Introduction

Medical gas cylinders are specialized containers used to store

and transport compressed or liquefied medical gases under
high pressure. They are crucial for delivering these gases to
patients in various medical settings, including hospitals,
clinics, and ambulances.
These cylinders are designed with specific safety features to
ensure the safe delivery of medical gases.

Medical gas cylinders are essential components in modern

healthcare, providing a safe and portable means of storing and
delivering medical gases that are vital for patient care. These
cylinders contain gases such as oxygen, nitrous oxide, medical
air, carbon dioxide, and specialty gas mixtures, each serving
specific medical purposes ranging from respiratory support to
anesthesia and medical diagnostics.

Manufactured under strict safety and quality standards,

medical gas cylinders are typically made of high-strength steel
or lightweight aluminum alloys to withstand high internal
pressures while remaining portable. They are designed in
various sizes and capacities to suit different clinical needs,
whether for use in hospitals, ambulances, home healthcare, or
emergency response situations.
Sources Of Gases

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Medical gases are crucial to the safe and effective practice of
anesthesia, providing essential agents for sedation, analgesia,
and maintenance of vital functions during surgical and
diagnostic procedures. The primary gases used in anesthesia
include oxygen, nitrous oxide, medical air, and volatile
anesthetic agents delivered through vaporizers.

1. Medical Gas Cylinders:

High-pressure cylinders are one of the main sources for
supplying gases like oxygen and nitrous oxide. These cylinders
are color-coded, clearly labeled, and connected to the
anesthesia machine through robust regulators and pressure
gauges. Cylinders provide a reliable backup when pipeline
supply is unavailable or during patient transport.

2. Central Gas Pipeline System:

In most modern hospitals, a centralized gas pipeline system
delivers medical gases directly to operating theaters, recovery
rooms, and intensive care units. This system ensures a
continuous, high-capacity supply of gases such as oxygen,
nitrous oxide, and medical air. Gases are stored in bulk tanks or
manifolded cylinder banks and distributed through a network of
pipes, outlets, and safety devices.

3. Vaporizers and Anesthesia Machines:

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Volatile anesthetic agents like sevoflurane, isoflurane, and
desflurane are stored as liquids in vaporizers attached to the
anesthesia machine. These vaporizers precisely convert the
liquid anesthetic into vapor, mixing it with carrier gases (oxygen,
nitrous oxide, or air) for inhalational delivery to the patient.

4. Oxygen Concentrators:
In some settings, especially in remote or resource-limited
areas, oxygen concentrators are used as an alternative source.
These devices extract oxygen from ambient air by filtering out
nitrogen, providing a continuous flow of concentrated oxygen
for anesthesia and respiratory support.

5. Backup and Emergency Sources:

To ensure patient safety, backup cylinders are always kept
available. In critical situations, portable gas delivery systems
can maintain supply during patient transport or equipment
failure.

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4
Based on the Type of Gas Stored

* Oxygen Cylinders

*Nitrous Oxide Cylinders

*Medical Air Cylinders

*Carbon Dioxide Cylinders

*Specialty Gas Mixtures

Cylinders
5
Medical gas cylinders are commonly made from molybdenum
steel because it can withstand high pressures safely. Some
modern cylinders include chromium alloy to reduce their weight
while maintaining strength. Since regular steel is not
compatible with MRI environments due to its magnetic
properties, special aluminum cylinders (and aluminum
machines) are used in MRI suites to ensure safety
and compatibility.
Oxygen Cylinder

6
Oxygen cylinders are one of the most essential medical gas
cylinders used in healthcare settings worldwide. They provide a
safe and reliable source of oxygen for patients who need
respiratory support during surgery, in critical care,
emergencies, or at home.

Material and Construction

Oxygen cylinders are usually made of seamless high-strength
steel or lightweight aluminum. Molybdenum steel is commonly
used because it can safely withstand high pressures. Some
modern cylinders include chromium alloys to reduce weight. In
MRI suites, special non-magnetic aluminum cylinders are used
to ensure safety near magnetic fields.

