CHAPTER 13 MEDICAL GAS OVERVIEW Chapter 13 of the Uniform Plumbing Code offers information and guidance regarding installation of piping for medical gases and vacuum systems. The requirements in Chapter 13 are applicable to Level 1 systems, these being critical care systems that require redundant sources for all gases and vacu- um. Level 1 systems must be capable of providing life support for patients who are unable to care for themselves, and who are not directly attended for the entire period of their _incapacitation. Consequently, in the event of a failure in one ele- ment of the medical gas system (for any reason), there must be an automatic switchover to the stand- by source(s) so that no interruption of service will ever occur. There must also be an alarm system with visual and audible signals to notify the respon- sible parties that a switchover has occurred, and that service or maintenance will be required. The nature and location of alarms will vary with the spe- cific application and location of the source equip- ment and its components, Source equipment and gas storage can be in the form of bulk storage, dewars (for liquid oxy- gen), cylinder storage (for gaseous oxygen, nitro- gen, and nitrous oxide), or compressors and vacu- um pumps. Compressed air may be provided in two forms; 1) medical air; or 2) instrument air Modical air must be prescribed by physicians sole- ly as a supplemental source to aid in human resp- ration (patient breathing) and is effectively a med- ication. It may also be utilized for calibration of medical devices used in respiratory applications. Medical air must be filtered, dried, and regulated to a pressure range between 50 and 55 psi. It, like all other Level 1 medical gases, shall be piped through copper pipe thet is cleaned and labeled for oxygen usage, assembled with cleaned and bagged fit tings, and brazed with BouP filler material, The compressors and accessories used to create med- ical air shall be specially listed for the application, and the end product shall meet the U.S. Pharmacopoeia standards for medical air. Medical air shall have no detectable liquid hydrocarbons, shall have less than 25 ppm of gaseous hydrocar- bons, and shall have no more than 5 cubic mil- ligrams of permanent particles that ate 1 micron or larger. Medical air shall also be dried sutticiently to ensure a dew point (condensation level) that is below 0° Celsius (82°F). Medical gas is alarrhed with a master alarm that signals during source changeover or when there is a 20 percent deviation (plus or minus) from normal operating pressures or when the system dew point exceeds +4” Celsius (+39°F). A variety of failures will result in a local alarm signal at the compressor(s) Note: “Local” alarms provide a signal at the equip- ment site; “Master” alarms monitor the equipment site (source and reserve source) and the pressure in the main lines of each medical gas and vacuum system; “area” alarms represent a warning system in the area of use and provide continuous visible and audible surveillance of the medical gas and vac- tuum systems, Alarms. Alarm requirements vary with the level of care being offered. In general, the require- ments are as follows: Level 1 Systems: Master Alarms: Master alarms monitor the operation and condition of the source of supply, the reserve source, and the pressure in the main lines of each medical gas and vacuum piping sys- tem, At least two master alarms ate required for a Level 1 system, one in the office of the person who is responsible for maintenance of the medical gas system, the other in an area that ensures continu- ous surveillance or observation, such as the tele- phone switchboard, the security office, or some other continuously staffed location. Alarm signals will originate from sensors that are installed in the main lines, immediately downstream from the soutce valves. When an additional main valve is installed, the sensor shall be downstream of that valve. Signals shall be comprised of both visual and audible indications. Visual indications are to remain in the alarm condition (visual) until the situ- ation that caused the alarm has been resolved. There shall also be a means to indicate when a si nal light has failed. Disconnection of witing at the sensor will also cause both an audible and a visual indication at the master panel. Audible signals are 134UPC ILLUSTRATED TRAINING MANUAL i cancelable but will reinitiate if another alarm condi- tion occurs after they have been silenced. ‘Area Alarms: Area alarm panels shall be provided to monitor all medical gas, medical/surgical vacuum, piped WAGD systems serving anesthetiz- ing locations, and other vital life support and critical areas, such as post-anesthesia recovery, intensive ‘care units, emergency areas, and other similar func- tions. Area alarms are located at a nurse's station or another location that will ensure continuous respon sible surveillance. Pressure increases or decreases of 20 percent within the medical gas systems being monitored will initiate an alarm signal. Alarms for medical/surgical vacuum piping will signal when the reduced pressure in the vacuum system rises to 12 inches of mercury (HV). Note: Standard atmospheric pressure at sea level is 29.92 inches of mercury. A medical vacuum sys~ tem normally operates in a reduced pressure range of 15 plus inches below atmospheric pressure, Sensors for area alarms serving piping in life-sup- port and critical care areas shall be installed on the outlet side of any related zone valve. By so doing, inadvertent or intentional closure of one of these valves will initiate an alarm and may prevent the patient(s) from suffering dire consequences. Sensors for alarms serving anesthetizing areas shall be installed ahead (source side) of zone valves, to allow intentionally shutting down one or more of the anesthetizing area zone valves without ‘causing an alarm. The sensor in this case is simply to assure that pressure is available in the system (ahead of the zone valve) if anesthetizing gas is needed, typically for an operating room procedure. Area alarm systems provide surveillance that is remote from the source but close to the area of use for Level 1 and Level 2 medical gas systems. Level 3 alarm systems (master alarms) provide visible and audible signals within the actual area of med- ical gas usage. Local Alarms: Local alarms will be sig- naled when a condition is occurring at the source equipment that is outside acceptable parameters. These continuous visible and audible signals will be transmitted from the gas storage and equipment site, Air compressors, vacuurn pumps, and gas headers may have a local condition that requires attention, therefore sensors will signal at both the source equipment itself and at the master alarm panel(s). Signal equipment will either be on the 132 equipment control panel or within a monitoring device such as a dew point or carbon monoxide monitor. Dew point is the temperature at which ‘water vapor will condense into visible liquid. Amed- ical air system will signal at both the local alarm and the master alarm(s) when the medical air dew point tomperature exceeds +4° Celsius (+39°F). Carbon monoxide content is also monitored, and any quan- tity in excess of 10 ppm will activate a local alarm as well as the master alarm(s). In all cases, local alarm signals are transmitted to the master alarms as well. Instrument ar is of much higher quality than medical air and wil alarm at a dew point of -30" Centigrade (-22°F). Instrument air is normally dried to a dew point of -40°C (-40'F). Instrument air is also filtered to exclude particulates larger than 0.01 micron. When compressors and vacuum pumps are incapable of satisfying the system demands, a backup or lag compressor (or vacuurn pump) will activate, a condition that will also trigger both local and master alarms. ‘Source equipment will provide local signals to indicate the operating status of specific equip- ment. These signals will be visual only and will typ- ically be represented by pressure or quantity gauges. Gas cylinder manifolds, bulk cryogenic liq- uid systems and their headers, emergency reserves, and instrument ait headers are all required to have local signals as well as master alarm indicators. There must be a label to desig- rato the condition that is being monitored. Valves: Medical gas systems have a num- ber of required valves that are assigned specific locations of installation. Medical gas valves shall ‘meet the following specifications: 1) They shall be 1/4-turn, full ported, ball type. 2) They shall be of bronze or brass con- struction. 8) They shall have factory-installed pipe extensions to facilitate brazing. 4) They shall be three-piece valves to per- mrt inline serviceability. Additionally a) Positive pressure valves shall be cleaned for oxygen service by the manu- facturer. ) Vacuum valves may be either ball or but- terfly type and are not required to be cleaned for oxygen service.HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS Medical gas and vacuum valves have the following applications: = Source Valves: These are installed in the immediate vicinity of the source gases, downstream from the manifold cabinets that typically house the signal transmitters, changeover switches, line pres- sure regulators, check valve(s), and pressure relief valve(s). Source valves are intended to isolate each connected medical gas piping system and its accessories from the connected source gases and the equipment cited above when gas storage is remotely located. = Main Valves: ‘These are main supply-line shutoff valves installed inside the building when source valves are not accessible from within the building (either because medical gas storage is remotely located or because the interior gas stor- age enclosure may be inaccessible due to limited access authorization). = Riser Valves: Each riser from a medical gas main is required to have a shutoff valve on the fiser at the point where it connects to the main, Riser valves shall be accessible and shall be prop- erly labeled. - Service Valves: Service valves ate installed on each lateral branch pipe connected to riser, thus allowing isolation for servicing or modifica- tion of the branch. Service valves are required to be installed ahead of any zone valves installed on that branch. Limited access is provided to these valves with the