DRAFT GUIDANCE NOTE ON

LIQUID MEDICAL OXYGEN (LMO) STORAGE TANKS

1. Rapid rise in COVID-19 cases and resultant rapid demand of medical oxygen has
provided a window of opportunity for re-visiting the SOP available on oxygen transportation,
storage infrastructure and safe handlining for patient use at the healthcare facilities. In this regard
GoI MHA, NDMA has issued guidelines on safe storage, transportation, and handling of liquid
medical oxygen (LMO) for medical use vide DO.5-95/2020/Mitigation dated 23rd April 2021 which
needs to be followed to minimize the inherent risk involved. Medical oxygen is an important drug
for saving lives, both for COVID – 19, as well as for other critical illnesses. Medical Oxygen is
available in gaseous form in cylinders, or in liquid form (Kept in cryogenic state, cooled to -183
degree centigrade), stored in cryogenic tanks.

2. Liquid Medical Oxygen (LMO) is a preferred source of medical oxygen, because of the
following reasons:

(a) The purity of oxygen from this source as per IP 2018 is 99% v/v of oxygen.
Moreover, the purity is constant, and does not vary with flow etc. This also makes it ideal
for use with ventilators and at critical ICU beds.

(b) There are no operational costs associated with Liquid Medical Oxygen (LMO)
administration. Once it is filled into the tank inside the hospital premises, it flows into the
Medical Gas Pipeline System (MGPS) of the hospital, on its own, (once the valve is
opened). No extra manpower, no electrical power, no maintenance, is required.

(c) LMO has no limitation of Flow Rate. It simply supplies at whatever flow rate is
required by the hospital, at any given point in time. Other sources of Oxygen may fail, or
shut down, if the flow required by the hospital at any given time, exceeds the flow rating
of the oxygen source.

(d) The storage capacity of LMO is large. One liter of Liquid Medical Oxygen is
equivalent to approx. 870 liters of gaseous Oxygen.

3. Healthcare facilities can be equipped with large bulk cryogenic liquid oxygen tanks that
are refilled periodically by a truck from supplier. The liquid oxygen tank supplies a centrally piped
system (MGPS) throughout the health facility independent of power supply. Liquid Medical
Oxygen (LMO) demands a MGPS. A safe, open, unhindered space in a hospital premise. It also
demands installation of a storage tank which needs a PESO license and a third-party supply
dependence. It also demands as a best practice of having 1 to 2 days oxygen supply through
cylinders as backup (Reserve). Liquid oxygen is a far better, economical, safer method than
supply through cylinders or PSA plants but is a supplier dependent method.

4. Cryogenic liquids are liquefied gases that have a boiling point between -150 degree
centigrade to -270 degree centigrade. Liquid oxygen is in a cryogenic form at -183 degree
centigrade. A typical liquid oxygen storage system consists of a cryogenic storage tank,
vaporizers, and a pressure control system. The LMO tank is a double walled vacuum insulated
vessel (Maximum Allowable Working Pressure of 16 to 18 Kg/square cm with certified standards
as per ASME/EN/Equivalent – ASME Sec.VIII/EN-13458-2/Equivalent), the capacity of which
can ranges from 2 Kilo Liters to 20 Kilo Liters. The walls are made of stainless steel designed for
a positive pressure at cryogenic temperature, with a vacuum between them (Filled with perlite
under vacuum), to insulate the contents from ambient heat.

5. Liquid oxygen is stored, transported, and handled in several types of containers,

depending upon the quantity required by the user. The types of containers in use include the
Dewar, cryogenic liquid cylinder and cryogenic storage tanks. All tanks are vacuum insulated and
equipped with various circuits to control product fill, pressure build up, pressure relief, product
withdrawal, and tank vacuum. Liquid transfer or withdrawal lines are insulated to minimize the
loss of liquid product to gas and is used to safely remove liquid product from either Dewars or
cryogenic liquid cylinders.

