Medical Gases

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Medical gases
Definition
A medical gas is defined as one that is manufactured, packaged, and intended for
administration to a patient in anesthesia, therapy, or diagnosis. Title 21 of the Code of Federal
Regulations (CFR) designates medical gases as drugs, and mandates the Secretary of the
Treasury and the Secretary of Health and Human Services to promulgate regulations for the
efficient enforcement of the Federal Food, Drug, and Cosmetic Act (FDA)(drug portion of 21
CFR). Such other regulatory bodies as the Department of Transportation (DOT) and national
organizations [e.g., the Compressed Gas Association (CGA) and the National Fire Protection
Association (NFPA)] write regulations and standards for compressed gases. Medical gases are
considered prescription drugs because their use as drugs is unsafe without the supervision of
a licensed practitioner or by properly instructed emergency personnel. Regulations regarding
the purity of these substances are established by the United States (/places/united-states-and-
canada/us-political-geography/united-states) Pharmacopeia/National Formulary (USP/NF).

Purpose
Medical gases are used within hospital settings for many purposes. They include the following
elements and compounds:

Oxygen, used to provide supplemental oxygen to the respiratory system

(/medicine/anatomy-and-physiology/anatomy-and-physiology/respiratory-system) ;
in dentistry in combination with nitrous oxide (/science-and-
technology/chemistry/compounds-and-elements/nitrous-oxide) ; and as an
emergency standby.
Nitrous oxide, used as an anesthetic agent in surgery; mixed with oxygen to help patients
relax during dental procedures; and in cryosurgery (the use of extreme cold to destroy
tissue).
Nitrogen, used to provide pneumatic pressure in medical equipment; to prevent
combustion and other chemical reactions; and as a component of many gas mixtures.
Carbon dioxide, used to inflate areas of the body for "keyhole" surgery (small incisions
made to accommodate surgical instruments ); mixed with air or oxygen to stimulate
breathing; and in cryosurgery or testing tooth sensitivity in dentistry.
 Medical air, used in administering breathing treatments and as a mixing component for
other respiratory gases.
Helium, used in breathing mixtures for patients with impaired lung functions.

Since medical gases are the most frequently administered drugs in the United States
(/places/united-states-and-canada/us-political-geography/united-states), the FDA is attempting
to heighten both consumer and industry awareness about this specialized category of
regulated products. Such related delivery hardware as regulators and tubing is also regulated
as medical devices.

Description
Cylinder markings

For the transport and delivery of a cylinder of compressed gas to a provider, the cylinder must
have designated markings permanently affixed to its neck to identify the regulatory body
governing the use of the cylinder; the service pressure; the serial number; the date of
manufacture; the last test date; a stick-on label identifying its contents; its hazard class and
color code (green for oxygen, blue for nitrous oxide (/science-and-
technology/chemistry/compounds-and-elements/nitrous-oxide), yellow for air). The cylinder is
equipped with a valve threaded into it that is specifically designed only for the specific type of
medical gas the cylinder is designated to contain.

Pin index safety system

The pin index safety system is used to prevent a cylinder of compressed gas from being filled
with the wrong gas, or to prevent the connection of the wrong cylinder to a yoke on an
anesthesia machine or to a pipeline within an institution. This system consists of three holes
drilled in the valve of the gas cylinder that mate with matching pins on the yoke of the pipeline
or anesthesia machine. The large central opening is the gas outlet of the cylinder. The other
two holes are drilled to comply with the specifications of the safety system for the gas the
cylinder is designed to contain. Despite the design of the safety system, it is not completely
proof against mixups. Incidents have been reported of hospital personnel removing an oxygen
fitting from an empty vessel, installing it on a nitrogen vessel and attaching it to the oxygen
supply system in an institution. Patient deaths have been reported as resulting from such
incidents.

Safety of hospital employees

In addition to concerns about patient safety, medical gases pose safety hazards to hospital
personnel as well. The National Safety Council (NSC) has stated that hospital employees are
41% more likely to lose time from work because of injury or illness than employees in other
fields. Hospital employees who work in or around laboratories or operating rooms are more
likely to be injured by exposure to medical gases than workers in other areas. The highest
risks are related to waste anesthetic gases, which result from inadequate maintenance of
anesthesia machines or from poor work practices during the administration of anesthesia. The
symptoms of acute exposure to waste anesthetic gases include drowsiness, depression,
headaches, nausea, irritability, and loss of coordination. Chronic exposure can result in liver or
kidney disease, cancer , or miscarriage .

