Frequently Asked Questions (FAQs) BOC Healthcare understands that you may have many questions regarding our products and services. Here you will find a list of some of our most frequently asked questions that can help you resolve any queries you may have.

BOC Healthcare offer an extensive range of medical grade gases , all covered by Marketing Authorisations, including:

• ENTONOX^® (50% nitrous oxide/50% oxygen)
• HELIOX21^® (21% oxygen/ 79% helium)
• Medical air
• Medical carbon dioxide
• Medical helium
• Medical oxygen
• Medical nitrous oxide
• Inhaled nitric oxide (supplied via INO Therapeutics)
• Lung function gas mixtures
• Medical gas mixtures
• 5% carbon dioxide/balance oxygen
• 10% carbon dioxide / balance oxygen
• 20% carbon dioxide / balance oxygen
• 5% carbon dioxide/balance air
• 9% helium/35% oxygen/balance nitrogen

If required we can also supply any other gas, not covered by our Marketing Authorisations to your specificationunder our Specials Licence.

Yes, we now have a comprehensive range of equipment including:

• Pressure regulators
• Flowmeters
• Demand valve
• Cylinder trolleys
• Cylinder storage solutions
• FireSafe nozzles
• Cylinder bags
• Pulse oximeter probes
• Oxygen sensors

And much more…

For details of all the equipment we offer please click here. 

BOC Healthcare has a wide range of training initiatives to assist healthcare personnel in understanding and learning how medical gases can be handled and used safely.

On site group training:

BOC Healthcare representatives have wide ranging knowledge and expertise in the use and safe handling  of medical gases and we can arrange to train a small group of healthcare professionals at your site.  Training courses vary according to the detailed level instruction necessary but include:

safety training on medical gas cylinder handling
storage and use
MGPS Training for Authorised and Competent Persons (BTEC accredited)
ENTONOX training for small groups of midwives and pain teams 

Online training:

This flexible and convenient form of education is available to a wide range of healthcare professionals and includes:

Comprehensive e-learning courses on safe cylinder management 

www.boctraining.co.uk  –  Here you will find everything you need to know about ENTONOX and its use in pain management, we are continually adding to this virtual educational resource and because it is centrally controlled it is always up to date and more cost-effective to manage we do not charge for accessing this form of training.

This information is contained in BOC Healthcare’s Medical Gas Data Sheet (MGDS) which contains the Summary of Product Characteristics (SPC) for the product plus the additional safety information necessary about the product. A printed copy of the relevant MGDS is given to BOC Healthcare customers when they first take the product. Customers can always access and download the very latest version of the MGDS directly from our website. 

Please click here to access MGDS documents.

In order to receive medical gases and associated services from BOC Healthcare, you will need to open an account with us simply by phoning 0800 111 333. A Customer Service Representative will then send you all the relevant paperwork for you to open an account.

Most medical gases are classified as a “pharmacy only” drugs and their supply must be restricted to healthcare professionals only. You will therefore be required to supply your professional qualification details, a pictorial form of identification, e.g. driving license before we can provide you with these products

Medical oxygen can be prescribed safely for the majority of patients without any associated risks. In all cases it should be used as prescribed and should be based on pulse oximetry or arterial blood gas samples.

There are few instances where care is needed when prescribing oxygen, these include:

- Use in neonates

- Chronic Obstruction Pulmonary Disease (COPD) patients who are hypercapnic

- Patients prescribed bleomycin and amiodarone

- Patients who have consumed paraquat

For further guidance please see relevant guidelines from the British Thoracic Society (BTS), European resuscitation council etc.

Alcohol wipes can be used to clean the body of gas cylinders to remove any dirt or contamination that may be present. However, they must not be used on the cylinder valve or the regulator as there is a risk of ignition if the alcohol is not allowed to evaporate.

If used to clean the cylinder, please allow enough time for the alcohol to evaporate before using the gas. If the cylinder valve is contaminated, the cylinder should not be used. See our contaminated cylinder section.

If you need to transport oxygen cylinders ideally you should use a vehicle that has been designed for the purpose. However, if you need to carry oxygen for your own personal use we would recommend that:

- You restrict the number of cylinders being carried to a minimum

- You secure and transport the cylinders in a separate compartment in the vehicle (such as the boot).

- They need to be secured ideally with a Cargo net or fixed with a Karibiner and strap.

- There should be adequate ventilation within the car

- We would also advise you to inform your Insurance company

There are no specific regulations covering the carriage of small quantities of medical gases in small cylinders. However, it makes sense to follow the requirements of the regulations covering the transport of gases in larger quantities. We recommend that you carry a transport emergency card (TREM card), which provides information for yourself and the emergency services on how cylinders should be handled in an emergency.

Printed TREM cards can be provided by BOC Healthcare for its customers upon request (0800 111 333).

You may also display a (green diamond) compressed gases safety sign on the vehicle when cylinders are being transported.  Windscreen signs are available from BOC Healthcare.

Medical oxygen is widely used in clinical practice to provide a basis for most modern anaesthetic techniques including pre and postoperative management.

