Designers Guide

Timothy Allinson, P.E., Murray Co., Long Beach, Calif.

Medical gas design, Part 1

he other day, one of our recently hired engineers came to me to talk about medical gas systems. This fellow is very smart and quite experienced but has not had a lot of hospital experience, so I gave him a little overview of what I know about med gas design. I thought you might enjoy reading about it too. The first thing to understand about med gas design is that there is no singular method of system sizing. Different engineers do it different ways. Some engineering offices have firmly established standards, and that is great, but I think they are few. I applaud the ones that do; its something I need to get around to here at my own office. Medical gas systems are generally governed by NFPA 99 as the design standard. The governing year of NFPA is very important, as the standard has changed considerably over time. Until last year, here in California we went by the 1999 edition, which, in my opinion, is far superior to subsequent editions. We now follow the 2002

edition, but I keep my 1999 edition near at hand as it is a valuable reference. I suggest that you obtain a copy if you dont have one. NFPA 99C is the condensed version of NFPA 99 that deals only with medical gas and not the cumbersome electrical portion. It is less expensive and easier to use, so if you want to purchase this standard, 99C would probably be your best bet. NFPA divides med gas systems into three levels. Level 1 is for a full-blown surgical hospital. The other levels are defined differently in the various years of NFPA 99, but suffice it to say that those levels are for other than full-blown surgical hospitals. This article will focus on Level 1 systems. One of the great things about the 1999 edition of NFPA 99 is that it has very specific information about sizing medical vacuum systems, complete with examples. Subsequent editions do not have such specific information. None of the editions are very specific about the pressurized gases (air, oxygen, nitrogen, N2O

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Designers Guide
and CO2), presumably because there is more room for error when designing pressurized systems compared to designing vacuum systems. The reason is that a medical vacuum system only has 4" of mercury (Hg) available for friction loss (less than 2 psi), while the pressurized systems have 5 psi or more, so there is an inherent factor of safety of 2.5 or greater when designing pressurized systems versus vacuum. For the purpose of this article, I will reference section numbers from the 1999 edition of NFPA 99. Where NFPA falls short as a design guide, other references must be employed. The ASPE Design Handbook 3, Chapter 2, has good information, but it needs to be used selectively. I also have a pipe sizing slide-chart printed in 1980 for Allied Healthcare products by American SlideChart Corp., which is a useful tool. Also, the major medical gas equipment manufacturers such as Allied, BeaconMedeas, and others have some useful design information in their catalogs and online. I use all of these references, coupled with a little common sense, when designing medical gas systems. Lets start with medical vacuum. The schematic arrangement for a vacuum system is not unlike a cold water plumbing system, with a few significant differences. Vacuum pumps do not draw their supply from a main; instead, they exhaust it through the roof. Care must be taken when locating the vacuum exhaust to keep it away from windows, air intakes and the like. Refer to the manufacturers literature when sizing the exhaust pipe. NFPA has a schematic of a typical medical vacuum pump arrangement (Fig. 4-3.2.1.10). All of this equipment comes skid-mounted when purchased from one of the major manufacturers, so this detail is of little use. NFPA Figure 4-3.1.2 shows a typical med gas system schematic. It is really drawn for oxygen in the way the supply is shown, but the remainder of the distribution system is essentially generic for all the medical gases, including vacuum. The supply main feeds one or more risers that have service shutoff valves on each floor. The floors are divided into zones with valve boxes (ZVB) located in the corridors. Zones should differentiate between room types as well as room quantities. Patient rooms should be zoned with one ZVB serving a reasonable number of rooms, often dictated by architectural arrangement. It is unusual to have more than 10 patient rooms along one corridor wall, and it is unusual to have more than 10 rooms served by one ZVB. While there is no maximum number of patient rooms dictated for a ZVB, the subject hospital might have criteria limiting their number. Keep in mind that the vacuum piping should parallel the
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Designers Guide
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air and oxygen, as well as the other gases required for the operating rooms and the like, where they occur. The piping shown in Fig. 4-3.1.2 is drawn single-line but would typically be representative of three or more med gas services in parallel. One noteworthy and poorly understood detail depicted in Fig. 4-3.1.2 is the requirement for alarm pressure switches. Patient rooms do not require alarm pressure switches associated with the ZVBs, just pressure gauges downstream (that come with the ZVB). Only anesthetizing, recovery and critical care areas require alarm pressure switches. In anesthetizing areas, the pressure switches are located upstream of the ZVB, while, in recovery and critical care, they are located downstream of the ZVB. Why this distinction exists I do not understand, but it is clearly shown in the diagram, as well as in later editions of NFPA 99, Figure A.5.1.4. In the patient rooms, the vacuum piping drops in the wall at the head of the bed to the vacuum inlets. These days, most patient rooms are designed with headwalls that incorporate two, three or four vacuum inlets. It is important to understand that multiple inlets are provided for the convenience of the doctors and nurses and are generally not used in unison. Once the system has been laid out in plan and risers drawn, the piping and vacuum pumps can be sized. This is where the various available references begin to differ in their strategy. NFPA recommends a design flow rate of 1.5 cfm per inlet for the first patient room and 0.25 cfm per inlet for two or more patient rooms, whichever is larger. When the number of outlets grows sufficiently large, a diversity is applied per the curve shown in Fig. A4.3.2.2.1. Curve B is for patient rooms, while curve A is for ORs and other critical areas. In contrast, the Allied slide-chart recommends 0.5 cfm per patient room with no diversity for the entire system. As a third approach, ASPE Table 2-6 recommends 1.5 cfm per patient room inlet with a diversity for distribution piping of 50% for surgical patient rooms, and 1 cfm per patient room inlet with a diversity of 10% for medical patient rooms. This distinction has never made sense to me, because all of the patient rooms I have come across (other than ICUs) are referred to as med-surge. ASPE has another diversity reference in Table 2-21, oddly referred to as medical laboratory vacuum, which has a sliding scale of 100% for four inlets, 80% for 12 inlets, and so on. This approach makes more sense to me than applying a singular diversity of either 50% or 10%, per Table 2-6. I use a combination of the multiple design options listed above when determining medical vacuum flow rate for designing the most efficient system. For example, the NFPA criteria of 1.5 cfm per inlet will produce oversized branch piping, especially with the common headwall condition of multiple inlets per bed. In contrast, the 10% diversity referenced by ASPE might produce undersized piping in certain parts of the system. The engineer must use his or her experience and discretion when making final design decisions in this respect
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or should consult with a mentor who has the appropriate experience. With flow rate known, the other variable required to size piping is friction loss. A widely accepted industry standard for sizing vacuum systems is a friction factor of 0.5" Hg loss per 100' of pipe. This is based on the fact that most systems have 4" Hg available for friction, with 19" Hg at the source and 15" Hg required at the inlet. Accordingly, the 0.5" friction factor will accommodate up to 800' of pipe length; most hospital systems are in that ballpark. However, for an unusually large or small system, the friction factor should be adjusted up or down accordingly. Based on these criteria, below is a table I developed to use for vacuum pipe sizing on a recent project. As the

