Home Oxygen Therapy (Pulmonary Rehabilitation Educational Booklet) Contents Home Oxygen Therapy - Right Patient Aim of Home Oxygen Therapy Operation of Oxygen Concentrator (Flowmeter Ball Type) Operation of Oxygen Concentrator (Turning Panel Type) Right Amount and Right Period of Time in Home Oxygen Therapy Cleansing and Disinfection Safety Precaution Maintenance and Repair Usage of Portable Oxygen Cylinder Usage of Portable Oxygen Cylinder Duration of the Oxygen supply Usage of Oxygen Conserving Device Cautions in Using Oxygen Conserving Device Other Oxygen Therapy Devices Coordinating Committee in Occupational Therapy, Hospital Authority 1
Home Oxygen Therapy Oxygen is vital to human beings. We need to take in oxygen from air constantly in our daily lives. Oxygen will be up taken by blood cells in the lungs while we inhale. The heart will then pump the oxygenated blood to the rest of the body. Right Patient for Home Oxygen Therapy: Patients with impaired lung functions will have problems of oxygen uptake and thus cannot cope with the oxygen demand of their bodies. As a result, hypoxaemia and symptoms of dyspnea will be induced. Physician will determine individual need of home oxygen therapy according to patients severity of exertional desaturation in daily activities, arterial blood gas results, etc. Home oxygen therapy should be applied as physician s prescription. Home oxygen therapy lessens the degree of hypoxaemia by providing the body with supplemental oxygen, and there is no addictive effect in using long term oxygen therapy. Aim of Home Oxygen Therapy Chronic hypoxaemia increases the loading of the right heart and may cause heart failure. Supplemental oxygen can reduce the burden of the heart, and thus reduce the chance of developing cor pulmonale. Proper use of home oxygen therapy can alleviate dyspnea and other related adverse symptoms, which, in return, improves your tolerance in performing activities of daily living. Moreover, it helps you to reduce the rate of hospital admissions and enhance your quality of life. Home Oxygen Therapy One of the most commonly used home oxygen therapy equipment is oxygen concentrator. Its function is to extract and condense oxygen particles from room air so as to generate highly concentrated oxygen. Operation of Oxygen Concentrator 1. Plug the oxygen concentrator into an independent socket. 2. Attach the nasal cannula to the oxygen outlet of the oxygen concentrator. 3. Switch on the oxygen concentrator. 2
Flowmeter Ball Type 4. Turn the knob to adjust the flowmeter ball to the oxygen flow rate as prescribed by your physician. 5. Adjust the oxygen flow rate back to zero before switching off the oxygen concentrator. 6. Switch off the oxygen concentrator. Remarks: The centre of flowmeter ball should be adjusted to the corresponding flow meter marking at eye level. Turning Panel Type 1. Turn the panel to the oxygen flow rate as prescribed by your physician. 2. Switch off the oxygen concentrator directly after use. Remarks: For users having flow rate equal to or less than 4 Liter Per Minute (LPM), there is no need to use the humidifier. The nasal cannula can be connected to the oxygen outlet directly. For users having flow rate more than 4 LPM, you should seek advice with your occupational therapist in determining the need of using the humidifier. In case you need to use the humidifier, you should fill it with sterile water. The humidifier should be disinfected regularly and the sterile water should be replaced daily. Right Amount and Right Period of Time in Home Oxygen Therapy 1. Right Amount (Flow Rate) Oxygen therapy, just like other pharmacological intervention, should be applied properly according to the dosage prescribed by your physician. Inappropriate adjustment of the dosage may induce undesirable effects to your health. Upon performing activities with higher level of exertion, patients may need to increase the oxygen flow rate by 1 LPM or above. Such increase should be based on the assessment of your occupational therapists and the flow rate of oxygen must be adjusted back to the original resting flow rate after completing those activities. Physician s prescribed dosage: At rest LPM During sleep LPM Exertion activities LPM 3
2. Right Period of Time (Duration) - Apply for at least 15 hours daily. The therapeutic effect of home oxygen therapy will be the best if continuously using it for 24 hours a day. - Apply as necessary. Cleansing - Clean the air inlet filter with soapy water once a week or whenever necessary. After rinsing it with running water, dry the filter with towel thoroughly. Allow it to dry before placing it back to the oxygen concentrator. - Use soapy water to clean the nasal part of the cannula so as to remove any attached nasal secretion. Rinse it with cool boiled water thoroughly and then allow it to dry in room air. - Disinfect the nasal cannula at least once a week. Disinfection - Prepare disinfectants in a clean container. It can be either a blend of white