NAME OF WORK :- CONSTRUCTION OF PROPOSED

MEDICAL COLLEGE AT MACHILIPATNAM IN

KRISHNA
DISTRICT , ANDHRAPRADESH

The Medical Gas Pipeline System (MGPS) comprises of

Following:
1. LMO Tank (20KL Primary Supply and 10KL Backup Supply)
2. Secondary Oxygen Manifold and Emergency oxygen manifold
with automatic control panels
3. Oxygen Flow meter with Humidifier Bottle
4. Nitrous Oxide Manifold and Emergency NO2 Manifold with
automatic control panel
5. Co2 Manifold and Emergency Co2 Manifold with automatic
control panel
6. Medical Air Supply System (4 Bar & 7 Bar) complete.
7. Medical Vacuum (suction) Supply System Complete.
8. Vacuum Units (Ward/Theatres/Low flow)
9. AGSS system Complete
10. Distribution Piping Complete with Accessories.
11. Gas Outlets with Probes
12. Area Valve Service System & Line Isolation Valve
13. Alarm Systems (Master & Area)
14. Bed Head Panels (Vertical & Horizontal)
15. High pressure tubes for O2, N2O, CO2, AGSS,
Compressed Air & Vacuum, Etc.
16. Electrical Wiring & Requirements
17. Operation and Maintenance (During DLP)
MGPS is intended to be a safe , convenient and cost effective to
the use of Portable cylinders , compressors & suction .
It delivers Medical Gases from the source of supply to the
terminal unit by means of a pipeline distribution system.

Medical Oxygen
Medical Oxygen 93 Percent USP/IP
Medical Air
Medical Nitrous Oxide
Medical Carbon Dioxide
Medical Vacuum ( Suction )
Anaesthetic Gas Scavenging System (AGSS)

Surgical Air -7
Each medical gas must be supplied from a separate system,
and it is essential that all parts of each system are gas specific
to ensure that there is no possibility of cross-connection
between any system
During the installation stage, extensive tests are carried out to verify that
there is no cross-connection.
Single MGPS line should not be used to supply Pathology departments,
dental department, general workshops or mechanical services.
ISO 7396-1/2 Origin European Nations (For ex: Italy, Spain, France, etc.)
(National Fire Protection Association) NFPA99- Origin, USA.

• (Health Technical Memorandum)HTM 2022/0201 Origin, UK.

Two doors should preferably be provided in a manifold room. One should
be large enough to facilitate cylinder handling and must be in an outside
wall.
• Exits must be free of all obstructionsInternal walls and ceilings, doors
should be of a suitable non- combustible two-hour fire-resistant material
as defined in BS 476- 4:1970 and BS 476 Parts 20–23 (1987)
Manifold rooms should not be located near high dependency wards.
Medical Oxygen is >99%, When the Term Medical Oxygen is used it
denotes Medical Oxygen 99%. Medical Oxygen 93 Percent USP/IP will
always be used as its full name

OXYGEN DELIVERY METHODS

Medical Oxygen >99%
Through individual gas cylinders (Bed side)
Through Oxygen Gas cylinder manifold via piping system • Through
Liquid Oxygen tank (LOX) via piping system
Medical Oxygen 93 Percent USP/ IP
Through Pressure Swing Adsorption (PSA) technology via Piping system

OXYGEN DESIGN PARAMETERS

Supply system should be designed to achieve continuity of supply to the
Terminal Units in normal condition and in a single fault condition
It should comprise of three sources of supply identified as “Primary”,
“Secondary” and “Reserve”
Primary and secondary supply should always be calculated on the peak
load.If LOX tank is deployed along with cylinder manifold, either can be
used as primary source, however LOX is preferred as primary source
because of cost effectiveness and convenience Piped oxygen is supplied
at a pressure of 4 Bar (400 kPa ) ie B/w 3.8 to 4.2 Bar at the terminal
end.A pressure drop of 5% is taken into consideration during design
Principle of Design “From Inside to Outside” shall be followed in
designing the MGPS Installation
Requirement of terminal units for each department should be taken and
marked Average Rate of Oxygen consumption to be assumed for design
calculations in wards shall be 10 Litres per minute, per patient
Rate of Oxygen consumption to be assumed for design calculations in
Operating Rooms and Ventilation stations shall be 100 Liters per minute,
per patient Design Flow rate to be assumed for pipe sizing, for Oxygen
Wards, Labour room, Newborn Care Stations -----10 LPM
Operating Rooms ------100 LPM
Ventilator Points -----100 LPM
Bio Medical Equipment Service-----100 LPM