notes indicate, it is based on the flow associated with a 0.5" friction factor, 0.5 cfm per inlet, two inlets per room and the NFPA Group B diversity curve. These criteria were condensed into a simplified table such that the piping could be sized based on the number of rooms served. This table was used only for sizing piping serving standard med-surge patient rooms. ICUs, ORs and other critical areas were sized using the flow rates and diversities appropriate for those occupancies. Lastly, the overall flow rate of the vacuum pump supply must be determined. As noted earlier, the major equipment manufacturers all have sizing criteria in their product literature; however, I prefer to just do a sum total of the patient room flow rate plus the flow rates associated with the critical care areas. This sum can then be compared to the flow rate determined by the manufacturers literature. If there is a considerable disparity between the two techniques, the engineer should investigate the basis of this disparity. Since starting this article, a new design-build hospital project came across my desk. The first thing I did was review the med gas equipment indicated on the criteria
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Designers Guide
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documents. I found that the medical vacuum pumps were obviously oversized for the scope of the project. I scrutinized the sizing with two different calculations. The criteria docs called for vacuum pumps rated for 196 cfm. I counted the vacuum inlets and came up with a total of 202 patient inlets and 40 OR inlets serving 16 ORs. I then did two calcs, one based on NFPA and one based on a sensible amalgamation of techniques. Heres the NFPA calculation: 202  0.25 cfm  24% = 13 cfm 16 ORs  1.5 cfm = 24 cfm Total: 37 cfm Refer to NFPA C-4.3 for further information on this calculation. Note that the 24% is from the NFPA Group B diversity curve. This total seemed low, especially compared with the criteria documents, so I did a second calculation as follows: 202  0.5 cfm  25% = 25 cfm 40  1 cfm  100% = 40 cfm Total: 65 cfm

This calculation is what I would call a hybrid approach, using a patient inlet flow rate compromise between the NFPA recommendation and the ASPE table. The diversity is consistent with NFPA. The OR flow rate is 1 cfm per inlet rather than 1.5 cfm per OR. The end result is a flow rate that feels right, as it is far less than the value called out on the criteria documents but twice the result of the NFPA calculation. Next month, I will continue with a discussion of the pressurized gas systems. I Timothy Allinson is a senior professional engineer with Murray Co., Mechanical Contractors, in Long Beach, Calif. He holds a BSME from Tufts University and an MBA from New York University. He is a professional engineer licensed in both mechanical and fire protection engineering in various states, and is a LEED accredited professional. Allinson is a past-president of ASPE, both the New York and Orange County Chapters.

The views and opinions expressed in this column are those of the author and do not reflect those of Plumbing Engineer nor its publisher, TMB Publishing.

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