Storage and Pressure

Oxygen is stored as a compressed gas under high pressure,
typically around 137–200 bar (2000–3000 psi) depending on the
cylinder type and size. Because of this, cylinders must be
robust, regularly tested, and fitted with safety devices to
prevent over-pressurization.

Sizes and Identification

Oxygen cylinders come in various sizes, from small portable
cylinders (e.g., B, D, E) used for patient transport or home use,
to large cylinders (e.g., G, H, J) used in hospitals and manifold
systems for continuous supply. Each cylinder is color-coded

7
and clearly labeled to avoid confusion; in many countries,
oxygen cylinders have a black body with a white shoulder.

Safety Features
To ensure safe use, cylinders have specific valve fittings and
may include a Pin Index Safety System (PISS) that prevents
incorrect connections to medical equipment. Cylinders are
fitted with pressure gauges and regulators to control gas flow
accurately.

Handling and Storage

Cylinders must be stored upright, secured properly, and kept
away from heat sources, oil, or grease. Regular checks for
leaks, damage, or expiry of test dates are essential to maintain
safety.

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>Liquid Oxygen

Liquid oxygen (LOX) is an important source of medical oxygen,

especially in hospitals and healthcare facilities with high
oxygen demands. It is oxygen that has been cooled to a very low
temperature (-183°C) so that it becomes a pale blue liquid.

Storage and Supply

Liquid oxygen is stored in large, vacuum-insulated tanks called
vacuum-insulated evaporators (VIEs) or cryogenic tanks.
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Because it is stored as a liquid, a large volume of oxygen can be
stored in a relatively small space — one liter of liquid oxygen
expands to about 860 liters of gaseous oxygen when warmed to
room temperature.

Advantages
• Bulk supply: Ideal for hospitals with high and
continuous oxygen needs.
• Cost-effective: Reduces the need for frequent cylinder
replacement.
• Continuous flow: Easily connected to a central pipeline
system that supplies oxygen to operating theatres, ICUs, and
patient wards.

How It Works
The liquid oxygen is kept at very low temperatures in insulated
tanks. When needed, it is converted into gaseous form through
a vaporizer and then delivered at controlled pressures through a
pipeline network.

Safety Considerations
• Liquid oxygen must be stored and handled with care
due to its extremely low temperature and high expansion ratio.
• Special insulated storage tanks and pipes are required
to prevent leaks and evaporation losses.
• Contact with skin or eyes can cause severe cold burns.
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 • As a strong oxidizer, it can increase fire risk — oil,
grease, and flammable materials must be kept away.

Uses
Liquid oxygen is widely used in hospitals as the main source of
medical oxygen for ventilators, anesthesia machines, and
oxygen therapy. Portable liquid oxygen systems are also
available for patients at home who need long-term oxygen
therapy.

Nitrous Oxide Cylinder

Nitrous oxide (N₂O) cylinders are widely used in anesthesia and

pain management. Nitrous oxide, commonly known as
“laughing gas,” is used for its anesthetic and analgesic
properties, often in combination with oxygen during surgeries
and dental procedures.

Storage
Unlike oxygen, nitrous oxide is stored as a liquid under pressure
because it liquefies at room temperature under about 745 psi
(~50 bar). This allows a large quantity of gas to be stored
compactly.

Cylinder Features

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 • Material: Made of seamless steel or aluminum alloy to
safely hold the liquid and gas under pressure.
• Color Code: In many countries, nitrous oxide cylinders
are painted blue for easy identification.
• Valve and Safety: Equipped with specific valve fittings
to prevent accidental connection to other gas lines. They also
have pressure relief devices for safety.

Sizes
Nitrous oxide cylinders come in various sizes. Large cylinders
are used in manifold systems to supply pipelines, while smaller
ones attach directly to anesthesia machines.

Handling Precautions
• Store upright in cool, dry places away from heat
sources (excess heat can cause pressure buildup).
• Check cylinder weight — because it’s stored as a
liquid, the contents are measured by weight, not just pressure.
• Avoid oil and grease near the valves.

Use in Practice
Nitrous oxide provides rapid onset sedation and mild
anesthesia, reducing the need for deeper general anesthetics. It
is especially common in dental clinics, labor wards, and minor
surgical procedures.