goal of avoiding errors or vandalism; conse- ‘quently, service vaives shall be located as follows: 1) Behind a locked access door. 2) Above a ceiling in a locked, open condi- tion 3) Ina secure area in a locked, open condition + Zone Valves: Zone valves are required ahead of all station inlets/outlets. Zone valves are to be readily operable by a person standing in the “corridor” of the floor served by these valves. Zone valve boxes shall be installed where they are visible and accessible at all times. Zone valve boxes shall not be installed behind normally open or normally closed doors, or otherwise hidden from plain view. Zone valve boxes shall not be located in locked rooms or areas. A zone valve shall be installed immediately outside of each life-support, critical ‘eare, and anesthetizing area for accessibility during an emergency. Zone valves shall be so located that losing the zone vaive(s) to one operating room or anesthatizing area will not effect the others. A pres- sure\vacuum indicator shall be provided on the downstream side of each zone valve and ahead of the patient station inlevoutlet fittings. Zone valves shall be labeled with the name or symbol for the spe- cific medical gas being supplied through that valve, ‘The patient room(s) or area being served shall also be identified on this label, in addition to a cautionary note that warns against closing or opening that valve except during an emergency condition. = In-Line Valves: In-line valves are option- al valves installed to aid in servicing of individual rooms or areas. In-line valves: a) Shall be located in a restricted area (lim- ited access) b) Shall be locked or latched open (to pre- vent inadvertent closure) ‘¢) Shall be property identified (for correct intentional closure). - Station Outlets/inlets: Each outlet/nlet at patient stations and other locations that require medical gas(es) and vacuum shall be “gas specific.” This applies whether the outlet/inlet is threaded or quick-coupled. Outlets (pressurized gases) shall have both a “primary” and a ‘secondary" valve (or assembly). Inlats (vacuum) require only a primary valve. The primary check valve is located in the face plate of the outlet, and the secondary check valve is installed in the back part of the assembly. No sec- ondary valve is required for the vacuum system because a piece of tape or cardboard can be used to block the secondary inlet after the face plate has been removed. Factory-installed copper tubes piped from station outlets (pressure pipe) shalllbe no longer than 8 inches and not less than 1/4 inch inside diameter. Factory-installed tubes on station inlets (vacuum pipe) shall be no longer than 8 inch- es and no less than 3/8 inch inside diameter. Pressure Tests: Each section of piping in a medical gas system is required to be tested with either pressure or vacuum. There are a variety of tests that may be required as follows: = Initial Pressure Test: The initial pressure test is performed prior to installation of any pres- sure-sensitive devices and is primarily a piping installation integrity test. The test pressure for all pressurized gases shall be at least 1.5 times the ‘working pressure of the system, but not less than 150 psi gauge pressure. The test pressure for a 133UPC ILLUSTRATED TRAINING MANUAL a vacuum system piped in copper shall be 60 psi gaugo. The test pressure for a Level S vacuum sys- tem shall be not less than 15 psi, unless the vacu- um piping is constructed of Schedule 40 PVC pipe, ‘which will require a vacuum test of not less than 19 inches of mercury. No positive pressure may be applied to a PVC vacuum system. Test pressures shall be maintained until each joint has been exam- ined using soapy water or an equivalent leak detec tion method. The vacuum test must stand with no detectable change In pressure. = Standing Pressure Tests for Positive Pressure Medical Gases: After successful comple tion of the initial pressure test, the system shall be subjected to a standing pressure test. These tests are conducted after final installation of outlet valves, face plates, and other distribution system compo- nents, such as pressure alarm devices, pressure indicators, pressure relief valves, manufactured assemblies, etc. Standing test pressures shall be at least 20 percent above normal line pressures and shall be applied for 24 hours. There will be no allowable loss of pressure during this period = Standing Pressure Tests for Vacuum Systems: Vacuum systems shall be tested at a reduced pressure of 12 inches of mercury for 24 hours with no change of pressure. The vacuum ‘source shall be removed during the test. ~ Cross-Connection Test: All medical gas piping systems shall be reduced to zero gauge pressure and all gas sources shall be disconnected. Each medical gas system shall then be charged (one system at a time) with Nitrogen NF (National Formulary) to a gauge pressure of 50 psi. Alter installation of appropriate faceplate adaptors, each outlet in every medical gas system shall be checked to determine whether itis pressurized. Obviously, only the system under test should have any line pressure, Each system is to be tested separately in the manner described above. Proper labeling of outlets/iniets shall also be established as a part of this test procedure, = Purge Test: Using appropriate test adap- tors, each outlet in the medical gas system shall be purged with a high-velocity nitrogen flow to remove all particulate matter. A suecesstul purge test will result in no discoloration of a white cloth placed in front of the purge gas discharge. Cryogenic Liquid Systems: — Liquid ‘Oxygen (LOX) is the most common cryogenic prod- 134 uct associated with a medical gas system. When large quantities of oxygen are to be consumed on- site the most efficient buik storage of this product is oxygen in the liquid (cryogenic) state. Liquid oxy- {gen will vaporize as It warms, a process that wi ‘occur naturally or with the assistance of an oxygen vaporizer, a process that is essential prior to distri bution through the piping system. Liquid oxygen storage vessels are required to be placed on con- crete pads to which they are firmly anchored. LOX tanks shall not be placed on asphalt or other petro- leum-based surfaces where spillage of liquid oxy- gen could result in a combustible reaction between the LOX and the petroleum. When bulk storage of LOX is maintained outside and/or remote from the building served, there shall also be an Emergency ‘Oxygen Supply Connection (EOSC) that is piped to the oxygen system. This connection Is to be pro- vided on the exterior of the building in an area that is accessible to emergency supply vehicles at all times. EOSC piping shall be connected immediate~ ly downstream of the main shutoff valve (not the source valve). EOSC connections shall be equipped with a relief valve(s) to prevent line pressures from ever reaching values more than 50 percent above normal operating pressures. Bulk cryogenic oxy- {gen sources shall be equipped with a reserve sys- tem comprised of elther a second cryogenic liquid vessel or a gas (oxygen) cylinder header (bottled gas), or both. Each of these reserve sources shall contain not less than an average day's supply of ‘gas. In addition to bulk storage reserves, but not as a substitute for these reserves, emergency reserve sources may be provided inside the bullding so long as they provide at least an average day's supply of medical gas. The objective is to have a standby source of critical gases sufficient to supply at least ‘one day's needs while arrangements are being made to replenish the primary source. Level 1 Medical Systems Source Valves: These valves are located in the immediate vicinity of the source equipment. ‘The function of these valves is to isolate the piping system that leads to the building from downstream of the source gas cylinders, dewars, compressors, vacuum pumps, etc., and any secondary gas stor- age or gas-producing equipment that is utilized to supply the medical gas system, The source valve is commonly installed just downstream of the mani-HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS. fold cabinet, which is normally in the near vicinity of the source gas manifold headers or dewars. Gases (bottled and otherwise): Instrument air (compressed ait) serves as an alter- native to nitrogen. It is used for medical support purposes (not patient air) and typically operates medical-use tools, booms, pendants, and similar equipment-related applications. It is not to be uti- lized for patient respiration, one reason being that it is supplied at a pressure of 165-180 psi, the same pressure as nitrogen when it is used for this pur- ose. Instrument air must meet much higher stan- dards than medical air for patient use. Medical instruments have close tolerances and are quick to matfunction when subjected to moisture or part cles. Instrument air is required to be filtered to .01 micron particle size (100 times cleaner than med- ical air), be free of hydrocarbon vapors, and be dry to a dew point of -40" Celsius (which is also -40°F) Instrument air compressors are required to produce Unregulated compressed air at not less than 200 psi ‘output pressure. Instrument air may be supplied by a single compressor (a "simplex" system) provided there is an adequate supply of reserve gas (nitro gen) available to ensure not less than one hour of normal operation. The gases we think of as true medical ‘gases include oxygen, nitrous oxide, and nitrogen. In addition to these more common gases, some facilities will be supplied with helium and carbon dioxide. When there are relatively small demand loads, or when used as standby gases, these gases are commonly stored in one or more banks of com- pressed gas cylinders that connect to a common’ header. When used in quantity, it is common to have bulk storage of certain gases, or in the case of oxygen, 10 store the gas as a cryogenic liquid. When maintained at a low temperature, oxygen remains in a liquid form. This allows a small quan- tity of stored liquid to be vaporized into a large ‘quantity of oxygen in the gaseous state. The con- tainer for this liquid oxygen is called a dewar, which is effectively little more than a highly efficient large thermos bottle. Medical gases may be stored at a location remote from the building, or under defined circumstances, may be stored within a building. Proper