Handling Medical

Oxygen and
Equipment
What will I learn?

Learning Objectives

By the end of this lesson you will learn about:

• Utilisation of medical oxygen as a life-saving commodity

• Precautions to be observed while handling medical
Oxygen
• General advice with regard to Oxygen management
Medical Oxygen: An essential supply!

NEED FOR MEDICAL IMPORTANCE OF A HANDLING OF

OXYGEN RELIABLE SUPPLY OXYGEN

Medical Oxygen is There are several

required across Having a reliable supply precautions that
many levels of the of Oxygen is a crucial must be observed
health system. People element of avoiding while handling
suffering from preventable deaths medical Oxygen in
respiratory distress among adults and order to ensure
may need Oxygen children globally. judicious and
support. rational utilisation.
What is Oxygen Stewardship?

• Medical oxygen therapy is given in most efficient and least

wasteful manner!
• Only giving supplemental oxygen to patients who need it
• Using the minimum amount of oxygen that’s needed
• Selecting the most efficient device/ interface
• Weaning off appropriately
• Turning it off when the oxygen is not in use

Oxygen is a DRUG
Use judiciously
Oxygen Stewardship….

• Need to identify and plug the wastages in supply

• Leakages from the oxygen source
• Cylinders- valves/ regulators
• Wall oxygen panel- connectors/ humidifiers
• Oxygen concentrator
• Leakages in manifold pipelines
Oxygen
Cylinders
Overview of Medical Oxygen Cylinders

Storage: Oxygen gas can

be compressed and stored
Filling and Transportation:
in cylinders identified by Accessories: Cylinders
Cylinders are filled at a gas
colour, labelling, require several accessories
manufacturing plant (and
general condition and and fittings such as high
transported to health
expiry date. resistance tubes, manometer
facilities), or at an Oxygen
for regulating pressure flow
Maintenance: Cylinders plant at a health facility that
and conserver for sensing
require periodic has a high-pressure
patients breathing pattern.
maintenance, commonly compressor.
provided by gas
suppliers at the point of
refilling.
Using an Oxygen Cylinder (1/2)

The oxygen cylinder is firmly secured

Bull nose is fitted with Oxygen valve by the nut using a two
in one spanner. Teflon tape is used to avoid any leakage
from the threading.

Controlling knob shall be in tight position when gas is

released from the cylinder.

Using cylinder Key or a Spanner, the spindle of the

cylinder is rotated in anti clockwise direction to release
the oxygen gas.

Check the reading in pressure gauge; a full cylinder will

show a pressure of around 2000 psi (140 kg/cm2).
Using an Oxygen Cylinder (2/2)

Turning off the flow of Oxygen:

Using the small cylinder wrench, turn the cylinder

on/off valve clockwise to close it.

Bleed off the pressure in the valve by opening the flow

regulator knob.

When the gauge reads zero, turn the flow regulator

knob to zero.
Procedure to change the cylinder

• Remove the regulator by loosening the T-handle.

1
• Slide pegs out of the holes on the valve post and remove the regulator.
2
• Remove the tab from the valve post on the new cylinder.
3
• Make certain there is a washer on the large post on the regulator.
4
• Attach regulator to cylinder by slipping regulator over valve post of cylinder.
5
• Align pegs located on the inside of regulator yolk with holes in valve post.
6
• Slide the regulator forward.
7
• Turn the T-handle on the regulator until it is tight.
8
• Turn on the Oxygen flow.
9
Types of oxygen cylinders

EXAMPLES OF CYLINDER SPECIFICATIONS

Older
A B C D E
Original system: Name
This uses an alphabetical system, starting with Newer
M4 M6 M9 M15 M24
Name
A for the smallest size and E for the largest
portable size.

New naming system:

This begins with the letter “M” for “medical”
followed by a number that signifies the
amount of cubic feet of Oxygen in that can
be compressed into the cylinder.
Caution to be exercised in handling Oxygen cylinders

Upright Position Protection From Protection From

Fire Punctures

Always follow FIFO

(first in first out) while
taking oxygen cylinder
from storage
Regular Flow Alterations With Readily Available

Maintenance Doctor’s Advice Contacts For Repair

Oxygen
Concentrator
Oxygen concentrator

• Oxygen concentrator extracts and separates oxygen from room air and
runs on electricity.
• Does not need refilling and can be moved easily.
• The maximum flow rates vary in different models: 5 - 10 L/ min
• FiO2 delivered >80-90%
Using an Oxygen concentrator (1/2)

Place it atleast 6 inches away from walls or other objects to

ensure good airflow in and out

Avoid using extension cords and plugging other devices to

the same electrical wall outlet

An alarm is heard as it is turned on for approximately 5

seconds; A similar alarm during use may suggest malfunction

Look for any leaks at the connections

Ensure back up in case of electrical failure

Fill distilled/ clean water in the humidifier bottle not

exceeding maximum mark
Using an Oxygen concentrator (2/2)

Regular maintenance

Ensure a heavy duty model is procured for continuous use

The equipment should be tested to be able to deliver the high FiO2 at

near maximal flow rates

Comply with manufacturer’s instructions- filters/ zeolite column

Fill distilled/ clean water in the humidifier bottle not exceeding maximum
mark
Liquid
Oxygen
Storage of Liquid Oxygen

1. Liquid oxygen is a cryogenic liquid having a boiling point of -297*F (-183°C) and should be stored
system in a cryogenic storage tank, with vaporizers and a pressure control system.