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13
Entonox Cylinder

Entonox is a medical gas mixture containing 50% oxygen and

50% nitrous oxide. It is commonly used for pain relief,
especially in labor, emergency trauma care, and minor
procedures. It provides rapid analgesia with minimal side
effects and does not require an anesthetist to administer in
many settings.

Cylinder Features
• Contents: Pre-mixed, ready-to-use 50% oxygen and
50% nitrous oxide.
• Storage: Stored as a homogenous gas under high
pressure (about 137 bar). Unlike pure nitrous oxide, Entonox
does not liquefy under normal storage conditions.
• Color Coding: Entonox cylinders are usually blue with a
distinctive white and blue quartered shoulder or band for clear
identification (color codes can vary by country).
• Valves: Fitted with specific connectors to prevent
accidental misuse.

Use
• Provides quick pain relief — the patient inhales it
through a demand valve or mouthpiece.
• Self-administered by the patient — they control how
much they inhale.
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 • Common in ambulances, emergency rooms, and
maternity units.

Precautions
• Cylinders must be stored above 10°C to prevent gas
separation (at low temperatures, nitrous oxide can separate and
liquefy, leading to an uneven mix).
• Always invert the cylinder several times before use if it
has been stored cold, to ensure the gas is evenly mixed.

Heliox cylinder

Heliox is a medical gas mixture of helium and oxygen,

commonly in ratios like 80% helium and 20% oxygen or 70%
helium and 30% oxygen. It is used to help patients with severe

15
airway obstruction or respiratory distress, as helium’s low
density reduces airway resistance and work of breathing.

Cylinder Features
• Contents: Pre-mixed helium and oxygen in a fixed ratio.
• Storage: Stored as a compressed gas under high
pressure, like oxygen cylinders.
• Color Coding: Heliox cylinders are usually painted
brown with a white or green shoulder (exact colors vary by
country standards).
• Valves: Fitted with specific connectors to prevent
accidental attachment to incorrect equipment.

Uses
• Used for conditions like severe asthma, upper airway
obstruction, or COPD exacerbations.
• Helps deliver oxygen more easily through narrowed
airways by reducing turbulent flow.
• Often used in ICU or emergency care with special
ventilators or breathing circuits.

Precautions
• Heliox requires specific flowmeters or regulators
calibrated for its lower density to deliver accurate flow rates.

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 • Not a replacement for oxygen therapy if the patient’s
oxygen needs are high, because the oxygen fraction is lower
than pure oxygen.

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Air Cylinder

Medical air is clean, compressed air used in hospitals for

patient care. It is different from industrial compressed air
because it must meet strict medical purity standards — it must
be dry, oil-free, and free of contaminants.

Contents & Storage

• Medical air is stored as compressed gas at high
pressure (around 137–200 bar) in seamless steel or aluminum
cylinders.
• It is often supplied via a central pipeline but portable
cylinders are used for backup or in areas without pipelines.

Cylinder Features
• Color Coding: Medical air cylinders are usually black
with a white/grey shoulder (varies by country).
• Valve: Equipped with standard regulators for flow
control.
• Sizes: Available in various sizes, from small portable
cylinders for patient transport to large cylinders for manifold
systems.

Uses
• Provides air supply for ventilators, anesthesia
machines, and nebulizers.
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 • Used to drive surgical tools or power pneumatic
medical equipment.
• Prevents excessive oxygen delivery when only room air
is needed.

Safety
• Must be handled and stored like other compressed gas
cylinders — upright, secured, away from oil, grease, or ignition
sources.
• Must not be confused with industrial compressed air.

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20
>Filling Ratio (Also called as filling density)

Filling ratio is an important safety term used for medical gas

cylinders containing liquefied gases (like nitrous oxide or
carbon dioxide).

Definition:
The filling ratio is the weight of the liquefied gas actually filled in
the cylinder divided by the weight of water the cylinder can hold
at 15°C.

\text{Filling Ratio} = \frac{\text{Weight of Gas}}{\text{Weight of

Water Capacity}}

Purpose:
It ensures that the cylinder is not overfilled, allowing enough
space for the liquid to expand safely if the temperature rises.

