connected to the medicalsurgical vacuum system under certain
conditions but discouraged.
Low vacuum (0.014 Hg at patient)
14

Applicable Codes and Regulations

AIA Guidelines for the Design

and Construction of Hospital and
Health Care Facilities
NFPA 99, Health Care Facilities
Other Codes and Regulations
Other Guidelines
State and Local Codes and
Regulations
15

AIA Guidelines
American Institute of Architects Academy of
Architecture for Health, Facilities Guideline
Institute and U. S. Department of Health and
Human Services
2006 Edition
Establishes minimum standards for constructing
and equipping health care facility projects
Basis for many state codes and regulations
Addresses all types of health care facilities
including general hospitals, nursing facilities,
outpatient facilities, rehabilitation facilities,
psychiatric hospitals, mobile units, hospice,
assisted living, etc.
16

AIA Guidelines
7.31.E5 The installation,
testing, and certification of
nonflammable medical gas
and air systems shall
comply with the NFPA 99.
(See table 7.5 for rooms
requiring station outlets.)
7.31.E6 Clinical vacuum
system installations shall
be in accordance with
NFPA 99.
17

Excerpt from Table 7.5

Station Outlets for Oxygen, Vacuum (Suction), and Medical Air Systems in
Hospitals1
Location

Oxygen

Vacuum

Medical
Air

7.2A

Patient rooms (medical and surgical)

1/bed

1/bed

----

7.2.B10

Examination/treatment (medical,
surgical, and postpartum care)

1/room

1/room

----

7.2C/7.2.D

Isolationinfectious and protective

(medical and surgical)

1/bed

1/bed

----

7.3.A

Critical care (general)

3/bed

3/bed

1/bed

7.3.A14

Isolation (critical)

3/bed

3/bed

1/bed

7.3.B

Coronary critical care

3/bed

2/bed

1/bed

7.3.D

Pediatric critical care

3/bed

3/bed

1/bed

7.3.E

Newborn intensive care

3/bassinet

3/bassinet

3/bassinet

Section

1 For any area or room not described above, the facility clinical staff shall determine outlet

requirements after consultation with the authority having jurisdiction.

18

NFPA 99, Health Care Facilities

Chapter 5 addresses gas

and vacuum systems.
2002 Edition or 2005
Edition
Chapters 13, 14, 17, 18, 19,
20, and 21 contain facility
specific requirements.
19

Chapter 5 Gas and Vacuum Systems

Section 5.1 establishes requirements for Level
1 systems.
Section 5.2 establishes requirements for Level
2 systems.
Section 5.3 establishes requirements for Level
3 systems.
Each section addresses sources, valves,
station outlets/inlets, manufactured
assemblies, pressure and vacuum indicators,
warning systems, distribution, labeling and
identification, performance criteria and testing,
and operation and management.
20

System Categories by Level of Risk*

Level 1: System serving patients where an
interruption of the piped gas or vacuum system
would place patients in imminent danger of
morbidity or mortality.
Level 2: Interruption of system would place
patient at manageable risk of morbidity or
mortality.
Level 3: Interruption of system would terminate
procedure but would not put patient at risk.
* The entire system shall comply to Level 1 if any part of the system
is required to be Level 1

21

Potential Hazards
Fire hazard O2 and N2O
support and enhance
combustion
Potential service interruption
Build-up of potentially
hazardous concentrations
Suffocation due to O2
displacement (N2, CO2, and
N2O)
Contamination
Mix-up of gases
22

FDA Public Health Advisory

This guidance is intended to alert hospitals,
nursing homes, and other health care facilities to
the hazards of medical gas mix-ups. The Food
and Drug Administration (FDA) has received
reports during the past 4 years from hospitals and
nursing hospitals involving 7 deaths and 15
injuries to patients who were thought to be
receiving medical grade oxygen, but were
receiving a different gas (e.g., nitrogen) that had
been mistakenly connected to the oxygen supply
system. This guidance makes recommendations
that will help hospitals, nursing homes, and other
health care facilities avoid the tragedies that result
from medical gas mix-ups.
23