ventilation of storage rooms and specifically worded signage at the entry into these rooms will be essential, in addition to fire-rating the room based upon the type of gases stored. Immediately downstream from each cyl der header there will be a header valve, followed by a pressure gauge (which serves as a header con- tents indicator), all of this leading immediately to a manifold control panel that houses the step-down regulator, line pressure regulator, check valves, change-over switch, isolation valves, local signal sensor, and pressure relief valve. Typically, gas cylinders, dewars, and bulk storage are supplied and maintained by the gas supplier who also owns and maintains the manifold control panel Effectively all ofthis equipment becomes par of the source gas “assembly” that supplies a regulated supply of gas to the site. Immediately downstream of each control panel will be a “source” valve that serves to segregate the distribution system from its stored gases and source equipment. Piping installed between the medical gas storage site and the main line shutoff valves (at the building) repre- sents the exterior portion of the medical gas piping system and is installed, controlled, and maintained by the hospital or other Level 1 facility. When med- ical source gases ate stored in an enclosure within the building, the source valve will obviously also be installed in that same enclosure. Medical air compressors and vacuum pumps may be installed together in one room with- in a hospital or other Level 1 building. Neither of these pieces of equipment are permitted to be installed in a room that houses medical gas cylin- ders or dewars. Interior rooms housing air-cooled medical air compressors and vacuum pumps shall be adequately ventilated to maintain the ambient temperature range recommended by the equipment manufacturers. Exhaust from vacuum pumps shall terminate as follows: a) Outdoors, b) At least 10 feet from any door, window, air intake, or other openings into buildings. ©) Ata level above air intakes. ) In a location where prevailing winds, adjacent buildings, topography, or other influences are not likely to divert exhaust products into building openings that lead to ‘occupied areas or that prevent safe disper- sal of the vacuum pump exhaust. Medical-air compressors are required to draw intake air from a source of presumed clean air in a location where no contamination is anticipated from combustion engine exhausts, fuel storage vents medical-surgical vacuum system discharges, par- 135UPC ILLUSTRATED TRAINING MANUAL nT ticulate matter, or sources of odor. The air-com- pressor intake shall be located outdoors above root level, at a minimum distance of 10 feet from any door, window, exhaust, or other air intake or open- ing into the building, and a minimum of 20 feet above ‘ground. Any alternate source that is deemed equal to or better than the specified source must be established as being continuously available on a 24 hours per day, 7 days per week basis. {In addition to conventional medical gases, medical ait, and medical vacuum, there may be a ‘separate vacuum system called a Waste Anesthetic Gas Disposal (WAGD) system. The reason for installing these systems is to provide a means of evacuating waste anesthetic gases during surgery, this so that the medical staff does not become par- tially incapacitated by inhalation of the same prod- uct that put their patient to sleep. The WAGD pip- ing may be connected to the regular vacuum sys~ tem, provided any flammable waste gases that may be drawn in are diluted well below their lower flam- mablity limit prior to entering the vacuum system. ‘The WAGD waste gases may also be drawn into a vacuum system that is dedicated solely to the WAGD exhaust function. The design and function of any such system is to be consistent with the design and installation standards applicable to a regular vacuum system. Medical vacuum systems fare equipped with local alarms (alarms at the source) that activate when the backup vacuum pump begins to run. Medical air systems are Gesigned to activate a local alarm, either when the backup compressor begins to run, of when exces- sive dew point or carbon monoxide are sensed in the system, In addition to the local alarms, an excessive dew point will also activate the master alatm(s) With the exception of medical vacuum sys~ tems, all medical gas piping and fitings shall have been factory-cleaned for oxygen service. Pipe and fitings shall remain sealed until prepared for instal- lation, and then shall be brazed within one hour alter these package seals have been broken. The system Is required to be pre-purged with nitrogen NF (National Formulary) to remove all ait (oxygen) 's0 that copper oxides will not form on the pipe’s interior walls. A continuous purge is required during the brazing process, but the piping system must never become pressurized during the brazing process. The flow of purge gas shall be maintained After the brazing process is completed until the 136 brazed joints are cool to the touch. Then the sys- tem is to be resealed and kept sealed, either until additional brazing takes place, or until medical equipment is being attached. Medical gas valves are designed with a factory-installed copper pipe pigtall extending from each outlet to prevent the Valve seats from boing damaged by heat during brazing. Medical gas valves may also be equipped with an attached purge valve that allows purging and brazing back to that valve (by providing a purge Vent) without necessitating the shutdown of all or @ portion of the effected branch, as would otherwise be required. Level 2 Level 2 systems are similar in most respects to Level 1 systems, the principal difference being that redundancy of gas and vacuum sources is not required. Level 1 systems may provide life support to patients who are not ambulatory and who, therefore, are relying totally on the depend- ability of whatever life support is required. Level 2 systems are not suitable for facilities that offer 24- hour service and that provide critical care life sup- port. A.evel 2 system would be suitable for an out- patient surgery facility where all of the medical gases required by a hospital might be necessary, put which offers close personal attention to individ- tal patients during their period of care. None of these patients would normally be Kept on life sup- port for an extended period of time (usually not fonger than the time it takes to arrange transporta- tion in order to get the patient to a hospital). Chapter 13 of the Uniform Plumbing Code address- ‘es neither Level 2 nor Level 3 patient care (dental offices, doctor offices, laboratories, etc.). However, plumbers routinely install medical gas piping in both Level 2 and Level $ facilities, therefore, itis impor- tant to know some of the distinctions between these three levels of medical care, It is also useful to know that a common reference source for design and installation of Level 2 and Level 3 installations is NEPA 99C (Medical Gas and Vacuum Systems). NFPA 99C addresses the medical gas and vacuum piping portion of NFPA 99, Another information Fesourca is ASSE Medical Gas Systems Installers, Inspectors, Verifiers, Maintenance Personnel, and Instructors Manual. These secondary references offer guidance to the installer, the inspector, and the verifier who will test the system upon completion to determine, among other things, that there are noHEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS cross-connections and, further, that all of the alarm systems funotion during an actual or simulated equipment or system failure, Level 3 A Level 3 system is one that serves occu- pancies where interruption of the piped medical gas would terminate procedures but would not place pationts at risk of further injury or death. Dental offices, medical offices, nursing homes, limited-care facilities, and similar occupancies can be classified as Level 3 faclities. However, when patients in these facilities are dependent upon mechanical ventilation or assisted mechanical ventilation, including during administration of anesthesia, the occupancy would be classified as a Level 2 and piped accordingly. Unless reliant totally or partially Upon a Level 1 facility's medical gas piping system (such as a dental office within a hospital), or where Level 2 life support may be required (temporarily) {or their patients, dental offices may be classified and piped as Level 3 facilities. Ass true with all levels of medical gas sup- ply, indoor enclosures for medical gas storage shall serve no other purpose and shall be of not less than ‘hour construction. Air compressors and vacuum pumps shall be located separately from oylinder storage enclosures and from other medical gas sys- tems. Enclosures shail be either gravity ventilated by two louvered openings (upper and lower) not less than 72 square inches each, or shall be mechanically ventilated when the total stored gas ‘quantity exceeds 3,000 cubic feet. Mechanical ven- tilation systems shall draw air from within one foot of the storage room’s floor and shall operate con- tinuously. The power supply for mechanical venti- lation of a gas storage enclosure shall conform to requirements applicable to an essential electrical system (emergency power source). The code is less than explicit on this matter but in order to ensure continuous mechanical ventilation, it would be necessary to connect a master alarm that is acti- vated when a sail switch or pressure sensor signals that there has been a fan system failure. There shall be not less than two banks of medical gas cylinders, each containing at least an average day's supply of required gases, or two oylinders of oxygen and one of nitrogen (when utilized), it cylinder stor- age is close to the point of usage. When cylinder storage is remote there shall be at least two oylin- ders of oxygen and two of nitrogen (when utilized). Cylinders shall be manifolded such that they will alternately supply the piping system. When the system is remote, automatic switchover shall be provided. Level 3 medical gas systems shall be equipped with at least a single master alarm locat- ed in an area of continuous surveillance while the facility is in operation. (Local alarms and area alarms are not required for Level 3 medical gas sys- tems). Master alarms for Level 3 gas systems will monitor the condition of the stored gas(es) and the pressure in the piping system. Vacuum systems and compressors or nitrogen cylinders used to power medical devices are not required to have warning systems. Vacuum systems installed above ground shall be graded toward the vacuum source. Vacuum systems installed underground and below ‘the building shall be installed in conduits that serve as sleeves for the vacuum piping within those con- duits. The same requirement holds true for all med- ical gases installed beneath an on-grade slab with- ina building. Brazing of gas or vacuum piping with- in a Level 3 installation shall be performed as required for Level 1 and Level 2 systems. System Verification. Upon completion of a medical gas system, it shall be subjected to a sys- tem verification inspection. This inspection will include the following 1) Standing pressure tests at normal oper- ating pressures. 