Oxygen Cylinder Safety at Home

What you have in the room

A home oxygen cylinder set usually includes:

• The cylinder, painted or labelled for medical oxygen. Colour codes vary by country, so rely on the label and the supplier's documentation, not colour alone.
• The valve, at the top, often with a hand wheel or a key, which opens and closes the gas.
• The regulator, attached to the valve, which lowers the pressure for safe use.
• A pressure gauge, showing how much gas remains.
• A flow meter or dial, where you set the prescribed litres per minute.
• A humidifier bottle in some cases, and the tubing and cannula or mask.
• A trolley or stand to keep it upright.

Use only equipment designed for medical oxygen. Never swap fittings from other gases, and never use adaptors to force a connection.

Where to keep it

• Upright and secured, chained or strapped to a wall, a stand or a trolley, so that it cannot fall. A falling cylinder is one of the biggest risks.
• In a cool, dry, well-ventilated place, away from direct sun, radiators, geysers, stoves, hot water pipes and electrical panels.
• Away from flames and sparks, including gas stoves, tandoors, candles, diyas, agarbatti, matches and lighters. The maker or supplier states the minimum distance; keep at least two metres from open flames or heat sources unless told otherwise.
• Away from oil, grease and flammable liquids, such as cooking oil, hair oil, petroleum jelly, solvents and paint.
• Not in a closed cupboard, a car boot in summer or a terrace in sun and rain. Do not leave it in a hot parked vehicle.
• Not in a corridor or stairway where it blocks the way out or can be knocked.
• Out of reach of children and visitors who may play with the valve.
• In an apartment, check society rules and avoid cluttering common areas; see lifts and apartment living for seniors.

Keep spare full cylinders and empty ones separate and labelled, so nobody mistakes an empty for a full one.

Handling the cylinder

• Never drag or roll it. Use a trolley. Carry only with the valve protected and with help; they are heavy.
• Never hold it by the valve or regulator.
• Do not drop or knock the cylinder. If it falls, close the valve, check for damage and leaks, and call the supplier before using.
• Do not paint, mark or alter the cylinder.
• Keep the protective cap on when the regulator is not attached, if the supplier provided one.
• Do not refill or decant oxygen. Only a licensed supplier may refill.

Connecting and opening safely

Ask the supplier to demonstrate, and follow the manual. In general:

1. Make sure no one is smoking and no flame is nearby. 2. Check that hands are clean and free of oil, hand cream and sanitiser. Never use oil or grease on the valve or regulator, even to ease a stiff thread. Use only what the supplier provides. 3. Inspect the regulator and washers for damage. Do not use if cracked, dirty or oily. 4. Attach the regulator with the correct fitting, finger-tight or with the supplied key, as instructed, without force. 5. Check the flow dial is at zero before opening the cylinder. 6. Open the valve slowly, a little at a time, standing to the side, not in front of the gauge, then fully open as the maker says, perhaps then back a quarter turn, if the manual advises. 7. Read the gauge to check there is enough gas. 8. Set the prescribed flow and confirm gas at the end of the tubing before putting the cannula or mask on the person. 9. To stop: close the cylinder valve first, then let the gas out of the line by letting the flow continue until the gauge falls to zero, then set the flow to zero. Follow the manual, since the order matters.

See oxygen flow rates and prescriptions: what families should know. Never change the prescribed flow yourself.

Reading the gauge and planning refills

The gauge shows pressure, which indicates how much gas remains. Learn the colour zones (full, low, refill) or the number scale on your regulator. Plan to exchange the cylinder when the needle reaches the low zone, not when it is empty, particularly at night. To estimate time, divide the litres of gas in the cylinder by the flow per minute, as in oxygen cylinder or concentrator: which suits home use?. Keep the supplier's number and a refill schedule, and always have at least one spare full cylinder if the person depends on it. In India, supply can tighten at night, on holidays and in crises, so order early.

Fire safety rules

Oxygen from a cylinder is almost pure, so the fire risk is even greater than with a concentrator.

• No smoking by anyone near the equipment or the person, in the room or home, including visitors and household helpers.
• No open flames or sparks nearby: candles, lamps, incense, gas stoves, matches, lighters, firecrackers.
• No oil, grease, petroleum jelly, hair oil, alcohol-based gel or balm on the face, hands, tubing connections, valve or regulator.
• No electrical heaters or hot objects close by.
• Avoid static: be careful with synthetic blankets and clothes near the face; do not rub the cylinder.
• Place a clear sign on the door and on the cylinder: "Oxygen in use. No smoking. No flames."
• Install a smoke alarm, test it monthly, and plan an escape route; see smoke and gas safety for older adults and safe use of oxygen and electrical equipment.
• If there is a fire, close the cylinder valve if it is safe to do so, remove the cannula, get everyone out and call 112 or the fire service. Do not go back in. Tell firefighters that medical oxygen is in the building.

Leaks

Signs of a leak include a hissing sound when the valve is open and nothing is connected, a drop in the gauge when the flow is off, a smell of rubber or cloth burning, or frost on the valve. A faint hiss from the cannula is normal; a hiss from the valve or regulator is not.

If you suspect a leak:

• Do not use a flame or sparks to check, and do not use soapy water unless the supplier specifically tells you to.
• Close the cylinder valve if it is safe.
• Open windows and ventilate, keep everyone away from ignition sources.
• Switch to a backup oxygen source if the person needs it; see oxygen at home and power cuts: a backup plan.
• Call the supplier and do not use the cylinder until checked.
• Call 112 if there is fire, heavy leakage or the person is in distress.

Moving and transporting

• Secure the cylinder upright in the car, on the floor behind the seat or in a purpose-made holder, with windows slightly open. Do not leave it in a hot, closed car.
• Do not smoke in the vehicle.
• Use the smallest cylinder that does the job for trips.
• Check the gauge before leaving and carry a spare.
• For trains, flights and buses, check rules and permissions in advance; see travelling with oxygen: trains, flights and road trips.

Daily and weekly checks

• Daily: gauge level, flow setting, tubing position, humidifier water, and that nothing flammable is nearby.
• Weekly: wipe the cylinder and trolley with a dry or slightly damp cloth, check the cap and regulator seals, check the cylinder's test or expiry date on the label and make sure the supplier's number is on display.
• After any knock or fall: inspect and call the supplier if unsure.
• Monthly: practise how to turn off the valve, so that anyone in the house can do so in an emergency.

Checking the supply and the label

Medical oxygen cylinders have labels stating the contents, the supplier, the test date and a batch number. Do not accept cylinders that look rusty, dented or unlabeled, or with a missing test date. Use medical-grade oxygen, not industrial oxygen, for patients. See medical device licences and safe buying.

When the cylinder is empty

Close the valve, remove the regulator carefully following the manual, put the cap back and label the cylinder "empty". Do not leave it with an open valve. Switch to the spare, set the prescribed flow and call the supplier for a replacement. Do not wait until the last one is empty. Return empties as agreed with the supplier, not stored indefinitely.

When to ask a professional

Ask the supplier for hands-on training, the correct regulator and written safety instructions. Ask your doctor for the prescription, target oxygen level and a plan for emergencies. Ask a nurse or pharmacist to check oximeter use; see pulse oximeters: how they work and how to use one. Call the doctor for increased breathlessness, drowsiness or confusion. Call 112 for severe breathlessness, blue lips, chest pain, collapse, a fire, a major leak or a fallen cylinder with a damaged valve.