vinegar and water in ratio of 1:3 or a blend of household bleach and water in ratio of 1:49. - Soak the nasal part of the cannula in the disinfectant, while the oxygen outlet of the nasal prongs should be pointing downwards. - Recommended soaking time is 60 minutes for diluted white vinegar or 10 to 20 minutes for diluted household bleach. - Rinse it thoroughly with cool boiled water. Allow it to dry in room air. - Advise to renew the whole set of nasal cannula and extension tubing every 2 to 3 months or when they become hardened. Safety Precaution - Smoking is contraindicated and strictly prohibited. - Use an independent standardized three flat pin socket for the oxygen concentrator. - Avoid hitting the portable oxygen cylinder against hard surface or objects. - Switch off the oxygen concentrator and turn off the portable oxygen cylinder whenever they are not in use. - Stay away from open flame during cooking. Recommend flameless cooking with rice cooker or induction cooker. - Use the extension tubing or longer nasal cannula, if necessary. Confine the overall length of tubing within 40 feet and avoid bending or twisting of tubing to ensure unobstructed oxygen flow. - Proper placing of oxygen tubing to avoid tripping over. Beware of fall risks due to messy 4
oxygen tubing on floor. - Place or store the oxygen equipment in a dry, clean and well-ventilated area. Keep the equipment at least 6 feet away from oil and grease contact, direct sunlight exposure, lighting, heat and flammable items. - Keep the vent of oxygen concentrator 1 foot away from wall for better cooling and ventilation effect. - Coil and place the unused nasal cannula and extension tubing in clean plastic bag for better hygiene. Maintenance and Repair - Oxygen equipment vending agency will provide free home-based maintenance for your rented oxygen concentrator every 2 to 3 months. - If the alarm (usually red light with beep sound) remains on even though the oxygen concentrator has already been switching on for a while, please check whether the oxygen concentrator is properly plugged in. Contact your corresponding vending agent for checking immediately, if the alarm persists. - There is a short period of beeping sound while switching on the oxygen concentrator (for some models only). If the sound level is weak, please contact the vending agent for replacing the internal battery. - If the flowmeter ball sinks below the set level, please check whether the nasal cannula is broken or the oxygen flow is obstructed. - There is a label displaying the name and telephone numbers of the vending agency. Contact the vending agency through its office number or emergency call number, in case of problems or mal-functioning of equipment. Operation of oxygen cylinder 1. Turn the switch in anti-clockwise direction for about 180 degree. (use the key if needed) 2. The gas pressure indicator of the regulator will move from the red zone towards the green zone 3. Adjust the oxygen flow rate to the level as recommended by the physician 4. When switching off the cylinder, turn the switch in clockwise direction till it is tight. 5. Wait for the gas pressure indicator moves back to zero position 6. Adjust the oxygen flow rate back to "0" or "off". Usage of Oxygen Cylinder Duration of the Oxygen supply If you plan to have outdoor activities e.g. medical follow-up, going to a restaurant, you can use the oxygen cylinder. You should plan and estimate the time you will need for that travel 5
and check whether there is sufficient amount of oxygen supply from the cylinder. Duration of Oxygen Cylinder Supply (Hour: min) Flow Rate (LM) Size of Oxygen Cylinder Capacity (Liter) 1 2 3 4 5 B 170 2:50 1:25 0:56 0:42 0:34 C 230 3:50 1:55 1:16 0:57 0:46 D 406 6:46 3:23 2:15 1:41 1:21 (Different vending agencies will have cylinders of different capacity. The above information is just for reference purpose.) Remarks: When you turn on an oxygen cylinder, with full capacity, the gas pressure indicator should point at the green zone, e.g. at 2000. If the gas pressure indicator drops to the red zone (it indicates that only one fourth or less of the total capacity has left), you should contact your vending agency to renew the oxygen cylinder as soon as possible. You can purchase a trolley from the vending agency to ease the burden of carrying a larger oxygen cylinder (e.g. D size cylinder). You can enquire about the possibility of using an extra oxygen cylinder from your vending agency if it is indicated. Please note that, according to the Fire Service Ordinance, each housing unit should not store more than 2 oxygen cylinders. Usage of Oxygen Conserving Device In case of having prolonged outdoor activities, the duration of oxygen supply from the oxygen cylinder may become insufficient. You can seek advice from your occupational therapist for adding an oxygen conserving device to the existing cylinder that can increase the usage duration by 2-3 folds. 1. Oxygen Conserving Device - Electronic Type 1. Connect the oxygen conserving device to the oxygen cylinder and then plug in the nasal cannula. 2. Turn the switch of the cylinder in anticlockwise direction for around 180 degree (use the key if needed). 6
