Medical Gas Pipeline System: A Convenient Way to Provide Medical Gases at Point of Care

Review Article

Medical Gas Pipeline System: A Convenient Way to Provide Medical Gases at Point of Care

Gurmeet Singh Sarla ^*

General and Laparoscopic Surgeon, Department of Surgery, Military Hospital Khadki, Pune, Maharashtra, India.

*Corresponding Author: Gurmeet Singh Sarla, General and Laparoscopic Surgeon, Department of Surgery, Military Hospital Khadki, Pune, Maharashtra, India.

Citation: Sarla GS. (2026). Medical Gas Pipeline System: A Convenient Way to Provide Medical Gases at Point of Care, International Journal of Biomedical and Clinical Research, BioRes Scientia Publishers. 6(6):1-3. DOI: 10.59657/2997-6103.brs.26.130

Copyright: © 2026 Gurmeet Singh Sarla, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: February 23, 2026 | Accepted: April 08, 2026 | Published: April 13, 2026

Abstract

Piped delivery of medical gases ensures patient safety, convenience and economical provision of medical gases at the point of medical care. There are stringent regulatory norms that govern the design, installation, commissioning, and operation of medical gas pipeline systems (MGPS). The statutory standards focus heavily on hardware. Moreover, safe supply of medical gases is dependent on 4 principles which include identity, adequacy, continuity and quality of supply. Although the capital costs of installing MGPS are high as compared to the operational costs, it significantly reduces the problems of safe storage, transportation, handling and noise associated with use of cylinders.

Keywords: medical gas pipeline system; oxygen, carbon dioxide; nitrous oxide; piped gas; manifold room; liquid oxygen; pressure swing adsorption

Introduction

Medical gases include oxygen, nitrous oxide and carbon dioxide and are classified as drugs requiring strict adherence to pharmacopoeia standards for purity and safety. Oxygen is required for respiratory therapy and life support, nitrous oxide is used in general anesthesia, carbon dioxide is used for insufflation during laparoscopic surgeries, medical air is used for ventilators and surgical air is used to operate pneumatic drills. Manifold is a device used to connect the outlets of one or more gas cylinders through a control panel to central piping system. Medical gas pipeline system (MGPS) is a pipeline distribution system through which medical gases and air are supplied from the source to the terminal unit in a safe, convenient and cost-effective way [1] thereby reducing the problems associated with use of gas cylinders such as safety, storage, porterage and noise. The objectives of MGPS are to provide adequate, safe, reliable, convenient, pure and economical medical gases at appropriate pressure at all outlet points.

Advantages

It is economical to have a centralized medical gas system in a health care facility with more than 200 beds and if the weekly consumption is likely to exceed 10000 liters. MGPS offers safety, reliability and reserve back up of medial gases. There is better pressure and quality control if medical gases are centrally supplied. Transportation of medical gases become easy, maintenance and operations are easier and health care delivery is uninterrupted if MGPS is installed.

Manifold

The manifold is a dedicated room for storage of gas cylinders and a raised level loading dock. It should preferably be outside the main building and away from other buildings with easy access to transportation for refilling of cylinders and adequate ventilation. The temperature of the room should not exceed 54 degrees celcius and adequate fire safety measures should be made available in the manifold room. There should be appropriate boundary and fencing with lockable doors and gates to prevent unauthorized entry. The indoor material for internal walls and ceiling should be of non-combustible, two-hour fire-resistant material. Racks, chains and other fastening and securing devices should be used to secure cylinders. Electrical rooms, transformers, diesel generators, cooking areas, stores housing inflammable and combustible liquids should be away from the manifold room.

Classification of Health care facilities as per National Fire Protection Association (NFPA):

As per NFPA 99, health care facilities are divided into 3 categories depending on the basis of effects in case of disruption of medical gas supply.

Level 1: Facilities where patients are on ventilatory support and an interruption in MGPS would place the patients in immediate danger.

Level 2: The interruption in supply of piped gases lead to manageable risk of morbidity and mortality.

Level 3: Interruption of medical gas supply system does not place the patients at risk.

Pipeline Installation

MGPS should be kept away from areas where there may be mechanical damage, chemical damage, excessive heat and splashing, dripping or contact with oil, grease, bituminous compounds and electrical sparks. It should not be installed in lift shaft, kitchen, laundry, autoclave room, incinerator room and generator room. It is better to enclose pipelines in non-combustible, non-corrosive material that have no electrolytic reaction with copper. The pipe should be manufactured from phosphorus deoxidized, non-arsenical copper [2] and installed vertically or horizontally without sagging or distortion. Other fittings including valves and control panel fittings should be made up of copper, brass, gun metal, bronze or stainless steel. All pipes need to be cleaned, degreased and free of particulate matter and toxic residues. No pipe smaller than 15mm outside diameter (OD) should be used anywhere in MGPS. Before use, pipelines undergo tests like nitrogen purging and 24-hour pressure checks to ensure that there are no leaks [3] and/or contamination.

