STORAGE AND

DELIVERY OF
MEDICAL GASES
MEDICAL GASES

 Laboratory gases are used for equipment calibration and

diagnostic testing.

 Therapeutic gases are used To relieve symptoms and

improve oxygenation of patients with hypoxemia.

 Anesthetic gases are combined with oxygen(O2) to provid

anesthesia during surgery
FIRE RISK

 FLAMMABLE

 NON FLAMMABLE
 NON BURN
 OXIDIZING
OXYGEN CHARACTERISTICS
 Constitutes almost 50% by weight of the earth’s crust and occurs in all
living matter in combination with hydrogen as water.
 STPD O2 has a density of1.429 g/L, being slightly heavier than air (1.29 g/L).
 Not very soluble in water,
 At room temperature and 1 atm pressure, only 3.3 ml of O2 dissolves in 100
ml of water.
 nonflammable, but it greatly accelerates combustion.
 Burning speed increases with either
 (1)an increase in O2 percentage at a fixed total pressure
 (2)an increase in total pressure of O2 at a constant gas concentration
 Both O2 concentration and partial pressure influence the rate of burning
Production
 Chemical methods for producing small quantities of O2
Include electrolysis of water and decomposition of
sodium chlorate (NaClO3).

 Most large quantities of medical O2 are produced by

fractional distillation of atmospheric air.

 Small quantities of concentrated O2 are produced by

physical separation of O2 from air.
Composition of air
(atmospheric air)
 78.1% nitrogen
 20.95% oxygen
 0.93% argon
 0.04% carbon dioxide
 Small amount of other gases
 Fractional Distillation.
 most common and least expensive method

 Atmospheric air filtered (pollutants,water,CO2) Joule-Thompson effect (the

purified air is liquefied by compression and cooled by rapid expansion) liquid O2 and
N2 is heated slowly in as distillation tower N2 with its boiling point of 195.8° C (320.5°
F), escapes first, followed by the trace gases The remaining liquid O2 is transferred to
specially insulated cryogenic(low-temperature) storage cylinders An alternative
procedure is to convert O2 directly to gas for storage in high pressure metal cylinders.

 These methods produce O2 that is approximately 99.5% pure. The remaining 0.5% is
mostly N2 and trace argon.
 U.S. Food and Drug Administration(FDA) standards require an O2 purity of at least 99.0%
Physical Separation

 Two methods are used to separate O2 from air.

 The first method entails use of molecular “sieves” composed of

inorganic sodium aluminum silicate pellets.
 These pellets absorb N2, “trace” gases, and water vapor from the
air, providing a concentrated mixture of more than 90% O2 for
patient use.
Physical Separation

 The second method entails use of a vacuum to pull

ambient air through a semipermeable plastic
membrane.
 The membrane allows O2 and water vapor to pass
through at a faster rate than N2 from ambient air.
 This system can produce an O2 mixture o approximately
40%.
 These devices, called oxygen concentrators, are used
primarily for supplying low-flow O2 in the home care
setting
Air
 Naturally occurring gas mixture that consists of 20.95% O2,
78.1% N , and approximately 1% “trace” gases, mainly
argon.
 At STPD, the density of air is 1.29 g/L, which is used as the
standard for measuring specific gravity of other gases.
 O2 and N2 can be mixed to produce a gas with an O2
concentration
equivalent to that of air.
 Medical-grade air usually is produced by filtering and
compressing atmospheric air
Typical large medical air compressor system
medical gas use air must:
 air must be dry and free of oil or particulate contamination.
 Reservoir tank Dryer
 The most common method used for drying air is cooling to
produce condensation.
 For avoidance of oil or particulate contamination, medical
air compressors have air inlet filters and
polytetrafluoroethylene (Teflon) piston rings as opposed to oil
lubrication.
 Large medical air compressors must provide high flow
(atleast 100 L/min) at the standard working pressure of 50
pounds per square inch gauge (psig) for all equipment in
use.
Smaller compressors
Smaller compressors
 available for bedside or home use.
 These compressors have a diaphragm or turbine that
compresses the air and generally do not have a reservoir.
 This design limits the pressure and flow capabilities of these
devices.
 For this reason, small compressors must never be used to
power equipment that needs unrestricted flow at 50 psig, such
as pneumatically powered ventilators
 However, small diaphragm or turbine compressors are ideal
for powering devices such as small-volume medication
nebulizers
Carbon Dioxide

