Your 14 Most Common Questions About Oxygen and Answers from Lung Experts

This is general information and not intended as medical advice. If you have questions about your own oxygen needs, show this information to your doctor and talk with him or her about whats best for you. Many thanks to Dr. Steven Kraker, Dr. Frank Adams, Dr. Robert (Sandy) Sandhaus, and Respiratory Therapist Helen Sorenson for their time and expertise in answering these questions. Answers are noted with the initials of each expert. 1. What is a normal blood oxygen level? 2. I am so short of breath. Why cant I have oxygen? 3. I am not short of breath. Why must I use the oxygen? 4. Can it hurt me if I dont have enough oxygen? 5. If I start on oxygen, wont I get addicted to it? 6. Can too much oxygen hurt me? 7. I am on oxygen now. Why cant I breathe any better? 8. Can I use my oxygen just when I am in the privacy of my own home and not when I go out shopping, to the movies or out to dinner? 9. What about oxygen at night? If I use it during the night when I sleep, will it carry over into the day? 10. Can oxygen cure me? 11. I have heard there are different types of oxygen and different ways to administer oxygen. Whats best for me? 12. I have heard there is something where you get oxygen through a little tube that goes through your neck into your windpipe. Is that for me? 13. Can oxygen into my nose get in even when I have clogged sinuses? 14. How long can my oxygen tubing be at home before the oxygen reaching me becomes less effective?

1. What is a normal blood oxygen level? FA: Oxygen levels are commonly measured by two techniques. The first is a blood gas in which a blood sample is taken directly from an artery. This is the most accurate assessment of oxygen. The normal oxygen level using this technique is 80-100 (mmHg). The second technique is bloodless [and painless] and is called pulse oximetry. The result here is not a direct measurement of oxygen but rather represents the percentage of hemoglobin that is saturated with oxygen. Hemoglobin is a protein in the blood that carries oxygen to the tissues. A light sensor is used which is commonly placed on a fingertip. Pulse oximetry is not as accurate as a blood gas and can be influenced by temperature and circulation. The normal oxygen saturation is 95-100%.

2. I am so short of breath. Why cant I have oxygen? SK: Believe it or not, in many cases you really cannot tell when you need or dont need oxygen. Many things contribute to shortness of breath, and though it is commonly believed by the lay person that shortness of breath means you need oxygen, that is not always the case. The converse is also true. Patients with significant lung disease who have chronically low blood oxygen levels sometimes refuse to use oxygen because they dont feel short of breath. For an accurate assessment of who needs oxygen and who doesnt we must rely on measured blood levels. This is done directly on blood drawn through a needle from an artery or indirectly by a simple device called an oximeter, which can accurately measure your blood oxygen level through your finger or your ear lobe. There are criteria that doctors use to determine who does and does not need oxygen, whether that be part time or 24-hours daily. These criteria are well established in the medical literature and are also adhered to by insurance companies in determine whether they will pay for prescribed oxygen. You can be quite short of breath and yet have an entirely normal blood oxygen level. In that case all of the oxygen we could possibly give is not going to affect your shortness of breath. There are other factors involved in that situation which must be treated in order to improve your shortness of breath.

3. I am not short of breath. Why must I use the oxygen? SK: Even patients who are not short of breath but yet have low blood oxygen levels can benefit from oxygen therapy in terms of quality of life and better functioning of important organs such as the brain, the heart, and the kidneys. In order to know whether you need oxygen or not your doctor needs to do some testing. If the testing does not indicate the need for oxygen, then attention needs to be focused on other contributing causes for your shortness of breath. Even though you may not qualify for oxygen at one time, it may be necessary to follow up your blood oxygen levels periodically (every 6 to 12 months) to determine if at some point in the future you may require oxygen therapy.

4. Can it hurt me if I dont have enough oxygen? RS: If you need supplemental oxygen, not getting enough oxygen to raise your blood levels of oxygen to an appropriate level can have very serious long term effects. Too little oxygen causes the blood vessels in the lungs to constrict making it more difficult for the heart to pump blood through the lungs. As a result, the pressure in the blood vessels feeding the lungs can rise, a condition known as Pulmonary Hypertension. If this goes on long enough the right side of the heart, the side that sends blood to the lungs, can fail, giving you a condition called right heart failure or Cor Pulmonale. In addition, if you don't have sufficient oxygen delivered to the tissues of the body, they can't function as they should. The organs most affected by low oxygen, in addition to the heart, are the muscles and the brain.

5. If I start on oxygen, wont I get addicted to it? SK: No, this is a myth. We have all essentially been addicted to oxygen since birth. We cant live without it. The air we breathe is approximately 21% oxygen. When a patient is started on supplemental oxygen they are often put on something in the range of 24 to 30% oxygen, so it is just a little more than is in the usual air you breathe. Using supplemental oxygen does not make you dependent on it anymore than you have already been dependent on it since your first breath. It is just that with lung disease you may need a little bit more oxygen going into your lungs in order to get an adequate amount through your diseased lungs into your blood stream. Using supplemental oxygen does not result in increasing demand for oxygen. The increased need is simply related to the progression of your underlying lung disease. Often patients who need oxygen find that as years go by and their lung disease gradually worsens that it takes more oxygen to get the same blood level. This is not because they were started on supplemental oxygen. It is merely because the disease has progressed (as is the natural course of many lung diseases). Often times patients feel that oxygen may be addictive because once they are started on supplemental oxygen they can never get off it. That is not because they have used the oxygen. It is just, again, related to their underlying disease. If the underlying lung disease is significant enough that oxygen is required in the first place, oxygen is likely going to always be required. Sometimes, when people are right on the verge of needing oxygen, but not quite needing it on an everyday basis, they may come to need oxygen temporarily during an acute illness. This is something that can happen when a person is near the need for continuous oxygen therapy and with an acute illness their body will be stressed enough to require oxygen temporarily. Then after recovery their oxygen level may be back up and they can come off oxygen again. Sometimes an acute illness will be the last straw that causes you to need supplemental oxygen from that point on. If your doctor feels you need to use oxygen, you should use it without fear of it causing dependence. Studies show that if you meet the criteria for needing oxygen and use it according to your doctors prescription that you will survive better and longer than a similar patient with a similar disease who chooses not to use oxygen.

