Oxygen accounts for about 21% of gas in air. Every cell in our body requires oxygen to function. In order for this oxygen to reach every cell, it is transported through the airways of the lungs. If there is a blockage in the airways from mucus or narrowing of the airways from swelling or constriction, air may not reach every cell. In some COPD patients, adequate air is brought into the alveoli, but the oxygen contained in the air is not able to pass into the capillaries surrounding the alveoli. Since the body cannot store oxygen, oxygen needs to be given whenever the body is low on oxygen. The need for continuous oxygen is called Long Term Oxygen Therapy.
Oxygen Therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care.
High blood and tissue levels of oxygen can be helpful or damaging, depending on circumstances and oxygen therapy should be used to benefit the patient by increasing the supply of oxygen to the lungs and thereby increasing the availability of oxygen to the body tissues.
People with asthma, emphysema, chronic bronchitis, cystic fibrosis or congestive heart failureuse oxygen therapy at home.
Oxygen is used as a medical treatment in chronic and acute cases, and can be used in hospitals, pre-hospital or entirely out of hospital treatments. Use of oxygen therapy is dependent on the needs of the patient and the views of medical professional advising.
Use in Chronic Conditions
A common use of supplementary oxygen is in patients with COPD, a common long term effect of smoking, who may require additional oxygen to breathe either during a temporary worsening of their condition or throughout the day and night.
Oxygen therapy can help people with a range of health conditions that affect breathing or blood circulation, including:
1. Chronic Obstructive Pulmonary Disease
2. Severe Long Term Asthma
3. Cystic Fibrosis
4. Pulmonary Hypertension
5. Obstructive Sleep Apnea
6. Heart failure
7. Diseases of the nerves and muscles or rib cage
When do I need oxygen
The need for oxygen is found by measuring the amount of oxygen in your blood stream. If your oxygen level is below critical level, then you need oxygen close to 24 hours a day. Some people with COPD do not need oxygen when they are inactive, but when exercising, such as walking, or with eating or sleeping.
Your healthcare provider will find out if you need oxygen therapy by taking a blood sample from your artery. This test is called Arterial Blood Gas, and measures carbon dioxide and pH in addition to oxygen. This can also be done with a Pulse Oximeter. Oximetry is performed by attaching a clip to your finger that shines a light through it. A tiny computer in the oximeter then determines your oxygen level by the color of light that shines from the other side. Oximetry only measures one characteristic of the oxygen in your body and since it is not as precise as an ABG, should be only used as a guide to oxygen therapy.
How much oxygen should I take
Oxygen is a medication prescribed by your healthcare provider. Optimally, the amount is carefully decided based on an ABG and then guided by oximetry. Once the amount is decided, the rate at which oxygen must be provided is decided by your provider. The treatment goal is basically to keep oxygen at a level that meets your body’s need for oxygen, usually above 89%. Too much or too little oxygen can hamper majorly with the respiratory system.
1. How many hours a day will I need Oxygen?
In some cases, oxygen is required only when exercising or sleeping. In most cases, however, oxygen should be used as close to 24 hours a day. If oxygen level is low, using less than 15 hours a day has not been shown to provide a benefit. If instructed to use continuous oxygen and choose to go off oxygen temporarily, it is best to do so only while resting quietly, not while sleeping, walking or exerting yourself.
To know how much oxygen is needed during exercise, an exercise stress test or a timed walk test is usually done.
2. Will I need oxygen while sleeping?
During sleep, the breathing is slowed down. In some cases, people that may not require oxygen while awake may require extra oxygen while sleeping. Your healthcare provider will determine if and how much oxygen you should take at night. Needs are determined using an oxymeter that will record your oxygen level while you sleep in your home or you may be asked to sleep at a sleep laboratory.
Methods of providing Oxygen Therapy
There are two common ways of providing Oxygen therapy. Oxygen can be delivered to you in your home in the form of:
A gas in various sized cylinders or by using an oxygen concentrator
Oxygen is stored under pressure in a cylinder equipped with a regulator that controls the flow rate. Because the flow of oxygen out of the cylinder is constant, an oxygen conserving device may be attached to the system to avoid waste. This device releases the gas only when you inhale and cuts it off when you exhale. This oxygen may also be provided in a small cylinder that can be carried around portably, but the larger tanks are heavy and must be left stationary at the workplace or residence.