Typical Examples:
• Nitrous oxide: Filling ratio ~0.75 in tropical climates,
~0.67 in cold climates.
• This means a cylinder that holds 100 kg of water should
not contain more than 75 kg of nitrous oxide in warmer regions.

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Importance:
If overfilled, the liquid may expand dangerously with
temperature changes, risking cylinder rupture or explosion.

>Medical Cylinder Valves

Cylinder valves are crucial components that control the safe

release of medical gases stored under high pressure.

Functions:
• Open or close the gas flow.
• Connect the cylinder to regulators or equipment.
• Maintain a gas-tight seal under pressure.

Types:
• Hand-operated valves: Opened by turning a spindle
with a handwheel.
• Pin Index Safety System (PISS): Small cylinders (like
oxygen or nitrous oxide for anesthesia) have a pin index to
prevent connection to the wrong gas system.
• Pressure Relief Devices: Many valves have burst discs,
fusible plugs, or spring-loaded relief valves to safely vent
excess pressure if the cylinder overheats.

Materials:
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Valves are made of brass or other corrosion-resistant metals to
handle high pressures and medical gas purity requirements.

Precautions:
• Keep valves clean — never use oil or grease.
• Always open valves slowly to prevent rapid gas
expansion.
• Use the correct regulator or flowmeter for each gas
type.

>Pressure gauge
A pressure gauge is a device used to measure and display the
pressure of the gas inside a medical cylinder or gas pipeline
system.

Purpose:
• Shows how much gas is left in the cylinder (for
compressed gases like oxygen and air).
• Helps monitor and adjust gas delivery during medical
use.

Working Principle:
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 • Most gauges work on the Bourdon tube principle: when
gas pressure enters the curved tube, it straightens slightly,
moving a needle on a dial to indicate pressure.
• The gauge is calibrated in units like bar, psi, or kg/cm².

Uses in Medical Practice:

• Attached to cylinders to check remaining gas supply.
• Integrated into anesthesia machines, regulators, and
manifold systems.

Special Notes:
• For liquefied gases (like nitrous oxide), the gauge
shows constant pressure until almost all liquid is vaporized, so
weight measurement is more reliable for knowing the remaining
content.
• Must be handled carefully — sudden pressure surges
can damage the gauge.

Safety Tip:
Always check the gauge before use to ensure the cylinder has
enough gas and is functioning safely.

>Central Supply

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A central gas supply system is a fixed installation in hospitals
that delivers medical gases like oxygen, nitrous oxide, medical
air, and vacuum (suction) to different areas through a pipeline
network.

Components:
• Source: Bulk liquid oxygen tanks (VIEs), large gas
cylinder manifolds, or on-site gas plants (e.g., medical air
compressors).
• Manifold: Connects multiple cylinders to supply gas
continuously — automatically switches to a backup bank when
one is empty.
• Pipeline System: Network of pipes carrying gases to
operating theatres, ICUs, wards, and emergency areas.
• Terminal Outlets: Wall-mounted outlets at patient
bedsides or operating rooms for quick connection to
equipment.
• Alarms & Safety: Pressure regulators, alarms for low or
high pressure, and backup supply ensure uninterrupted flow.

Advantages:
• Continuous, reliable supply of medical gases.
• Saves time and effort compared to handling individual
cylinders.
• Safer — reduces cylinder handling inside clinical
areas.
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Precautions:
• Regular maintenance to check for leaks,
contamination, or pressure faults.
• Clear labeling and color coding to avoid cross-
connections.

>High Pressure System

The high pressure system refers to the part of an anesthesia

machine or medical gas setup that handles gas stored at
cylinder pressure (typically 137–200 bar).

Where It Starts and Ends:

• Begins at the gas cylinder (e.g., oxygen, nitrous oxide).

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 • Includes the cylinder valve, hanger yoke, yoke block,
and pressure gauge.
• Ends at the pressure-reducing valve (regulator) which
lowers the high pressure to a safe, constant working pressure
for delivery to the patient.

