If you or a loved one has been ordered to be on oxygen therapy, it’s important to understand how to properly use your oxygen and the things that need to be considered when oxygen is in use in the home.
First, oxygen is an essential element in our air that keeps us alive. Normal “ambient air” is approx. 21% oxygen. It is an odorless and colorless gas. Some individuals who have lung impairment will need what is called “supplemental oxygen”. Basically, the 21% oxygen in ambient air is not enough to keep a normal level of oxygen in the blood. In order to be appropriate for supplemental oxygen therapy, a doctor or practitioner will perform oxygen testing with a small device called a pulse oximeter. This shows how much oxygen is “saturated” in the bloodstream and is read as a percent...ideally it should be over 90% at all times. The testing, normally, should include a resting test, where your oxygen level is tested while you are sitting still but awake, and a walking or ambulation test which will test oxygen levels while you are walking or performing some sort of exertional task. Lastly, some patients will need to also have an “overnight” oxygen test (aka nocturnal oxygen test). This test is to determine if oxygen is needed while sleeping. A person that needs supplemental oxygen may be using it 3 different ways (when sitting, when moving around and when sleeping) and each way may be different (ie: 2 liters at rest, 4 liters with exertion, and 1 liter with sleep). Your doctor or practitioner will determine the amount of oxygen needed in each scenario and will write a prescription with the amount needed (liter flow) and when it should be used (at rest/exertion/sleep). Because oxygen is considered a “drug” it is regulated by the FDA and needs a prescription to dispense.
Oxygen for medical use is not the same as oxygen for industrial use. Industrial use oxygen contains many impurities. Medical grade oxygen is available in liquid form (used mostly in institutions), compressed gas (cylinders), and via an oxygen concentrator which uses sieve beds to sift out the nitrogen and trace elements in ambient air and deliver a high concentration of oxygen. In the home, you will mostly see concentrators and cylinders. We rarely see liquid oxygen being used in the home as it is costly and inconvenient. Oxygen concentrators are also known as stationary concentrators come in a variety of liter flows and sizes. They are large and bulky and made for home use. It is important to know your prescription and to use the oxygen exactly as it is prescribed; too little can cause you to have sustained low oxygen levels which can lead to many health issues and too much can be dangerous as well.
So, a stationary concentrator will stay in the home...but what do I do if I need to go out?
If you are prescribed to use oxygen when you are walking around or performing tasks, and you are still fairly active outside of your home, you may want to consider a portable oxygen concentrator (aka POC) or a refillable oxygen cylinder system. These two systems allow the individual on oxygen therapy to remain active. Your doctor or practitioner can help you to determine which system would suit you best. Some of the systems on the market utilize a “pulse dose” regulator to deliver a pulse of oxygen to the patient...but only on inspiration. This can be a problem for people who require high liter flows (POC’S have limitations), for those who cannot generate enough negative pressure to open the valve to get the dose of oxygen delivered to them, and for those who just cannot keep their blood oxygen levels in the safe range while using it. POC’s run on a battery so it is important to manage the charging of the unit so that you do not run out of oxygen while you are away from home. Refillable cylinder systems have limitations as well. If you plan on being out of your home for an extended period of time, you will need to fill and take with you several full cylinders to replace as you deplete one. Some refillable cylinders also utilize the "pulse dose” regulator. Cylinders need to be stored lying down to eliminate the possibility of them falling over and rupturing.
Other things to consider when on home oxygen therapy: tripping and falling. Most oxygen systems will use a 25foot or 50foot length of connecting tubing so that the patient can reach most of the rooms in the house. For the elderly, the vision impaired and the gait impaired this can pose a hazard. Falls within the home are some of the most common injuries to this group. It is recommended that you use the shortest length of tubing needed to reach the major rooms in the house. Pick up all throw rugs or any obstacles in hallways or on stairs. Encourage the oxygen user to “gather” the tubing as they walk and keep it up away from their feet. For our sight-impaired individuals, you can try colored tubing (purple or green) so that it is easier to see against the floor. For those in wheelchairs, be aware that the oxygen tubing can get caught in the wheels and become “kinked”. If the tubing is kinked, there will be no flow from the tubing. If you are ever in doubt that there is flow coming from the tubing, simply put the prongs from your nasal cannula into a glass of water and observe for bubbles. If there are bubbles, you have flow.
Oxygen will not spontaneously combust, but it will support a flame. What does that mean? No oxygen system will just burst into flames; however, if a flame is introduced to the oxygen flow it will get bigger and hotter. When oxygen is used in the home it is recommended that an “Oxygen In Use” sign be posted on your outside doors. This is for several reasons. It is to let anyone that is entering the home know that smoking is not allowed in this home and to let the local fire dept (in the case of a fire) know that there is an oxygen system in the home and it needs to be located and removed so that it does not cause the fire to get bigger. It is also recommended that you do not wear your oxygen while cooking (especially with gas or propane) and that you keep at least 5 feet away from any open flames (fireplace, candles, etc). Remember...a fire needs three things to get going and keep going: oxygen, fuel, and a spark
Using oxygen in this day and age is easier than it has ever been in the past. There are many systems that can be used and it’s important to try and match the system you are using to your lifestyle. Remember, oxygen is a drug and should be treated just like all of your other medications. If you ever have any questions about your oxygen therapy, contact your doctor or practitioner, if you have any questions about your oxygen system, contact your oxygen provider.
Author Profile: Laura Castricone, Respiratory Therapist
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