6. The LMO storage tank should have pressure valve, safety devices, two separate liquid
withdrawal valves with dual parallel regulator system for uninterrupted supply, 3-way gauge valve
for isolation of line pressure with manual control. The tank should be PESO certified and outer
shell material used should conform to EIGA IGC 73/08/E/IS2062/SA36. A typical system
requirement for hospital installation is as follows:
 LMO Storage Tank
 Ambient Air Vaporizer – should provide ambient air heat exchange which is able to
vaporize 300-600 N cu M per hour LMO into vapours.
 Pressure regulation skid
 Interconnecting pipe between tank and vaporizer.
 Foundation bolts for tank and vaporizer

7. LMO tanks are installed vertically in open space in the hospital premises. The selection
of location should comply with PESO regulations. Allocated space should be 9M (W) X 16 M (L)
at ground level and should be accessible for smooth movement of LMO tanker from/to the site.
The supply of liquid medical oxygen shall conform to specified codes (latest edition): Medical
Oxygen IP 2018 and subsequent revisions. Avoid installation of LMO tank in the indoor
environment or near drain or pits. The site should not have overhead power or other utility cable.
The site should be fenced having a gate for entry/exit. Fire extinguishers & water connection,
lighting, safety warnings, earthing pit etc.

8. Vaporizers convert the liquid oxygen into a gaseous state. A pressure control manifold
then controls the gas pressure that is fed to the process or application. The atmospheric vaporizer
should be of suitable material (Non-ferrous) for operation at low pressure. Oxygen converts from
a liquid to gaseous state in contact with the ambient temperature as it expands over approx. 860
times. The tank has a built-in evaporator so that the liquid oxygen keeps on evaporating into
Oxygen gas (Natural evaporation rate should be less than 1% of net volume per day). Vessels
used in liquid oxygen service should be designed for the pressure and temperature involved.
Piping design should follow similar design and conform to national standards and codes.

9. Some important points to be kept in mind, while planning installation of LMO tanks at the
healthcare facility are appended below (General Specifications of LMO Tank is placed at
Annexure C):

(a) The tank should be located in open space (open to sky)

(b) Vacant space should be provided within a radius of 5 meters around the tank.

(c) Suitable distance from any combustible substance should be maintained. Liquid
oxygen in itself is not an explosive but facilitates combustion easily.

(d) Easy approach of truck which comes to fill the tank.

(e) Permission from Chief Controller of Explosives, Nagpur (Regional offices available
across the country).
 (f) Existence of a Medical Gas Pipeline System (MGPS) network in the hospital is a
pre-requisite for any source of Medical Oxygen, including LMO for delivery till individual
bedside.

(g) The back up or secondary source of oxygen, mandatory as per MGPS norms and
standards, remains the high-pressure Oxygen cylinders (Type D), connected to the gas
manifold.

10. The norms for setting up of PSA Plants and LMO tanks have been issued by Ministry vide
letter dated 6th July 2021 (Annexure A).

11. Safety Considerations: The hazards associated with liquid oxygen are exposure to cold
temperatures that can cause severe burn injury, over pressurization due to expansion of small
amounts of liquid into large volumes of gas in inadequately vented equipment, oxygen enrichment
of the surrounding atmosphere (defined as atmosphere containing more than 23.5% oxygen),
and the possibility of a combustion reaction if the oxygen is permitted to contact a non-compatible
material. The low temperature of liquid oxygen and the vapours it releases not only pose a serious
burn hazard to human tissues but can also cause materials or construction to lose their strength
and become brittle enough to shatter. Any clothing that has been splashed or soaked with liquid
oxygen or exposed to high oxygen concentrations should be removed immediately and aired for
at least an hour. Personnel should stay in a well-ventilated area and avoid any source of ignition
until their clothing is completely free of any excess oxygen. Clothing saturated with oxygen is
readily ignitable and will burn vigorously.