Other Codes & Regulations

ANSI American National Standards Institute

ASME American Society of Mechanical Engineers
ASSE American Society of Sanitary Engineering
ASTM American Society for Testing and Materials
AWS American Welding Society
CGA Compressed Gas Association
Pamphlets: G-4 Oxygen Systems, G-4.1 Cleaning
Equipment for Oxygen Service, 02-DIR Directory of
Cleaning Agents for Oxygen Service, etc.
24

Designing Medical Gas Systems

Estimating flow
requirements
Selecting equipment
Pipe sizing
Zone valves and alarms
Electrical service
Equipment space
requirements

25

Estimating Flow Requirements

Number of outlets
Flow rate per outlet
(depends on the
specific gas and outlet
type)
Diversity factor
(depends on the
number and type of
outlets)

Medical Gas Flow Reqmts.

Project:
Project #:
Outlet Location

Thoracic OR
Major OR
Minor OR
Special Procedures
Delivery Rooms
Recovery Beds
Outpatient Revcovery Beds
Intensive Care Beds
Emergency Beds
Pat. Surgical Beds
Pat. Medical Beds
Nurseries Beds
LDRP Beds
Labor Beds
Treatment Rooms
Exam Rooms
Autopsy
Respiratory Therapy
Radiology Rooms
Nuclear Medicine
Cardiac Stress
Anesthesia Workrm.
Total
Average Load (cfm)

# of OR's Vacuum # of
Med. Air # of
Oxygen # of Nitrous # of
Nitrogen
or beds
outlets
outlets
outlets Oxide outlets
(cfm)
(cfm)
(cfm)
(cfm)
(cfm)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0
0
0
0
0
0.0
0
0
0
0
0
0.0
0
0
0
0
0
0.0
0
0
0
0
0
0.0
0
0
0
0
0
0
0

0
0

0.0
0

0
0

0
0

0
0

0
0

26

Typical Outlet Flow Requirements

O2 1 SCFM (6.5 SCFM for adult
ventilator and 1 SCFM for infant
ventilator)
N20 1 SCFM
N2 1.5 SCFM per operating room
MA 1 SCFM
MV Varies
WAGD 1 SCFM (Some
anesthesia systems use modified
interface valves with larger inflows
up to 2 SCFM)
27

Typical Diversity Factors for O2 & N2O

Quantity of Outlets

Diversity (%)

13

100

4 12

75

13 20

50

21 40

33

Diversity charts yield erratic flow calculations.

Many designers prefer to use diversity graphs.
28

SCFM vs. ACFM

Loads are calculated in SCFM. Compressors
and vacuum pumps, however, are typically
rated in ACFM.
SCFM = Standard cubic feet per minute
(14.696 psia and 60F*)
ACFM = Actual cubic feet per minute
ACFM = Pst
x (T1 + 460) x SCFM
(P1 Pv)
(Tstd + 460)
* Sometimes other conditions are used such as 70F, 68F, and 36% RH
29

Selecting Equipment
Altitude is important!
100 SCFM = 107 ACFM in Los Angeles
100 SCFM = 130 ACFM in Denver
Consider worst case ambient conditions.
ACFM requirements are at their highest on hot
and humid days.
ACFM approaches infinity at higher vacuums
10 SCFM = 17 ACFM @ 12 Hg
10 SCFM = 50 ACFM @ 24 Hg
10 SCFM = 153 ACFM @ 28 Hg
30

Bulk Oxygen Systems

3.3.1.9 Bulk system. An assembly of
equipment, such as storage containers,
pressure regulators, pressure relief devices,
vaporizers, manifolds, and interconnecting
piping, that terminates at the point where the
system gas at service pressure first enters the
facility supply line. Bulk systems contain more
than 20,000 ft3 of oxygen or 3,200 lb of nitrous
oxide including unconnected reserves on the
site.
31

Bulk Oxygen Systems

Typically involves a
cryogenic liquid
Subject to NFPA 50,
Standard for Bulk Oxygen
Systems and NFPA 99
(2005 Edition)
Reserve Supply (2nd
cryogenic vessel with
economizer or cylinder
header)
Emergency oxygen supply
connection at each building
or in-house reserve with
minimum 1 days supply
32

Emergency Oxygen Supply Connection

Inlet must be
located on the
outside of the
building.
Inlet must be
accessible at all
time and in all
weather
conditions.