MANIFOLD
Duplex Control Manifold with automatic changeover connected to two
header bars High-Pressure, Low Flow System
Source for Primary supply or Secondary supply or the Emergency
Reserve supply Maximum 10 Gas Cylinders in each bank of the manifold
All the cylinders should stand vertically even during storage
Cylinders should be chained during use and standby
Each port is connected to a cylinder by flexible pigtail connections; a
header bar; and an outlet port Change over from “Duty” to the “Standby”
bank of cylinders shall be Automatic Preferably based on pneumatic
pressure Audio Visual Alarm system Average mounting Height at its
centre shall be 1650 mm from FFL
Three pressure gauges on the front of the control cabinet
Pneumatic relief valve in Hospital Distribution Line
Master alarm panel should be installed at a suitable place
• Installed at the place of duty of manifold technician
Audio-visual alarm should be there
It should be set for a 10-20% drop in the line pressure
PIPELINE NOMENCLATURE
Main Hospital Supply Pipeline or Gas Service Specific Trunk Pipeline:
from Manifold to Building
Feeder Pipeline which includes Risers: Horizontal & Vertical upto
distribution pipeline
Distribution Pipeline or Branch Pipeline: serves one floor or a part of it,
no vertical movement
Drop pipe: distribution to terminal units

PIPELINE MATERIAL
Medical Grade Copper, which is phosphorous deoxidised non-arsenical
copper conforming to BS EN 1412:1996 grade CW024A (Cu-DHP).
Seamless, round, solid drawn, sizes confirming to BS EN 13348
Suitable for installing vertically or horizontally without sagging or
distortion.
The material temper shall be as under.
For Tailpipe: R220
For Pipe of Nominal Outside Diameter (OD) 12 mm – 54 mm: R250 (half
hard)
For Pipe of OD 76 mm and above: R290 (hard)

PIPELINE INSTALLATION
All tubing, valves and fittings shall be thoroughly checked for any grease,
oil or other combustible material
Nitrogen Purge: During the brazing of pipe connections the interior of the
pipe shall be purged continuously with Nitrogen
Silver Brazing: Flux-less silver brazing alloy to be used, silver copper-
phosphorus brazing alloy CP 104 conforming to BS EN 1044:1999. Soft
solder or 50/50 solder must NEVER be used on a Medical Gas System
Before the wall outlets are installed, blow the pipes free of any
particulate Pressure Testing Locating Leaks Cross-connection Testing
Pipe sizing is determined either by Volume of Gas to be delivered or by
impact of overall pressure required.