The pressure valves must be checked frequently. When cylinders are empty, the regulators must be removed and placed on a full cylinder.
An oxygen concentrator is an electrically powered device that separates the oxygen out of the air, concentrates it, and stores it. This system has a number of advantages because it doesn’t have to be resupplied. It is also not as costly as liquid oxygen. Extra tubing permits the user to move around with minimal difficulty.
Advancement in this product has brought us small portable systems that afford even greater mobility. A cylinder of oxygen, however, must be kept as a backup in the event of power failure.
Make sure that the air inlet is not covered and that it allows fresh air into the concentrator. This filter should be washed once a week in dishwasher detergent. The filter must be completely dry before re-inserting. The concentrator should be serviced after approximately 10,000 hours of use of annually. Improper maintenance may result in low concentrations of oxygen being delivered.
Oxygen delivery devices
There are three common means of Oxygen Delivery.
1. A nasal cannula is a two-pronged device inserted in the nostrils that is connected to tubing carrying the oxygen. The tubing can rest on the ears of may be attached to the frame of eye glasses.
2. People who need high flow of oxygen generally use a mask. Some people who use a nasal cannula during the day, prefer a mask at night or when their noses are irritated or clogged by a cold.
3. Transtracheal oxygen therapy requires the insertion of a small flexible catheter in the trachea or windpipe. The transtracheal catheter is held in place by a necklace. Since transtracheal oxygen bypasses the mouth, nose, and throat, a humidifier is absolutely required at flow rates of 1LPM or greater.
On-Demand Oxygen Device:
On Demand oxygen delivery devices deliver a small amount of oxygen, usually when you begin to take a breath in through your nose. The device is connected to the oxygen source by the nasal cannula. The device senses the start of inhalation and immediately gives a short pulse of oxygen.
Nose congestion and mouth breathing may make it hard for the delivery device to sense inhalation. Some types of devices have an alarm that goes off if no breathing activity is detected. Most of the On Demand devices are battery driven and the batteries need to be replaced every couple of weeks.
Transtracheal oxygen is oxygen delivered through a catheter placed directly through the neck into the trachea. Delivery of oxygen directly into the trachea provides higher amounts of oxygen to be delivered because little is wasted. A cosmetic advantage of transtracheal oxygen therapy is that the tubing is not as visible as with standard devices.
Patients must be evaluated, educated and monitored by a trained team of healthcare providers. Complications of Transtracheal Oxygen Delivery are not frequent, but can be serious.
What are reservoir cannulas
A reservoir cannula operates by storing oxygen in a small chamber. Storage of oxygen takes place while you are breathing out. This stored oxygen is available when you breathe in. This may allow you to require lower flow rates while still receiving the same amount of oxygen. There are two types: Oxymizer and the Pendant Oxymizer. The difference in the two devices is the location where the storage chamber is located.
Do I need a humidifier on my oxygen system
If you use transtracheal oxygen, humidification of the oxygen is important. With other delivery systems at less than 4 litres per minute, humidification is not usually necessary or beneficial. If you have dryness in your nose, you can use a saline spray. The humidifier is a bottle filled with sterile or distilled water. The oxygen passes through the water to gather moisture. Water from the humidifier should be changed every 1-2 days.
What should I watch out for while I am on Oxygen
In some cases, too much oxygen may lead to an increase of carbon dioxide in your blood. This can give symptoms like drowsiness and difficulty keeping awake. Receiving too much oxygen while sleeping can also result in a morning headache. A sign of too little oxygen is a general fatigue-like feeling. Contact your healthcare provider if any of these symptoms are noticed.
OXYGEN THERAPY FOR ASTHMA PATIENTS
Oxygen therapy is typically used to treat moderate, severe and extreme cases of asthma. It involves attaching a source of oxygen to specialized tubes. At the end of the tubes can be a nasal prong or face mask that the patient wears. Breathing the oxygen through the apparatus increases the supply of oxygen to the body of the asthmatic patient. Asthmatics who receive oxygen therapy experience a variety of benefits, including better sleep, increased alertness and more stamina. In emergency attacks, it also prevents any damage to the heart.
Using Oxygen therapy for too long can be toxic to all patients including asthmatics.