12. Safety while storage and handling liquid oxygen:

 Store and use liquid containers with adequate ventilation. Do not store containers
in a confined area or in area unprotected from extremes of weather.
 Cryogenic containers are equipped with pressure relief devices designed to control
the internal pressure. Under normal conditions these containers will periodically
vent product. Do not plug, remove or tamper with any pressure relief device.
 Oxygen must be separated from flammables and combustibles by at least 5 M or
2.5 M fire wall. Post ‘No Smoking” and ‘No Open Flames’ signages.
 Cryogenic containers must be stored, handled and transported in the upright
position. When moving, never tip, slide or roll containers on their side. Use a suitable
hand truck or trolley for moving smaller containers. Avoid mechanical & thermal
shock while moving cryogenic oxygen cylinders
 Use only transfer lines and equipment designed for use with cryogenic liquids.
should be well insulated.
 Personnel must be thoroughly familiar with properties and safety considerations
before being allowed to handle liquid oxygen and its associated equipment. The
eyes are most susceptible to the extreme cold liquid and vapours of liquid oxygen.
 A diffuser to be attached to the transfer hose to reduce turbulence & release of gas
while filling up from tanker.
 Use phase separator or funnel for the inlet of the receiving hose pipe.
 Never dispose-off liquid cryogens down the drain or sink. Allow cryogenic liquids to
evaporate in a ‘Fume Hood’ in open space.

13. Regulatory requirement

 All statutory requirements of the Chief Controller of Explosives of India and SMPV
rules need to be followed; besides all regulations and guidelines put forward by
the State/UT competent authority.
 Civil work & PESO approval (Online application)
  PESO approval for filling & operation of the LMO installation
 Fencing & gate around the installation.
 Fire extinguisher, water connection, lighting, safety signages, earthing pit for
lightening arrestor.
 Allocated space for installation should be 9M(W) X 16M(L)
 Site should be selected at ground level, outdoor, without overhead power or other
utility cable.
 Should have assigned space for smooth movement of LMO tanker from/to the
installation.
 Display of liquid oxygen level and outlet gas pressure should be provided.
 Automatic change over should be provided between the LMO tank and existing
oxygen manifold in the health facility premises.

14. Submittals:
 Approval letter from CCOE along with approved drawing from CCOE.
 Approval letter from CCOE for use of cryogenic vessel(s) at site.
 Certificate from the authorized inspection agency.
 Heat chart for pressure parts.
 Dimensions check report.
 Dished End report.
 Mechanical properties test report for production test coupon.
 Visual inspection report.
 Radiography examination report
 Liquid penetrant examination report
 Cleaning inspection report.
 Hydro-pressure test report.

15. Maintenance and Training

 The vendor/supplier should organize satisfactory on-site training to the health

facility staff designated by the authority for a period of 2 weeks
 Refresher training shall be provided by the vendor/supplier at the time of
scheduled preventive maintenance visit by service engineer.
 Maintenance, repair, and safety of the whole installation and LMO related to liquid
oxygen vessel will be the responsibility of the supplier and monitored by the
hospital management committee.
 The oxygen tank and associated equipment, control panel, pipeline etc should be
placed under CAMC for 5 years. On-line helpline support/complaint system shall
be provided by the vendor/supplier.

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Encl: 1. Annexure A – Letter from MoHFW dated 6th July 2021.

2. Annexure B – Layout diagram.
3. Annexure C – Draft General Technical Specifications of LMO Tank
ANNEXURE B
 ANNEXURE C

DRAFT TECH SPECS OF LIQUID MEDICAL OXYGEN STORAGE TANK

The double walled Vacuum Insulated Evaporator (VIE) shall be constructed of stainless-steel
inner vessel contained within a carbon steel outer vessel. The annular space between the vessels
shall be filled with non-inflammable perlite insulation material to insulate under vacuum. The VIE
should be self-pressurizing type by partial evaporation of liquid oxygen through a pressure
building coil by a non-ferrous imported pressure regulator.

The vessel shall be supplied as a functional whole with all materials of construction & the cleaning
regime suitable for medical grade liquid oxygen. Material used (including lubricants) should
conform to EIGA IGC 73/17/E (Revised version of Doc 73/08).