When sizing, for Medical Vacuum, always provide pipes of one size
higher diameter to prevent clogging.
• No pipe smaller than 12 mm OD shall be used anywhere in the MGPS
Installation. No pipe smaller than 15 mm OD shall be used anywhere in
this installation in the Surgical Suite including Operating Rooms, pre-
operative and post-operative Wards.No pipe smaller than 15 mm OD
shall be used anywhere in the installation for the Medical Vacuum
Service.
All valves shall be of the lever ball type
• Flanged O-ring seal connections
Which open and close with a 90- degree rotation
• The handle should be in line with the pipeline when open
All Valves are in Open position in a commissioned MGPS system
Main Line Valve (Source Shut Off Valve):
• Provided at outlet of the supply source
• Must always be accessible to authorized persons only
Branch Valves including Riser Valves:
• Base of risers and every major branch
• Placed in secured location Line Valves Assembly (LVA)
• Provided at the defined sections
• At entry & exit of each section Zone Valves
• Provided at each fire zone
• Accessible to floor staff
• Accessible to the fire staff
• Should be marked in floor evacuation plan
Area Valve Service Unit Modules (AVSU).
• Area Valves, when provided with NIST Gas Specific Connectors, Gas
Pressure Switch, and Pressure Gauge (optional)Single Gas Service Unit
or Multi-gas Service Unit Installed at 1000mm to 1800mm height
Assist in Emergency Gas Alarm ManagementAlarm and Monitoring
Display Unit should be installed at the Nursing Station.Audio Visual
Alarm system
• Should be placed at the nursing stations
• It should display the pressure of various MGPS lines
• The alarms should be set at the critical value of the pressure drop
Terminal units shall be leak proof and allow plugging of probes from
front
• Push to insert and press-to-release mechanism for probes.
• Self-sealing valve on disengaging the probe
• Non return valve for ease of line servicing and repairing
• Colour-coded, Gas Specific front plate
• Terminal units shall be leak proofArea Valve Service Unit Modules
(AVSU).
• Area Valves, when provided with NIST Gas Specific Connectors, Gas
Pressure Switch, and Pressure Gauge (optional)Single Gas Service Unit
or Multi-gas Service UnitInstalled at 1000mm to 1800mm height
Assist in Emergency Gas Alarm Management Alarm and Monitoring
Display Unit should be installed at the Nursing Station. Mounting height
900- 1600mm from FFL, recommended 1300mm Dimensions of probes
shall be as per BS 5682:2005. It is essential that probes be machined
from stainless steel.
• Minimum clearance of 150 mm on either side Colour coding is
described in the table
Provided for dispensing gases in wards and patient care areas.
Also houses nurse call system, flow meters, infusion pumps, reading
light.Running panels along the walls.

• Similar to bed head panels

LIQUID OXYGEN (LOX) TANK

Liquid Medical Oxygen is a low-pressure high flow supply system
Tank is made of stainless-steel inner pressure vessel that is supported in
a mild steel outer shell duly insulated in between.
Duplex (Two) ambient-heated vaporiser Pressure Control Equipment to
control the pressure and flow Liquid Oxygen Tank- Planning
Considerations Adequate space should be left on all sides of the VIE
The area should be fenced properly for access control Vacuum or
suction is the most widely used MGPS service Piped Vacuum Systems
will be provided in Wards, Intensive Care Units, Treatment Rooms,
Obstetric Suites, LDR Rooms, Operating Rooms Bank of multiple
vacuum pumps of smaller capacity is deployed as a multiplex system
Suction pressure is also regulated at the terminal point by the Healthcare
provider Designed to maintain a vacuum of 300 mm Hg (40 kPa) at each
terminal unit

For pipe sizing the design flow is assumed to be 40 LPM & 15 LPM
at 300 mm Hg in OT and wards respectively
Vacuum Pumps- duplex or triplex
• Tanks- two vacuum receivers
A PLC based controller with sequencing or cascading effect
Duplex filtration & isolation system, connected to the discharge (exhaust)
system with a silencer/ muffler Exhaust discharge at highest point of
building & away from any air intake Alarm to indicate vacuum pump
failure, integrate master alarm system Ward vacuum unit is equipped
with
• A regulator
• The vacuum bottle are available in various sizes from 250ml to 2 lts.
• Based on the usage bottle size may vary eg. OT needs larger bottle
size.
• Suction catheter is connected to the ward vacuum unit CENTRAL
PUBLIC.

MEDICAL AIR 4
Blending agent with Medical Oxygen when it is delivered to a patient
Considered as manufactured drug on- Site Delivered at a pressure of
370-400 Kpa Medical Compressed Air is monograph:
Oxygen II. Carbon Monoxide III.Carbon Dioxide IV.Nitrous Oxide + nitric
Oxide V.Sulphur Dioxide VI.Humidity  23.5% v/v > 10 ppm > 500 ppm > 
2.5 ppm > 5 ppm Flow rate of MA4 is calculated to be 40 & 80 LPM per
point for OT and ICU respectively Compressors- Multiplex
• Oil & Moisture separator
• Air Dryer- refrigerant or Desiccant
• Air receiver
• A PLC based controller with sequencing or cascading effect
• Filtration system
• Drainage
An assembly of three filters must be placed for delivery of the clean Air:
1. Pre filter (5 or 1 μm ) 2.Fine/ Bacterial filter (0.01μm) 3.Coal Filter/
tower With the help of the filter assembly, we will be able to achieve
IS/ISO 7396-1 class air quality. Filters should be checked regularly for
clogging. The Medical Grade Air Compressors should use oil-free or oil-
less technologies to reduce post compressor treatment of compressed
air.
• Medical Grade Air Compressors deploy both Reciprocating and Rotary
Compressors Technologies. These include, but are not limited to, the
following.

