Use caution in the presence of oxygen. Oxygen is a fire hazard because it lowers the temperature at which materials catch fire in the presence of an ignition source, such as a spark or heat from a light source.undefined#ref3">3
The goal of oxygen use is to treat hypoxemia, but excess oxygen use can cause hyperoxia, causing worse outcomes.2
Home oxygen therapy may be needed for short-term or long-term use. Short-term oxygen therapy may be administered via a nasal cannula or a simple mask. In most cases, long-term oxygen therapy is administered via an oxygen-conserving device (OCD). When a patient has a permanent tracheostomy tube, a T-piece or tracheostomy collar is used. Oxygen that is administered directly into the trachea via a tracheostomy tube or transtracheal catheter should be humidified. OCDs reduce the amount of oxygen that the patient uses, enabling him or her to use a smaller and lighter unit and reducing the overall cost of the therapy.1
There are three types of OCDs: reservoir nasal cannula, demand oxygen delivery system, and transtracheal oxygen catheter.
There are three types of oxygen delivery systems available for home use: compressed oxygen cylinders, liquid oxygen systems, and oxygen concentrator systems (Table 1).1,2
Home oxygen equipment is designated as durable medical equipment (DME) in the home setting. A patient who requires home oxygen should be given extensive instructions on how to use oxygen therapy efficiently and safely. To enhance home safety, The Joint Commission’s National Patient Safety Goals for oxygen therapy in the home setting requires completion of a home risk assessment to identify associated risks.3 In addition, patient education about the safe use of oxygen in the home should be provided (Box 1). When initiating and managing ongoing oxygen therapy, the nurse should collaborate with the patient, practitioner, family, caregiver(s), DME provider, and payer.
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Do not place an oxygen concentrator system in a closet (Box 1).
Rationale: A demonstration is a reliable technique for teaching psychomotor skills and enables the patient, family, and caregivers to ask questions.
Rationale: Checking the status verifies that an adequate oxygen supply is available for the patient’s use.
Rationale: Checking the liquid system verifies that an adequate oxygen supply is available for the patient’s use.
Rationale: Ambulatory tanks of liquid oxygen need to be filled when empty.
Fill ambulatory tanks only when they are empty. If cold oxygen from the reservoir mixes with warmer oxygen left in the ambulatory tank, the ambulatory tank will malfunction.
Rationale: Wiping the filling connector removes dust and moisture from the system.
Rationale: Applying firm pressure to the top of the stationary reservoir prevents oxygen from leaking during the filling process. If oxygen leaks during the filling process, the connection between the ambulatory tank and the reservoir tank may ice up, causing them to stick together.
Rationale: Overfilling causes the ambulatory unit to malfunction because of high pressure in the tank.
Do not touch any frosted areas; contact with the skin may cause skin damage from frostbite (Box 1).
Rationale: Ice often forms during the filling process. Wiping the filling connectors removes moisture from the oxygen system.
Rationale: The oxygen flow rate provides the prescribed amount of oxygen. Exceeding the prescribed amount of oxygen can be harmful, such as in cases where the patient has chronic obstructive pulmonary disease.
Rationale: A return demonstration allows for correction of any errors in technique and a discussion of their implications.
Rationale: Respiratory tract infections increase oxygen demand and often affect oxygen transfer from the lungs to the blood, exacerbating the patient’s pulmonary disease.
Rationale: Instructing the patient, family, and caregivers on safe home oxygen practices ensures the safe use of oxygen in the home and prevents injury to the patient, family, and caregivers (Box 1).
Rationale: Asking the patient, family, and caregivers about any challenges helps determine their ability to deal with stressors that are associated with home oxygen use and indicates the patient’s risk for inappropriate oxygen use.
Rationale: Having the patient, family, and caregivers repeat given information determines their knowledge of what to do if there is a power failure or equipment failure or if the patient’s status worsens.
Rationale: Interdisciplinary communication ensures that all members of the care team are kept abreast of the patient’s progress toward goals and any changes to the plan of care.
American Lung Association. (2022). Supplemental oxygen. Retrieved September 26, 2022, from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/supplemental-oxygen.html (Level VII)
Heuer, A. J. (2021). Chapter 57: Respiratory care in alternative settings. In R.M. Kacmarek, J.K. Stoller, A.J. Heuer (Eds.), Egan’s fundamentals of respiratory care (12th ed., pp. 1279-1298). St. Louis: Elsevier.
New York State Office of Fire Prevention and Control. (n.d.). Home oxygen fire safety. Retrieved September 26, 2022, from https://www.health.ny.gov/prevention/injury_prevention/children/toolkits/fire/docs/home_oxygen_fire_safety.pdf
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