6. Can too much oxygen hurt me? SK: You should consider oxygen as a medication. Accordingly it should be treated like any other drug prescribed, that is, it should be used in appropriate doses. Just because some is good, it doesn't mean more oxygen is necessarily better. You should rely on the advice of your doctor who knows your particular case. Some lung diseases require a certain level of supplemental oxygen when the patient is at rest, but more oxygen is needed during times of exertion. Other lung diseases require a set amount of supplemental oxygen on a continuous basis, and

increasing the dosage beyond the prescribed amount could be detrimental. You will have to discuss your own individual situation with your doctor to determine what is best for you. Under some circumstances it can be detrimental to increase your own oxygen without consulting your doctor, just as if you increased your own heart medicine, blood pressure medicine, or diabetes medicine without consulting your doctor. Again, I think the best way to go about it is to think of your oxygen like another drug prescription and to follow the specific instructions very carefully just as you would with any of your other medicines. RS: There are some very specific situations in which it can be harmful to be on too much oxygen. However, for most people with chronic obstructive lung disease or COPD who receive oxygen through a nasal cannula, the answer is no, too much oxygen won't hurt you. Using too much oxygen is wasteful and can cause dryness and other discomforts. So what are the situations in which too much oxygen can be harmful? The brain regulates breathing based on the amount of carbon dioxide in the blood. Some individuals with very severe COPD retain carbon dioxide in their blood and the brain begins to then regulate breathing based on the amount of oxygen in the blood. Giving such a person too much oxygen can actually turn off their drive to breathe and cause life threatening respiratory arrest. Therefore, people with very severe COPD should check with their healthcare provider about whether they are at risk for this type of reaction to too much oxygen. There are two other situations in which too much oxygen can be harmful. The first is giving high flow oxygen to newborn babies, which can cause blindness. The second is giving 100% oxygen to someone for a very long time, usually through a tube into the windpipe attached to a breathing machine or ventilator. Receiving very high amounts of oxygen over many days in this manner can injure lung cells.

7. I am on oxygen now. Why cant I breathe any better? HS: This is a question we hear all the time. It might make sense that if your O2 (oxygen) levels are fine, all is right with the world, but that is not always the case. Dyspnea, or the sensation of difficult breathing does not always correlate well with the amount of oxygen (O2) in the blood - so oxygen levels may be fine, but breathing is hard. When O2 levels are okay and you may feel like you "can't breathe," your dyspnea may be caused by anxiety (often caused by the feeling of not being able to breathe). Its a vicious cycle. This is where pursed lip breathing is most useful, because is slows down breathing, relaxes you and often makes breathing easier. Another hint to decrease the sensation of difficult breathing is to sit in front of a fan - cool air facial stimulation decreases the sensation of dyspnea. Pulmonary rehabilitation patients tell me time and time again that the most important thing they learn from rehab is how to breathe correctly.

8. Can I use my oxygen just when I am in the privacy of my own home and not when I go out shopping, to the movies or out to dinner? SK: Using supplemental oxygen is sometimes inconvenient or embarrassing for patients and this leads to the temptation to use it only when I need it. Again I would refer you to what we covered above and that is that you really cant tell when you need oxygen and when you dont unless your blood oxygen levels are being measured. Studies show that if you meet the criteria for continuous oxygen use, using it less than 18 hours a day is probably equivalent to using none at all. If your doctor prescribes 24-hour daily oxygen therapy you should try to use it as close to 24 hours a day as practical. Of course there are times you may need to take it off, when you shave or put on make-up or do other daily hygiene. This is not harmful for short periods of time. If you have any questions about this, it is a good idea to go over them with your doctor, pulmonary rehabilitation nurse, or respiratory therapist.

9. What about oxygen at night? If I use it during the night when I sleep, will it carry over into the day? SK: Occasionally patients need oxygen only at night while asleep. Other patients may only need oxygen part of the day, but usually this is with any type of exertion such as walking or getting out and doing errands, etc. If your doctor determines from testing that you do not need oxygen 24 hours a day, it will usually be necessary either at night during sleep or just when you are up and active out doing errands or some of the activities we talked about above. Often in this situation the only time you really dont need supplemental oxygen is when you are sitting quietly resting at home reading

a book or watching television. Human nature says that is the time you would like to be using your oxygen but ironically you really need it most when you are out and about. RS: The oxygen that gets into your blood by using supplemental oxygen leaves your system within several minutes after removing your cannula. Therefore, although the oxygen you use during the night can have many long-term beneficial effects, the oxygen itself is gone from your system fairly soon after you turn off the oxygen tank or concentrator. Many patients only need oxygen when they sleep and their oxygen levels are fine without supplemental oxygen during the day. But if you need oxygen both at night and during the day, using it only at night, while better than not using oxygen at all, is not sufficient to keep you well oxygenated during the day.

10. Can oxygen cure me? SK: No. Your oxygen does not treat your underlying lung disease. It just helps to fulfill needs that your diseased lungs cannot manage on their own. It is helping you to do a little better with what you have, but it cant improve your lung function. It is kind of like having to wear glasses because your eyes aren't entirely normal. Wearing glasses doesnt fix your eye problem. They just help your eyes to see better. If you take your glasses off, your eye problem is still there and you cant see very well. The same is true for your oxygen. It just helps you do a little better with the lungs you have. Your lungs are still the way they were. Your body cannot store oxygen, so if you take your oxygen off, your blood oxygen level will go back down again within minutes.