It is used to restore the tissue oxygen tension towards normal by  improving oxygen availability in a wide range of conditions such as:

Nitrous oxide is an extremely safe medicinal gas when used appropriately and with the correct scavenging equipment and air exchange rates. The current UK exposure levels of a 100ppm (based on an 8hour time weighted average) are easily achieved when these systems are adopted.

Therefore nitrous oxide should be administered in rooms with suitable ventilation and/or scavenging equipment. It should be administered at the lowest effective flow to avoid waste and ecological consequences.

It has been demonstrated that, “as long as routines for gas scavenging, in line with occupational limits, are followed, there is insufficient evidence to recommend any routine medical surveillance of personnel exposed to trace concentrations of waste anaesthetic gases” (1)

Nitrous oxide is predominantly used as a background anaesthetic agent and as such would be used within the theatre setting which would allow scavenging to take place. In areas where it might be used outside of theatre such as the MRI suite then good ventilation must be ensured and exposure should be kept to a minimum. There are portable scavenging systems available for use in areas where ventilation may be restricted.

References:
(1) McGregor DG, Baden JM, Bannister C et al. Task force on anesthetic gases – Information for management in anesthetizing areas in a post-anesthetic care unit (PACU). American Society of Anesthesiologists – 1999 – Park Ridge, IL - USA

- It is more cost-effective

- Less supervision required

- Analgesic properties help to reduce pain

- No pain associated with nitrous oxide administration unlike some other anaesthetics

- Can be used in conjunction with all anaesthetic agents

Of the small 5% contribution that nitrous oxide makes to the total greenhouse effect, most of this is due to agriculture. Clinical sources of nitrous oxide form only 1% of this contribution. Thus, the clinical use of nitrous oxide only contributes 0.05% towards the total greenhouse effect.

Nitrous oxide is an extremely safe medicinal gas when used appropriately and with the correct scavenging equipment and air exchange rates. The current UK exposure levels of a 100ppm (based on an 8hour time weighted average) are easily achieved when these systems are adopted.

Therefore nitrous oxide should be administered in rooms with suitable ventilation and/or scavenging equipment. It should be administered at the lowest effective flow to avoid waste and ecological consequences.

It has been demonstrated that, “as long as routines for gas scavenging, in line with occupational limits, are followed, there is insufficient evidence to recommend any routine medical surveillance of personnel exposed to trace concentrations of waste anaesthetic gases” (1)

Adding any additional oxygen will reduce the benefits achieved with using HELIOX21. However, where additional oxygen is deemed necessary for the patient, oxygen up to 40% concentration may be administered.

It should be noted that if concentrations above 40% oxygen are required then you may wish to consider an alternative treatment.

• Viasys Avea
• eVent LS
• Hamilton
• Maquet Servo-i

Yes, ENTONOX (50% nitrous oxide/ 50% oxygen medical gas mixture) is a fast-acting, non-invasive analgesic that is particularly advantageous for treating short term procedural pain in children. 

ENTONOX is licensed for use across all age groups. As long as the child is able to activate the demand valve and understand instructions on how to use the equipment, then it is safe to use.

It is possible to use ENTONOX with a tracheostomy but a special connector would be required to allow this to happen. With a tracheotomy, you would need to use a small neonatal mask attached to the demand valve

A Tremcard is recommened when transporting ENTONOX. This can be provided by BOC Healthcare for its customers upon request (0800 111 333). Windscreen signs are available from BOC Healthcare for community midwives.

We would also recommend that gas cylinders are secured and transported in the boot of a vehicle, ideally with a Cargo net or fixed with a Karibiner and strap. There should be adequate ventilation within the car and it is advisable to inform your Insurance company if you have not done so already.

ENTONOX is a ready-to-use gas mixture consisting of 50% nitrous oxide and 50% oxygen; it is used exclusively for short term pain relief in a wide range of settings. It has the advantage of very rapid onset and offset analgesic action.

ENTONOX is widely used in obstetrics during childbirth, for emergency care in the ambulance service and for minor painful procedures in hospitals and clinics including:

 - acute trauma

 - suturing

 - wound dressings

 - colonoscopies

BOC Healthcare is introducing a wide range of new equipment to use with our ENTONOX medical gas. As well as having convenient and cost effective integrated valve technology on our cylinders we have recently introduced a range of new products, including:

• A high quality ENTONOX  Demand Valve

• A versatile and convenient ‘all-in-one’ pain relief package consisting of a twin cylinder bag and optional trolley wheels.

For more information on ENTONOX visit www.boctraining.co.uk. This will give you the chance to learn all about how pain is perceived, the variety of analgesics available (including ENTONOX), and how each of these analgesics work and the associated advantages and disadvantages.

References:
(1) Dunning DG, McFarland K, Safarik M. Nitrous-oxide use. II. Risks, compliance, and exposure levels among Nebraska dentists and dental assistants. Gen Dent. 1997 Jan-Feb;45(1):82-6. 