2) Ctoss-connection tests. 3) Alarm tests during simulated failures, 4) Piping purge at 8 cubic feet per minute to remove any remaining particulates. 5) Piping particulate test. This involves flowing 35 cubic feet of gas per system through at least 25 percent of each piping zone at a velocity of no less than 3.5 cubic feet per minute. 6) Piping purity. This is a test that flows nitrogen NF of the source gas through a device that measures hydrocarbons and halogenated hydrocarbons as they com- pare with those in the test or source gas. ‘The maximum difference allowed between the two is; hydrocarbons - 1 ppm; halo- genated hydrocarbons ~ 2 ppm. The piping Purity test also includes a dew-point read- ing at the most remote outlet on each sys- tem. The dew point shall not exceed 500 parts per milion at 12°C (63.6°F). 137UPC ILLUSTRATED TRAINING MANUAL iS 7) Operational pressure. This is a test for residual pressure when the system is oper- ated at a designated flow velocity. For ‘example, a system that normally operates at 50 psi can have no more than a 5-pound pressure loss when flowing at 3.5 cubic feet per minute. ‘These final “verifier” test procedures are to confirm that the medical gas system is in compll- ance with all applicable code requirements and that all systems (including the alarms) are functional. It is crucial that no cross-connections exist, that no ‘one exhausts the supply of medical gas in use at a critical time, and that the purity of the gas in use will cause no harm to the patient. A safe installation is not a matter of chance, nor can any procedures be allowed that do not require competent design, installation, and verification of a medical gas sys- tem. Rules are best followed by those who under- stand the premise upon which those rules are based, and this is especially so as it pertains to sys- tems which, by their very purpose, have a life-and- death component. Pipe Sizing, Medical gas piping is sized based upon objectives more so than sizing tables. ‘The following are general pipe sizing stipulations and other rules: 1) No branch or main in a medical gas syS~ tem shall be less than 1/2-inch inside diam- eter. 2) No branch or main in a medical vacuurn system shall be less than 3/4-inch diame tet 8) Drops to individual station outlets shall be no less than 1/2-inch inside diameter. 4) Runouts to alarm panels and connecting tubing for gauges and alarm devices are permiltad to be 1/4-inch in diameter. 5) Medical gas piping shall not be installed in Kitchens, electrical switchgear rooms, elevator shafts, and areas with open flames. 6) Medical gas piping shall not be located where it is subject to contact with oil 7) Hangers for copper piping shall have a ‘copper finish and be sized for copper tubing, '8) Underground medical gas piping outside of a building shall have a 96-inch cover. 138HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS CHAPTER 13 HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS This chapter on medical gas systems was adopted by the IAPMO membership in 1992, revised in 1998, and first appeared in the 1994 edition of the Uniform Plumbing Code as Appendix F. In 1997, ‘Appendix F was changed to Chapter 13. It was writ- ten to provide regulations for the design, installa- tion, inspection, and certification of medical gas and medical vacuum systems. Faulty installations of medical gas piping have caused injury and death to patients receiving medical gas during surgery and ‘can damage or destroy expensive medical equip- ment. For these reasons, itis particularly important {or installers and inspectors working on these sys- tems to have expertise in the design and installati of medical gas and vacuum systems. Medical gases are commonly used for anes- thetizing a patient during surgery, assisting patient breathing, powering ventilators, and operating sur- gical tools. Medical vacuum systems remove blood, saliva, and other organic debris from the patient's body during surgery and are used frequently in ‘other medical treatments. Problems that may result from faulty medical gas piping include unstable pressure and flow, overall poor quality of the instal~ lation, and contamination of the gas by moisture, particulates, hydrocarbons, or bacteria. 1301.0 General Special fixtures and systems within health care facil ities occur and require special attention. In order for these fixtures and systems to provide safe operation and also provide safety for the patients, the follow- ing requirements in this chapter shall apply. Alteration to medical ges systems shall comply with the requirements of Chapter 13, while portions of the piping system unaffected by the alteration should comply with the standards in effect at the time of the installation. Exceptions to this practice would be where existing systems adversely impact the performance of the system. 1802.0 Medical Gas and Vacuum Piping Systems It is required that anyone either installing or verify- ing a medical gas or vacuum system show evi- dence of competency, such as a certificate issued by a recognized agency acceptable to the Authority Having Jurisdiction. The plumbers, installers, or technicians must be certified to the requirements of ANSVASSE 6010 Standard, Professional Qualification Standard for Medical Gas and Vacuum System Installers. This standard currently requires not only classroom instruction in medical gas systems but also passing a practical brazing exam to demonstrate proficien- cy. Certified brazers are further required to main- tain certification through continuity, at least on a semiannual basis in accordance with ASME Section xl 1303.0 Protrusions from Walls Any area where a patient may be transported, either by a gumey, hospital bed, or wheelchair, shall be kept clear from any obstructions in order to allow a clear, safe path of travel ‘These obstructions may include drinking foun- tains, control valves, pipe risers, medical gas sla- tion outlets, vacuum inlet stations, or any other device that may restrict the safe transportation of the patient. 1304.0 Psychiatric Patient Rooms In order to protect the safety of psychiatric patients, all fistures and fitings shall be of the vandal-proof type. All piping and fixture traps shall be concealed, This may be accomplished by locking the cabinet/vanity doors that allow access to the ipiping and fixture traps. 1305.0 Locations for Ice Storage In order to protect the making and storage of ice from possible contamination from any source, ice makers and ice storage chests shall be located in an area that can be constantly observed by staff members. Nurses stations are one such area. 1306.0 Sterilizers 139UPC ILLUSTRATED TRAINING MANUAL iS 1306.1 General. All sterlizers and bedpan steam- ers shall be installed in accordance with the UPC and the manufacturer's installation instructions. 1308.2 Indirect Waste Connections. All indirect waste pipe from a sterlzer or bedpan steamer shall bbe piped to an approved receptor located in the same room as the piece of equipment through an airgap in acoordance with this chapter and chapter 8. Indirect waste pipe shall not exceed 15 feet in developed length and shall not be smaller in size than the outlet of the equipment it serves. All indi: rect waste pipe that serves a bedpan steamer shall be provided with a 3 inch (80 mm) trap. 1307.0 Vapor Vents and Stack for Sterilizers 1307.1. General. All sterlizers that have a provi- sion for a vapor vent and that the manufacturer equites be vented must be vented above the root. ‘These vents shall be installed per the manufactur- v's installation instructions and shall not be con- nected to any drainage system vent. 1308.0 Aspirators 1308.1. Prior approval is required before any aspi- rator can be installed. All aspirators or other water- supplied suction devices shall be installed in accor- dance with Chapter 6 and Chapter 8 of this code. Part Il- Medical Gas and Vacuum Systems 1309.0 Scope Chapter 13 covers the installation of medical gas and vacuum piping from the point of supply to the user outlet or inlet. Although important to oper- ation of medical gas systems, requirements for portable systems, cylinder storage, bulk supply sys~ tems, electrical requirements, waste anesthetic gas disposal (WAGD), surface-mounted medical gas rail systems, and systems with nonstandard pres- ‘sures are not covered in depth, as those provisions exist in other codes and documents. This chapter ‘addresses medical gas and vacuum piping systems installod in hospitals, outpatient surgery facilities, emergency rooms, medical clinics, trauma centers, and other facilities that require life support. 1310.0 Definitions 1310.1 Building Supply - The pipe from the source of supply to a building or structure. 