 At STPD, CO2 is a with a specific gravity of 1.52 (approximately 1.5 times heavier
than air).
 CO2 does not support combustion or maintain animal life.
 For medical use, CO2 usually is produced by heating limestone in contact with
water.
 The gas is recovered from this process and liquefied by compression and cooling.
The FDA purity standard for CO2 is 99%.
 Mixtures of O2 and 5% to 10% CO, are occasionally used for therapeutic purposes
 Therapeutic uses include the management of singultus (hiccups), prevention of
the complete washout of CO2 during cardiopulmonary bypass, and regulation of
pulmonary vascular pressures in some congenital heart disorders.
 However, CO2 mixtures are more commonly used for the calibration of blood gas
analyzers and for diagnostic purposes in the clinical laboratory.
Helium

 Helium (He) is second only to hydrogen as the lightest of

all gases; it has a density at STPD of 0.1785 g/L.
 He is odorless, tasteless, nonflammable, and chemically
and physiologically inert.
 It is a good conductor of heat, sound, and electricity but
is poorly soluble in water.
 Although He is present in small quantities in the
atmosphere, it is commercially produced from natural
gas through liquefaction to purity standards of at
least99%.
Helium
 He cannot support life, so breathing 100% He would cause
suffocation and death.
 For therapeutic use, He must always be mixed with at least 20%
O2. Heliox (a gas mixture of O2 and He) may be used clinically to
manage severe cases of airway obstruction.
 Its low density decreases the work of breathing by making gas
flow more laminar.
 He must always be combined with at least 20% O2 The higher the
concentration of O2 used in a heliox mixture, the less likely it is
that heliox would be beneficial.
 Heliox mixtures of less than 60% He are rarely used clinically.
Nitric Oxide
 Nitric oxide (NO) is a colorless, nonflammable, toxic gas that
supports combustion.
 It is produced by oxidation of ammonia at high temperatures in
the presence of a catalyst. In combination with air, NO forms
brown fumes of nitrogen dioxide (NO2).
 Together, NO and NO2 are strong respiratory irritants that can
cause chemical pneumonitis and a fatal form of pulmonary
edema.
 Exposure to high concentrations of NO alone can cause
methemoglobinemia.
 High levels of methemoglobin can cause tissue hypoxia.
Nitric Oxide

 NO is approved by the FDA for use in the treatment of

term and near-term infants for hypoxic respiratory failure.
 The American Academy of Pediatrics (AAP) has
published a policy statement recommending the use of
NO in the care of term and near-term infants when
mechanical ventilation is failing because of hypoxic
respiratory failure.
 The AAP suggests that NO be used before
extracorporeal membrane oxygenation.
Gas Cylinders

Pounds per
square inch

10 years test dates

10% greater than its

service pressure
Cylinder Sizes
and Contents
 Cylinder Safety Relief Valves
 These relief valves are of three basic designs:
 The frangible metal disk ruptures at a specific pressure.
 The fusible plug (small cylinders) melts at a specific temperature.
 The spring-loaded (large cylinders )valve opens and vents gas at a set high pressure. In each
case, the activated valve vents gas from the cylinder and prevents pressure from becoming too
high.
Filling (Charging) Cylinders

 Compressed Gases.
A gas cylinder normally is filled to its service pressure
(the pressure stamped on the shoulder) at 21.1° C (70°
F). However, approved cylinders can be filled to 10%
greater than service pressure
Filling (Charging) Cylinders

 Liquefied Gases.
 Gases with critical temperatures greater than room
temperature can be stored as liquids at room
temperature.
 These gases include CO2 and N2O.
 The filling density is the ratio between the weight of
liquid gas put into the cylinder and the weight of
water the cylinder could contain if full. The filling
density for CO2 is 68%. The filling density of N2O is 55%.
Measuring Cylinder Contents
 Compressed Gas Cylinders.
 For gas-filled cylinders, the volume of gas in the cylinder is directly
proportional to its pressure at a constant temperature.
 Liquid Gas Cylinders.
 The vapor pressure of liquid gas cylinders varies with the
temperature of the contents. The pressure in an N2O cylinder at
21.1° C (70° F) is 745 psig; at 15.6° C (60° F), the pressure
decreases to 660 psig. As the temperature increases toward the
critical point, more liquid vaporizes, and the cylinder pressure
increases. If a cylinder of N2O warms to 36.4° C (97.5° F) (its
critical temperature), all the contents convert to gas. Only at this
temperature and higher does the cylinder gauge pressure
accurately reflect cylinder contents
 Estimating Duration of Cylinder
Gas Flow
 The duration of flow of a cylinder can be estimated if the following
are known:
 (1) the gas flow,
 (2) the cylinder size,
 (3) the cylinder pressure at the start of therapy
Computing Cylinder Duration of Flow

