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The Requirements for Safe Administration of Nitrous Oxide in QUAD A Facilities

We have recently received several questions regarding the use of nitrous oxide in QUAD A facilities.

The use of Nitrous Oxide in QUAD A facility classes B, C-M, and C is permitted; however, the safety requirements listed in 1-A-12 and 4-C-16 below must be met for the administration and the delivery system:

1-A-12: In this facility, operations may be performed under:    

Nitrous Oxide, which may be administered by any of the following:    

  • Anesthesiologist   
  • Certified Registered Nurse Anesthetist (CRNA) under physician supervision if required by state/local law   
  • Anesthesia assistant as certified by the National Commission for the Certification of Anesthesiologist Assistants (NCCAA) under direct supervision of an anesthesiologist   
  • Registered nurse under the supervision of a qualified physician

4-C-16: If nitrous oxide alone is used, then a safe delivery system is used.  A safe delivery system meets the following criteria:    

  1. Alarms   
  2. Gas scavenging   
  3. Color coding of tanks, knobs, and hoses   
  4. Diameter index safety system for non-interchangeable connection of gases - pin index safety system   
  5. Oxygen fail-safe system and oxygen flush capacity   
  6. Quick connection for positive-pressure oxygen delivery   
  7. Emergency air inlet   
  8. Reservoir bag   
  9. Storage in secured area  

Thank you for choosing QUAD A. If you have further questions, please feel free to submit them to standards@QuadA.org 

We appreciate your commitment to patient safety. 

Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.