Main Components:
• Cylinder: Stores gas under high pressure.
• Cylinder Valve: Controls gas flow in or out of the
cylinder.
• Yoke Assembly: Holds the cylinder and connects it
securely to the machine.
• Pressure Gauge: Shows the cylinder’s gas pressure.
• Pressure Regulator: Reduces the cylinder’s high
pressure to a lower, usable pressure for the intermediate
system.

Importance:
• Safely manages high-pressure gas to prevent
equipment damage or accidental high-pressure delivery to the
patient.
• Ensures a steady supply of gas at a consistent
pressure.

Safety Features:

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 • Pin Index Safety System (PISS) to prevent wrong gas
connection.
• Check valves to stop backflow.
>Yoke Assembly

The yoke assembly is an essential part of an anesthesia

machine’s high-pressure system. It connects small
compressed gas cylinders (like oxygen or nitrous oxide)
securely to the machine, ensuring a safe and leak-proof gas
supply.

Location

It is located on the back or side of the anesthesia machine and

is usually designed to accept small cylinders (e.g., E-size).

Functions of the Yoke Assembly

• Provides a secure mounting for the cylinder.
• Creates a gas-tight seal between the cylinder and the
machine.
• Ensures the correct gas is attached using the Pin Index
Safety System (PISS).
• Prevents backflow of gases with a non-return (check)
valve.

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 • Directs gas from the cylinder into the high-pressure
system for further pressure regulation and use.
Yoke Body:
• The main metal frame that holds the cylinder in place
against the machine’s inlet port.
• Usually made of strong metal to withstand high
pressure.

Retaining Screw or Clamp:

• Holds the cylinder firmly in position against the yoke.
• Tightened by hand to prevent leaks.

Nipple:
• A metal tube through which the gas flows from the
cylinder valve into the machine.
• Precisely aligned with the cylinder outlet port.

Bodok Seal (Washer):

• A special rubber or fiber washer placed between the
cylinder valve and the yoke nipple.
• Ensures a tight, leak-proof connection.

Pin Index Safety System (PISS):

• Prevents accidental connection of the wrong cylinder.
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 • Metal pins on the yoke match holes in the cylinder
valve — only the correct gas cylinder will fit.

Check Valve (Non-return Valve):

• Prevents gas from flowing backward into an empty
cylinder or another cylinder of a different gas.

Filter:
• A fine mesh filter is placed at the gas inlet to trap dirt or
debris, protecting the machine from contamination.

Safety Features

Pin Index Safety System (PISS):

• Each gas has a unique pin arrangement, preventing
cross-connection.
• Example: Oxygen has pin positions 2 and 5; nitrous
oxide has 3 and 5.

Check Valve:
• Stops reverse gas flow which can cause dangerous gas
mixing.

Bodok Seal:
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 • Prevents leaks at high pressure.

Precautions When Using a Yoke Assembly

• Always check the Bodok seal — replace it if damaged
or worn out.
• Tighten the retaining screw properly to avoid leaks.
• Never use oil or grease near gas connections — can
cause fire/explosion.
• Check the pin index for proper alignment — never force
a wrong cylinder onto the yoke.
• Inspect the filter for blockages.

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32
>Pin index system brief

The Pin Index Safety System (PISS) is a safety feature used on

medical gas cylinders — mainly small cylinders (like E-type) —
to prevent accidental connection of the wrong gas cylinder to an
anesthesia machine or regulator.

How It Works
• Each gas cylinder has holes drilled in a specific pattern
on its valve face.
• The corresponding yoke on the anesthesia machine
has pins that match the pattern for that specific gas.
• Only the correct cylinder with the matching hole
arrangement will fit onto the yoke.
• For example:
• Oxygen: Pin positions 2 and 5
• Nitrous oxide: Pin positions 3 and 5

Purpose

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 Prevents wrong gas connection, which could be dangerous
for the patient.
Provides an automatic check for gas identity.
Improves safety in busy clinical settings.

Precautions
• Never use extra washers to force an incorrect cylinder
to fit.
• Always check pins and holes for damage or dirt.
• Replace worn Bodok seals to maintain a good seal.

