Gas Cylinders

Issues of Concern

Pressure Release Device

The release of pressurized gas can be hazardous, and extreme caution should be exercised. Gas pressure levels should be reduced from the stored high pressure to a workable, usable level. A pressure regulator should be used in this situation, and any time contents are being removed or used from the cylinder. Do not tamper with pressure-release devices. Do not use any cylinders with visibly defective pressure-release devices. Pressure-release devices and gas outlets should never be pointed in any direction that could cause harm. While attached to an anesthesia machine, the cylinder valves should be in the off position while not in use. This is to prevent leakage and to allow notification via an alarm of a failure in the pipeline gas supply. If the cylinder were left open and a pipeline gas supply failure occurred, the anesthesia machine would consume the cylinder's oxygen, and the provider would not be notified until the cylinder was depleted.[4][5]

Safe Usage

A cylinder should be inspected for malfunctions and defects before use. Full cylinders are usually placed with a tamper-evident seal. This is generally a tear-off seal on the valve outlet and is removed before use. Proper cylinder inspection includes the outlet, pin-index safety system, and pressure-relief device. The valve outlet should be cleaned before use. Only use cylinders marked with DOT (Department of Transportation) or ICC (Interstate Commerce Commission). In Canada, cylinders may be marked with BTC (Board of Transportation Commissioners) or CTC (Canadian Transport Commission). A cylinder should be connected to a regulator to reduce the compressed, stored pressure to a working, usable pressure. Inspect the regulator for signs of damage or foreign materials.[6]

Safe Storage and Transportation

Cylinders must be stored upright and secured with a rack, strap, or chain to minimize the risk of tipping over. Cylinders should be transported using a cart or carrier. Never drop or hit cylinders, and never drag, roll, or slide cylinders, even for a short distance. Only qualified personnel should refill cylinders. While using cylinders, avoid flammable substances, smoking, open flame, or any other incendiary sources. Cylinders should be stored in a dry, cool, well-ventilated area, away from weather exposure. Cylinders should be stored at temperatures less than 125°F (52°C).

Oxygen cylinders have more specific storage requirements than other medical gases. While oxygen cylinders can be stored in the same space as other non-flammable medical gases, as long as they are properly segregated, full and empty cylinders cannot be stored together. The separation of full and empty cylinders prevents the accidental usage of an empty cylinder during an emergency. Partially full oxygen cylinders may be stored in the same location as full cylinders, provided that they are adequately labeled.

Clinical Significance

Use Boyle's law to calculate how much oxygen time remains in an E-sized cylinder. Boyle's law states that at a fixed temperature (room temperature) of an ideal gas, the pressure is inversely proportional to volume. Boyle's law can be further rearranged to state that pressure times volume equals a constant. The following is the formula:

• P1 * V1 = P2 * V2

One could compare a cylinder of gas at a filled volume (V1 = 660 L) and pressure (P1 = 2200 psi) to the current pressure (P2) read on the cylinder. This would provide the information needed to solve for the current volume (V2) remaining in the tank in liters. The following is the formula:

• P2/P1 * V1 = V2, or

(Measured pressure remaining using the integrated pressure gauge in psi/2200 psi) * 660 L = Liters of oxygen remaining in the tank.)

This Volume (V2) can be used to determine the amount of unit time remaining in the cylinder, given the gas's current flow rate.

• V2/Flow rate = unit time remaining, or
• Liters of oxygen remaining in the tank/oxygen setting in liters/minute = minutes of oxygen remaining

The same formulas can be used in cylinders containing a pure gaseous form. However, calculations for nitrous oxide are only applicable once the pressure drops below 745 psi, due to the presence of both liquid and gaseous forms in the tank. The pressure remains constant until 75% of the 1590 L of gas is consumed, which is approximately 400 L remaining in the cylinder. From this point until empty, the above formulas apply. Prior to this point, the cylinder must be weighed to determine the amount of gas remaining.

The transportation of gas cylinders is highly regulated by local, state, and federal agencies in most countries. In the United States, the Department of Transportation is the governing authority. Further, there are manufacturer guidelines to ensure that the cylinders have been tested and are safe. Some of the tests cylinders undergo include tensile strength testing, hydrostatic testing, impact testing, burst testing, and pressure cycling. Once the cylinder is manufactured, it must have all the vital information permanently etched on it.[7]

Nursing, Allied Health, and Interprofessional Team Interventions

Skills

Knowledge of gas cylinders and their proper management and utilization is important.

Strategy

It is most appropriate to maintain continuous, closed-loop communication among all members of the perioperative care team regarding the need for, technique of, and potential management issues associated with gas cylinders.

Ethics

It is necessary to obtain thorough, informed consent from either the patient or their designated and authorized decision-maker before administering anesthesia, as this likely involves gas cylinders. It is most appropriate for all team members to feel empowered to state to the team or the patient any concerns they might have regarding the process, as this ensures buy-in from all stakeholders and provides additional layers of review and insight into problematic matters as soon as possible.

Responsibilities

All team members have a duty to communicate their concerns, responsibilities, and activities to all other team members, both contemporaneously and as indicated throughout the perioperative period, in accordance with their professional discretion.

Interprofessional Communication

All team members should respect the free flow of information and concerns among team members without allowing or producing an environment of hostility.

Care Coordination

All team members should consider it their duty to neither disrupt the work of other team members nor, through their actions or inaction, create additional issues or increase the workload for others.