33

Medical Air Compressors

Sufficient number and capacity of compressors
to serve the calculated peak demand with the
largest unit out of service (N + 1 redundancy).
No oil in compressor or separation of
crankcase and compressor with 2 seals and
atmospheric vent.
Receiver (sufficient size to avoid compressor
short cycling)

34

Medical Air Compressors

2 Dryers (dewpoint below 32 deg.
F at any level of demand)
Filters (98% efficient at 1 micron)
Dewpoint and CO monitors
55 - 60 psig
Intake requirements

Above roof
Not close to any contaminants
Minimum of 20 above the ground
Can connect to OR supply air after
HEPA filter if no belts or motors in
airstream

35

Medical-Surgical Vacuum Pumps

Sufficient number and capacity of
pumps (N+1 redundancy)
Vacuum receiver
18 to 22 Hg
Connection of WAGD to medicalsurgical vacuum system (MSVS) is
accepted under certain conditions
but not desirable.
Exhaust restrictions
Atleast 10 away from any
building opening
Different level from air intakes

36

Connecting WAGD to MSVS

Most common implementation of WAGD in
USA is a direct connection to MSVS.
Frequent Assumptions
Cheap (no impact on pump or pipe sizing)
O2 is sufficiently diluted

Many MSVS utilize an oil-lubricated vacuum

pump.
Potential Hazards
Fires in vacuum pumps
Pumps run excessively
37

Connecting WAGD to MSVS

Suggestions
Use a separate low vacuum system for
WAGD if possible.
If a combined WAGD MSVS system is
unavoidable, consider WAGD inflows (2.0
SCFM per location) when sizing the pumps
and avoid the use of an oil lubricated pump.

38

Manifolds and Cylinders

2 equal headers (any number
in 2005 Edition)
Minimum of 2 cylinders per
header (any number in 2005
Edition)
Not less than an average
days supply per header
Automatic changeover to
reserve header
Consider vendor proximity
when sizing the manifold
(more cylinders is better).

39

Space Requirements
Cylinder and Manifold Rooms
Dedicated room
Close to loading dock
Ventilated
Heated by indirect means (steam or
heating water)
1 hour fire resistance rating
Electrical devices located at or
above 5 AFF
All relief valves vented to outside
20 deg. F minimum temperature for
N2O and CO2
Each cylinder must be individually
secured (2002 edition)

40

Space Requirements
Bulk Systems
NFPA 50 & 99
Outside
Secure
Illuminated
Accessible
Vacuum Pumps and Medical Air Compressors
Can be located in same room as chillers, air
handlers, etc.
Ventilated to prevent accumulation of heat 41

NFPA 50

42

Pipe Sizing

Flow Rate (considering

diversity)
Allowable friction loss
Equivalent length of pipe
Minimum pipe sizes

43

Pipe Sizing Example

45 SCFM of Medical Air

Longest run is 333 feet
Equivalent length = 333 feet x 150% = 500 feet
Allowable pressure drop* = 5 psi
Pressure drop = 5 x 100 = 1.0 psi
100 feet
500

*Allowable pressure drop is approximately 10% of the

source pressure. Approximately 5 psig for O2, CO2, MA,
and N2O, 15 20 psig for IA and N2, and 3 Hg for
vacuum.
44

Pipe Sizing Example

Pressure Loss, PSI per 100 feet in 50 PSI compressed air piping
SCFM

Nominal Pipe Size, inches

1-1

1-1

0.30

0.03

0.01

10

1.15

0.18

0.05

0.01

15

0.40

0.11

0.03

20

0.69

0.20

0.05

0.02

25

1.14

0.31

0.07

0.03

30

0.44

0.10

0.05

35

0.61

0.14

0.06

40

0.80

0.18

0.08

45

1.00

0.23

0.10

50

0.29

0.13

60

0.42

0.18

Minimum pipe size is 1. Suggest 1 or 1 to provide capacity

for future growth.

