Medical gas supply

Published on 13/02/2015 by admin

Filed under Anesthesiology

Last modified 13/02/2015

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Medical gas supply

Martin L. De Ruyter, MD

Medical gases most common to anesthesia include oxygen (O2), nitrous oxide (N2O), and air. Historically the less frequently used medical gases include helium (He), nitrogen (N2), and carbon dioxide (CO2), but there has been a recent surge in the use of CO2 secondary to the advancement of laparoscopic and robotic procedures. Several governing bodies regulate medical gases, but the containment and delivery of these gases via a medical gas cylinder system is controlled via standards set by the United States Department of Transportation. Medical gas cylinders are the foundation for central pipeline supply of gases to the operating room (OR) and hospital. Additionally, a cylinder system (typically the smaller E cylinders) exists in the OR as a backup for unanticipated failure of the central pipeline supply (Figures 1-1 to 1-3).

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Figure 1-1 The index safety system is one of several features of medical gas cylinders that is in place to ensure that the correct cylinder is attached to the correct gas inlet in the back of the anesthesia machine. Cylinders are color coded; each cylinder has a label identifying which gas it contains, and the cylinders attach to the back of the anesthesia machine using the pin-index safety system. Two pins incorporated into the yoke of the machine, just below the gas inlet, line up with two holes on the gas cylinder, allowing only the correct cylinder to be connected to the correct inlet. (© Mayo Foundation for Medical Education and Research. All rights reserved.)
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Figure 1-2 ​A close-up view of the yoke assembly in the back of the anesthesia machine. The two pins that are immediately below the gas inlet on the anesthesia machine occupy one of seven possible standardized positions. For O2, the pins are in the 2 and 5 position and line up with the corresponding inlet on the O2 cylinder. As the clamp on the yoke assembly is tightened, the cylinder is secured up against the gas inlet for O2. If the pins line up correctly, when the valve on the cylinder is open, the correct gas will flow into the correct inlet. If the pins are not lined up correctly, the cylinder will not be able to be tightened into the yoke, no contact will be made between the gas inlet and cylinder, and, therefore, the gas won’t flow into the inlet. (© Mayo Foundation for Medical Education and Research. All rights reserved.)
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Figure 1-3 ​Hoses, color coded for each gas, can be connected to the appropriate gas outlet with an adaptor that has a disc-index system unique to the gas for that outlet. The system comprises a central tube, through which the gas flows, and two small metal rectangles placed on the surface of the adaptor that are, again, unique to each gas, such that an O2 hose can only be connected to an O2 outlet. (© Mayo Foundation for Medical Education and Research. All rights reserved.)
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