This document discusses oxygen planning and management in hospitals. It covers various oxygen sources like liquid medical oxygen and oxygen cylinders. It explains how to estimate oxygen needs based on bed capacity and flow rates. It also discusses the current situation in Indian hospitals, highlighting the need for primary and reserve oxygen supplies as well as alarm systems. The document provides good practices for oxygen system planning like automatic changeover between supply and backup sources. It stresses the importance of disaster planning through measures like hourly monitoring, conserving oxygen use, and having protocols to offset loads and escalate issues during emergencies.

1. @ CMC Pulse - 24/05/2021
Dr. Lallu Joseph
Quality Manager &
Assoc. General Superintendent
CMC Vellore
CHRISTIAN MEDICAL COLLEGE
VELLORE
Oxygen Planning and
Management

2. @ CMC Pulse - 24/05/2021
Anatomy of my presentation
1. Oxygen Sources
2. Supply of Oxygen/ Back up
3. Estimating Oxygen Needs
4. Current situation in Indian Hospitals
5. Planning of the system – Good Practices
6. Disaster Planning

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1. Liquid Medical Oxygen (LMO)

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Liquid Medical Oxygen (LMO)
• Cryogenic Source
• Most popular choice for big hospitals and hospitals with
connectivity (good supply chain)
• Stringent licensing requirements
• Cleanest source > 99% pure
• Oxygen stored in liquid state
• At 15 Degree C, 1 L of liquid oxygen can produce 842 L of oxygen
• At 27 Degree C, 1 L of liquid oxygen can produce about 888 L of
oxygen
• Bought in Kilogram (MT), paid in cu.m of liquid, consumed in litres
per minute (gas).
• 1 kg is about 0.867 L of liquid
• 1 kg is about 0.769 cu.m of gas
• 1 cu.m is 1000 L of gaseous oxygen

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Oxygen Manifold

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Manifolds
• Manifolds – Main supply for small hospitals
• 1st level of backup hospitals with LMO
• Right bank and Left bank- Pressurized
• D type cylinders – 6.7 cu.m (Nomenclature different in
countries)
• Purity > 99%
• Common types of cylinders used in India
1. A Type- 5L capacity of water- 1 cu.m oxygen (Anaesthesia Machine)
2. B Type- 10L capacity of water- 1.47 cu.m (Transport Cylinders)
3. D Type- 44L capacity of water- 6.5-7 cu.m (Bulk Cylinders)

7. @ CMC Pulse - 24/05/2021
How many hours will it last?
• Gauge reads the pressure
• Full cylinder pressure = 138 bar
• Gauge reading = 130 bar (94% full)
• 94% of 6500 L of oxygen gas = 6110 L
• Patient on 2 LPM will receive 50 hours of oxygen supply
• Patient on 4 LPM will receive 25 hours of oxygen supply
• Patient on 10 LPM will receive 10 hours of oxygen
supply
• If connected with ventilator, CPAP, BPAP it can work upto
6 bar
• If connected with flow meter with mask, nasal prong it
can work upto 2 bar

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Oxygen Concentrator

9. @ CMC Pulse - 24/05/2021
Oxygen Concentrator/ Generator
• Constant source
• Separates oxygen from atmosphere (Adsorbing under
pressure)
• Adsorbent material - Zeolite (aluminium silicate)
• Purity – 90% to 95%
• Argon with small quantity of nitrogen
• Purity good with 75- 80% load
• Two technology- PSA (Pressure Swing Adsorption) & VSA
(Vacuum Swing Adsorption)

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2. Oxygen supply
• Three components/ backup
• Primary Supply
• Secondary Supply
• Reserve Supply
• Depends on the size of the hospital, complexity of
operations and distance

11. @ CMC Pulse - 24/05/2021
Oxygen supply system
Primary Supply Secondary Supply Reserve Supply
Gas cylinder
manifold
Automatic manifold
changeover system
1. Manual emergency
cylinder manifold
2. Automatic system to
provide 4 hours
1. Automatic manifold
system to supply entire
hospital
2. Automatic manifold
for ICU
LMO
1. Single vessel
2. One vessel of duplex
system – same area
3. One vessel of duplex
system – separate area
1. Automatic manifold system
2. Second vessel
3. Second vessel in separate
area
Automatic manifold –
entire hospital/ ICU,
HDU
Oxygen
concentrator
Plant size as per hospital
requirement
1. Single vessel
2. Automatic manifold
system
Automatic manifold –
entire hospital/ ICU,
HDU

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Supply Layout

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3. Estimating oxygen needs
Historical oxygen use Facility-level estimation
To estimate the amount of
oxygen an existing facility
needs
To estimate the amount of
oxygen a facility will need
• Records of past oxygen
use
• Number of general beds
• Number of critical care beds
• Or specific facility
infrastructure plans
• *
What is
your goal?
What are
your data?
Essential
questions
* Plan for 100% bed occupancy
Source: WHO - Tools and resources for oxygen system planning and procurement

14. @ CMC Pulse - 24/05/2021
Determining peak flow
Number of
beds
Flow rate
(LPM)
Required LPM
Standard beds 700 0.75 525
Critical care beds 100 10 1000
Total 800 1525
• 1525 LPM = 10135 D Type cylinders per month or two 1000 LPM PSA/
VSA plants or two numbers of 5 KL LMO plants
• Average consumption is generally 35% - 40%

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4. Current situation in Indian Hospitals
Source: Paul C, Paul J, Babu A. Hospital oxygen supply: A survey of disaster preparedness of Indian hospitals. Indian J
Respir Care 2020;9:216-20.
Primary Oxygen Supply Reserve Oxygen Supply
Alarm systems

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5. Planning of the system – Good Practices
• Auto changeover from supply to backup
• Common mistake – single pipeline from the primary
source
• Cylinder manifold should not be placed at the same site
as the LMO or Oxygen concentrator
• Reserve supply at a different location even if both are
manifolds
• Manifolds and concentrators (higher floors) at higher level
to mitigate flood and other disasters
• Primary supply should meet requirement of atleast 4 days
and reserve 3 days (B type cylinders are not reserves)

17. @ CMC Pulse - 24/05/2021
6. Disaster Planning
• Hourly monitoring
• Oxygen conservation measures, Oxygen audit/
stewardship programs
• Offset loads- portable concentrators, reduce surgical load,
frequent audit of pipelines and terminal ends, use of
medical air instead of oxygen for anesthesia machines
( 400 LPH for an adult patient)
• Alert levels to be fixed
• Core oxygen monitoring group
• Escalation matrix
• Disaster management protocol

18. @ CMC Pulse - 24/05/2021