45

Minimum Pipe Sizes

Mains and branches in
medical gas piping
systems
Mains and branches in
medical-surgical vacuum
systems
Drops to individual
outlets/inlets
Runouts to alarm panels
and connecting tubing
for gauges and alarm
devices
46

Valves
Zone Valves
Must be a wall between the zone valve and the outlets served.
All outlets must be served through a zone valve.
A zone valve cannot serve outlets on more than one story.

Future Valves

Optional
Must be locked closed
Must be located in a restricted area
Must be properly identified

Service Valves
Must be located behind a locked access door or locked open
above a ceiling or in a secure area
Minimum of 1 per floor per riser

Riser Valves
Required at each riser

47

Valves and Alarms

Critical care
areas include
ICU, CCU,
PACU, Cath
Labs,
Emergency,
and Delivery.
48

Electrical Service
Medical air compressor and
medical vacuum pumps must
be served by the equipment
branch of the essential power
system for a delayed automatic
connection.
Connection to critical branch is
permitted. (Recommended
when generator paralleling
systems with load shed circuits
are used.)
49

Electrical Service
Medical gas alarms must
be connected to the life
safety branch of the
essential power system.
Manifolds must be
connected to the
essential power system.
Cylinder room ventilation
equipment must be
connected to the
essential power system.

50

Constructing Medical Gas Systems

Coordination of Work
Labeling
Installer Qualifications
Brazing, Soldering, and
Purging
Materials
Acceptance Testing

51

Coordination of Work
Communication and
Coordination are essential!
Establish who has authority to
shut off medical gas or vacuum
valves (facility personnel either
perform shut down or witness).
Recognize the different
systems.
In renovations, multiple
shutdowns and
verifications/certifications may
be required.

52

Labeling Medical Gas Systems

NFPA 99C
Table 5.1.11

53

Labeling Medical Gas Systems

54

Installer Qualifications
Installers of medical gas and vacuum systems
shall meet the requirements of ANSI/ASSE
Standard 6010 Professional Qualifications
Standard for Medical Gas and Vacuum System
Installers.
Prior to any installation work, the installer of
medical gas and piping shall provide and
maintain documentation on the job site for the
qualification of brazing procedures and
individual brazers . . . .
* NFPA 99, Chapter 5

55

Brazing and Soldering

Brazing required for all Level 1 & 2 systems

Use of flux not allowed except when brazing
dissimilar metals

Soldering allowed only for Level 3 systems

Lead based solders not allowed

56

Brazing

Brazed joints
appear as dark,
burnt
connections.

57

Soldering

Soldered joints
appear as
bright silver
connections.

58

Purging

Continuous, oil-free, dry

nitrogen purge required
during all work on medical
gas systems
Required to eliminate
oxidation
Less than1% oxygen prior
to brazing (2005 edition)
59

Purging

60

Materials
Tubes, valves, fittings, station outlets, and other piping
components in medical gas systems shall have been
cleaned for oxygen service by the manufacturer prior to
installation.
Each length of tube shall be delivered plugged or capped
by the manufacturer and kept sealed until prepared for
installation.
Pressure gas tubes shall be hard-drawn seamless copper
ASTM B 819 medical gas tube.
Vacuum tubes shall be hard-drawn seamless copper.
The use of roll grooved and gasketed joining methods is
permitted for vacuum only (2002). Plastic pipe is
permitted for Level III vacuum only.

Materials
Medical gas branches shall take off at an
angle of 45 degrees or more above the
pipe.

62

Materials

63

Materials

Secure medical
gas fitting storage

64

Materials

Separate,
protected,
medical gas
pipe
storage

65

Materials

Pipe caps in
place on
medical gas
piping until
connection

66

Acceptance Testing
NFPA 99C, Chapter 5, requires
separate installer and third party testing.
Installer performs initial, non-certified
tests
Third-party performs verification and
testing
System Verifier - Individual who actually
conducts required tests; pressure/flow
readings, purity, etc.
Inspector - Individual verifies physical
aspects of installation; connections,
labeling, materials, etc.; reviews verifier
tests reports and installer certifications.
67

