IHEAProfessionalDevelopment Seminar No.

2 / 2006
Developments in the Design and Installation of Medical Gases

DESIGN PRINCIPLES

Presented by Geoff Hislop

DESIGN PRINCIPLES
What gases, why and how?

1. INTRODUCTION
Oxygen, or as it was once called, dephlogistated air, is one of the oldest gases used for
medical purposes. It was initially discovered by a Polish alchemist Michal Sedzijoj in the late
16 th century. It was subsequently rediscovered a number of times later.

Since then a number of gases have been found to be useful for medical and other purposes.

An increasing number of these useful gases have found their way into hospitals and associated
facilities and are now required to be provided, installed and looked after on hospital sites. Not
all of the gases encountered will be used for directly medical procedures; some like liquid
nitrogen, liquid helium are in common use in support facilities such as research laboratories,
imaging, kitchens and the like.

Some services are not strictly gases at all but tend to be lumped in together with medical gas
services. Medical suction, also called medical vacuum, is an example commonly reticulated
throughout hospitals.

Hospital Engineers and Consulting Engineers are required to deal with medical gas services
from the point of view of maintenance, design and installation of new or upgraded services
and, increasingly today, occupational health and safety.

To assist in these tasks it is useful to have an appreciation of the design principles involved in
medical gases.

2. MEDICAL GAS SERVICES

Medical gas services which may be encountered are: -

Gases for Respiration

Oxygen for medical purposes – Liquid oxygen bulk cylinders, bottle storage.

Carbogen – (5% CO2, balance O 2.) – 12 cylinder bundles. Assists and stimulates respiration.

Helium-oxygen mixture – (20% O2, balance helium). - Cylinders - Respiration under pressure.

Synthetic air – (20% O2, balance N2) - Cylinders and 12 cylinder bundles.

Medical air – atmospheric breathing grade air – compressors and cylinders.

“Heimox” – Linde make mobile portable liquid oxygen equipment.

“Heimox Ska” – Linde oxygen concentrator. Increases oxygen percentage of air.

nCAP Respiration - Nasal Continuous Air Passage overpressure respiration equipment.

Nitrous oxide N2O– low level anaesthetic. Cylinder banks.

Entonox – (50% nitrous oxide, 50 % oxygen).- Cylinders.

Xenon Xe– Anaesthetic rare gas, expensive, closed circuit reclaim apparatus. Future use.

Other Medical Systems

Medical suction – suction pumps.

Medical suction – venturi generated at point of use (undesirable).

Surgical tool supply – May be either air or nitrogen – high pressure and volume.

Tourniquet air - panel monitors and controls med air to tourniquet

Active gas scavenge – collection and discharge of exhaled air containing anaesthetic.

Liquid helium – cryogenic cooling of MRI scanners. Dewers no reticulation.

Liquid nitrogen – cryosurgery and cryoconservation. Mobile dewers or piped.

Carbon dioxide – insufflation with CO2 eases endoscopy, in baths skin vasodilator.

Other Systems

Liquid nitrogen – cryogenic cooling for kitchens and laboratories. Reticulated as liquid.

Laboratory gases Methane

Hydrogen

Propane

Acetylene, acetylene (solvent free) and acetylene/synthetic air

Argon

Synthetic air

Oxygen

Carrier gases, zero gases and calibration gases.

Standardised gas mixtures such as O2/He/N2 mixtures for blood

gas and lung function tests.

Compressed air - non medical – usually used for workshop air, equipment actuation such as
sterilizer doors and pneumatic controls. Should not be fed off medical air systems.

3. Storage and Generation of Medical Gases

Most of the gases listed will be encountered in cylinders of various sizes. Often where usage
is small or localized the cylinders will be installed on or next to special equipment. This is
often the case in laboratories.
It is essential that cylinders be restrained in suitable racks. Heavy cylinders falling can cause
injury and high pressure cylinders can take of like a rocket if the valve happens to be broken
off.

Where usage is small or intermittent cylinders will be mounted on trolleys for mobile use.

Intermediate use usually involves a number of cylinders mounted in a manifold arrangement

with piping reticulation to point of use. The manifolds are normally changeover manifolds
with both duty and standby cylinder banks, automatic changeover and pressure switches for
alarm.

Higher consumption involves the provision of bulk liquid storage vessels located outside the
building with provision for bulk liquid tanker truck access. Backup by means of auto
changeover cylinders is normally installed.

Those gases which can be generated directly on site such as medical air and medical suction
are normally provided by installing multiple compressor sets and suction pump sets. Medical
air installations are normally provided with auto changeover cylinder manifolds. It is not
practical to provide backup storage for medical suction systems.

The large tanks installed on both compressed air and suction systems are designed to even out
the demand and reduce cycling on and off of the compressors or pumps.

Central medical air and medical suction plant should comprise multiple compressors or pump
sets. A minimum of two sets each of 100% is required for backup with three sets (3x50%) or
more being better. The system should maintain full design flow with any one set out of
operation due to failure or maintenance.

Medical air compressors should be of the oil-free type. If rotary such as screw compressors
they should not be of the oil-lubricated type. Reciprocating compressors need to be designed
for breathing air use.

It is normal to install central air driers in the medical air system. There are a number of
different types of these such as refrigerated driers and desiccant driers. The moisture
absorbing media in desiccant driers needs to be regenerated. At first sight the air-regenerated
driers appear to be simplest. The draw-back of air-regenerated driers is that they tend to use
quite a lot of compressed air for the regeneration which takes away from the available
compressor capacity.

