Medical Gas Cylinder Handling Best Practices for Hospitals and Clinics

Compressed medical gases are gases and liquids in pressurized cylinders administered for different purposes. They can be used for anesthesia, patient respiration or powering surgical tools.

Handling gas cylinders is dangerous. Regulatory bodies like the Occupational Safety and Health Administration (OSHA) and the National Fire Protection Association (NFPA) provide standards to ensure safety. This article by Meritus Gas breaks down the information you should know.

Safety Considerations for Medical Gas Cylinders

The main safety considerations for medical gas cylinders include storage, transportation, handling and disposal methods. Although stored in sturdy containers, compressed gases are susceptible to hazards like leaks and explosions. Gas type also affects best practices, whether you’re working with oxygen, carbon dioxide, nitrogen, nitrous oxide or helium. Following the appropriate standards protects you and patients alike.

1. Storage Requirements

Gas cylinder storage requirements depend on the cylinder’s gas volume:

• Up to 300 cubic feet: Gas cylinders can be stored in open areas if they’re properly secured and don’t obstruct corridors.
• From 300 to 3,000 cubic feet: Gas cylinders should be stored in a dedicated, lockable enclosure.
• Over 3,000 cubic feet: Storage rooms with stringent fire resistance ratings should be used.

The storage area must be cool, dry and well-ventilated. Heat coming from radiators, steam pipes or open flames can cause explosions. When placed outdoors, the gas cylinders should be protected from direct sunlight and extreme temperatures. Temperatures generally shouldn’t exceed 125 degrees Fahrenheit, but specific temperature requirements vary based on gas type. Note that freezing weather can lead to condensation and pressure changes, reducing the effectiveness of the gases.

Position gas cylinders upright within floor racks or stands, or strap them to walls. When the cylinders aren’t in use, secure the valve protection caps in place. The storage space should have enough room to avoid overcrowding. Also, medical gas cylinders should be at least 10 feet away from doorways and openings for buildings with only one exit. Avoid placing them near exits, exit pathways, stairs or other locations where objects can strike them.

Proper ventilation can prevent leaks that lead to health risks or explosions. Ventilation systems should be specific to the gas type. A vertical cylinder cage can provide adequate ventilation while securing the cylinders from unauthorized access.

Additionally, keep the storage room clean, especially from combustible materials like oil and grease. No other materials should be stored inside the room. If the room has a sprinkler system, the cylinders can be a minimum of 5 feet away from flammable materials. This distance increases to 20 feet without sprinklers. The storage room should have warning signs to prevent staff from placing dangerous materials around it.

2. Transportation Requirements

Transport medical gas cylinders carefully. They should never be dragged, slid, rolled or dropped. Ensure they don’t hit other surfaces, and prevent them from hitting other cylinders.

Use a freight elevator when transporting cylinders within buildings as much as possible. In a passenger elevator, only allow people to ride with you if the compressed gas is nontoxic. Some medical gases, like helium and nitrogen, can be toxic. If released in a low-oxygen environment, like an elevator, they can cause unconsciousness, brain damage and even death. The cylinder’s labels should indicate the gas type. Don’t rely on the color identification because this can vary per manufacturer.

Additionally, use wheeled carts designed to securely hold gas cylinders. They come with straps or chains for fastening. Make sure you don’t exceed the cart capacity. A full-sized cylinder can weigh up to 300 pounds.

When transporting gas cylinders between locations, secure them within the vehicle. The caps should be in place, and the regulator should be turned off. The Department of Transportation (DOT) requires the current inspection date to be stamped on the cylinder.

3. Handling Requirements

Apart from the gas type, gas cylinder labels should indicate whether they’re full, in use or empty. Separate them accordingly. The manufacturer’s guidelines or the safety data sheet provide specific instructions on how to operate and troubleshoot the equipment. These guidelines should be accessible to all staff and integrated into the facility’s standard operating procedures.

Using personal protective equipment is essential. Depending on the gas content, consider wearing:

• Safety glasses for eye protection.
• Face shield with safety glasses for face protection.
• Gloves for hand protection.
• Closed-toe shoes or steel-toed boots for foot protection.

When receiving new gas cylinders, return those with illegible labels to the supplier. Obtain replacement labels for older cylinders with worn-out markings. The principal investigator should also ensure the cylinders are tested for leaks before accepting them. Only those trained in leak detection methods should perform the procedure.

Be sure to use the proper tools to remove valve protection caps, open and close the valves, and attach or remove the regulators or fittings. The valve protection caps should always be secured in place unless the gas cylinders are in use.

4. Disposal Requirements

Compressed gas cylinders aren’t considered regular waste. You should return empty, leaking or damaged cylinders to the supplier. Ensure the valves are closed and the caps are secured in place to prevent any residual gas from escaping. You should also follow labeling and segregation procedures even with empty cylinders.

It’s important to maintain proper documentation of returned cylinders, including the date of return and any relevant details about their condition. Be sure to follow any specific instructions provided by your supplier or local regulations regarding the disposal process.