Installer Performed Tests

Initial blow-down using oil-free, dry N2
After installation of piping
Before installation of components
(alarm devices, pressure indicators,
relief valves, etc.)
Initial pressure test
1.5 x working pressure for pressure
gases
60 psig for vacuum
Each joint must be examined
Cross-connection test
Systems tested one at a time with
oil-free, dry N2 at 50 psig
Proper labeling of inlets/outlets

68

Installer Performed Tests

Piping purge test
High volume flow of test gas
No discoloration of white cloth
Start at most remote outlet
from zone valve
Standing pressure test
24 hours
20% above normal system
pressures
69

Third Party Testing

NFPA Chapter 5, System Verification

(performed after acceptance of installer tests)
by party other than the installer and meeting
requirements of ANSI/ASSE Standard 6030

70

System Verification
Test gas shall be oil-free, dry N2 (small projects
affecting a limited number of areas may use the
source gas).
Standing Pressure Test (10 minutes)
Cross-Connection Test
Individual pressurization
Pressure differential
Valve Test
Alarm Test
Piping Purge Test
71

System Verification

Piping Purge Test

Piping Particulate Test
Final Tie-In Test
Operational Pressure Test
Medical Gas Concentration Test
Medical Air Purity Test
Labeling
Source Equipment Verification
Note: Be sure to specify the appropriate edition of NFPA 99 to the
Third Party!

72

Maintaining Medical Gas Systems

Administration
Purchase specifications for
cylinders and regulators
Training
Special precautions for cylinders
and manifolds
No contact with oil or grease
Protected from contamination
Protected from damage
73

Maintaining Medical Gas Systems

Warning signs
Preventive maintenance
Periodic testing of alarms
Annual testing of CO
monitor
Documentation
Record drawings
Test results
74

Summary
Proceed with caution. Medical gas
systems present many hazards.
Know the codes. Medical gas
systems are tightly regulated.
AIA Guidelines
NFPA 99
There are 3 types of systems.
Level 1 (Imminent Danger)
Level 2 (Manageable Risk)
Level 3 (Little or No Risk)
75

Summary
Flow rates depend on quantity of
outlets, type of outlets, and diversity of
use.
Medical air compressors and vacuum
pumps capacities are based on ACFM
not SCFM.
Refer to NFPA 50 for work related to
bulk O2 systems.
Medical air compressors and medical
vacuum pumps require N + 1
redundancy for all components except
the receiver.
Although common, connecting WAGD
to MSVS is discouraged.

76

Summary
More cylinders are better.
Cylinders and manifolds must be
in a dedicated room.
Piping and equipment should be
sized to accommodate future
growth.
Numerous requirements for
valves and alarms.
Medical vacuum pumps, medical
air compressors and alarms
must be connected to the
essential power system.
77

Summary
Service interruptions must be carefully
coordinated and scheduled.
Installers must be qualified.
Brazing is required for Level I and Level 2
systems.
Tubing must be delivered cleaned and
capped.
Pressure gas tubing must be ASTM B 819
hard drawn copper.
Materials must be stored in a suitable
manner.
Everything must be labeled.
All systems must be tested by the installer.

78

Summary
All systems must be thoroughly
tested by a third party prior to use.
Documentation is critical.
Maintenance staff must be
properly trained.
Special precautions are
necessary.
Preventative maintenance is
required.
Alarms must be periodically tested.

79

Further Study
NFPA 99, Health Care Facilities Handbook
(2005 Edition available on 4/1/05)
AIA Guidelines for Design and Construction of
Health Care Facilities
ASPE Data Book, Special Plumbing Systems,
Chapter 2
FDA Public Health Advisory, Guidelines for
Hospitals, Nursing Homes, and Other Health
Care Facilities
Healthcare Plumbing and Piping: New
Designs for WAGD Systems by Mark Allen,
Beacon Medical Products
80

Further Study
The Human Factors of Medical Gas Systems by
Ed Lyczko, the Cleveland Clinic Foundation
Medical Gas Distribution System: Lifeline of a
Modern Hospital by Prabir Kumar Hag
ACFM vs. SCFM vs. ICFM by Squire-Cogswell
Sizing Medical Gas Piping by Mike Frankel,
Utility Systems Consultants
NFPA 99, A Preview of the Changes by Mark
Allen, Beacon Medical Products.
81