19-10 1310.2 Critical Care Area — Those special care units, intensive care units, coronary care units, angiography laboratories, cardiac catheterization laboratories, delivery rooms, operating rooms, post- anesthesia recovery rooms, emergency depart- ments, and similar areas in which patients are intended to be subjected to invasive procedures and connected to line-operated, patient-care-relat- ed electrical appliances. [NFPA 99 3.9.135.2] 1910.3 General Care Areas — General care areas are patient bedrooms, examining rooms, treatment rooms, clinics, and similar areas in which it is intended that the patient will come in contact with ordinary appliances such as a nurses-call system, electric beds, examining lamps, telephones, and entertainment devices. [NFPA 99 2-2] 1310.4 Manifold — A device for connecting outlets of one or more gas cylinders to the central piping systam for that specific gas. [NFPA 99 2-2] 1310.5 Medical Air— For purposes of this standard, medical air is air supplied from cylinders, bulk con- tainers, medical air compressors, or has been reconstituted from oxygen USP and oil-free, dy hitrogen NF. Medical air shall be required to have the following characteristics: (1) Be supplied from cylinders, bulk containers, medical air compressor sources, or be reconstituted from oxygen USP and oil-free diy nitrogen NF (2) Meet the requirements of medical air USP (3) Have no detectable liquid hydrocarbons (4) Have less than 25 ppm gaseous hydrocar- bons (6) Have equal to or less than § mg/m of permanent particulates sized 1 micron or larger in the air at normal atmospheric pressure [NFPA 99 3.3.106, 5.1.3.5.1] 1310.6 Medical Gas - Gas used in a medical facility, including oxygen, nitrous oxide, nitrogen, carbon dioxide, helium, medical air, and mixtures of these gases. Standards of purity apply. 1310.7 Medical Gas System — Complete system consisting of a central supply system (manifold, bulk, or compressors), including contro! equipment ‘and piping extending to station outlets at the points where medical gases may be required. 1310.8 Medical Vacuum System — See 1310.19, Vacuum System — Level 1 1310.9 Nitrogen, Oil-Free, Dry (Nitrogen for Brazing and Testing) — Nitrogen complying, at @ minimum, with nitrogen NF. [NFPA 99 2-2]HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS 1310.10 Patient Care Area - Any portion of a health care facility wherein patients are intended to be examined or treated. [NFPA 99 2-2] 1310.11 Purge, Flow— The removal of oxygen from a system by oil-free, dry nitrogen during brazing. 1310.12 Purge, System — The removal of nitrogen from a system with the medical gas required for that system. 1310.13 SCFM — Standard cubic fet per minute, (NFPA 99.3:3.159) 1310.14 Special Hazard Area— An area such as a kitchen or electrical switengear room. 1310.15 Station Inlet — An infot point in a Type | medical-surgical piped vacuum distribution system at which the _user makes connections and discon- nections. [NFPA 99 2-2] 1310.16 Station Outlet — An inlet point in a piped medical/surgical vacuum distribution system at which the user makes connections and disconnec- tions, (NFPA 3.3.167) 1310.17 Use Point — A room or area of a room where medical gases are dispensed to a single patient for medical purposes. A use point is permit ted to be comprised of a number of station outlets of different gases. [NFPA 99 2-2] 1310.18 User Outlet - See Station Outlet. 1310.19 Vacuum System — Level 1 — A system consisting of central vacuum-producing equipment with pressure and operating controls, shutoff valves, alarm waming systems, gauges, and a net- work of piping extending to and terminating with suitable station inlets at locations where patient suction could be required. [NFPA $9 2-2] 1310.20 Valve, Isolation — A valve which isolates one piece of equipment from another. 1310.21 Valve, Riser— A valve at the base of a ver- tical riser, which isolates that riser. 1910.22 Valve, Service - A valve serving horizontal piping extending from a riser to a station outlet or inlet. 1310.23 Valve, Source — A single valve at the source which controls a number of units that make up the source 1310.24 Valve, Zone — A valve which controls the gas or vacuum to a particular area. 1310.25 Waste Anesthetic Gas Disposal - The process of capturing and carrying away gases vent- ‘ed from the patient breathing circuit during the nor- ‘mal operation of gas anesthesia or analgesia equip- ment. [NFPA 99 3.3.178] 1311.0 General Requirements The general requirements in Chapter 13 include pro- visions for an adequate supply of medical gases and vacuum service from both primary and secondary sources, evidence of competency of installers and verifier, and general discussion of code compliance, 1312.0 Plan Review 1812.1 All new and altered medical gas and vacu- um systems must have specific site and piping plans drawn for review prior to installation. The installer needs the plans to guide the work. The Authority Having Jurisdiction must be able to refer to plan specifications to ensure that code requirements are met, and a copy of the approved plans must stay on the jobsite for the owner's future reference. There is very litle room for deviation from the plans since proper installation is critical to life safety. 1912.2 Plans and specifications shall show, in detal: Installing the piping and components correctly the first time eliminates the need for corrections and results in a safe system. Also, plans showing the exact location of pipelines, valves, outlets and inlets may ald in finding system problems in the case of an ‘emergency and will save future installers time 1312.2.1 In the plot plans, itis important to show relationships of pipe lines and storage areas to other buildings, facilities, hazardous areas, and surgical areas. Its always necessary to indicate the location of driveways, property lines, and streets and their relationship to the storage of medical gas cylinders. 1912.2.3 Another component to thorough plan’ development is the incorporation of lists ofall materi- al specifications. Not only does the installer need to be able to reference the correct materials for installa- tion, but so do clinic or hospital officials, health off- cials, and fire safety officials. The more detailed a medical gas and vacuum piping plan is, the more assurance everyone has that the system will be com- plete and free from error. 1313.0 System Performance 1313.1 Medical gas systems are designed to oper- ate at certain pressures. The user inlets and outlets require a certain amount of flow to provide enough ‘oxygen, medical vacuum, nitrous oxide, compressed air, nitrogen, helium, and/or carbon dioxide to ensure that the medical gas and medical vacuum needs of 1341UPC ILLUSTRATED TRAINING MANUAL the patient and the medical equipment are met. See Table 13-1 for the required operating pressures. 4313.2 Table 13-2 lists the minimum flow rates required for each medical gas and for medical vac- uum. Always be sure to read the footnotes in the tables. Footnotes may provide limitations and/or clarity performance or installation procedures. 1313.3. Table 19:3 lists the minimum number of sta~ tion inlets and outlets needed for medical gas and vac- tuum systems. Some rooms are required to have mul tiple inlets or outlets because many medical proce- dures require the use of more than one inlet or outlet. 1315.0 Required Pipe Sizing ‘The specific method for sizing medical gas or medical ‘vacuum piping systems is described in this section. 4315.1. Whore the maximum demand for each med- ical gas or vacuum system and the maximum length ‘of piping between the source equipment and the most distant station outlevinlet does not exceed the valves in Table 13-6, the size of each pipe section of tho system shall be determined by means of Table 13-4 and 13-6. Systems beyond the range of Table 1366 shall be sized by means of the methods set forth in 1315.3 of this chapter. 4315.2. To determine the size of each section of pipe in any system within the range of Table 13-6, proceed as follows: 1315.2.1. Measure the length of the pipe from the source equipment location to the most remote sta~ tion inlevoutlet on the system. 1318.2.2 In Table 13-6, select the column showing that distance or the next longer distance if the table ‘does not give the exact length. 1318.23 Starting at the most remote outlevinlet, find in the vertical column just selected the medical gas or vacuum demand for that inleVoutlet. If the ‘exact figure of demand is not shown, choose the rnext larger figure below in the column. 1315.24 Opposite this demand figure, in the first column at the left in Table 13-6 willbe found the cor- rect size of pipe. 4315.25 Using this same vertical column, proceed ina similar manner for each section of pipe serving this inlet/outlet. For each section of pipe, determine the total gas or vacuum demand supplied by the section, using Table 13-4. 4318.26 Size each section of branch piping not previously sized by measuring the distance from 19-12 the source equipment location to the most remote inlet/outlet in that branch and follow the procedures of Sections 1315.22, 1315.2.3, 1815.24, and 1315.25 Note: Size branch piping in the order of the dis- tance from the source location, beginning with the ‘most distant outlet not previously sized. 131.3 For conditions other than those covered by 4316.1 of this section, such as longer runs of greater gas or vacuum demands, the size of each gas or vacuum piping system shall be determined by standard engineering methods acceptable to the ‘Authority Having Jurisdiction, and each such sys- tem shall be so designed that the total pressure drop or gain between the source equipment and any inlet/outlet will not exceed the allowable pres- sures shown in Table 13-1 1316.0 Workmanship 1316.1 All design, construction, and workmanship must be in conformance with accepted engineering practices and with other requirements outlined in this chapter. 1316.2 This chapter prohibits the following prac- tices: concealing cracks, holes, or other imperfec- tions in materials by welding, brazing, ot soldering, or by using paint, wax, tar, or other leak-sealing repair agents. The defective material must be removed and replaced with sound material. 4316.3 Deburr all tubing to the full bore by using a deburring tool and remove burrs or other projec: tions from the tubing Cleanliness is especially important when installing medical gas systems. Care must be taken to ensure these systems are not contaminated by tho installer or the surrounding environment. It is recommended, but not required by code, that installers wear clean cotton gloves and change them when they are soiled. Wear disposable rubber gloves when washing fitings to protect your hands from irritating cleaners and to reduce the possibility of tube or fitting contamination. Tubing and fitings used for medical gas sys- tems are conventional Type K or L copper tube and fitings regularly used on plumbing jobs, except they have been cleaned and then sealed to keep them {ree from dirt and debris until ready to be installed. ‘See Section 1310.0 for information on cleaningHEALTH CARE FACILITIES AND MEDICAL GAS AND VAGUUM SYSTEMS. The storage area for tubing, fitings, vaives, and appliances should be on-site in an area set aside, away from normal construction activity. Storage areas for tubing and fittings should be sealed off as much as practical from smoke, dust, dit, and mois- ture. A separate job trailer might be necessary for a large project that is expected to last for many weeks. For projects of short duration, an area tent- ed with plastic sheathing may be adequate. Preplanning is essential to the successful installa- tion of medical gas and vacuum systems. Medical gas and vacuum systems must be cor- tified. See Section 1323.0 on certification. 