KEY TERMS
Compressed medical gas —Any liquefied or vaporized gas alone or in combination with
other gases.

Cryogenic vessel —A metal container designed to hold liquefied compressed medical gases
at extremely low temperatures.

Cylinder —A metal container designed to hold compressed medical gases at a high pressure.

Manifold —A pipe or chamber with several openings for funneling the flow of liquids or gases.

Regulator —A mechanism that controls the flow of a medical gas.

Operation
Storage and transport of liquid oxygen

Pipelines serve as a convenient and economical method for the distribution of medical gases
throughout a health care institution by reducing the number of gas cylinders required. This
reduction contributes to the cleanliness of the facility, simplifies gas delivery, decreases the
cost of the gas, and serves to decrease the number of personnel injuries related to the
movement of heavy gas tanks. Liquid oxygen, stored at a temperature between -230– -283°F
(-150°– -175°C) in double-walled stainless steel (/earth-and-environment/minerals-mining-and-
metallurgy/metallurgy-and-mining-terms-and-concepts-25) containers built to withstand a
pressure of 250 lb per square inch gauge (psig), is the system used by most health care
facilities for the main supply of this gas. Since liquid oxygen can vaporize rapidly with an
abrupt rise in temperature to create dangerously high pressure, the bulk oxygen container
must be located away from the institution for safety reasons. An underground pipeline, fitted
with protective casings in areas of high surface loads, is used to transport the oxygen to the
main facility's distribution system. Alarm systems are used to monitor the condition and
operation of the liquid oxygen container. To avoid misfillings of oxygen containers, hose
connections must be noninterchangeable. A high-pressure cylinder manifold system with an
automatic switch-over valve serves as a reserve supply of liquid oxygen.

Storage and transport of liquid nitrous oxide

Cylinders of liquefied nitrous oxide connected to a gas manifold usually serve as the supply of
this medical gas for facilities. The manifold controls the release of nitrous oxide from each
tank. The gas is reduced to a working pressure of 45–55 psig before entering the main
pipeline. Like liquid oxygen, liquid nitrous oxide has an automatic switch-over valve for a
 reserve bank of cylinders. These banks of gas cylinders are located in a designated storage
room, which is usually adjacent to the facility's loading dock. To prevent cross-filling of tanks or
rupture of the pipeline, a system of check valves, shutoff valves and pressure relief valves is
employed.

Installation and inspection specifications

Pipelines in health care facilities must be constructed from hard-drawn seamless medical gas
type tubing. All pipelines delivered to these facilities must also be cleaned for oxygen service,
permanently labeled, and capped. Supports for the pipelines must have a copper finish if the
support is to make contact with the copper tubing. Only qualified technicians should undertake
all welding of medical pipelines. Shutoff valves are required throughout a facility's pipeline
system; in particular, those that service a patient area should also have a pressure gauge. A
newly installed pipeline system must be cleaned in accordance with set regulations before it is
tested. The NFPA requires that both the installer and the user corroborate the findings of the
pipeline testing before it is used with patients; and a record of these test results must be kept
on file by the facility. Although this testing is designed to ensure the medical gas pipeline
system is safe for patients, regulations addressing the requirements for the companies that
perform the testing and the certification of pipeline systems have not been established. The
American Hospital Association, however, does provide recommendations and verifications for
the choice of a company to perform the inspection.

Operating rooms

Noninterchangeable outlets for medical gases located in operating rooms may be placed on
the ceilings or walls. Each one must be color-coded and labeled with the name or chemical
symbol of the medical gas it delivers. Automatic closing mechanisms in the outlet of each
pipeline will prevent the leakage of gas when the mating end of the transfer hose is absent.
The Encyclopedia
Gale end of each hose used
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and Allied Health the pipelines to an anesthesia machine must be color-
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Medical Gases

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