The LMO tank should have Liquid outlet & Gas Outlet along with all the necessary valves and
accessories. There is constant display of the level of LMO and pressure etc. inside the vessel.
The output from the tank is connected through a copper pipe of suitable diameter to the MGPS
network at the MGPS Manifold.

Quantity: 10 KL x 1 No.

Installation: Outdoor

Type : Double walled, vertical


Capacity : Minimum 20,000 liters water capacity

Design code: ASME Sec.VIII Div.I latest Edition / EN - 13458-2 Annexure-C/ AD2000
MARKBLATTER 2004 Edition

Max. working pressure: 17 Bar G

Design temperature: -196 to +50 degrees Centigrade

Hydraulic Test Pressure: 26 Bar G

Type of Insulation: Vacuum , perlite filled

Safety Valve Set pressure valve : 17 Bar G (Dual safety valve with three way diverter valve)

Bursting Disc Set Pressure : 23 Bar G

Standard fittings : Pressure rising coils
capacity and size, dual safety valve with imported three
way diverter valve, bursting disc., pressure gauges, liquid over flow line, Liquid level gauge and
adequate numbers of extended spindle glove valve etc.

The pressure regulator installed should be made of suitable material (Non ferrous) with bonnet &
trim parts. Inlet pressure max. 20 Kg/sq cm., outlet pressure range within 0.5 to 10 kg per sq cm
(adjustable).

Maximum Evaporation Rate: <1% of net value.

Material of Construction: Inner shell and wetted parts of SS 304
Outer shell of CS ASTMA 516
Gr. 70 / CGA 341 2002 EN13455 S275/S355

Joint Efficiency: 100%


Radiography :100% for inner, for outer spot

External piping: From LMO Tank to Vaporizer SS304. From Vaporizer to inlet of
Pressure
Reducing Station SS304.
From Outlet of Pressure Reducing Station to Main header
Copper.


Cryogenic Valves: Non-ferrous

Cryogenic Safety Valves: Non ferrous

Pressure Building regulator: Non ferrous with standard specifications.

Leak Detection test: Helium Leak detection

Inspection: By 3rd party (SGS/LLOYDS/TUV)

Cleaning Nitrogen: with degreasing for Service and Pressurize

Withdrawal rate: 1000 cum per hr. at 12 bar G

Should have safety features in line with Global Safety as part of installation The minimum
safety (Alarm) features for LMO installation are as follows:

 Alarm VIE (Vacuum Insulated Evaporator)

o For low content level (audio-visual) and
o Low pressure alarm (audio-visual) and backup at manifold room.
 Alarm VIE low pressure alarm (audio-visual) low pressure in pipeline system. Deviation
or fall in pipeline pressure by more than plus minus 10% from nominal distribution
 pressure (The nominal distribution pressure should be within the range of 400kPa to 500
kPa).
 Alarm for changeover from primary to secondary supplies.
 Alarm for secondary or reserve supply below minimum pressure.
 Dual parallel regulator system for uninterrupted supply in case of regulator has to change
for repair. One regulator is set at 4.2 bar and the other at 3.8 bar as per international
practice.
 Three-way gauge valve for isolation of line pressure with manual manoeuvre.
 Remote monitoring telemetry-continuous monitoring of VIE stock based on daily
consumption (automatic modification of tank replenishment).

Pressure Reducing Station

 The healthcare facility supply pipeline reducing station which reduces supply pressure
must consist of dual parallel regulator system.
 Both regulators must be online, and all isolation valves and regulators must be kept
in the open position.
 The nominal distribution pressure should be maintained within the range of 400kPa to
500kPa.
 Pressure relief Valve – Medical oxygen pipeline system should be provided with a
pressure relief device downstream of the line pressure regulator connected by means
of a 3-way valve.
 Material used should conform to (including lubricants) EIGA IGC 73/17/E
 The control equipment should be protected from weather.

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