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#ref5">5
The goal of oxygen use in a prehospital setting is to treat hypoxemia, but excess oxygen use can cause hyperoxia, causing worse outcomes.3
Oxygen is a medication used in and out of the hospital setting. Home oxygen therapy may be short-term or long-term for the patient who is hypoxemic, who has respiratory complications, or who is experiencing activity intolerance. Short-term oxygen therapy may be administered via a nasal cannula or a simple face mask. When a patient has a permanent tracheostomy tube, a T-piece or tracheostomy collar is used for oxygen administration. Oxygen administered directly into the trachea via a tracheostomy tube or transtracheal catheter should be humidified.4
Long-term oxygen therapy is usually administered via an oxygen-conserving device (OCD) (i.e., oxygen concentrator). OCDs reduce the amount of oxygen that the patient uses, enabling the use of a smaller and lighter unit and reducing the overall cost of the therapy.1 There are three types of OCDs.
There are three types of oxygen delivery systems available for home use (Table 1): compressed oxygen cylinders, liquid oxygen systems, and oxygen concentrator systems.2
Home oxygen equipment is designated as durable medical equipment (DME) in the home care setting. When initiating and managing ongoing oxygen therapy, the nurse should collaborate with the patient, practitioner, caregiver(s), family, DME supplier, and payer. A patient who requires home oxygen should be given extensive instructions on how to use oxygen therapy efficiently and safely (Box 1). To enhance home safety, an oxygen home risk assessment should be performed, including assessing smoking materials, other fire risks, and the functioning of smoke detectors in the home.
Do not place an oxygen concentrator system in a closet.
Rationale: Demonstrating the steps is a reliable technique for teaching psychomotor skills and enables the patient 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.
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 reservoir tank may ice up, causing them to stick together.
Be aware that overfilling will cause the ambulatory unit to malfunction because of high pressure in the tank.
Rationale: If the unit does not separate easily, it is most likely because the valves from the reservoir and ambulatory unit are frozen together.
Do not touch any frosted areas because contact with the skin may cause skin damage from frostbite.
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.
Instruct the patient that exceeding the prescribed amount of oxygen can be harmful (e.g., if 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 on safe home oxygen practices ensures the safe use of oxygen in the home and prevents injury to the patient and family.
Rationale: Asking the patient and caregiver whether they are experiencing any difficulties allows the nurse to determine the patient's and caregiver's ability to deal with stressors that are associated with home oxygen use and the patient's risk for inappropriate oxygen use.
Rationale: Having the patient and caregiver repeat safety and emergency information allows the nurse to determine their knowledge of what to do in cases of power failure and equipment failure or if the patient's status worsens.
American Lung Association. (2020). Oxygen therapy. Retrieved July 22, 2021, from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/supplemental-oxygen.html (Level VII)
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier.
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