TYPE OF COMPRESSORS

Reciprocating Single Acting One Stage Compressor (suitable for 480

kPa – 930 kPa pressure)
• Reciprocating Single Acting Two Stage Compressor (suitable for upto
1200 kPa pressure)
• Reciprocating Diaphragm Compressor (these provide un-contaminated
air) Reciprocating Compressors can be of a lubricated, non-lubricated or
oilless design RotaryAirCompressors Rotary Helical Screw
Compressors: Suitable for low vibrations, continuous operation; compact
size and are suitable for high output volume but are not particularly
suited to frequent starting and stopping operations. (suitable for
minimum 780 kPa discharge pressure)
RotaryScrollCompressors:Intrinsically oil-free, quiet, have low vibration,
are compact and are suited to frequent starting and stopping operations.
(suitable for 780 kPa discharge pressure) Rotary Sliding Vane
Compressor (Single Stage or multistage) are not oil free, and are
considered suitable only for vacuum applications only.
MEDICAL CARBON OXIDE
Medical Carbon Dioxide (CO2) is insufflations gas laparoscopy
• Ventilation is very critical for the rooms where CO2 is used
• Provided only in the Operating Rooms
• Positioned in a shaded area, away from direct sunlight or source of
heat
• pressure regulator will be provided with heating arrangement
• Nominal Distribution Pressure to be considered is 410 kPa
• Design Flow rate is 50 Litres per minute

CARBON OXIDE MANIFOLD

Primary supply will be two banks of minimum 2 number of D Type
• No secondary bank required
• Automatic change over panel with heater
• Emergency reserve supply cylinders in the OT
• All piping & Installation work will be as discussed above CENTRAL
PUBLIC WO

MEDICAL NITROUS OXIDE

Nitrous Oxide is used for anaesthetic and analgesic purposes
• Provided only in the Operating Rooms in this MGPS Installation.
• Positioned in a shaded area, away from direct sunlight or source of
heat
• Nominal Distribution Pressure to be considered is 410 kPa
• Design Flow rate is15 Litres per minute

NITROUS OXIDE MANIFOLD

Primary supply will be two banks of minimum 4 number of D Type
• Secondary: Two banks of minimum 2 number of D Type, N2O Gas
Cylinders
• Automatic change over panel with heater
• Emergency reserve supply- small cylinders in the OT
• All piping & Installation work will be as discussed above

ANAESTHETIC GAS SCAVENGING SYSTEM (AGSS)

To drain out excess anaesthesia gases from the OT
• Collects and removes waste gases from the patient breathing circuit
and the patient ventilation circuit
• Operating Rooms (OR) will be provided with an active Anaesthetic Gas
Scavenging (Disposal) Systems
• Dedicated, High Flow, active extraction and disposal system
• Flow rate of 50 to 80 LPM
• Shall provide open scavenger interface The AGSS shall have following
system components. Scavenging, Transfer and Receiving System Unit
Disposal System Unit.

AGSS Disposal System Unit

Skid mounted, Simplex pump with directly coupled impeller assembly, to
its totally enclosed, fan-cooled, electric motor.
• Motor control unit & Starter
• Air inlet filter & Vacuum flow regulator
• Moisture drain flask and flexible connector
• Discharge should be at a safe place away from any air intake source.