>Making of pin index system

The Pin Index Safety System (PISS) is a mechanical design

feature built into the cylinder valve and yoke assembly to
ensure that only the correct gas cylinder can be connected to
the right gas inlet on an anesthesia machine.

How It Is Made

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 Cylinder Valve Face:
• Each medical gas cylinder has a valve face with two
small holes drilled at specific positions and distances apart.
• The hole pattern is unique for each gas — for example:
• Oxygen: Pin positions 2 and 5
• Nitrous oxide: Pin positions 3 and 5
• Air: Pin positions 1 and 5

Yoke Pins:
• The yoke assembly on the anesthesia machine or
regulator has two fixed metal pins projecting from it.
• These pins match the hole pattern for that specific gas.

Matching Fit:
• When attaching the cylinder, the pins must fit exactly
into the matching holes.
• If the wrong gas cylinder is used, the holes won’t align
with the pins — so the cylinder cannot be connected.

Sealing Surface:
• A Bodok seal (washer) is placed between the valve face
and the yoke nipple to ensure a gas-tight connection when the
pins are correctly aligned.

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>Pin index position for gases on yoke of anesthesia machine

36
>Higher pressure regulator

A high-pressure regulator is a device used in medical gas

systems (like anesthesia machines) to reduce the very high
pressure of gas stored in cylinders (e.g., 137–200 bar) to a safe,
constant, and lower working pressure (e.g., 4 bar) suitable for
patient use and equipment.

Purpose
• Controls and maintains a steady outlet pressure, even
when the cylinder pressure drops as the gas is used.
• Prevents dangerous high-pressure gas from directly
reaching flowmeters or patients.

How It Works
• Uses a spring-loaded diaphragm or piston mechanism.
• The high-pressure gas enters the regulator.
• As the pressure increases, the diaphragm adjusts a
valve to keep the outlet pressure stable.
• Many anesthesia machines have built-in regulators for
each gas.
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⸻

Features
• Made of strong, corrosion-resistant materials.
• Often has a pressure gauge to show inlet (cylinder)
pressure and outlet (regulated) pressure.
• Safety vents or relief valves prevent over-
pressurization.

Importance
• Essential for safe and accurate gas delivery.
• Protects sensitive equipment and patients.
• Ensures a continuous and reliable flow at the desired
pressure.

>Intermediate Pressure System

The intermediate pressure system is a part of the anesthesia

machine’s gas flow system that handles medical gases after

38
they leave the high-pressure regulator but before they reach the
low-pressure flow control devices.

Pressure Range
• The gases are at a moderate, reduced pressure —
usually 35–55 psi (about 2–4 bar).
• This is much lower than cylinder pressure but high
enough for reliable gas flow.

Components
• Pipeline Inlets: Where the machine connects to
hospital central pipeline gas supply.
• Pipeline Pressure Gauges: Show the pressure coming
from the hospital supply.
• Pipeline Check Valves: Prevent backflow if pipelines
are disconnected.
• Cylinder Pressure Regulators: Reduce high cylinder
pressure to intermediate level if a cylinder is used.
• Oxygen Flush Valve: Delivers oxygen at intermediate
pressure directly to the breathing circuit for emergency
flushing.
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⸻

Functions

Delivers gases at a safe, constant working pressure.

Allows switching between pipeline gas supply and cylinder
supply.
Supplies gases to flowmeters, vaporizers, and downstream
parts of the system.

Importance
• Maintains patient safety by ensuring stable gas
delivery.
• Protects flowmeters and vaporizers from damage due
to high pressure.
• Ensures uninterrupted gas flow if the pipeline supply
fails (cylinders act as backup).

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41
>Low pressure system

The low pressure system is the final part of an anesthesia

machine’s gas supply pathway. It handles gases after they pass
through the flow control valves — just before the gases reach
the patient.

Pressure Range
• Operates at slightly above atmospheric pressure (near
zero gauge pressure).
• Unlike the high and intermediate systems, it is not
pressurized by pumps — the pressure depends on the patient’s
breathing or ventilator.

