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Home Oxygen & Sleep Specialists
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Caring for the Oxygen Patient at Home

Indications for Oxygen Therapy
Oxygen is used for patients who cannot keep their oxygen levels in their blood elevated. Oxygen therapy decreases the work of breathing, and decreases the work of the heart. These patients are usually short of breath (S.O.B.), may have difficulty performing daily activities and chores, may have a bluish tinge to their lips or nail beds. They may also fatigue easily.

How To Determine Who Needs Oxygen
The determination to put a patient on oxygen or not, is made by the patient's doctor, the hospital, the VNA nurse and the respiratory therapist who cares for them at home or in a laboratory. We determine if patients needs oxygen by testing them in one of two ways:
1.) Arterial Blood Gas (ABG): this is an "invasive" procedure where a needle is inserted into the patient's artery at either the wrist or the front side of the elbow. This is not done in the homecare setting.
2.) Saturation Test (SAT): this is a "non-invasive" procedure, which involves putting a small clip onto one of the patient's fingers and seeing how much oxygen is "saturated" in the blood. It is read as a percentage. Any patient who has a SAT of 88% or less is a candidate for oxygen.

Types of Oxygen Systems
Oxygen can be delivered to the patient in several different ways. Oxygen comes in either gas or liquid form.

1.) Oxygen Concentrators
These units are made to be used in the home. They plug into a three-prong outlet in the patient's home and make their own oxygen while they are running. This gives the patient an indefinite supply of oxygen. These units are equipped with alarms that will sound if the "purity" of the oxygen produced by these machines is less than 85% and they will also alarm when the machine requires maintenance or if there is a power failure.

2.) Gas Cylinders
These aluminum cylinders are painted "green", which is the universal color for medical oxygen cylinders. Gas cylinders come in many different sizes, but the most common sizes you will see in the home are:
E-cylinders: large, pulled by cart by the patient or used in home as "emergency" oxygen source if there is a power failure.
D-cylinders: one half the size of an E-cylinder, used for portability with a carry bag.
M-6 cylinders: small, 4 pound cylinder usually used with a "conserver" or "conserving device", used by active patients for portability.

3.) Self-filling Oxygen Systems
These units are a combination of an oxygen concentrator and a separate piece that fills gas cylinders at home. These are very efficient systems that allow patients to be extremely independent. Patients on these system have be able to tolerate a "conserver" or "conserving device."

4.) Liquid Oxygen
This form of oxygen is stored in a self-contained, large reservoir that contains approximately 100 pounds of liquid oxygen, which needs to be re-filled (usually every week.) A Health Complex driver will go to the patient's home each time a refill is needed. A patient on this system will also have a portable oxygen system to use when they go out. The patient will have to fill his own oxygen portable when he or she needs it. Oxygen that is in liquid form is -297 degrees Fahrenheit! It is very important that patients and caregivers are very careful when handling liquid oxygen, as it can cause a frost burn if it comes into contact with bare skin!

What is a Conserving Device?

Oxygen is delivered to a patient in what is usually called "continuous flow." This means that whether or not the patient is inhaling or exhaling, the flow of oxygen is "continuously" entering the body. With a "conserver", a patient will only get a flow of oxygen when they inhale, but now when they exhale. For patients who want to remain active outside the home, this is the best way to go. HOWEVER . . . a patient has to be tested via "pulse oximeter" to determine if the patients SAT remains above 90% while on the conserver. This order needs to be written by the patient's doctor. Conservers are: lightweight and last much longer than standard continuous flow oxygen cylinders. The "conserving device" is not the cylinder itself, but the "regulator" that attaches to the top of the cylinder. The regulator controls the flow and amount of oxygen that comes out of the cylinder.

Delivery Devices: oxygen can be delivered to the patient by either a "nasal cannula" which is a clear tubing with prongs that are inserted in the nostrils, or by "mask", which is a vinyl mask that fits over the patients nose and mouth. Masks can only be used if the patient is on 5 liters/min (LPM or L/M) or higher. Liter flows for patients are determined by the doctor.