(2) Hoerauf K, Funk W, Harth M, et. Al. Occupational exposure to nitrous oxide and desflurane during earnose-throat-surgery. Can J Anesth. 2000 47:10:pp 984–988. 

(3) Fin BR et al. Tetratogenic Activity of Nitrous Oxide, Nature Vol 214 Apr 8 1967.

BOC Healthcare also holds a Specials Licence which allows them to manufacture and supply medical gases that are not covered by a Marketing Authorisation.

Under this licence, BOC are able to produce any medical gas/ gas mixture specifically requested by doctors and pharmacists. As there are no Marketing Authorisations covering these products, the doctor takes the responsibility for the safety and efficacy of the products but BOC is responsible for the quality of the product.

• AK (height: 1.54m x diameter: 0.23m – 40L water capacity) 
• AV (height: 0.68m x diameter: 0.18m – 10L water capacity)
  

BOC has a marketing authorisation for a specific lung function gas mixture. This is composed of:

0.3% carbon monoxide

10% helium

21% oxygen

Balance nitrogen

This is referred to as lung function gas mixture 4.

Our safety data sheets are available on this website. Please click here to view them

Alternatively, you can request them by contacting  our sales office on 0800 02 0800 or email: specialproducts@boc.com

The LIFELINE Kit is a serviced package and therefore not available for outright purchase. As part of the service, you can have the comfort of knowing that your cylinder will be replaced within 24hours (except for the weekend, where delivery will be made on the next working day) and your kit will be serviced annually to ensure that it is fully equipped and in good working order.

If you need to transport a LIFELINE kit containing an oxygen cylinder, we would recommend that:

• You secure the cylinder within the bag

• You secure and transport the kit in a separate compartment in the vehicle (such as the boot). It needs to be restrained ideally with a Cargo net or fixed with a Karibiner and short strap.

• There should be adequate ventilation within the car

• We would also advise you to inform your Insurance company

There are no regulations covering the carriage of LIFELINE kits in vehicles. However, it makes sense to follow the requirements of the regulations covering the transport of gases in larger quantities. We recommend that you carry a transport emergency card (TREM card), which provides information for yourself and the emergency services on how cylinders should be handled in an emergency.

Printed TREM cards can be provided by BOC Healthcare for its customers upon request (0800 111 333).

You should routinely check your cylinder has sufficient gas by reading the live gauge. If not contact BOC Healthcare on 0800 111 333. Upon delivery of your LIFELINE kit a work report will have been completed to ensure that the cylinder is in working order.  On the annual service another work report will be completed.

The oxygen in the cylinder will expire after 3years. The kit is serviced annually to ensure that everything is in order. In terms of the gas within the cylinder this is dependant on the flow rate at which the oxygen is administered. Flow rates can vary between 1 – 15Litres per minute. The cylinder contains 460Litres of gas. So at maximum flow rates, the cylinder should last just over 30minutes.

In order to replace your oxygen cylinder, simply call our Customer Service Centre (CSC) on 0800 111 333 and order a replacement cylinder. We will endeavour to replace the cylinder within 24hours (except for weekends, where delivery would be made on the next working day).

*Anapen is a Prescription Only Medicine (POM) and can only be supplied to prescribing healthcare professionals.

It is not a legal requirement, but it is recognised as best practice and contained within the guidelines for the “Standards for Clinical Practice and Training issued by the Resuscitation Council (UK).

In July 2006, the Resuscitation Council (UK) in conjunction with the British Dental Association issued guidelines that recommended all clinical areas should have immediate access to an oxygen cylinder, resuscitation drugs, equipment for airway management and an automated external defibrillator (AED).

• A lightweight medical oxygen cylinder with integral valve

• One CPR face mask

• One length of tubing

• One adult non re-breathing mask

• One pair of nitrile gloves

• One clinical waste bag

• LIFELINE signage

Additional items such as *Anapen, pulse oximeter can be ordered upon request. Please contact our sales team on 0161 930 6010 or email: bochealthcare-uk@boc.com to get a cost for these products and place an order.

This is a service offering developed by BOC Healthcare Medical Engineering Services (MES). The services offered include:

• Project management of installation work
• Design of medical gas pipeline systems (MGPS)
• Assistance in the selection of equipment
• Documenting the operational procedure
• A planned preventative maintenance scheme
• Guaranteed compliance
• Remote monitoring systems
And much more…

For more detailed information on the services BOC Healthcare can offer view our brochure here.

Within Medical Engineering Services (MES) we are able to provide a variety of training courses for healthcare professionals and people working within the hospital environment. These include:

• Authorised Person (MGPS)
• Competent Person (MGPS)
• Safe handling of medical gases
• Train the instructor
• Safe handling of Cryogenic liquids

For further information on our training courses click here to view our brochure

Any staff member that comes into contact with medical gases.

BOC Healthcare is able to supply self-service kits for their Carnèt equipment range, allowing your EBME department to service the equipment and therefore save costs. In addition equipment servicing training courses are available for relevant healthcare personnel.

Service exchange may be available for older BOC supplied equipment.