11. I have heard there are different types of oxygen and different ways to administer oxygen. Whats best for me? SK: Oxygen is oxygen and whether you use liquid oxygen tanks of gaseous oxygen or a device called an oxygen concentrator, it is individualized for each patient depending on their needs. You can get excellent treatment with supplemental oxygen by any of the types of oxygen just mentioned. Liquid oxygen is just gaseous oxygen compressed into a much smaller volume so that it becomes liquid. As it is allowed to escape from its container into your oxygen tubing it becomes gaseous oxygen the same as you would get from a simple oxygen tank. For patients who are more active and mobile, liquid oxygen can sometimes be a nice alternative because they can be out and about for a longer time using a smaller sized tank. An oxygen concentrator is good for patients who are fairly sedentary and dont get out much. An oxygen concentrator takes oxygen from the air in a way similar to how a dehumidifier takes water from the air. Just like the water from your dehumidifier runs out through a hose into a drain, the oxygen from your oxygen concentrator runs through the tubing into your nose at a set flow rate prescribed by your doctor. The device runs on electricity in your home so you usually need to have some spare oxygen tanks in case there is a power outage. Depending on your prescribed oxygen flow rate, a small portable tank may last you up to a few hours. Some patients like to get out more, sometimes for several hours at a time, and don't want to have to carry extra tanks with them. These patients might benefit from an oxygen conserving device. Usually these devices give you oxygen only every other, every third, or every fourth breath depending on how they are programmed. By extending the length of time you can go on a set amount of oxygen, you are actually using up less oxygen per minute. In some cases, this can be sufficient, but in other cases this is not adequate. Your doctor can test you to see if a conserving device is right for you. The message is that oxygen is oxygen whether it is liquid, gaseous, or from a concentrator. The dose you need is whatever your doctor has determined is sufficient to maintain a normal blood oxygen level during your usual normal daily activities at home and away.

12. I have heard there is something where you get oxygen through a little tube that goes through your neck into your windpipe. Is that for me? SK: What you are referring to is called transtracheal oxygen therapy. It is not a tracheostomy. It is a very small, soft, plastic tube that passes through the skin of your neck just below your Adams apple and enters directly into your trachea or windpipe. This method of giving oxygen is used by patients who have had trouble with nasal or sinus problems from nasal oxygen, or by patients who get sores or ulcers from the oxygen tubing. It is also recommended for some patients who need so much oxygen that it is impractical to give it through the nose. You can get by on about half as much oxygen

if it is given directly into the trachea as opposed to taking it into the nose. Some of the oxygen that goes into your nose unavoidably just escapes into the atmosphere. The transtracheal oxygen catheter is not for all people who need oxygen. It does require some special care and you have to be able to do this care yourself on at least a daily basis, sometimes more. You still have to have a nasal cannula for oxygen to use when you are removing your transtracheal catheter and cleaning it, or for emergencies if your transtracheal catheter should come out. If you are wondering whether you are a candidate for transtracheal oxygen you should ask your doctor.

13. Can oxygen into my nose get in even when I have clogged sinuses? HS: That depends on the degree of obstruction/sinus congestion. If the nasal passages are completely swollen/blocked, a cannula might not be as effective but if your sinuses are congested a little, you are likely breathing more through your mouth, then the oxygen going into the nasal passages will be pulled into the lungs by the air coming in through the mouth. I have seen patients put their cannula in their mouth, but that does not usually make the delivery of oxygen to the lungs any more effective.

14. How long can my oxygen tubing be at home before the oxygen reaching me becomes less effective? HS: The length of the oxygen tubing should not affect the liter flow of oxygen being delivered. It just may take a little longer for the oxygen to get to you initially like when it is first turned on but once it is flowing, it should remain constant. Even though oxygen is a gas, we have to think of it in terms of being a liquid if the pressure at the tank remains constant (which it does until the tank has less than 500 psi), the liter flow, 2 LPM (liters per minute), 3 LPM, etc. will remain constant. Think in terms of a garden hose if the pressure/flow of water coming out of the faucet is constant, regardless of the length of the hose, the same amount of water will exit the other end. The only thing that may affect oxygen delivery is if there is an occlusion/obstruction in the tubing.

mportant Safety Guidelines Specifically for Home Oxygen Tanks

Several oxygen guidelines are logical and, as a matter of fact, typical. But don't take it for granted that you know everything: please refresh your knowledge. As a caregiver (or as a patient), you need to know the incredibly essential rules to having safe home oxygen tanks. Whatever you must know about your oxygen equipment must be fresh in your mind always, just in case. From the most complex aspects to the simplest details, mistakes can happen virtually anytime, and domestic accidents are very common. Do not let your oxygen equipment become the cause of a preventable catastrophe. The primary concern of this article is the safety of the patient, caretaker or caretakers, and the home in which they live. Please take serious note of the information provided here if you use or plan to be using any kind of at - home medical oxygen equipment in the near future. 1. Be sure to use some kind of oxygen concentrator if you do not have to be concerned about filling or re-filling your oxygen tank. An oxygen concentrator will never have to be refilled. Usually it divides oxygen from nitrogen and other gasses within the air of the room or other space around it. However, as you likely know, these are not made to be portable oxygen delivery systems. Concentrated oxygen tanks are convenient, readily available, and do need to be refilled. 2. If you have liquid oxygen tanks, make sure you know exactly what to do to refill it - as well as the warnings specific to that particular piece of oxygen equipment. This recommendation is not to be taken lightly. I highly suggest that you are not only familiar with this information - but that it is memorized.

3. Liquid oxygen is also very portable. Most importantly though, if you use portable liquid oxygen in small tanks you must have a large oxygen tank available at home. You can use a large liquid oxygen tank to refill smaller tanks, and they provide the freedom you want. 4. If you have a large (as well as small) liquid oxygen tank, always be sure that your large liquid oxygen tank is full enough - and always have a back - up plan for oxygen delivery in case of an emergency. The best back - up method will likely be the one recommended by your physician. 5. If it ever occurs, contact your oxygen supplier the moment you notice any damage to your oxygen equipment. 6. Always have a portable oxygen delivery system (most likely a tank) prepared or filled in case you have to go somewhere quickly. 7. Never smoke, have sources of high temperatures, or fire of any kind near or around your oxygen equipment. Even if you do not know of any reason why you should need to - it is still highly recommended that you put up hazard signs such as 'no smoking' signs wherever your oxygen is stored. 8. Have telephone numbers handy. Keep manufacturer hotlines at home as well as away from home for 24 hour emergency assistance with your medical equipment. If you have oxygen equipment of any kind you can not be afraid to ask if you are unsure about anything regarding use or safety. Always consult the manufacturer, pharmacist (or provider) and / or your doctor if you have any questions whatsoever. Even if you feel strange asking what you believe are simple questions, you must know the answers. In addition to the information I have provided here, you must follow the doctor's and manufacturers' instructions and know them as well as you know each of the guidelines provided above. You can prevent any potential complications with life - saving equipment such as oxygen tanks. Medical science and advanced medical equipment can certainly improve a patient's life - but only if the possible complications are carefully avoided.

