Safe Handling of Medical Gas Cylinders

Ernest E. Allen, ARM, CHFM, Senior Patient Safety Risk Manager, The Doctors Company

Medical gas cylinders are commonly used in physician and dental offices, ambulatory surgery centers, acute care hospitals, and other types of healthcare facilities. When incorrectly used, handled, or stored, gas cylinders can create dangerous physical and chemical hazards for patients and staff.

The use of medical gas cylinders in healthcare facilities is covered by the following standards:

During office or facility surveys, CMS, The Joint Commission, or other accrediting agencies can cite for improperly handling medical gas cylinders.

The guidelines below can help you handle compressed medical gas cylinders safely and stay in compliance with the standards.

Segregate and Label Full and Empty Cylinders

NFPA, OSHA, and accreditation agencies require full and empty gas cylinders to be segregated when stored. Label stored gas cylinders by placing a “Full” or “Empty” sign on the storage cart, a tag around the neck of the cylinder, or signs on the wall space behind the stored cylinders. Labeling them is important to ensure that staff can pick up a full oxygen cylinder when needed. Check cylinders on a periodic basis and replace empty cylinders (at 500 psi) with full ones. To help monitor the amount of oxygen used, purchase oxygen cylinders that include the pressure gauge.

Secure All Cylinders

A compressed gas cylinder can become a flying missile if it falls on its stem and releases the high gas pressure. To avoid potential injury, property damage, or fire, never leave a cylinder standing free or unsecured on the top of a patient cart, bed, or exam table. When not in use, medical gas cylinders should be secured in stands or storage carts, or chained to walls. One chain is sufficient to secure the cylinders, except in seismic areas, where two chains may be recommended.

Calculate the Maximum Oxygen Storage Limit

NFPA 99 limits the amount of oxygen stored in a smoke zone to 300 cubic feet. Each E-size cylinder holds 25 cubic feet of oxygen, so the maximum number of E cylinders allowed is 12. Keep in mind that a large H cylinder holds 250 cubic feet of oxygen, so the maximum number allowed to be stored in a smoke zone would be one H cylinder and two E cylinders.

“In Use” Exception: Oxygen cylinders attached to an anesthesia machine, wheelchair, or patient cart are considered “in use” and are not counted when calculating the amount of oxygen stored in a smoke zone.

Oxygen Storage Options: Some facilities use special UL-rated fire cabinets to store more than 12 E cylinders in a smoke zone. For example, you could safely store 24 E cylinders or more in a cabinet with a one-hour rating. If you use a storage room with one-hour fire-rated walls and a 45-minute fire-rated door, you could store up to 3,000 cubic feet of oxygen. You would, however, need to maintain a safe distance between the oxygen cylinders and any combustible materials in the room. If the storage room has sprinklers, only five feet of distance between the cylinders and combustible materials is required. If the room does not have sprinklers, a distance of 25 feet is required. The door to a large medical gas cylinder storage room should be kept locked.

Secure Outside Cylinder Storage

If stored outside, medical gas cylinders should be in a fenced area with a locked door or gate for security. NFPA 99 advises protecting cylinders during winter from accumulations of ice or snow and, during summer, screening cylinders from continuous exposure to direct rays of the sun in localities where extreme temperatures prevail. Consider installing a small roof over the medical gas cylinder storage area.

For additional information, see our companion article “Medical Gas System Safety” or contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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