NIROUS OXIDE
Nitrous oxide (medical) is a colourless, odourless, tasteless gas. It is
supplied under pressure as a liquid in a cylinder with a valve to control
the outflow of gas. A variety of sizes of cylinders are available containing
different volumes of nitrous oxide. It is categorized as an inhalation gas.
There are no other ingredients. Nitrous oxide (medical) mixed with 30%
oxygen is used in general anaesthesia. It may be used with a wide
variety of other anaesthetic drugs allowing lower doses of the other
anaesthetic drugs. Nitrous oxide (medical) mixed with 50% oxygen is
used to reduce pain in a number of situations such as childbirth, dental
work and other painful procedures such as the wound and burn dressing,
the insertion of cannulae or needles into veins. It is occasionally used as
an insufflating agent in laparoscopy and as a refrigerant in cryosurgery.
Head injury. Pneumothorax.
 Decompression sickness
. Following air encephalography.
 Severe bulbous emphysema
. During myringoplasty
. Occluded middle ear
. Renal cyst.
 Nitrous oxide should not be used as an analgesic or anaesthetic agent
for more than 24
 hours, unless your doctor monitors you carefully. Take special care
with nitrous oxide (medical).
 Care is needed in the handling and use of nitrous oxide (medical) gas
cylinders.
 Nitrous oxide (medical) can be used if you are pregnant.
 Breast-feeding.
 Ask your doctor or pharmacist for advice before taking any medicines.
 Nitrous oxide (medical) can be used if you are breast-feeding.
 Driving and using machines.
 It is recommended that you do not drive or operate machinery for 12
hours after the use
 of nitrous oxide .

Nitrous oxide (medical) will be administered via inhalation and you will be
given a facemask, mouthpiece or nasal prongs to use. The facemask or
mouthpiece connected to nitrous oxide (medical) via a suitable medical
device. The device must be operated in the manner described by the
manufacturer. These systems will only be used to give you nitrous oxide
under the direct supervision of attendant and suitably trained medical
personnel. The concentration of nitrous oxide used in your treatment will
depend on the condition it is being used to treat. Your doctor will tell you
how long the treatment will nitrous oxide (medical) will last. Follow the
instructions given to you by your doctor. During use the cylinder should
be kept upright, away from heat in a well-ventilated area. Connections
for hoses, valves etc. must be kept clean and dry. If necessary, clean
only with plain water. Do not use solvents. Use clean, lint free cloths for
cleaning and drying off. Use no oil or grease on valve or associated
equipment. Do not allow naked flames near the cylinder. If you use more
nitrous oxide (medical) than you should: If you may have used more
nitrous oxide (medical) than you should, talk to a doctor or pharmacist as
soon as possible.

Over dosage is rarely a problem. Inappropriate, unwitting or deliberate

inhalation of nitrous oxide will ultimately result in unconsciousness,
passing through stages of increasing light headiness and intoxication
and if there is an absence of oxygen, death from asphyxiation will occur.
The treatment is removal to fresh air, mouth to mouth resuscitation and if
necessary the administration of oxygen.
Like all medicines nitrous oxide (medical) can have side effects. Nitrous
oxide inactivates vitamin B12 and following prolonged use or exposure to
nitrous oxide may result in megaloblastic bone marrow changes. Nitrous
oxide passes into all gas containing spaces in the body faster than
nitrogen passes out. This may result in bowel distension, middle ear
damage and rupture of the eardrums If you notice any side effects not
mentioned in this leaflet, please inform your doctor or pharmacist.
Respiratory Effects: All aesthetic gases increase respiratory rate and
diminish tidal volume. Unlike other agents, however, the increase in rate
produced by nitrous oxide may actually provide a net increase in minute
ventilation Therefore, when used alone for mild to moderate sedation,
nitrous oxide does not depress ventilation. However, when it is combined
with sedatives or opioids that depress ventilation, a more pronounced
and clinically important depression may result. Cardiovascular Effects:
Nitrous oxide mildly depresses myocardial contractility, but this is offset
by its ability to activate sympathetic activity. In both normal patients and
those with coronary artery disease, sub anaesthetic concentrations of
nitrous oxide (0.1 to 0.5 MAC) have little influence on cardiac output,
stroke volume, and heart rate. Chronic Toxicity: Nitrous oxide has been
implicated in the adverse effects on health seen in those individuals who
are chronically exposed to trace amounts of the drug. These adversities
include infertility, spontaneous abortion, blood dyscrasias, and
neurologic deficits. These concerns pertain only to chronic exposure; it is
presumed that healthy surgical patients could receive nitrous oxide
without harm.Transfer to Gas-Filled Spaces: The blood gas partition
coefficient of nitrous oxide is 0.46, which is more than 30 times greater
than that of nitrogen (0.014). When a patient's inspired gas mixture is
switched from air containing approximately 78% nitrogen to an
anesthetic mixture containing 70% nitrous oxide, the nitrous oxide will
enter gas-filled spaces more than 30 times faster than nitrogen can exit
the space. Diffusion Hypoxia: When inhalation of high concentrations of
nitrous oxide is discontinued, high partial pressure in blood transfers
nitrous oxide to the alveoli rapidly. This dilutes the partial pressure of
oxygen in the alveoli and may lead to hypoxemia. For this reason, it is
conventional practice to provide the patient with 100% oxygen during the
first few minutes following discontinuation of nitrous oxide. Analgesic and
Anesthetic Action: The mechanism by which anesthetic gases produce
general anesthesia is unknown. The leading theory suggests that they
bind to proteins within neuronal membranes and somehow modify ion
fluxes and subsequent synaptic transmission Keep Nitrous oxide
(medical) out of the reach and sight of children. Nitrous oxide (medical)
should be stored in a well-ventilated place, under cover and kept clean
and dry. Cylinders should be stored where they will not be exposed to
extremes of temperature. They should preferably be stored between 10
C and 30 C. Full cylinders should be stored separately from empty
cylinders and separately from non-medical cylinders and from other
medical cylinders containing different gases. Use by date Check the date
given on the batch label attached to the cylinder. Do not use Nitrous
oxide (medical) after the expiry date given on the label.