Home Oxygen Therapy More and more people are using oxygen therapy outside the hospital, permitting them to lead active, productive lives. People with asthma, emphysema, chronic bronchitis, occupational lung disease, lung cancer, cystic fibrosis, or congestive heart failure may use oxygen therapy at home. The Prescription A physician must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minutereferred to as liters per minute (LPM or L/min)and when you need to use oxygen. Some people use oxygen therapy only while exercising, others only while sleeping, and still others need oxygen continuously. Your physician will order a blood test that will indicate what your oxygen level is and help determine what your needs are. The Equipment There are three common ways of providing home oxygen therapy:

A liquid oxygen system; A standard oxygen concentrator, and A portable oxygen concentrator

Home oxygen is rarely delivered in the older large, steel gas cylinders any longer since frequent and costly home deliveries are necessary every few days to replace empty tanks. Each of the three current methods of providing home oxygen is examined in more detail below. Liquid Oxygen Oxygen is stored as a very cold liquid in a large, barrel-like vessel (called a dewar) that acts like a large thermos. When released, the liquid oxygen immediately converts to a gas and you breathe it in, just like the compressed oxygen in the older steel cylinders. An important advantage of liquid oxygen is you can transfer some of the liquid oxygen into a smaller, portable vessel that can be carried when you have to leave your home. The time you can spend away from the dewar can be extended if there is an oxygen-conserving device built into the portable vessel. Oxygen-conserving devices will be explained below. A liquid oxygen dewar must be periodically refilled by the home care company but not as frequently as with the older steel tanks. This is because 1 unit of liquid oxygen expands to 860 units of gaseous oxygen. However, liquid oxygen is expensive and will evaporate from the dewar when not being used. When used as directed, a full dewar can last up to 2 weeks. Standard Oxygen Concentrator This is an electrically powered device, weighing about 50 pounds, that separates oxygen from the air by removing nitrogen. Since air is a mixture of 78% nitrogen and 21% oxygen, removing the nitrogen allows the oxygen to concentrate to over 90%. This system has a number of advantages. Since a concentrator essentially makes its own oxygen, there is no need for resupplies by the home care company. However, you must have a small cylinder as a backup in the event of a power failure. You should also advise your local electric utility company that you use oxygen in order to get priority services when there is a power failure. Your home care company can also provide you with small, lightweight, portable cylinders to use when you must leave your home, for example when you visit your doctor, or go grocery shopping. Empty cylinders will need to be replaced by your home care company. However, one way to make these smaller cylinders last longer is to use an oxygen-conserving regulator. These regulators deliver a short burst of oxygen, but only when you inhale. Since no oxygen is flowing when you exhale, oxygen is conserved. Cylinders with an oxygen-conserving regulator can last 34 times longer than when oxygen is flowing all the time, as is the case with older regulators. Some home care companies now offer a special pressure booster that can take some of the oxygen produced by your concentrator to refill the small portable cylinders. This is a great advantage since you can refill your own cylinders when you get back home. By refilling your own portable cylinders, you don't have to worry about calling your home care company to replace empty cylinders. Portable Oxygen Concentrator Advances in technology have significantly reduced the size and weight of the standard oxygen concentrator. There are various models of lightweight portable oxygen concentrators. Some weigh as little as 5 pounds where others weigh closer to 17 pounds, but all are easily transportable. So, not only can a portable concentrator be used in your home, but you can also take it with you whenever you need to leave your home. Portable concentrators can be powered from a standard household electrical outlet, from the power outlet in any motor vehicle, or from a rechargeable battery. This feature makes portable concentrators very convenient, and eliminates the need for small portable cylinders. Since they are battery operated, portable concentrators can also be used when taking a trip on an airplane. However, you might have to take along additional batteries depending on how many hours the flight will take. Since there are many different models of portable concentrators, there are also differences in how much concentrated oxygen each model can produce. As a rule of thumb, the smaller the portable concentrator, the lower the amount of oxygen it can concentrate each minute. For some patients, the smaller portable concentrators may not be able to produce enough oxygen to meet their needs. It is therefore very important to have a respiratory therapist confirm that a particular model will work for you. Otherwise you might not get enough oxygen when you need it. Oxygen Administration Devices The most common way to administer home oxygen is with a nasal cannula. This is a two-pronged piece of soft vinyl at