Using a Pressure Regulator on Compressed Gas Cylinders

The regulator is the mechanical device for controlling the pressure discharge of the compressed gases. When setting up the device, review the manufacturer’s recommendations. Additionally, the Compressed Gas Association (CGA) cylinder number and the regulator should match. Don’t forcibly connect a valve or an incompatible regulator to the cylinder. 

The valve should be clean and free from dust or dirt before use. You can do this by “cracking” the valve — opening and closing the valve quickly — unless the cylinder contains toxic gases. After attaching the regulator, perform a leak test using leak detection liquids. These can include detergent-based liquids, but avoid ordinary soap solutions that may contain oils.

Open the valves slowly, with the outlet pointing away from you or other people. Only use supplier-recommended wrenches when doing so.

Maintenance Best Practices

Regular inspection and maintenance keep medical gas cylinders in good condition. They also ensure the gas cylinders remain safe to use. If you’re qualified to perform the inspection, complete one before and after each use. Here’s what you can do:

1. Check for damage or wear that could be causing leaks on the cylinder and hose.
2. Examine the valves and regulators for corrosion.
3. Test and ensure the gas flow rates remain accurate and consistent.
4. Inspect for purity changes, which can indicate contamination.
5. Verify that the correct parts are used as approved by the manufacturer.

Perform the visual inspection based on the DOT’s Hazardous Materials Regulations and according to the standards set by the CGA. Leak tests should be performed periodically. If you find any issues, your facility should have a straightforward process for reporting them.

Documenting maintenance and repair activities is a regulatory requirement. Records should include the date, what actions were taken, which parts were replaced and the name of who performed the activity.

Main Hazards Associated With Gas Cylinders

Medical gas hazards depend on the gas content, but they generally involve fire, explosion, toxicity, corrosivity and oxygen deficiency. The hazard can be labeled zero to immediately dangerous to life or health. For instance, leaks can contaminate or lead to inaccurate concentrations of gases. These can endanger patient and staff health and lead to ramifications for the facility.

Pipework explosive failures can be caused by direct overpressurization or indirect overpressure caused by a gas ignition or chemical reaction. This can also be due to corrosion, mechanical damage or an insufficient pressure rating.

Alarm systems can spot hazards that humans can’t sense. However, major leaks should be easy to discern. Watch out for abnormal sounds and hissing, unknown odors, and visible damage. Regular inspection and maintenance can alleviate these risks, but it can be hard to predict when equipment will fail. Your healthcare facility should have backup equipment and protocols for when incidents happen.

Emergency response procedures should be specific to the equipment you handle, the gas type and facility features. Learn your facility’s methods for situational assessment and evacuation processes. Note that in some instances, extinguishing a fire can be more dangerous than letting it burn, as it could lead to uncontrolled gas leaks or explosions.

Staff Training Requirements

Proper training in handling medical gas cylinders is essential for the safety of both staff and patients. While healthcare professionals often receive initial training as part of their job, ongoing education and awareness are crucial for maintaining a safe environment.

• Safe handling: To prevent accidents, all staff interacting with cylinders must be trained in correct lifting, moving and securing techniques.
• Emergency procedures: Training should cover responses to leaks, malfunctions and other hazards.
• Equipment knowledge: Staff should be familiar with gas types used in their work, as well as the equipment and how to operate it.
• Regulatory compliance: Training should include OSHA and NFPA guidelines to ensure compliance and safety. Make sure to prioritize ongoing education to keep up with new guidelines. Facilities should offer workshops and resources to keep staff updated on safety protocols.

Who Regulates Gas Cylinders?

Multiple regulatory bodies provide gas cylinder standards:

• OSHA: OSHA provides standards for storing, handling and using compressed gas cylinders.
• NFPA: The NFPA 99 Health Care Facilities Code is the primary code used for medical gas systems. It details comprehensive guidelines for designing, installing, storing and labeling compressed gas cylinders.
• CGA: CGA is an industry trade association that develops standards for producing, transporting and handling compressed gases. OSHA and DOT also widely adopt these standards.
• Food and Drug Administration (FDA): The FDA sets regulations, like the Current Good Manufacturing Practice, for certain medical gases. These include manufacturing, packaging, labeling, storing and distribution requirements.
• DOT: The DOT considers medical gas cylinders hazardous materials and provides transportation rules to ensure safety.

The Best Practices Are the Safest

Handling medical gas cylinders in hospitals and clinics can be dangerous. It’s essential to keep best practices and relevant regulations in mind. In summary, you should:

• Store medical gas cylinders in a secure area, with adequate ventilation and away from flammable materials.
• Transport the cylinders carefully without dragging, sliding, rolling or dropping them.
• Follow the manufacturer’s guidelines in setting up and using the gas cylinders.
• Perform regular inspection and maintenance to ensure cylinders are safe to use.
• Learn the emergency response procedures in your facility in case an incident occurs.

Following the standards set by the relevant regulatory bodies, like OSHA and NFPA, is essential. Ongoing training will also help you continue to handle gas cylinders safely.