# Medical Gas Supply Systems > Medical gas supply for OT Technology: 4 bar pipelines, cylinder manifolds with auto-changeover, area valves, outlets, PSA plants and liquid oxygen in India. - Canonical URL: https://prepelephant.com/topics/allied/operation-theatre-technology/gas-supply-systems-ott - Exam / course: Allied Health · Subject: Operation Theatre Technology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Medical Gas Supply Systems", PrepElephant, https://prepelephant.com/topics/allied/operation-theatre-technology/gas-supply-systems-ott ## Direct answer Four hundred kilopascals — about 4 bar — is the pressure at which medical gases arrive at the theatre wall, having travelled from a cylinder manifold or central plant through copper pipework, area valve service units and terminal outlets that only accept their own gas-specific connectors. A manifold runs duty and reserve banks of large cylinders with automatic changeover when the duty bank falls; hospitals above a certain size add liquid oxygen storage (the vacuum-insulated evaporator) or pressure-swing-adsorption plants — the technology India scaled across districts during the COVID-19 second wave. Daily, the technician verifies outlet pressures, keeps the machine's reserve ready, and knows which area valve shuts in a fire: the gas supply is a building-wide system the theatre plugs into, not a cylinder in the corner. ## What you must remember - **Line pressure:** about 4 bar (400 kPa, roughly 50 psi) at the terminal outlet — the number the machine's pipeline gauge should read during every check. - **Manifold:** duty and reserve banks of J-size cylinders; automatic changeover at a set falling pressure with an alarm at the central panel; cylinders regrouped and part-used ones labelled. - **Central plant options:** liquid oxygen VIE storage for large hospitals; pressure swing adsorption (PSA) plants producing 93% ± 3 concentration oxygen — widely installed in Indian government and district hospitals after 2021. - **Distribution:** degreased copper pipework with brazed joints, area valve service units (AVSU) isolating each theatre or zone, and gas-specific terminal outlets (Schrader-type or pin-indexed) preventing cross-connection. - **Non-interchangeability:** outlet connectors, hose connections (NIST-type) and machine inlet fittings are gas-specific by shape and thread — the engineering behind "you cannot plug oxygen into the nitrous line". - **Anaesthesia machine reserve:** at least one E-size oxygen cylinder on the machine yoke, kept half-full or better, for pipeline failure and patient transport. - **Alarms:** central gas plant panel alarms for bank depletion and line pressure deviation; theatre area gauges checked daily and recorded. - **Fire response knowledge:** in a theatre fire or major leak, the zone's area valve is shut — every technician must know its location, because it is behind the panels, not at the bed. ## The daily supply round, beginning at the wall The round starts in the theatre: wall outlet gauge near 4 bar, hose undamaged, each gas flowing cleanly at the outlet. The reserve cylinder on the yoke is opened briefly — pressure noted, roughly 137 bar for a full oxygen cylinder — and closed again, its valve re-seated. In the corridor, the AVSU panel is intact — this is the valve that stops gas to this theatre in a fire, and every technician must know where it is. At the manifold room or plant, the duties are bigger: duty bank pressure recorded, changeover verified (a reserve bank that never rotated is a silently emptying asset), leaks sniffed by sound and soap — never by an open flame — and the alarm panel's status lamp confirmed healthy. For a PSA plant, the round adds the concentration readout and compressor status; for a VIE, tank level and pressure, with frost line and venting behaviour understood. Cylinders are stored upright, chained, separated into full and part-used, caps on when off the machine. Every finding is written down — supply failures announce themselves days ahead in gauges nobody read. ## Where students slip The first wrong belief is "the pipeline is unlimited": a pipeline failure — maintenance error, closed area valve, plant shutdown — is why the machine carries its checked daily reserve. The second is pressure confusion: candidates quote cylinder pressure (about 137 bar for oxygen) as pipeline pressure; the pipeline is 4 bar after regulation, and mixing the two numbers in one answer loses both. Third, the pin index system is described for wall outlets — pin indexing belongs to cylinder valves; wall outlets use gas-specific Schrader or profiled connectors, a different engineering for the same principle. Finally, PSA-plant answers without the concentration (93% ± 3) or the COVID-era rationale read as slogans; the viva wants both. ## Frequently asked questions ### At what pressure is medical gas delivered at theatre outlets? About 4 bar (400 kPa), regulated down from cylinder or plant pressure — verified daily on the machine's pipeline gauge during the check. ### How does a cylinder manifold maintain supply? Duty and reserve cylinder banks with automatic changeover at a preset falling pressure, annunciated at the central alarm panel, and manually rotated for refilling. ### What is a PSA oxygen plant? A pressure swing adsorption plant extracting about 93% ± 3 concentration oxygen from air on site — the technology widely deployed across Indian hospitals from 2021 onwards. ### What is an area valve service unit? A zone isolator that shuts medical gas supply to one theatre or area — the first valve to close in a fire or major leak, and every technician must know where it is. ### Why does the anaesthesia machine keep a reserve cylinder? For pipeline failure and patient transport: a half-full or better E-size oxygen cylinder, checked daily, bridges any central supply interruption.