1317.0 Materials 1317.3 Medical gas systems are required to be piped with listed or approved seamless Type K or L copper tubing. 13174 Listed wrought copper fittings suitable for making brazed connections shall be used. Other devices installed in medical gas systems, including valves, manifolds, and station inlets/outlets, must be copper, brass, bronze, or other suitable materi- als. Plastic components are often used in station inlets and outlets and other patient equipment. Other materials may be used under the provisions of Section 301.0 with prior approval from the Authority Having Jurisdiction. 1317.8 All valves used in medical gas systems and medical vacuum systems must be, except those at the source of supply and at station outlets‘inlets, three-piece fullway ball valves with brazed exten- sion. These valves shall open and close using no more than a 1/4 turn, All the working parts of the valves must be noncorrosive and oilfree. All valves shall be labeled to identify the type of gas the valve controls. 1818.0 Cleaning 1318.1 Cleaning is critical to preventing contami- nation of the system. All piping, vaives, fitings, and other components used in medical gas systems must be suitable for and compatible with oxygen service. This section requires that they be internal- ly cleaned prior to delivery to the installation site to remove oll, grease, and other oxidizable materials. In medical vacuum systems, piping does not have to comply with cleanliness requirements, nor does it have to be compatible with oxygen. 1318.2 Precleaned and sealed copper tubing is readily available from most suppliers with advance notice. Cleaned and bagged fittings are similarly available. Section 1318.2 limits on-site cleaning to recleaning joints that have become contaminated Immediately prior to assembly, Example of Cleaning Contaminated Fittings. Figure 13-4 shows a typical cleaning station. Clean fittings by immersing them in a bath of one of the ‘chemical mixtures listed above. Rinse the fittings in hot water and blow dty immediately with dry nitro- ‘gen. Alter cleaning, place fittings in sealable plastic bags, either individually or in small quantities. Fittings must remained bagged until use. Never clean ahead more than a one day's supply of fit tings. Several commercial versions of presealable plastic bags are available. Zipper-type bags are also acceptable. Atter cleaning, cap all piping, including short nipples. Fabricated piping that is not yet brazed can be protected from infiltration of dust and contami- nants by capping all unbrazed joints. All such fabri- cated pipe should be brazed or taped within 24 hours of fabrication. Clean the outside of all tubes, joints, and fittings by washing with hot water after assembly and braz- ing. Threaded joints in piping systems must be made up with polytetraflurorethylene (such as Teflon) tape suitable for oxygen service or other thread sealants suitable for oxygen service, Sealants are applied to the male threads only. Clearly, all of these requirements and recom- mendations for a clean, sanitized system are impor- tant. Though some of these steps to cleanliness are time-consuming and expensive, even a novice installer will quickly learn to plan his or her work to protect pipe and fittings from dirt, debris, and other forms of contamination, 1319.0 Installation of Piping See Figure 18°5 for a drawing of a typical medical 495 piping system. See Section 1920.0 of this chapter on joints for brazing instructions. 1319.2 Where possible, do not install tubing in spe~ cial hazard areas but, in no case, can medical gas and vacuum piping be installed in kitchens or elec- trical switchgear rooms. 13:13UPC ILLUSTRATED TRAINING MANUAL 1319.4 In some areas, buried piping must be pro- tected from freezing conditions by being buried below the frostline, Tubing also needs to be pro- tected from corrosion and physical damage. For example, buried tubing shall be deep enough to prevent any excessive stresses or strains that could ‘cause damage and create a failure. There shall be 36 inches (914 mm), of clean backiill material ‘above the tubing. Where physical damage to the tube is unlikely, then the coverage may be reduced to 18 inches (457 mm). The tubing must be laid on a firm bed so it is continuously supported for its entire length. The tube must be installed in a con- tinuous spit enclosure to protect the tube during backfiling. A continuous tape or marker shall be placed above the enclosure that identities the spe~ tific name (type) of the pipeline. In addition to this tape or marker, there shall be a continuous warning marker that is to be installed at the midpoint (depth) of the trench. All exposed tubing must also be pro- tected from carts, trucks, or other equipment that can damage it. 1319.8 Flexible connectors may be used, provided they are approved or listed and are not longer than necessary. Flexible connectors must not penetrate walls, loors, ceilings, of parttions, Connectors must have a minimum burst pressure of 1,000 psig (6,900 kPa gauge). 1319.11 Piping support is important because fall- ure of the tube could cause a dangerous situation. Al piping, fittings, and other components must be adequately supported and braced. Installations must conform to seismic requirements of the UPC and the Authority Having Jurisdiction. Station inlets and outlets may be recessed or installed by other means to protect them from phys- ical damage. Once the outlet or inlet is installed, there must also be adequate protection of the valve and any attachment. (See Table 13-7.) 1320.0 Joints “The skill and workmanship of the brazer is critical to making a good joint. Proper brazing is important medical gas piping. Improper brazing or rapid {ehock) cooling of the joint can result in fallure of the joint, The keys to brazing are the cleanliness of the metal, how much heat is applied to the joint, and the 1344 manner in which the heat is applied. Copper-to-copper joints must be brazed without flux, using @ copper phosphorus or copper-phos- phorus-silver brazing filer metal During brazing, an oil-free, dry nitrogen purge must be continuously flowing to avoid oxidation and prevent other contaminates from entering the piping system, Dissimilar metals, such as copper and brass, ‘must be brazed using an approved or listed brazing flux and a silver brazing filler metal. Flux-coated filer metals may be used to avoid flux penetration to the interior of the piping system. ‘The following procedure, as outlined in ASME- AWS B 2.2, must be followed for brazing joints in a medical gas piping system: fa) Cut all tubing square using a clean, sharp tubing cutter or other device that is free from grease, oil, or ‘other lubricants not suitable for oxygen servioe. b) Ream all tubing to the full bore. ¢) Clean tubing and fitings in preparation for braz~ ing with an abrasive cloth, pad, or brush. Do not use steel wool because it may contain oil ) During brazing, a USP-grade nitrogen or argon ppurge must be continuously flowing to avoid oxidation and prevent other contaminates from entering the pip- ing system. e) Copper-to-copper joints must be brazed without flux, using @ copper phosphorus or copper-phos- phorus-siiver brazing filer metal. Dissimilar metals, Such as copper and brass, must be brazed using an ‘approved oF listed brazing flux and copper-phos- phorus or a silver brazing filler metal. Flux-coated filler metals may be used to avoid flux penetration to the interior of the piping system. f) Insert the tubing into the fitting. The assembly should be firmly supported so that it will remain in alignment during brazing. 9) Apply heat to the parts to be joined, preferably ‘with an oxylacetylene torch. Use a slightly reduced (excess fuel) flame, with a feather on the inner blue cone. Heat the tubing first, beginning about 1 inch (25.4 mm) from the edge of the fitting, sweeping the flame around the tubing in short strokes at right angles to the axis of the tubing. Move the flame ‘continuously, not remaining on any one point long enough to damage the tubing. Continue heating the tubing unt the flux becomes clear and quietHEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS h) When the flux is transparent, sweep the flame back and forth continuously along the axis of the joint to maintain heat on the parts to be joined |) Apply filler metal at a point where the tubing enters the fitting, moving the fiame back and forth. When hot enough, the filer metal will flow readily into the space between the tubing and fitting. Keep the flame away from the filer metal. When the joint is filled, a continuous line of filer metal will be visi- ble around the joint. j) Allow joints to cool naturally with the purge gas flowing in the tubing. k) For joints brazed with flux, after the filer metal has solidified and the joint has cooled, remove excess, flux from the exterior of the joint with a clean cloth, brush, or swab and warm water. This cleaning reduces the risk of hardened flux temporarily retaining pressure and masking an imperfectly brazed joint I) After brazing, all tubing must be capped, the purging gas allowed to remain in the system until the system is tested and inspected. im) After cleaning the outside of each brazed joint, ‘examine it for the following unacceptable conditions. (1) Presence of flux or flux residue. (2) Excessive oxidation of the joint. (8) Presence of unmelted filler metal. (4) Failure of the filler metal to be clearly visi- ble all the way around the joint at the interface between the fitting and the tubing (6) Cracks in the tubing or fitting, (6) Cracks in the filer metal (7) Failure of the joint to hold the test pressure, (See section on testing.) Brazed joints which are defective because of condi- tions (1), (), (4), (6) or (7) can be repaired, but no more than twice. Brazed joints that are defective because of conditions (2) or (5) must be replaced. To prevent oxidation from occurring inside the tube, all tube ends shall be capped leaving the oil- free, dry nitrogen in the system. It is recommended to leave a slight purge of nitrogen on the system to ‘compensate for any leakage that could allow air into the system, contaminating it 1820.2 All tubing shall be cut square using a clean, sharp tubing cutter or other device that is free from grease, cil, or other lubricants not suitable for oxy- gen service. All tubing shall be reamed to the full bore. 1820.3. All tubing and fittings must be cleaned in preparation for brazing with a nonscratching cloth, ad, or brush. Do not use steel wool because it may contain oil 1321.0 Valves, See Figures 13-6 and 13-7 for examples of valves. Station inlets and outlets are considered as valves. Gate valves are not allowed in medical gas sys- tems 1821.1.1 Enclosures must be large enough to per- mmit valve operation. The handle in the no-flow posi- tion must prevent the door from closing. Figure 13- 8 shows a zone valve box. 1921.3.3 Zone valves are located immediately out- side each anesthetizing room and should be visible and accessible. They should not be located behind doors or otherwise hidden from view. Zone valves shall be located in each special care area or adjacent to the nursing station. 