one end of plastic tubing that is placed about inch into your nostrils. The tubing rests over your ears, or can be attached to the frame of specially designed eyeglasses. The other end of the tubing is connected to the oxygen equipment, where the oxygen flow is set. Another way to administer oxygen is with a transtracheal catheter, but this is not for everyone. It requires insertion by a physician of a small flexible plastic catheter in the neck, just below the Adams Apple. The catheter is held in place with a necklace and the oxygen supply tube is connected to the catheter. The oxygen is then delivered directly into your lower windpipe. Transtracheal oxygen delivery has several advantages. When you button the collar of your shirt or wear a scarf, no one can tell that you are using oxygen. Also, since oxygen is delivered directly into the airway (bypassing the mouth, nose and upper throat), much lower oxygen flow rates are required. Some people using transtracheal can get by with oxygen flow rates of to liters per minute instead of the more common 2 liters per minute. There are a few disadvantages associated with transtracheal oxygen. One is that you might need to attach a humidifier bottle to your oxygen equipment to add some moisture to the oxygen. This is usually needed when the oxygen flow rate is 1 liter per minute or greater. You must also take special daily care of the small opening in your neck (called a stoma) to prevent infection. The catheter will also need to be replaced every so often. Safety You should never smoke while using oxygen. Warn visitors not to smoke near you when you are using oxygen. Put up no-smoking signs in your home where you most often use the oxygen. When you go to a restaurant with your portable oxygen source, ask to be seated in the nonsmoking section. Stay at least five feet away from gas stoves, candles, lighted fireplaces, or other heat sources. Don't use any flammable products like cleaning fluid, paint thinner, or aerosol sprays while using your oxygen. If you use an oxygen cylinder, make sure it is secured to some fixed object or in a stand. If you use liquid oxygen, make sure the vessel is kept upright to keep the oxygen from pouring out; the liquid oxygen is so cold it can hurt your skin. Keep a fire extinguisher close by, and let your fire department know that you have oxygen in your home. If you use an oxygen concentrator, notify your electric company so you will be given priority if there is a power failure. Also, avoid using extension cords if possible. Care of Equipment The home care company that provides the oxygen therapy equipment you use should provide you with instructions on user care and maintenance of your particular equipment. Here are some general guidelines for your cleaning procedures. You should wash your nasal prongs with a liquid soap and thoroughly rinse them once or twice a week. Replace them every two to four weeks. If you have a cold, change them when your cold symptoms have passed. Check with your health care provider to learn how to clean your transtracheal catheter. The humidifier bottle should be washed with soap and warm water and rinsed thoroughly between each refill. Air dry the bottle before filling with sterile or distilled water. The bottle and its top should be disinfected after they are cleaned. If you use an oxygen concentrator, unplug the unit, then wipe down the cabinet with a damp cloth and dry it daily. The air filter should be cleaned at least twice a week. Follow your home medical equipment and services company's directions for cleaning the compressor filter. Dos and Donts

Don't ever change the flow of oxygen unless directed by your physician. Don't use alcohol or take any other sedating drugs because they will slow your breathing rate. Make sure you order more oxygen from your dealer in a timely manner. Use water-based lubricants on your lips or nostrils. Don't use an oil-based product like petroleum jelly. To prevent your cheeks or the skin behind your ears from becoming irritated, tuck some gauze under the tubing. If you have persistent redness under your nose, call your physician.

Trouble Call your physician if you experience frequent headaches, anxiety, blue lips or fingernails, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Also, call your physician if you feel any symptoms of illness. Medicare, Medicaid, and Commercial Insurance Certain insurance policies may pay for all your oxygen, but payment is based on laboratory results, diagnosis, and other information. Your physician or home care company may be able to answer your questions about coverage. Reviewed: April 12, 2012

Using Oxygen at Home

Why would you need to use oxygen at home?
If you have chronic lung disease, your health care provider may prescribe oxygen. Examples of chronic lung diseases are asthma, emphysema, chronic bronchitis, lung cancer, cystic fibrosis, and heart failure.

Oxygen therapy can help you:

Breathe better. Sleep better. Feel better. Be more alert. Have more stamina. Lead a more normal life.

Oxygen at very high levels over a long time can be dangerous, which is why you need a prescription from your health care provider. The prescription will spell out how much oxygen you need per minute (flow rate) and when you need to use oxygen. Some people need oxygen therapy only when they exercise or while they sleep. Others need to use oxygen around the clock. Your health care provider will measure the level of oxygen in your blood to see how much oxygen you need.

How can you get oxygen?

There are 3 ways to get oxygen at home: *Tanks of Compressed Gas. Oxygen gas is stored under pressure in large, heavy tanks or small, portable tanks. The large tanks are kept at home, while the small tanks can be carried with you. *Tanks of Liquid Oxygen. Oxygen is stored in these tanks as a very cold liquid. The liquid changes to a gas when it is released from the tank. Liquid oxygen is more expensive than the compressed gas, but it takes up less space and is easy to transfer to portable tanks. *Oxygen Concentrator. This is an electric device that separates the oxygen out of the air and concentrates it. It is not as costly as liquid oxygen, but you must have a tank of oxygen as a backup in case of a power failure. You breathe oxygen from the tank or concentrator in 1 of 3 ways: A nasal cannula is soft, plastic tubing that rests on your ears. Two thin prongs fit just inside your nostrils.

Cannula

Pendant

Oxyarm

A mask that fits over your nose and mouth may work best if you need a high flow of oxygen. Transtracheal oxygen therapy requires the insertion of a small flexible catheter in your trachea (windpipe). The transtracheal catheter is held in place by a necklace. A humidifier is usually needed with transtracheal oxygen.

What is an Oxygen Concentrator?

Oxygen concentrators are stationary, electrical units that absorb nitrogen from ordinary room air and provide a continuous flow of oxygen. These systems are less expensive than liquid oxygen and do not need to be refilled. Typically, they are the most costeffective source of oxygen therapy. Approximately 80% of Medicare home oxygen patients use oxygen concentrators in the home; however, concentrators are not an ambulatory source of oxygen. When ambulation is required, most patients rely on lightweight gaseous portable cylinders paired with a conserving device. Some patients are provided only with a large, heavy, non-ambulatory E cylinder that is pulled around with a cart. Unlike liquid oxygen, compressed gas cylinders do not evaporate. This allows the patient to take along extra cylinders for extended outings, which is the key feature and benefit to compressed gas systems. Eventually, the cylinders must be refilled or replaced by the homecare providers when the patient depletes the oxygen supply. The Homefill II is a device that compresses the oxygen it receives from a concentrator into the cylinder connected to it. The following sections describe the compressor, concentrator, cylinders, and the process of filling cylinders.

Benefits of the Homefill II Portable Oxygen System

Unlimited portable oxygen - cylinders may be filled over and over. Cylinders weigh less than 5 pounds and last up to 5 hours (at 2 LPM equivalent flow). No worrying about deliveries or running out of oxygen. Promotes freedom and independence. Safe and easy to use. No liquid freeze-ups. Each cylinder has its own built-in regulator and conserving device - No need to change regulators. No dragging cumbersome and embarrassing oxygen carts around in public. Wear over the shoulder or around the waist. No batteries or maintenance required.