Main Components
• Flowmeters (Rotameters): Precisely control and
measure the flow rate of each gas.
• Vaporizers: Add controlled amounts of volatile
anesthetic agents (like sevoflurane) to the gas flow.

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 • Common Gas Outlet (CGO): Final mixing point where
the gas and anesthetic vapors exit the machine toward the
breathing circuit.

Functions

Delivers the exact mixture of gases and anesthetic agents to

the patient.
Allows accurate adjustment of gas flows and
concentrations.
Maintains patient safety by preventing leaks and delivering
stable concentrations.

Precautions & Safety

• Leaks in the low pressure system can directly affect
the patient.
• Regular leak tests are done before each use.
• Modern machines often include one-way valves and
alarms to detect flow faults.
>Rotameter

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A rotameter is a flowmeter used in anesthesia machines to
measure and control the flow rate of medical gases like oxygen,
nitrous oxide, or air.

How It Works
• It consists of a vertical, tapered glass or transparent
tube with a float (bobbin or ball) inside.
• Gas enters the bottom and flows upward.
• The float rises until the upward force of the gas equals
the weight of the float — its height indicates the flow rate.
• The flow rate is read at the top, middle, or widest part
of the float, depending on the design.

Features
• Allows precise adjustment of gas flow.
• Calibrated for each specific gas — because gases have
different densities and viscosities.
• Usually arranged in series for different gases side by
side.

44
 • Marked in units like liters per minute (L/min).

Functions

Provides an accurate measurement of gas flow to the

patient.
Allows the anesthetist to control the amount of each gas
delivered.
Ensures patient safety by preventing under or over-delivery.

Precautions
• Must be kept upright and vertical for correct reading.
• Handle gently — the glass tube is fragile.
• Check for leaks or stuck floats before use.

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46
>cylinder Manifold

A cylinder manifold is a fixed installation used in hospitals to

connect multiple gas cylinders together so they can supply
medical gases (like oxygen or nitrous oxide) continuously to a
central pipeline system.

Purpose

Provides a steady and reliable gas supply to the hospital,

operating theatres, ICUs, and wards.
Ensures an uninterrupted flow by automatically switching
from one cylinder bank to another when one side is empty.

Components
• Multiple Cylinders: Arranged in parallel rows (called
banks).
• Manifold Piping: Connects the cylinders to a common
outlet.
• Changeover Device: Switches supply from the empty
bank to the reserve bank automatically or manually.
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 • Pressure Regulators: Reduce cylinder high pressure to
a safe pipeline pressure (usually 4–5 bar).
• Non-return Valves: Prevent backflow between
cylinders.
• Pressure Gauges: Indicate cylinder and pipeline
pressures.

Advantages
• Easy to handle large gas volumes.
• Reduces the need to move single cylinders in patient
areas.
• Provides a backup in case one bank runs out.

Common Gases Supplied

• Oxygen (most common)
• Nitrous oxide
• Medical air

48
>color coding

Color coding is a universal safety system used to easily identify

different medical gases by painting cylinders in specific
standard colors.

Purpose

49
 Prevents mix-ups between gases (e.g., oxygen vs. nitrous
oxide).
Improves patient safety during anesthesia and medical gas
use.
Makes cylinders easily recognizable in busy hospital
environments.

Standard Color Codes (Examples)

• Oxygen: Black body with a white shoulder (or entirely
white in some countries)
• Nitrous Oxide: Blue body
• Air: Black and white or gray body
• Entonox: Blue and white quarters on the shoulder
• Heliox: Brown and white
• Carbon Dioxide: Gray body
• Vacuum/Suction: Yellow (for pipeline outlets)

Note: Colors can vary slightly by country (British Standards, ISO,

Indian Standards).

50
Where It’s Used
• Cylinder bodies and shoulders.
• Pipeline outlets and wall connectors.
• Flowmeter knobs and hoses.

Safety Point
• Always confirm label and valve marking along with
color — never rely on color alone!

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52
>Piped Gas System

A piped gas system is a permanent medical gas pipeline

network installed in hospitals to supply essential medical gases
(like oxygen, nitrous oxide, medical air, and vacuum) directly to
patient care areas.