Special high quality air filters are installed to further assure the quality and of the medical air.
The pressure of the supply air needs to be reduced to reticulation pressure.

Medical suction system should be provided with filters and “catch-pots”. Normally two
collection bottles is series should be used at the point of use to reliably collect any liquid or
other material.

4. RETICULATION
Reticulation of piped services is normally carried out as a gas.

Piping is normally copper piping. It is important that the piping be internally clean, all ends
kept capped during construction and be purged with a suitable gas during welding. Details
and requirements are set out in Australian Standard AS 2896.

It is particularly important to avoid oil or grease in piping or in valves. Combination with

pure oxygen can result in spontaneous combustion.

Some installations of medical suction have been carried out in PVC piping however AS2896
notes that plastic materials can result in cracks and leakage as the material degrades with age.

Piping for liquid nitrogen or other liquid gases are designed as special vacuum insulated
double wall pipelines generally factory pre-fabricated in sections of stainless steel. The
design, installation and maintenance of these very low temperature cryogenic pipelines must
only be carried out by specialists.

Pipe sizing information for various gases flowing in pipes is not readily available and is not
included in AS2896. One source of pipe pressure loss chart information is British Health
Technical Memorandum No.22 “Piped Medical Gases, Medical Compressed Air and Medical
Vacuum Installations”.
A
S

2
8
9
6

d
o
e
s

i
n
c
l
u
d
e

r
e
c
o
m
m
e
n
d
a
t
i
o
n

AS 2896 gives requirements for the number of outlets in various departments and the
recommended diversity factors to be used when sizing pipes. This information can be used to
determine design flow rates for pipe sizing.
Our experience is that the number of medical gas outlets set out in AS2896 is likely to be on
the high side compared to actual usage. This, however, will tend to provide some spare
capacity in the system for the installation of additional outlets in the future or replans of
hospital areas.

All hospital systems need to have spare capacity in their design to allow for future increase in
demand. One economical way of providing spare capacity is by sizing piping systems
conservatively to accommodate an increase in flow rate in the future. This is especially
important in the case of main runs.

In the case of departments or floors the use of piping loops can provide flexibility and the
possibility of isolating part of the piping system rather than having to isolate the whole
system. Installation of valves at “quarter points” around a ring main is one way however care
is required in life safety critical systems to ensure that inadvertent or incorrect isolation can be
identified, accessed and rectified with minimal disruption.

It is usual to provide isolation valve sets for individual departments to allow isolation of each
medical gas in the event of emergency such as a fire or uncontrolled oxygen or nitrous oxide
leak. Single and multiple valve isolation wall boxes are available for installation for thus
purpose.

If isolation or failure of a medical gas service occurs it is essential that local and central alarm
is given. Electronic medical gas alarm panels are available for installation for this. Wherever
there is an isolating valve wall box there should be a corresponding medical gas alarm panel.
Each panel is wired to pressure switches downstream of the isolating valves and gives audible
and alpha-numeric indication of the alarm condition id supply pressure fails.

As many of the medical gas alarm panels are electronic and operate on low voltage, a
transformer or plug-pack is required. This can be a point of failure and maintenance
problems. Plug-packs are to be avoided as they may dislodge from GPO’s due to vibration.
Transformers or other local power supplies need to be located in an accessible and identifiable
position. The poor old sparky has to find it to fix it.

The panel should be located at or near a nurse station or other monitored positioning the
department so the audible alarm can be heard. The alarms should also be connected to the
central Building Automation System (BAS) if available.

5. MEDICAL GAS OUTLETS

Medical gas outlets are normally wall-mounted either singly or in multiple panels with a wall
box and wall face plate. Each outlet is identified with colour and with engraved lettering.
Outlets are available with screw connections, quick-connect and dual use connections. They
are designed to be pin-indexed to minimise the possibility of plugging into the wrong outlet.

Some installations are required to be made using services duct with both electrical outlets and
medical gas outlets installed along the same duct fixed to the wall. In this case the services
duct needs to have punchouts in the face to accept the medical gas outlets. This requires
detailed coordination. The services ducting can also be a long-delivery item.

The location of medical gas outlets is important. In a department such as Emergency where a
large number of electrical and gas outlets have to be provided for each bed, location to allow
convenient access without tubes presenting trip hazards can be a problem to solve

Some usage requires the use of services pendants particularly in operating theatres. These
centralise the outlets close to the table and avoid tubes draped across the floor. Services
pendants come in a wide variety of designs and types from various manufacturers both fixed
and moveable. The moveable arm types are also available in motorised models. All pendants
tend to be very expensive.

6. SUMMARY OF DESIGN PRINCIPLES

In summary, the design principles for medical gases are a matter of working backward from
the outlets to the central plant.

• Ascertain the required number, type and locations of medical gas outlets
from users.

• Prepare layouts of the piping runs to determine pipe run lengths.

• Locate medical gas isolating valve boxes.

• Locate medical gas alarm panels.

• Locate central equipment – compressors, vac pumps and bulk tanks.

• Determine the flow rates of each medical gas using diversity factors from
AS 2896.

• Use design flows and lengths of run to determine pipe sizes.

• Use diversified flows to size capacity required for main supply.

• Size equipment taking into account backup – minimum 2 compressors or

vac pumps.

• Select type of equipment.

• Prepare schematics of system showing all valves, equipment, components

etc.

• Specify each item of equipment and component in detail.

That’s it. See, it’s quite simple really.