Oxygen Conserving Device Electronic Type (Cont d) 3. Check whether the duration of oxygen supply is sufficient or not. 4. Adjust to the appropriate flow rate. 5. Switch to the oxygen conserving mode. 6. Switch off the main switch by turning it in clockwise direction after usage. And switch it back to the mode of continuous flow. 7. The indicator of the flow meter will drop back to zero position. Then adjust the flow rate back to the lowest level. Oxygen Conserving Device Pneumatic Type 1. Connect the oxygen conserving device to the oxygen cylinder and plug on the nasal cannula. 2. Switch on the cylinder by turning it in anti-clockwise direction (You can use a key if needed). 3. Check whether the duration of oxygen supply is sufficient or not. 4. Adjust to the appropriate flow rate, and switch to the oxygen conserving mode. 5. Switch off the main switch by turning it in clockwise direction after usage and switch it back to the mode of continuous flow. 6. When the indicator of the flow meter drops back to zero position, adjust the flow rate back to the lowest level. Cautions in Using Oxygen Conserving Device 1. When using oxygen conserving device of electronic type, a green light will flash to indicate that you are breathing in properly. On the other hand, the red light and the audible alarm will be on if your breathing is not deep enough (e.g. for around 15 seconds). If that happens, you should check whether the nasal cannula is properly attached and also beware of breathing pattern as well. If the red light or audible alarm persists, you should contact your oxygen vending agency for maintenance immediately. 2. In case the conserving function is not working properly, you can simply switch it back to the mode of continuous flow to ensure adequate supply of oxygen. 3. For those using the electronic type, you should replace the battery as soon as possible if the low battery signal light is on. *There are some variations in terms of the functions of the different kinds of oxygen conserving devices. You should enquire with your occupational therapist about the different functions and operations. 7
Other Oxygen Therapy Devices & Accessories Oxymizer (Reservoir Cannula) The reservoir should be kept dry in order to maintain performance. You should renew it in case it becomes wet inside. Need regular replacement, approximately every one month. Oxymizer cannot be used together with other oxygen conserving devices (whether it is the electronic type or pneumatic type). Portable Oxygen Concentrator Portable Oxygen Concentrator is a kind of compact, light, portable oxygen concentrator. It is operated with rechargeable battery so as to facilitate the user to participate in longer duration of outdoor activities or traveling. It supplies the oxygen flow from 1LPM to 6LPM; according to the different types of model. With different flow rates of oxygen output, the duration of oxygen supply will also be different (approximately around 50 min to 10hrs). *There are some variations in terms of the functions of the different kinds of Portable Oxygen Concentrators. You should enquire your occupational therapist about the different functions and operations. Emergency: Out of power or the concentrator has broken down You should keep calm, reduce your exertion as possible and take more rests. Try practicing some relaxation exercises and maintain the tranquil mind. You can use the portable oxygen cylinder during such situation. Contact your oxygen vending agent for maintenance immediately. Conclusion Home Oxygen Therapy aims at providing supplemental oxygen to reduce hypoxaemia and its associated pathophysiological changes in the body, allowing the patients to cope with daily activities and at the same time relieving dyspnea. Proper use of home oxygen therapy enables you to maintain your usual daily activities such as self-care, work and leisure. It can also increase your confidence in coping with your life situations, allow you to maintain good quality of life and also enhance life expectancy. If you have any enquiry, you can contact your occupational therapist Mr. / Ms. by the following number. 8
Hospital Occupational Therapy Department Oxygen Usage Instruction Name: Date: Activity Flow Rate Sleeping (includes nap) Resting and Light Activity: such as - talking, eating, grooming (while sitting), watching TV or desk work. Moderate Activity: such as - Dressing, toileting, walking around your own home or doing light housework, e.g. making a bed, sweeping floor, vacuuming, preparing simple meal (no-flame). Heavy Activity: such as shower (in standing position), shopping with grocery-carrying, walking upstairs/uphill or doing heavy housework, e.g. scrubbing floors, washing & hanging heavy clothes. Remark: Please seek advice from physician if increase distress. 9