 PROBLEM: The RT needs to determine how long a G cylinder of O2

with a gauge pressure of 800 psi set to deliver 8 L/min will last until
empty.
Computing the Duration of a Liquid
Oxygen Container
 PROBLEM: The manifold system of the hospital was failed on your
shift and you have to use bedside oxygen tank the nurse ask you
how many oxygen cylinder are needed for each of your patient
receiving oxygen therapy.
 H cylinder 1800 psi
 Patient A receiving O2 at 2Lpm via nasal cannula
 Patient B receiving O2 at 10lpm via non rebreathing mask
 Patient C receiving O2 at 5Lpm via face mask
Estimating Duration of Liquid
Oxygen Cylinder Gas Flow
 The only accurate method for determining the volume of gas in a
liquid-filled cylinder is by weight.
 Because 1 L of liquid O2 weighs 2.5 lb and produces 860 L of O2 in its
gaseous state, the amount of gas in a liquid O2 cylinder can be
calculated with the following formula:
Estimating Duration of Liquid
Oxygen Cylinder Gas Flow
 After the amount of O2 remaining in the cylinder is determined, the
duration of the gas in minutes can be calculated with the following
formula:
Computing the Duration of a Liquid
Oxygen Container
 PROBLEM: The RT needs to estimate
how long Mrs. Jones’ portable
liquid O2 container will last if it
contains 3 lb of liquid O2 that
supplies an O2 delivery device
running at 2 L/min
Gas Cylinder Safety
Cylinder Storage
 Store gas cylinders in racks or chain cylinders to the wall to prevent
them from falling or becoming damaged.
 • Other than the wooden racks used to store the cylinders, store no
other combustible material in the vicinity of cylinders or gas supply
systems.
 • Store gas cylinders away from sources of heat. Keep the cylinder
temperature less than 125° F (<51.7° C).
 • Store flammable gases separately from gases that support
combustion, such as air, O2, and N2O.
Cylinder Storage
 • If a cylinder is not in use, keep the protective cylinder cap in
place.
 Do not store air compressors and gas cylinders together. A fire
involving one or the other can damage both gas delivery
systems
 • Contain and store cylinder supply systems in an enclosure
constructed of a material with at least a 1-hour fire resistive rating
that is well ventilated and well drained.
 • Segregate full and empty cylinders; store them separately if
possible.
Cylinder Storage

 Place on each door or gate of the enclosure a sign that cautions

the presence of an oxidizing gas and alerts against
smoking. This sign must be readable from a distance of
at least 5 ft (1.5 m).

 Store liquid O2 containers in a cool, well-ventilated area

because of the venting of small amounts of O2 from
these low-pressure containers. The venting of O2
prevents these containers from overpressurizing because
liquid O2 is continuously converting to gaseous O2
Cylinder Transport
 Use cylinder carts with a securing mechanism for
transportation of cylinders.
 • Keep the protective cylinder caps in place during
transportation of cylinders.
 • Protect gas cylinders from striking other cylinders or
objects to avoid damaging the safety devices, valve stems,
or the cylinder itself.
 • Avoid dropping, dragging, or rolling cylinders in transport.
 • Do not transport cylinders for use that are not
appropriately labeled.
Cylinder Use
 Secure gas cylinders at the patient’s bedside in a way that
prevents them from falling. Secure cylinders to the wall with
a chain, bind or chain them to a suitable cart, or support
the cylinder with a stand.
 • Do not use flammable materials, especially oil or grease,
on regulators, cylinders, fittings, or valves. This restriction
includes oily hands, rags, and gloves.
 • Never cover a cylinder with any material, including bed
linens or hospital gowns.
Cylinder Use
 • Open the cylinder valve slightly to remove dust
and dirt before attaching the regulator. When
slightly opening the valve, ensure no one is in front
of the valve. “Crack” the cylinder before bringing it
to the patient’s bedside.
 • Never use cylinder valves or regulators that need
repair.
 • Do not alter or deface cylinder markings or color.
 • Never place cylinders near sources of heat.
 Cylinder Use

 • Never secure cylinders to movable objects unless the object

has an apparatus that can contain the cylinder safely.
 • Ensure that the connection between the regulator and the
cylinder valve is an American standard safety system (ASSS)
for H and G cylinders and a pin-index safety system (PISS) for E
cylinders.
 • When O2 is in use, post a “No Smoking” sign unless signs in
the entrances are posted that prohibit smoking in the facility.
Bulk Oxygen
 By definition, bulk O2 storage systems hold at least 20,000
cubic ft of gas, including the unconnected reserves that are
on site.
 either gaseous or liquid form, but liquid storage is most
common.
 When needed, the O2 flows from this central source
throughout the facility through a piping system with outlets
conveniently located
 several advantages over portable cylinders
Bulk Oxygen

 initially expensive to construct, but far less expensive over

the long-term.
 less prone to interruption
 regulate delivery pressures centrally, eliminating the
need for separate pressure-reducing valves at each
outlet.
 These systems also operate at low pressures, making
them much safer than high-pressure cylinders.