OXYGEN THERAPY FOR EMPHYSEMA PATIENTS
Emphysema is a chronic lung disease that is most often caused by smoking. When small pouches of air at the end of air passageways called bronchioles are destroyed, emphysema occurs, and there is no cure. It’s one of the conditions included in COPD. People suffering from it have great difficulty in breathing and have insufficient oxygen in their blood, depriving cells and lungs of needed oxygen.
There are a number of medications used to treat emphysema, including steroid inhalers, antibiotics to manage infections and bronchodilators to alleviate symptoms. But since people aren’t getting enough oxygen, oxygen therapy is often prescribed to improve breathing.
OXYGEN THERAPY FOR CHRONIC BRONCHITIS PATIENTS
The goal of therapy for chronic bronchitis is to relieve symptoms, prevent complications and slow the progression of the disease. Quitting smoking is also essential for patients with chronic bronchitis, since continuing to use tobacco will only further damage the lungs.
Treatment may include:
Bronchodilator Medications: inhaled as aerosol sprays or taken orally, these may help to relieve symptoms of chronic bronchitis by relaxing and opening the air passages in the lungs.
Steroids: inhaled as an aerosol spray, steroids can help relieve symptoms of chronic bronchitis. Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood pressure, diabetes and cataracts.
Antibiotics: antibiotics may be used to help fight respiratory infections common in people with chronic bronchitis.
Oxygen Therapy: as a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen. Oxygen comes in various forms and may be delivered using different systems, including those that can be used at home
Surgery: lung volume reduction surgery, during which small wedges of damaged lung tissue are removed
Pulmonary Rehabilitation: an important part of chronic bronchitis treatment is pulmonary rehabilitation, which includes education, nutrition counselling, learning special breathing techniques, help with quitting smoking and starting an exercise regime.
OXYGEN THERAPY FOR CONGESTIVE HEART FAILURE PATIENTS
Congestive Heart Failure is a condition in which the heart has trouble pumping blood, and as a result fluids build up in the body. Oxygen supplements are recommended for some people with congestive heart failure; a health care professional can provide diagnosis and treatment options for the condition.
Treatment is carried out using Nasal Cannula, Face Masks and Positive Pressure Ventilation.
You should NEVER smoke while using oxygen. Visitors must also be warned regarding the same.
When commuting or traveling, ask to be seated in the non-smoking section.
Maintain atleast 5 feet distance from gas stoves, candles, lighted fireplaces, etc.
If using a cylinder, make sure it is fixed or stationary somewhere safe.
If using liquid oxygen, make sure the vessel is kept upright to keep the oxygen from pouring out. It is so cold, it can hurt and damage the skin.
If using an oxygen concentrator, notify your electric company so you will be given priority if a power failure occurs.
The home medical equipment and services company that provides oxygen therapy equipment must provide customers with instructions on user care and maintenance of your particular equipment.
Certain guidelines for cleaning procedures:
Wash your nasal sprongs with a liquid soap and thoroughly rinse them once or twice a week.
Replace every two to four weeks
If you have a cold, change them when your cold symptoms have passed
Humidifier bottle should be washed with soap and warm water and rinsed thoroughly between each refill. Air dry before refilling.
For oxygen concentrator: unplug the unit, wipe down the cabinet with a damp cloth and dry daily. The air filter should be cleaned at least twice a week.
Strict Do’s & Don’ts
Don’t ever change the flow of oxygen unless directed to do so by physician
Don’t use alcohol to take any other sedating drugs because they will slow your breathing rate
Make sure to order more oxygen from dealer in a timely manner
If you have persistent redness under your nose, call your physician
To prevent cheeks or skin behind your ears from becoming irritated, tuck gauze under the tubing
Traveling with oxygen
It is safe to travel with oxygen. However, various transports have different regulations about their use with oxygen. Contact the specific transport to know such regulations before traveling.
When traveling by car, oxygen equipment must be fastened securely in an upright position so that the equipment is stable during the trip.
When traveling by boat, ferry, train or bus, take the same considerations as traveling by car.
When traveling by plane, you should plan your trip weeks in advance and inform the airline and check their regulations. Obtain an oxygen prescription from your doctor that provides your diagnosis, present condition, a statement that it is safe for you to travel by air and oxygen prescription. Your oxygen company can help to arrange for oxygen at the airport and travel destinations. Make sure you keep a copy of your oxygen prescriptions, medical prescriptions, know the health facilities and healthcare providers at each travel destination. Carry extra medication on the plane with you.