Safety Issues with Oxygen Therapy

Overall, oxygen therapy is extremely safe to use in the home. It has been routinely used for decades in the home care setting with little incident. Call us anytime, day or night, to report problems or ask questions. In homecare we say: "The only silly question is the one you don't ask!" This is what we do for a living, so feel free to call us with any questions or concerns. Our objective is to give the best care to our patients in their home and we respect and value your input to achieve this goal.

Below are tips to keep yourself safe.

* Oxygen is not in itself combustible; however, it will accelerate a flame and make a fire burn hotter.
* Oxygen should not be used within 5 feet of an open flame.
* (Examples: candles, fireplace, wood burning stove, gas stove, cigarettes, lighters, etc.)
* Patients should never smoke while on oxygen. If a patient must smoke, they need to remove the oxygen source from their face and be without oxygen for at least 30 minutes before lighting up. Even though the oxygen may be off the face or turned off, the body and clothing can remain "oxygen rich" for up to 30 minutes!
* Oxygen signage should be posted on entry and exit doors of the oxygen patient's home. This is to alert anyone who enters that there is oxygen being used in the home, but more importantly, it is to alert the fire deptartment, in the event of a fire, that oxygen is in use.
* Oxygen cylinders should be stored lying on their sides in a secure place (under a bed, etc.) or in a cart that cannot easily fall over. You must be careful when handling oxygen cylinders that you do not drop them, especially on their "stem." The gas in these cylinders is under pressure and can become projectiles if they are dropped and broken!
* Liquid oxygen is very, very cold (-297 degrees Fahrenheit!!), as stated above, do not let liquid oxygen come into contact with bare skin, or you risk frost burn. Liquid oxygen portables (when filled) need to be kept in an upright position or they will leak and make a loud noise. Liquid portables should only be filled before the patient is going out. Do not fill the portable the night before as it will dissipate by morning. In hot, humid weather, liquid oxygen has a tendency to form condensation and sometimes the portable will freeze to the source. To remedy this, simply pour water onto the part that is frozen together to defrost or call Health Complex for advice.

Maintenance
* Nasal cannulas or masks are disposable items and need to be changed every other week or if they become soiled. Health Complex will provide the patient with enough supplies to make this possible. These supplies are at no extra charge to the patient.
* If a patient complains of "dryness" while on oxygen, call us or the doctor's office. A humidification bottle (sometimes referred to as a "bubble bottle") can be attached to the oxygen source. Oxygen is dry, colorless and odorless.
* Patients can have up to 50 feet of tubing attached to the oxygen source for moving around the house. No more than 50 feet can be hooked up.
* Oxygen sources (concentrator, self-fill unit, liquid reservoir) require periodic maintenance from the manufacturer or homecare company (we will keep track of the maintenance schedule.) The patient or caregiver only needs to clean the filters on the concentrator once per week in plain water and wipe down the unit with a damp rag to remove dust. Do not spray the oxygen source with chemical cleaners.
* Additional oxygen cylinders to replace empties are delivered by Health Complex when a patient needs them. Liquid oxygen is usually delivered once per week by a homecare company driver. Self fill cylinders are filled as needed by the patient from their system.

Miscellaneous Supplies for Oxygen Patients
* Oxy Ears: many oxygen patients experience skin breakdown on the outer edge of their ears from wearing the nasal cannula. There is a product called "oxy ears" that is small pieces of spongy material that goes over the cannula tubing to cushion the ears.
* Bubble Bottle: for humidifying the oxygen coming into the patient. These bottles need to be emptied and cleaned each day or the patient can risk infection from a "water-bourne" illness. These bottles should be thrown out every other week and replaced with a new one.
* Carry Bags: for portables - there are various types of bas to make it easier for patients to carry their portable oxygen. Some bags are for over the shoulder, some can be used as waist pouches, and some can be used as a back pack. Ask us and we'll be happy to supply the appropriate bag for the patient's lifestyle.
In homecare we say: "The only silly question is the one you don't ask!" This is what we do for a living, so feel free to call us with any questions or concerns. Our objective is to give the best care to our patients in their home and we respect and value your input to achieve this goal.


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