2. These tanks are usually fixed structures

3. Do not plug, remove or tamper with any pressure relief device.

4. Ensure adequate ventilation, keep all valves and outlet caps closed when not in use.

5. Report any malfunction to the vendor. Keep repair team’s contact readily available.

6. Oxygen must be separated from flammables and combustibles by at least 20 feet or a half-
hour fire wall. Post "No Smoking" and "No Open Flames" signs.

7. Usually the tank is refilled once it’s half empty

Oxygen storage
• Liquid oxygen tank
• Oxygen cylinder assembly
• Suitable for small unit
• Only as back up in emergency at AIIMS
A
B

A: Vapourization of liquid oxygen

B: Gaseous oxygen at high pressure
(~70psi) outlet pipe
C: Delivery to hospital wards
C
Sites for leakage
• Loose connections between oxygen pipes,
valves, pressure gauze, joints
• Enclose the storage area and pipes with
metal grills (prevent physical damage)
Precautions for safe storage and use

Refer to Guidelines & Safety Precaution
Standards in India like-
• Gas Cylinders Rules 2016, Petroleum &
Explosives Safety Organization (PESO),
Department for Promotion of Industry and
Internal Trade
• Bureau of Indian Standards (BIS)
• National Disaster Management Authority,
Govt. of India (2021)
Safety Indexed Connector Systems, refer
• American Standard Safety System (ASSS)
are encouraged for larger cylinders and
attachments
• Pin-Index Safety System (PISS) for small
cylinders (up to & including size E) & their
attachments
• Diameter Indexed Safety System (DISS) is
recommended for low-pressure connections

Ensure regular evaluation of safety relief valves, tank

pressure and temperature etc. as precautionary measures
Safety Considerations while handling Liquid Oxygen (1/2)

Any clothing that has Organic materials can

been splashed or soaked
with liquid oxygen or
exposed to high oxygen
concentrations should be
removed immediately
and aired for at least an
hour
Personnel should stay in a
well-ventilated area and
avoid any source of
ignition until their clothing
is completely free of any
excess oxygen.
react violently with
oxygen when ignited by a
spark or even a mechanical
shock are oil, grease,
asphalt, kerosene, cloth, tar,
and dirt that may contain oil
or grease.

Do not permit smoking or open Ensure that liquid oxygen or oxygen-enriched

flames in any areas where liquid air does not come in contact with organic,
oxygen is stored or handled. flammable or combustible substances
Safety Considerations while handling Liquid Oxygen (2/2)

A minimum of six air

If liquid oxygen spills on
asphalt or other surfaces
contaminated with
combustibles, do not walk
on or roll equipment over
the area of the spill
Systems used in oxygen
changes per hour is
service must meet
suggested in the building for
stringent cleaning
proper ventilation. Oxygen-
requirements to eliminate
enriched atmosphere is one
any incompatible
containing more than 23.5%
contaminants
oxygen

Keep sources of ignition away for Review the Material Safety Data

30 minutes after all frost or fog has Sheet (MSDS) and follow all safety

disappeared recommendations.
Personnel and
Institutional Safety
Safety Considerations for facilities

FINALIZE AN ESCAPE INTIMATE FIRE KEEP AWAY ITEMS

KEEP AWAY PLAN FOR
PLACE A NO DEPARTMENT OF PRONE TO SPARKING
INFLAMMABLE AND
SMOKING SIGN EMERGENCIES OXYGEN USE AND STATIC
SHARP ITEMS

CHECK KEEP THE KEEP EQUIPMENT KEEP A LOG OF

INSTALL SMOKE FACILTY
ELECTRICAL CLEAN AND DUST AVAILABLE
ALARMS
EARTHING VENTILATED FREE OXYGEN
Recap of the lesson
Key aspects for Management of Medical Oxygen

Ensure regular
Keep backup stock
surveillance for any
available in case of any
wastage through the
exigency.
device or accessories.

Medical Oxygen is available

in limited supply. Over-stocking of medical
Unjustified usage may lead Oxygen is strongly
to deprivation for the discouraged.
needy.