Color Coding

White color band indicates oxygen, French blue color band indicates nitrous oxide, white and black color band suggests compressed air, yellow color band shows vacuum and grey color band is indicative of carbon dioxide. All pipelines, delivery points and medical gas cylinders have uniform color codes [3].

Medical Oxygen

Medical oxygen 99 percentage can be supplied by oxygen cylinders, MGPS or through liquid oxygen tank. Medical oxygen 93 percentage is provided through pressure swing adsorption (PSA) technology. The flow rate needs to be 10 liters per minute and the pressure of 400 kilopascal at the bed-side outlet for effective delivery of medical oxygen. The oxygen supply unit should be designed to provide uninterrupted supply consisting of primary, secondary and reserve supply sources [4]. The manifold room has 2 banks of D type cylinders of 2 days consumption attached to a fully automatic change over control panel. The average rate of consumption is calculated as 10 liters per minute in general ward and labor room and 100 liters per minute in Operation room and ICU.

Liquid Oxygen Tank (LOX)

Liquid oxygen tank is a preferred primary source of oxygen because of cost effectiveness and convenience. LOX is a low pressure, high flow system having a capacity of at least a week. The tank is made up of stainless-steel inner pressure vessel which is supported in a mild steel outer shell with insulation in between the two. At 1 atmospheric pressure and at a temperature of 15 degrees celcius, one volume of liquid oxygen yields 842 times of its volume of oxygen in gaseous form allowing highly efficient storage system [5]. LOX tanks need to be anchored firmly to a concrete pad and kept away from combustible materials like asphalt and tar as they can create an explosive mixture when in contact with liquid oxygen. It should be appropriately fenced with double gates and there should be no sunken areas, trenches, manholes, pits or drains nearby [6].

Pressure Swing Adsorption (PSA)

PSA is a cost-effective, energy efficient and sustainable source of oxygen by using zeolite molecular sieves to selectively adsorb nitrogen, carbon dioxide and moisture from air, producing 90-93 percentage oxygen. It uses dual adsorption beds operates on a cyclical process where one adsorption bed traps nitrogen while the other regenerates thereby ensuring uninterrupted supply of oxygen. PSA also known as oxygen concentrator is convenient, quick to install and scalable for small to medium capacities.

Carbon Dioxide

Carbon dioxide is used as an insufflation gas for laparoscopic surgeries and is generally provided only in Operation theatres. The cylinders are positioned in shaded areas away from direct sunlight or source of heat. Carbon dioxide is supplied through 2 D type cylinders and designed to supply gas at a flow rate of 50 liters per minute.

Air

Air is used to provide power to tools, ventilators and nebulizers [2]. Oxygen is avoided as a power source because of high cost and fire hazard. Air is provided at 400 kilopascals to drive ventilators and at 700 kilopascals to drive surgical tools.

Anesthesia Gas Scavenging System (AGSS)

Anesthesia gases, especially nitrous oxide can be harmful if not removed from operation theatre. AGSS incorporate a canister system which captures the unused gases, filters, and recycles them preventing occupational exposure and reducing environmental pollution [7].

Safety of MGPS

Copper seamless pipes with fluxless silver brazing are used which should be as per American Society for Testing and Materials standard and Lloyd's certification [8].

Each system should be gas specific and color coded and all measures to prevent cross connection should be taken. The final delivery points are also colour coded, incorporating either the diameter index safety system or of quick connect type which are of two types including Diamond and Chemetron type [9].

Medical gases should be provided as pure and filtered to highest quality possible. Pipe need to be pressure tested for leaks and blown free of any particulate matter. Cylinders need to be color coded, marked with cylinder number, size, type of gas, full, in service or empty; kept steady with safety chains and in charge of the inventory holder under lock and key.

Manifold room needs to be manned 24 hours with provision of periodic training of MGPS staff about safety and security at medical gas area, practicing mock drills of pipeline failure, fire and explosion; maintaining log books and periodic preventive maintenance and leak test for pipelines.

Conclusion

MGPS is a cost effective, safe and convenient way to provide medical gases at the point of care for ventilation, oxygen therapy, anesthesia, minimal access surgery and as a power source for surgical tools. It reduces the problem of storage, transportation, handling and noise associated with the use of cylinders. MGPS ensures the correct medical gas is delivered at the point of health care delivery in appropriate quantity and quality; in an uninterrupted manner. Universal color coding exists for different gases. Stringent quality parameters exist for installation of MGPS and all parts of each system are gas specific to avoid cross connections. Pipes are blown free of any particulate matter before installation and pressure testing is carried out to check for leaks. Manifold needs to be manned round the clock and all efforts should be put for security and safety at medical gas area.

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