The Compressor

The Homefill II is a compressor that requires 2 amps of current and consumes 200 watts of power. It has about the same size footprint as a concentrator, stands 15 inches high, and weighs about 33 pounds. Its average noise level is less than 50 decibels. It takes up no more floor space than your concentrator if you purchase the optional table. Set the table over your concentrator and place the Homefill II on top..

The Concentrator

The concentrator that accommodates the Homefill II is Invacare's Platinum 5, a 5 Lpm concentrator . This concentrator can support your oxygen needs up to 3 Lpm while simultaneously allowing Homefill II to fill a cylinder. It requires 4 amps of electrical current and consumes 400 watts of electrical power. It has a footprint of 14 by 18 inches, stands 26 inches tall, and weighs 51 pounds. Its average noise level is rated at 60 decibels. The Homefill II compressor and the Platinum 5 concentrator are available in both 110 volt and 220 volt configurations.

The Cylinders

The Homefill II will fill only those cylinders that come with it, which are the M6 (or B), ML6, and M9 (or C) cylinder. The typical Homefill II user orders two cylinders. You need to determine and order enough cylinders to support your needs. If you travel, you must carry sufficient full cylinders with you, have a Homefill II available at each destination, carry your concentrator and compressor with you, or you must temporarily rely on portable oxygen from a different source. The table at the end of this article

should help you decide both what type and how many cylinders you should order. Each cylinder has a contents gauge and a pneumatic conserver that are permanently attached to the cylinder.

The Contents Gauge

The contents gauge measures the internal pressure of the cylinder. When full, the internal pressure is 2000 psi (pounds per square inch), and the gauge's pointer is in the green area. When the pressure falls below 500 psi, the pointer is in the red area, indicating that in a very short time, the cylinder needs to be replaced.

The Conserver
The EasyPulse is the conserver that has been modified so that it can be permanently mounted on Homefill II cylinders. Although it has an Invacare label, it is a product of Precision Medical . Its rotary switch has seven positions: Off. CF (continuous flow), and five pulse positions. When set to 2, the EasyPulse provides the 20 bpm (breaths per minute) user with a 28 ml pulse on each inhalation. If the user breathes either slower or faster than that, the volume of the pulse automatically adjusts so that the user receives the same volume of oxygen each minute. For example, at the same setting, the pulse of the 10 bpm user is 35 ml and that of the 30 bpm is 21 ml. According to its manufacturer, the EasyPulse extends the life of a cylinder by a factor of 3.5. For the 2 Lpm user whose breathing rate is 20 bpm, this means that a full M9 cylinder, which empties in 2 hours on continuous flow, will last about 7 hours with the EasyPulse . A full M6 or ML6, which empties in 1.4 hours on continuous flow, will last about 5 hours with the conserver. It is known that there is a higher percent of oxygen in a cylinder that is filled by your provider than in a cylinder filled at home by you concentrator. The difference is so small that it had been clinically demonstrated to be the same. (J. Lewarski, et al. A clinical comparision of portable oxygen systems: continuous flow compressed gas vs. oxygen concentrator gas delivered with an oxygen conserving device. (RC Journal 48:1, 2003)

The Filling Process

The Homefill II compressor fills an M6 or ML6 in about an hour and a half, and an M9 in about two and a half hours. The compressor seems to be easy to operate for a person who reads the instructions and abides by the safety messages that appear in the users' instruction manual. There is also a 15 minute VCR video that describes the complete filling process and provides troubleshooting guidance. After turning on both the concentrator and compressor and allowing them to warm up, place an empty cylinder in the compressor's cradle and connect it to the compressor. The five indicator lights on the compressor's control panel monitor the filling process to completion and note any problems along the way. When the process is complete, the color of the lights assure you of the amount and purity of the oxygen in the cylinder. The cylinder is a cinch to connect to the compressor. All you do is put it on and press down until you hear a click. To remove it, you merely pull the collar down to release the cylinder.

Selecting the Right Number and Size of Cylinders

The following table shows the weight of an EasyPulse system with the M6, ML6, and M9 cylinders. It also shows the duration of these cylinders at its five pulse settings, assuming a breathing rate of 20 bpm, and its duration on continuous flow. Use this table to select the type of cylinder that is both not too heavy for you to carry and has the duration you expect at your prescribed setting. Once a type of cylinder is selected, you can calculate the number of cylinders you need to order with the Homefill.

TABLE OF EASTPULSE VALUES

Duration (in hours) at 20 bpm (breaths per min) when set to the following: -----------------------------------------------------------------------------------------Cylinder Weight* 1 2 3 4 5 CF** ------------------------------------------------------------------------------------------M6 4.5 9.2 4.9 3.6 2.9 2.5 1.4 -------------------------------------------------------------------------------------------

ML6 5.2 9.2 4.9 3.6 2.9 2.5 1.4 ------------------------------------------------------------------------------------------M9 14.2 7.6 5.6 4.5 3.9 2.0 ------------------------------------------------------------------------------------------* approximate weight in lbs., with full cylinder ** at factory-set 2 Lpm

What special precautions do I need to take?

Pure oxygen is a fire hazard. Keep a fire extinguisher close by, and let your fire department know that you have oxygen in your home. Oxygen makes any fire burn faster and hotter. Keep flammable items away from the oxygen supply, such as:
alcohol aerosol sprays cleaning fluid, paint thinner, or other solvents perfumes petroleum products such as gasoline or oil.

Keep oxygen at least 5 feet away from sources of flames, sparks, or high heat. Examples include:
cigarettes gas stoves and heaters candles Lit fireplaces.