1321.4 Source Valve Valves must be located in medical gas and vacuum systems as follows. Valves are installed at the build- ing supply. Valves shall be installed at the building supply at the entrance of the building, the source of supply, and at each manifold located upstream of the building supply valve. Valves must also be located at each piece of source equipment. 1921.6 Riser Valve Additionally, shutoff valves are located at each floor of each horizontal branch between the riser and the first station inleYoutlet. Qazi Zone valves are important for isolating the gas supplying special-use areas. No other intervening shutoff valves may be installed for anesthetizing suites and special care areas. When a zone valve is closed, it must not affect any other zone. Each zone valve more than 15 feet (4572 mm) from a station inlet/outlet needs to have a service isolation vaive installed immedi- ately adjacent to the riser for that branch. 1822.0 Pressure Regulating Equipment Pressure regulating equipment is necessary to mon- itor and control the pressure in medical gas and vac- uum systems. Medical and maintenance personnel should be able to tell what the pressure is at a 1345UPC ILLUSTRATED TRAINING MANUAL lance, The medical gas and vacuum pressures must be maintained within the range of pressures listed in Table 13-1. This section details the require- ments for pressure regulators and pressure gauges. The following are safety recommendations when dealing with pressure regulating equipment: When the supply system is remote, the ‘switchover from the primary source to the secondary source should be automatic. Gas cylinders should be manifolded so that they can alternately supply the piping system. Each bank should contain atleast an average day's supply. Regulators needing repair and cylinders with valves that do not operate prop erly should never be used. If competent in-house repairs cannot be made, such equipment should be repaired by the manufacturer or should be replaced. Never lubricate regulators, ftings, or gauges with oll of any other flammable substance. The high-pres- sure valve on an oxygen cylinder should be opened Slowly, with the face of the pressure gauge on the regulator pointed away from all persons. Never use ‘oxygen fittings, valves, regulators, or gauges for any service other than oxygen. Figure 13-9 shows a pressure regulator. Figures 19-10 and 19-11 show locations where pressure regulating equipment should be installed. 1323.0 Station Outlets/Inlets Because station inlets and outlets vary in size and design from manufacturer to manufacturer, it is important to follow the manufacturer's guidelines and installation procedures for installing inlets and outlets. Figure 13-12 shows some of the types of station inlet and outlets used today. ‘All systems must be purged prior to the instal- lation of station outlets and inlets. Station inlets and outlets are considered as valves. 1924.0 Marking and Identification ‘There have been cases in which medical gas piping was incorrectly labeled, causing the death of a patient who recelved the wrong gas. This section covers the ‘code for code requirements on labeling pipe, valves, and manifolds in medical piping systems. Label all piping, valves, and station inlets/outlets and ensure that the proper gas is flowing in the des- ignated pipe. All enclosures housing valves must also be labeled and color coded to match the type of gas. 1316 The table below shows the required labeling ‘colors for medical gas and vacuum systems. These colots are used throughout the United States. Marking Colors Gas Background Letters Medical Air yellow black Nitrogen black white Nitrous Oxide blue white Oxygen green white Vacuum white black Helium brown white Carbon Dioxide __gray_black or white 1325.0 Alarms Piping systems are not complete until audible and visual alarms and alarm panels are installed and are operable, Alarms indicate any change in pres- ‘sure above or below the normal operating pressure ranges listed in Table 19-1 and also detect change in pressure from one supply source to another or any failure in the system of the emergency reserve. ‘Alarms for medical gas and medical vacuum systems must be approved prior to their use. Funetioning of all alarm components must be verl- fied in accordance with testing and monitoring requirements of the manufacturer and the Authority Having Jurisdiction. Figure 13-13 shows an alarm panel. 4326.0 Medical Air System Medical air is ordinary air that has been com pressed by an air compressor. It must be fitered ‘and dehumidified to remove the contaminants and ‘water that are present in ordinary air. Air compres- sors must be installed in well-lit, ventilated, clean, land accessible locations. 1326.1. Medical air systems need two or more ait ‘compressors, which work separately, to provide con- tinuous service in the event that one unit fails. Each system must have separate shutoff vaives so that tho system will not have to be completely shut down when itis being serviced. Figure 13-14 shows an air ‘compressor. 126.2 Air intakes for medical air compressors must be located outside of the building above roof level, located in an area which is free from contam- ination and moisture. Air intakes must be turnedHEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS down and screened as shown in Figure 13-15. 1326.31 An isolating valve shall be installed at every medical air compressor so the largest com- prossor can be shut off due to failure or repair with- out affecting the operation of other units. 1326.4. Drains must be installed on dryers, after- coolers, separators, and receivers for the purpose of water removal and must be extended to approved locations. Figure 13-15 shows the piping layout of a typ cal medical air system. 1327.0 Medical Vacuum Pump System Vacuum plants (Figure 13-16 shows a duplex vacu- um pump assembly) must be installed in well, ventilated, clean, and accessible locations. Adequate drainage facilities must be provided, locat- ed separately from other medical vacuum system sources and readily accessible for maintenance. Figure 13-16 shows a typical vacuum pump, Figure 13-17 shows the piping layout of a typical medical vacuum system. 1927.1. Medical vacuum systems require two vacuum pumps to provide continuous service in case one unit fails. In addition, a receiver tank piped to the system must be installed. Medical vacuum systems must be ‘equipped with isolation valves so that each pump and receiver can be serviced without disruption to any other area. Every vacuum pump shall nave an iso- lation valve installed, so that when it is closed due to pump failure or repair it will not affect the opera- tion of any other units, 1827.2 Termination of the vacuum exhaust must be outside the building, located at least 10 feet from any door, window, air intake, or other openings into the building, provided further that the termination shall be at a different level from air intakes. This method should eliminate the possibility of contami nated waste entering any other systems. The exhaust pipe terminus shall be tumed downward and screened to prevent the entry of anything that ‘could cause a blockage. 1827.8 Drains from vacuum pumps shall terminate to an approved receptor in an approved location 1329.0 Testing and Inspection All new and changed existing medical gas systems and medical vacuum systems ate required to be inspected. Portions of existing systems may need to be inspected if they are affected by new or changed piping, When the installer determines that the work will stand the test, he or she is ready to request the inspection. The installer has the responsibility to notify the Authority Having Jurisdiction. The inspec- tion can be done as early as 24 hours after the request, but may be done later than 24 hours. If the installer makes no contact with the inspector, he or she should not assume that the inspection is waived and that work can continue, Itis the duty of the Authority Having Jurisdiction to provide notice of corrections needed and viola- tions found during the test. The correction notice may be posted at the jobsite or mailed or delivered {o the permittee or an authorized representative. Refusal or failure to comply with a correction notice ‘or order within 10 days is considered a violation of this code and is subject to the penalties for violations sot forth elsewhere in this code. Each Authority Having Jurisdiction has its own set of laws, ordinances, or guidelines regarding inspection. Prior to doing any work within a jurisdic~ tion, find out the necessary procedures and require- ments to get work inspected and the requirements for final approval. Never cover any medical gas or vacuum piping system until all piping has been tested, inspected, and approved. If the system is covered or concealed before being tested and inspected, notice to uncover the work will be issued to the permittee by the Authority Having Jurisdiction. The work must then be uncovered for inspection. Remember, it is very costly and time-consuming to remove walls and floors to do an inspection that should have been done prior to concealing the piping, 1829.3 The permit holder is responsible for calling for the medical gas or medical vacuum piping inspection. Any equipment, material, or labor nec- essary for inspection and testing must be provided by the installer. All tests are to be witnessed by the Authority Having Jurisdiction or the jurisdiction's representative. If the representative finds that any of the work will not or cannot pass any of the required tests, the representative must not pass the installation and the installer will have to request reinspection and retest of the system as required by the representative. The testing of the system may have to be redone in it’s entirety. 