Nitrous oxide works very rapidly – it reaches the brain within 20

seconds, and relaxation and pain-killing properties develop after 2 or 3
minutes. The depth of sedation can be altered from moment to moment,
allowing the person who administers the gas to increase or decrease the
depth of sedation. Other sedation techniques don’t allow for this. For
example, with IV sedation, it’s easy to deepen the level to accept local
anaesthetic of sedation, but difficult to lessen it. Whereas with laughing
gas, the effects are almost instant. Other sedation techniques have a
fixed duration of action (because the effects of pills or intravenous drugs
last for a specific time span), whereas gas can be given for the exact
time span it’s needed for. It can also be switched off when not needed
and then switched on again (though to avoid a roller-coaster effect, you
shouldn’t do this too abruptly). There’s no “hangover” effect – the gas is
eliminated from the body within 3 to 5 minutes after the gas supply is
stopped. You can safely drive home and don’t need an escort. With
nitrous oxide, it’s easy to give incremental doses until the desired action
is obtained (this is called “titration”). So the administrator has virtually
absolute control over the action of the drug, preventing the possibility of
accidental overdoses. While giving incremental doses is possible with IV
sedation, it’s not possible with oral sedation (as a result, oral sedation
can be a bit of a hit-and-miss affair). For certain procedures – those
involving gums rather than teeth (e. g. deep cleaning) – it may be
possible to use nitrous instead of local anaesthesia. N2O acts as a
painkiller on soft tissues such as gums. However, its pain-relieving
effects vary a lot from person to person and can’t be relied upon. No
injection is required. In cases of very severe needle phobia, getting
laughing gas first can help you feel relaxed enough to allow the needle
required for IV sedation to be inserted in your arm or hand. The very
deep state of sedation achievable through IV sedation will then allow
you.

Nitrous oxide in anaesthesia machines: stored as a liquid with vapour on

the top at a pressure of 4400 kPa. The filling ratio is the percent ratio of
the weight of gas in cylinder to the weight of water the cylinder would
hold at 16.c) of this cylinder is the weight of the fluid in the cylinder
divided by the weight of the water required to fill it. In the UK, the filling
ratio is 0.75. In hotter climates, the ratio is 0.67 Accident & emergency:
resuscitation room, per trolley space 10 Operating 15 Maternity:
operating suites 15 Radiological: all anaesthetic and procedures rooms
15 Critical care areas 15 Oral surgery/orthodontic: consulting rooms 15