Never smoke while you are using oxygen. Warn visitors not to smoke near you when you are using oxygen. The highest safe temperature for the oxygen tank and accessories is 125F (52C). Take precautions to prevent leaks from tanks of oxygen. If you need oxygen at home, a technician will help you set up your system. Always follow instructions for attaching the regulator. The tanks should be secured so that they do not fall over. Carefully seal them whenever they are not in use. The company that supplies your home oxygen will assist you with a setup and delivery schedule for bringing replacement tanks to your home. If you use a concentrator, tell your electric company so you will be given priority for repairs if there is a power failure. Clean the air filter on the concentrator at least once a week.

What else do I need to know if I am using oxygen at home?

Wash cannulas or masks once or twice a week. Use liquid soap and rinse thoroughly. Change to a new cannula or mask every 2 to 4 weeks. If you are using a transtracheal catheter, check with your health care provider to learn how to clean your catheter and humidifier bottle. Oxygen therapy dries the inside of your nose and mouth. Use water-based lubricants such as KY Jelly on your lips or in your nose. Don't use an oil-based product, such as petroleum jelly. Make sure you have good dental and gum care. To keep your cheeks or the skin behind your ears from becoming irritated, tuck some gauze under the tubing. Do not drink alcohol. It may slow your breathing rate. It may also cause you to forget the rules for being safe with oxygen.

Make sure your health care provider knows all the medicines and supplements you are taking. Do not change the flow of oxygen without your health care provider's approval. Too much oxygen does not help. It can cause you to breathe too slowly, which allows too much carbon dioxide to build up in your blood. Too little oxygen can worsen shortness of breath and be harmful. Talk with your provider if you think your oxygen level needs to be adjusted. You can travel with oxygen, but will need a special small tank. Talk with your provider about your options. Call your health care provider if:
You have a lot of headaches. You feel more nervous than usual. Your lips or fingernails are blue. You have unusual drowsiness or confusion. Your breathing is slow, shallow, difficult, or irregular. Call your health care provider or your oxygen supplier if you have any questions about oxygen safety.

The Invacare HomeFill II lets oxygen patients get out and enjoy life. Where will you go next?

Oxygen Therapy at Home

What is oxygen?
Oxygen is a gas that you cant see, taste, or smell, but it is in the air all around us. Everyone needs oxygen in order to live. The amount of oxygen in the air is always 21 percent. This is enough for people whose heart and lungs work normally. A person with heart or lung problems may benefit from breathing air with more oxygen.

Why use oxygen therapy?

Oxygen therapy is used for any condition that may reduce the amount of oxygen available to the body, such as lung or heart disease. If your body is not getting enough oxygen from breathing the air around you, your doctor may put you on oxygen.

How do you know that you need oxygen?

Your doctor will order 1 of 2 tests to determine the amount of oxygen in your blood. In an arterial blood gas (ABG) test, blood is drawn from an artery, usually in your wrist. This test directly measures the amount of oxygen in your blood. The other test is pulse oximetry (ok-SIM-ehtree, sometimes called SpO2 or O2 Sat). A probe is attached to a machine called an oximeter that indirectly measures how much oxygen is in your blood. The painless probe may be attached to your fingertip, ear lobe, or forehead. It should be checked while you are resting, sleeping, and during activity.

Why Oxygen is Important

Oxygen is necessary for your body. It is used by all of your main organs and tissues. When your body does not get enough oxygen, you may have difficulty breathing, problems with your heart, fatigue, loss of memory, headaches, or confusion. Using oxygen decreases the work your heart has to do. Oxygen is one of your best medicines.

Oxygen Prescriptions
Oxygen is a medicine and it must be prescribed for you to get it. After your tests are completed, your doctor may prescribe oxygen on a temporary basis or for long-term therapy. Most insurance plans, including Medicare and Medicaid, will cover most of the cost as long as your test results show that you need the oxygen. The remaining cost is often covered

by supplemental policies. Insurance coverage varies, so check with your insurance provider about your coverage. Your health care provider can help you choose a company to meet your oxygen needs.

When to Use Oxygen

Since oxygen is a medicine, your doctor will prescribe how much oxygen to use and when to use it according to your specific needs. Make sure you adjustand readjust the liter flow according to your prescription and activity. _____________ liter(s) per minute during rest _____________ liter(s) per minute during exercise/activity _____________ liter(s) per minute during sleep It is very important that you never increase or decrease your oxygen unless your doctor says you may.

Oxygen Supply Systems

Concentrators Depending on your needs, oxygen may be delivered from a concentrator at home. A concentrator pulls air from the room and filters out the nitrogen to provide oxygen. A concentrator needs electricity and may increase the home electric bill. You should have a generator or backup cylinder in case the power goes out. Your home care equipment company should provide a backup cylinder. Tell your electric company if you have a concentator. Portable oxygen concentrators, weighing just under 10 pounds, have become available. To learn more about these, you can go to: www.homeoxygen.org/airtrav.html. Compressed Gas Oxygen Cylinders Oxygen may be delivered as a gas under pressure in oxygen cylinders. These cylinders are made of steel or aluminum. The aluminum cylinders weigh less than the steel cylinders. Once empty, the cylinder can only be refilled by the home care equipment company. Liquid Oxygen Oxygen also may be delivered via a liquid oxygen system. Liquid oxygen turns into a gas when you use it. This means that large amounts of oxygen can be stored in a small container. When the portable liquid oxygen system is empty, you can fill it from a larger liquid stationary system. The home care company fills the stationary system every 1 to 2 weeks depending upon your oxygen prescription. This system gives you more flexibility and mobility.

System Sizes
Each type of oxygen delivery system is available in different sizes. They are:
Stationary (large) Portable (medium) Ambulatory (small)

Stationary Sources Stationary sources are any large tanks that cant be easily moved. Examples are a concentrator, liquid reservoir, or large compressed cylinder (H or K cylinder).

Portable Systems Portable systems include equipment that is mobile and weighs more than 10 pounds. Examples are a mid-size liquid canister, mid-size compressed cylinder, and more recently a portable oxygen concentrator. Ambulatory Systems Ambulatory systems include equipment that can be carried and weighs less than 10 pounds. Examples are a small liquid canister or small high pressure gas cylinder. Oxygen delivery devices Ways of delivering oxygen include a tube that goes into the nose (nasal cannula), a mask, and a transtracheal catheter. Oxygen may be delivered continuously or intermittently through a pulsed system.

