Professional Documents
Culture Documents
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
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
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
13
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
Oxygen
Vacuum
Medical
Air
7.2A
1/bed
1/bed
----
7.2.B10
Examination/treatment (medical,
surgical, and postpartum care)
1/room
1/room
----
7.2C/7.2.D
1/bed
1/bed
----
7.3.A
3/bed
3/bed
1/bed
7.3.A14
Isolation (critical)
3/bed
3/bed
1/bed
7.3.B
3/bed
2/bed
1/bed
7.3.D
3/bed
3/bed
1/bed
7.3.E
3/bassinet
3/bassinet
3/bassinet
Section
1 For any area or room not described above, the facility clinical staff shall determine outlet
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
25
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
Diversity (%)
13
100
4 12
75
13 20
50
21 40
33
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
33
34
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
36
38
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
43
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
45
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
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
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
NFPA 99C
Table 5.1.11
53
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
56
Brazing
Brazed joints
appear as dark,
burnt
connections.
57
Soldering
Soldered joints
appear as
bright silver
connections.
58
Purging
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
68
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
72
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