Purpose

Provides a continuous, reliable, and safe supply of medical

gases to wards, ICUs, operating theatres, and emergency areas.
Reduces the need to handle individual gas cylinders near
patients.
Ensures quick and convenient access to gases at the point
of use.

Components
• Source: Bulk supply like liquid oxygen tanks (VIEs),
cylinder manifolds, or compressors (for air).
• Manifolds: Connect multiple cylinders for backup.

53
 • Pipeline Network: Copper or stainless steel pipes carry
gases throughout the hospital.
• Zone Valves: Control flow to specific areas and allow
maintenance or emergency shut-off.
• Terminal Outlets: Wall or ceiling outlets at patient
bedsides for easy connection to equipment.
• Alarm Systems: Warn of leaks, pressure loss, or supply
failure.
• Pressure Regulators: Maintain a safe, constant delivery
pressure (usually 4–5 bar).

Advantages
• Safe, clean, and cost-effective gas delivery.
• Minimal cylinder handling inside patient areas.
• Easy to monitor and maintain.

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55
>Labelling of cylinders

Labelling is an important safety requirement for medical gas

cylinders to ensure that the contents are clearly identified, and
that users handle and connect them correctly.

Purpose of Labelling

Prevents accidental use of the wrong gas.

Provides important information about the gas, pressure, and
safety instructions.
Ensures compliance with national and international safety
standards.

Key Elements on a Cylinder Label

• Name of the Gas: Clearly written (e.g., Oxygen, Nitrous
Oxide).
• Chemical Symbol: For example, O₂, N₂O.
• Color Coding: The cylinder’s shoulder/body color
matches the standard code for that gas.
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 • Cylinder Size: Often marked by a code (e.g., E-type, F-
type).
• Filling Pressure: The maximum safe pressure when full.
• Lot or Batch Number: For tracking and safety checks.
• Expiry or Re-test Date: Indicates when the cylinder
must be tested again for safety.
• Manufacturer’s Details: Company name and contact.
• Safety Warnings: For example, “Medical Gas — Not to
be used for industrial purposes”, or “No oil or grease”.

Placement
• The label is usually a durable sticker or printed band
attached to the cylinder body near the shoulder.
• It should be clear and legible, even if the cylinder is old
or scratched.

Safety Tip

Never rely only on color coding — always check the label and
valve markings before use.

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>Storage of cylinders

Proper storage of medical gas cylinders is essential for safety,

gas quality, and readiness for use in hospitals and clinics.

Basic Principles

Store cylinders in a well-ventilated, dry, and clean area.

Keep away from heat sources, flames, or sparks — cylinders
must be stored below 50°C.
Store full and empty cylinders separately, clearly labelled to
avoid mix-ups.
Store cylinders upright and secured with chains or racks to
prevent tipping.
Protect valves from damage — always keep valve caps or
covers on unused cylinders.

Special Precautions
• Keep oxygen cylinders away from oils, grease, or
flammable materials — oil + oxygen is a fire hazard.
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 • Do not store flammable gases near oxidizing gases
(e.g., oxygen).
• Follow local fire safety rules and no smoking signs.

Handling
• Use cylinder trolleys for moving cylinders — never roll
or drag them.
• Handle with care to avoid knocking or dropping.

Regular Checks
• Inspect cylinders for leaks, rust, or damage.
• Check expiry/re-test dates.
• Rotate stock so older cylinders are used first.

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Medical gas cylinders are a vital component of modern medical
practice, especially in anesthesia, emergency care, and critical
care. They provide a safe and portable source of essential gases
like oxygen, nitrous oxide, air, and specialty gas mixtures when
piped supply is unavailable or as backup.

Their safe use depends on strict standards — including correct

color coding, the Pin Index Safety System, proper storage,
regular inspection, and careful handling. Together, these safety
measures prevent gas mix-ups, leaks, and accidents.

In summary, medical gas cylinders ensure that life-saving gases

are always available, helping healthcare providers deliver safe
and effective care to patients in hospitals, clinics, and in the
field. Proper knowledge and responsible use of these cylinders
are essential for every healthcare professional.

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Bibliography

//Slideshare
//Wikipedia

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