Skin Care
The oxygen tubing may irritate the skin behind your ears. The oxygen may irritate the inside of your nose. Some tips to help with this irritation include:
Use normal saline spray or water-soluble jelly, such as brand name KY Jelly, to moisten the inside of your nose. Avoid petroleum-based products, such as brand name Vaseline. Petroleum products do not cause fires, but they will support burning if a fire occurs. If you have soreness around your ears, put cotton padding over the soreness. You can also call your doctor or home care equipment company.

Safety Tips
Always store oxygen containers upright in an open and well-ventilated area. Make sure they will not tip over.
Do not store paper, fabric, or plastic near oxygen units. Watch for kinks in your oxygen tubing. You will get a 50-foot supply of tubing for oxygen delivery at home. Be careful not to get caught or trip on this tubing. Be careful with metal fittings and pipes on liquid systems to avoid frost injury to your skin. Fasten your oxygen tanks upright in your car. Do not put oxygen tanks in the trunk. Do not leave home with less than half a tank. Tell your local fire department that oxygen is in the home. A sign should be posted that you have oxygen in your home. Make sure smoke detectors are working. Make sure fire extinguishers are easy to reach and not outdated. Do not use appliances that could create a spark in the room with the oxygen unit, such as hair dryers or electric razors. Ask your doctor for other options if you have a gas stove. Be careful when unplugging any appliance. Keep oxygen units and tubing at least five feet away from any source of heat, such as open flames, stoves, space heaters, or candles. Do not use flammable products around oxygen, such as aerosols and cleaning products. Do not smoke or allow anyone to smoke around you. Post a no-smoking sign in clear view. In a restaurant, ask to sit in the no-smoking section. Tell your electric company that you have a concentrator. Test the alarm system on your concentrator regularly.

Traveling with Oxygen

You can still travel even if you need oxygen. Many people with heart and lung diseases travel freely. All it takes is a little planning. Talk to your doctor and home care equipment company before you travel. At different altitudes, your oxygen needs may change.

Youll need to answer these questions before your trip so you can plan how much oxygen youll need:
How long will you be gone? How will you get there (car, plane, bus, train)? How long will it take you to get there?

Driving
If you are driving, make sure all oxygen containers are secure at all times.
Tanks Keep upright and make sure tank is secure. If you have to lay the tank on its side, make sure that it cant roll. Liquid oxygen canister Must be kept upright at all times. You may want to loop the strap attached to the canister over the headrest of the seat next to you. Have a handicapped parking sticker in clear view. Ask your doctor about applying for a handicapped parking sticker.

Air Travel
If you are flying, make your arrangements as far in advance as possible. Tell the airline that you use oxygen when you make your reservation. You must have a statement from your doctor saying that you need oxygen in order to fly on a commercial airline. Ask about the airlines guidelines for passengers needing oxygen. You may not be allowed to bring your own oxygen on board. Some airlines may require you to use the oxygen supplied by the airline. The airlines charge for oxygen, but the charges vary. Some airlines may require you to use a portable oxygen concentrator. These units are available for rent if needed. You may want someone to be responsible for taking your oxygen tank or canister back home once you board the plane. You may take your liquid or compressed gas cylinder system on board only if it is empty. Be sure to ask about oxygen needs during a layover or if there is a delay. Contact your home care equipment company to be there when you arrive at your destination. Confirm your arrangements 48 hours before your trip and arrive at least 3 hours early the day of your trip.

Cruises
Most cruise lines accept people with oxygen. A doctors letter and advance notice of 4 to 6 weeks is required. You must arrange and provide your own oxygen and equipment.

Train Travel
Oxygen equipment can be brought on board, but you must tell your train service provider in advance. Amtrak requires notification at least 12 hours in advance that you will be bringing oxygen on board. Be sure of the total traveling time so that you take enough oxygen. Take at least 20 percent more than you need in case of delays. If you cant take enough oxygen, make arrangements with an oxygen supply company to re-supply you at stations along the way. Confirm with the reservation agent that the train will be stopped at the station long enough for you to receive oxygen delivery. Check with your train service provider for detailed oxygen travel arrangements as soon as possible before your trip.

Bus or Taxi Travel for a Long Distance

Long distance bus or taxi carriers generally require advance notice. Contact your bus or taxi company for details and help to meet your needs while traveling with oxygen.

Travel Trailer
A travel trailer allows you to bring an entire liquid or concentrator system with you. You must take a few extra safety measures:
Make sure the system is secure and cannot be knocked over or roll. Make sure that no other items can bump or damage it. Keep all oxygen tanks, canisters, and equipment secure. Drive safely to avoid accidents and unnecessary jarring and bumping that may cause the oxygen system or other items to become loose.

Resources for Traveling with Oxygen

National supply chains and many local dealers belong to a network of oxygen providers and can help you make arrangements.
A website called Breathin Easy has listings of oxygen suppliers located throughout North America. Visit http://www.breathineasy.com or call 1-888-699-4360. A resource for air travel is www.homeoxygen.org/airtrav.html. Many travel agents specialize in planning for travelers with special needs and can help with oxygen.

Several companies can arrange oxygen in destinations around the world. They do charge a fee for this service, but will take care of all the details. Always ask your oxygen provider for help before you travel with oxygen. Questions to ask your supplier
How do I estimate how long my system will last? How do I estimate what is left in my system? What routine care and maintenance is needed for my equipment?

It is very important to know your system. Work with your supplier and keep their telephone number handy. For further information on oxygen, go to www.portableoxygen.org.

Feelings About Wearing Oxygen

It is common to feel uncomfortable about wearing oxygen in public. Some people choose to isolate themselves and stay home. Others may choose to go out without oxygen. This makes them short of breath, tired, and uncomfortable. Using your oxygen takes the work off your heart so you can be more active and enjoy life more. Reviewed 2011
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