1829.7 A rough test is required of all piping, prior to 1347UPC ILLUSTRATED TRAINING MANUAL the attachment of system components, but after installation of the station outlets/iniets. In preparation for the rough test, test caps are installed. The source valve must be in the closed postion, Testing pressure must be maintained at 450 psig (1.03 MPa) or 1-1/2 times the working pressure with oil free dry nitrogen until every joint is checked Any leaks must be located by means of soapy Water. Dishwashing liquid or other non-caus- te soap is commonly used. To do the soapy water test, mix soap with water in a bucket. Then brush the soapy water over the fittings. When a hole or improper joint is present, the leaking alr, nitrogen ‘will cause the soapy water to bubble in that location. 1329.9 The final testing of medical gas and med- ical vacuum systems is done after installation of all system components, including alarms, compres- sors, and tanks. As in the rough testing, oil-free dry nitrogen is used. A 24-hour standing pressure test is performed at 20 percent above the normal operat- ing line pressure. Pressure changes due to variar tions in the ambient temperature are allowed, usu ally up to one percent or 0.66 psi (4.6 KPa) or ten persent of the allowable pressure. If any leaks are found, the system must be retested as required by the Authority Having Jurisdiction. 1331.0 System Certification Because of the safety problems resulting from improper installed medical gas and vacuum sys~ tems, these systems not only must be tested and inspected, but must also be certified. 4391.11 The certification must be done by a qual- ified third party verification agency which is approved by the Authority Having Jurisdiction. The verifiers must be certified to the requirements of ANSI/ASSE 6039 Standard, Medical Gas Veriiers Professional Qualifications Standard... In addition to an extensive background and knowledge of the systems vital to successful healthcare, each person must pass a comprehensive exam, demonstrating these skills and abilties. The ASSE standard includes a detailed, thorough list of procedures to properly and safely verily medical gas systems. An independent third part, not the installing contractor, must perform system verification. The only excep tion is made for in-house personnel, however veri- fiers must still be certified. 4331.2. The verification agency places the system 19:18 in service and makes sure it works properly. As deseribed in Section 1331.0, the ceriification tests ‘must include the following: 1331.2.1. Verifying compliance with the installation requirements; 4331.2.2 Testing and checking for leakage, correct zoning, and identification of control valves; 41331.2.3. Checking for identification and labeling of pipelines, station outlets, and control valves; 4391.24 Testing for cross-connection, flow rato, system pressure drop, and system performance; 41931.2.5 Functional testing of pressure relief valves and safety valves; 4331.2.6 Functional testing of all sources of supply: 4931.2.7 Functional testing of alarm systems, including accuracy of system components; 41331.2.8 Purge flushing of system and filling with specific source gas; 4391.2.9 Testing for purty and cleanliness of source gases; 1331.2.10 Testing for specific gas identity at each station outlet. 4331.3 The verifier shall provide the reports to the Authority Having Jurisdiction, which rust review It prior to acceptance of the system.HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS taste tea (oremtiesen Hose Gx ane Yewm Stns system bol ‘nr Pressure Maximum Presse (Oxygen Oe 50 psig (0.34 MPa) 50 (45-0) psig Medical Vacuum Vac 12! Hg Nitrous Oxide N20 50 psig (0.34 MPa 50(4+5-0) psig Medical Compressed Air Med Air 50 psig (0.34 MPa) 50(45-0) psig Nitrogen Ne 1160 psig (1.10 MPa) 199 psig Helium He 50 psig (0.34 MPa) 50(15-0) psig Carbon Dioxide C02 50 psig (0.34 MPa) 50(+5-0) psig Non-Standard Nitrogen Ne 200 psig (1.36 MPa) 300 psig (2.08 MPa) Taste 2 Minimum Flow Rates Oxygen 71 CFM per outlet (20 LPM) Nitrous Oxide 71 OFM per outlet (20 LPM) Medical Compressed Air .71 CFM per outlet’ (20 LPM) Nitrogen 16 CFM (0.42 m/min.) free air per outlet Vacuum 4 SCFM (0.03 Sm'/min.) per inlet’ Carbon Dioxide 71 CFM per outlet’ (20 LPM) Helium 71 CFM per outlet (20 LPM) Any room designed for a permanently located respiratory ventilator or anesthesia machine shall have an outlet capable ofa flow rate of 180 LPM (6.36 CFM) atthe station outlet For testing and certiicaion purposes, individual station inlets shall be capable ofa fow rate of 3 SCFM, while maintaining a system pressure of not less than twelve (12) inches (905 mm) atthe nearest acjacent vacuum nt, ~ Gorsooama dS wlodouew'y Wotedoxoa yxq2t fadmmmda¥ cate igo Lait) 1319UPC ILLUSTRATED TRAINING MANUAL TABLE 13-3, Minimum Outiets/Inlets per Station Location ‘Oxygen Medical -Mecieal «Nitrous Nitrogen Helium Carbon Vacuum = Ar Oxide Dioxide Pationt rooms for madioal/surgical, ‘wed tihed—stibed = - = obstetrics and pediatios Examinationtreatment for nursing units toed = toed — = - ee Intensive care (al) ged bed ibed = = a Nursery aibed ——2ibed_——ted = 7 a a General operating rooms 2itaom atom Zoom trom = troom = = Cystoscopic and invasive 2iroom = Slroom = 2hroom = - = special procedures Recovery Delivery and bed Ie Abed = - - laboridelivery! aireom — iroom* —titoom = = & recovery rooms! ‘Labor rooms ‘feed toed Vbed et = = Fiatadengemergowy Thad Theat od Ht - = es treatment ‘Autopsy — —tetatonWetation tf Es ‘anesthesia workroom = tistaion «= station 2 = = + Incudes podiatiic nursery 2 Includes obstetic recovery. ‘Emergency trauma rooms used or surgical procedures shal be classified as goneral operating rooms. 44 Yaouum iets roquirod ate in addition to any inlets used as part ofa scavenging system for removal of anesthetizing gases. TABLE 13-4 system Sizing — Flow Factors for More than One Inlet/Outlet Terminal Unit System Minimum Flow Requirements’ Minimum Permissible ‘System Flow’ Number of Diversity Percentage SCFM (iters/minute) InletiOutlet Terminal of Average Flow per All Pressurized ‘Vacuum ‘Units per Facility InlevOutlet Terminal Units Medical Gas Systems Systems 1-10 100% ‘Actual Demand See 14-25 75% 7.0 (200) Table 26-50 50% 18.1 (875) 195 51-100 50% 17.5 (500) + Flow rates of station inleis/outlets per Table 13-2. 2 The minimum system flow is the average inlet/outlet flow times the number of inleYoutlet terminal units times the diversity percentage. 13:20HEALTH CARE FACILITIES AND MEDICAL GAS AND VACUUM SYSTEMS a TABLE 13-5 ‘Outlet Rating for Vacuum Piping Systems | Free-airAllowance, Zone Allowances: | Expressed as CFM (LPM) Cortidors-Risers at Atmosphere Main Supply Line-Valves Simutaneous | _Airto Be Location of Metical-Surgical Usage, | Transported Vacuum Ouets Per Room | Per Outlet | Factor Percent | CFM (LPN) Operating Rooms (Gapehaa) Major A" (Racca, Open Hear)| 35 (00.1) | = 100 35. (@23) (Organ Transplant) | 35 (68:1) | — 400 35. @31) (Rocca! Thorac) | 35 (68:1) | — 100 35. @91) Majo“8 (A Other Major ORs)| 2.0 (666) | — 100 20 (686) Minor 19 @es)| - 100 10 33) Delivery Rooms (Yoraaa Q)| 1.0 (28.3) - 100 1.0 (283) Recovery Rooms (Post- ‘Anesthosia) and Intensive Care Units (a minimum of 2 outlets per bed in each such department) icv ‘st outlet at each bed - |a0@so} 50 15 25) 2nd outlet at each bed = | 49 (263) 30 05 (142) Srd ute at each bed = | 40 a3) 10 01 (8) Al ofers at each bed = | 10 33) 10 01 @8) Soon —— Emergency Rooms - | 10 @3) 100 10 83) Aoo)sby {f Patent Rooms | Surgical ~ ChAO , - | 10 @aa) 50 0s (142) Medal Mua = | 19 @as) 10 01 3) Nurseries — (Sey =| 19 ea 10 ot @8) Qactg — Treatment and Examining Rooms| —- | 05 (142) 10 005 (14) eae —| MoH Ae - [aoe] 2 o4 (113) Inhalation Therapy, Cental Supply end insrecional reas | - | 10 (@8)| 0 01 8) “Free air at 1 atmosphere 1921a UPC ILLUSTRATED TRAINING MANUAL, (taste Spi Conroe itt x Ree thas, ‘Maximum Delivery Capacity3 in SCFM (LPM) Medical Gas [Pipe Size Length of Piping in Feet (mt System Inch? | 100 (30) 250 (76) 600 {152) 750 (228) 1000 (804) wz | 150 (425)| 106 (300) | 74 (203) 59 (167)| 5.1 (144) Oxygen a4 | 40.0 (1133) | 283 (G01) | 196 (655)| 15:7 (445) | 133 G77) 1 | 50.0 (1416) | 60.0 (1416) | 40.2 (1138)| 32.2 (912)| 27.7 (784) ve | 150 (425) 95 (269)| 65 (184) 5.3 (150)| 45 (127) Nitrous Oxide! 3/4 | 300 (@49)| 24.7 (699) ) 17.1 (484)| 13.7 (388)| 11.7 (G91) 1 | 400 (1113) | 40.0 (1133) | 34.7 (989)| 26.2 (798) | 28.9 (688) we | 181 Gi2)| 11 @14| 78 @2)| 63 7) 53 (151) L-stodical Air | 94 | 40.0 (7133)| 299 (@47) | 21.0 (698)| 16.5 (467)| 14.1 (399) + | 50.0 (1446) | 50.0 (rate) | 42.1 (1192)| 95.8 (1013) | 202 (826) srt 1 | 228 (e4sy| 137 (asa) } 95 (209)) 76 215) 65 (184) Vacuum sais | a0 (1195) | 245 (694) | 16:7 (473)| 133 (G77)| 11.2 (17) sia | 637 (1804) | 389 (1101) | 268 (759)| 21.1 (600) | 17.9 (607) 2. \192.7 (9758) | 81.4 (2305) | 66.0 (1586)| 45.0 (1274) | 98.9(1084) v2_| 25.0 (7o8)| 26.0 (708) | 250 (708)| 238 (674) | 20.6 (583) Nivogen 4 | 60.0 (1609) | 60.0 (1699) | 60.0 (1699)] 60.0 (1699) | 54.2(1535) 4 \110.0 (115) [110.0 (2116) | 110.0 (8116) | 11000 (atts) | 110.0(8115) + Length of piping includes a 80% allowance for tings. 2 One-half inch (12.7 mm) clameter pipe isthe minimum size allowed in medical gas systems. 3 Based on the following maximum pressure drops: ‘Oxygen, nitrous oxide, and medical air ~ 5 psig (10° Hg) Vacuum ~ 1 96 psig ( Ho) Nitrogen ~ 20 psig (41" Hg) 19:22