What is oxygen therapy:
The atmosphere contains 21% oxygen. Oxygen therapy devices provide more than 21% oxygen for patients in order to prevent or correct hypoxia. Patients with chronic hypoxemia need to use oxygen at home under the direction of the physician. Long-term oxygen therapy can reverse tissue hypoxia, and can improve physical function and quality of life.
 
The purposes of home oxygen therapy:
  1. Improve tissue hypoxia.
  2. Reduce the energy needed for breathing.
  3. Improve activity tolerance.
  4. Avoid hypoxia complications.
  5. Improve sleep and life quality.
 
Diseases may require home oxygen therapy:
  1. Chronic obstructive pulmonary disease.
  2. Interstitial lung disease. 
  3. Bronchiectasis.
  4. Sleep apnea syndrome.
  5. Congestive heart failure.
  6. Terminal cancer.
 
The preparation of oxygen equipment before the patient returns home:
  1. First, the doctor will undertake an assessment to determine what type of oxygen equipment the patient needs to use.
  2. Collect information from the online website of oxygen equipment companies.
  3. You can either rent or buy an oxygen tank or an oxygen concentrator, and you may need a pulse oximeter for home use.
  4. Consult various medical equipment companies to compare the rental methods and possibilities of oxygen machine models, and prices.
  5. After deciding and completing the ventilator setting, send the equipment to the ward to test whether it meets patients'' needs.
  6. Assure if the equipment is functioning properly, the patient adapts well and the caregivers can operate it smoothly.
  7. Request regular maintenance from the vendors as long as the patient is discharged.
  8. Browse the City Government Bureau of Social Affairs website or call the Bureau to inquire about the qualifications for subsidy, and get the official certification from the hospital if required.
 
Precautions for home oxygen therapy:
  1. The doctor will write a prescription of oxygen flow rate for you. You must use the flow rate prescribed by your doctor. Do not adjust the flow rate or turn off the oxygen without a physician’s order, even when bathing and eating. Too much supplemental oxygen can cause adverse effects, and too little will not achieve therapeutic effects.
  2. Seek medical attention as soon as possible in the event of hypoxemia or hypercapnia.
    1. Symptoms of hypoxemia: difficulty breathing, shortness of breath, pale face, disturbed restlessness, poor orientation, headache, purple lips or fingers.
    2. Symptoms of hypercapnia: lethargy, morning headaches, confusion.
  3.  Seek medical attention as soon as possible if you have symptoms of infection: such as fever, chills, shortness of breath, increased wheezing, increased cough, increased sputum with color changes and thickening.
  4. Check for leaks and the pressure gauge of the oxygen tank often to make sure you don’t run out of oxygen. Oxygen must be shut off when not in use to avoid oxygen leakage.
  5. When using an oxygen concentrator, prepare a small oxygen tank in case of emergencies, as power outages or machinery failures.
  6. When using a nasal cannula:
    1. Remove the nasal cannula every eight hours and give the patient nasal and oral care with a wet cotton swab.
    2. Check the nasal cannula prongs frequently for obstruction by secretion. If there is any secretion obstruction, replace with a new nasal cannula first. Then, wash the cannula just removed from the patient, keep dry and available to use.
    3. Discard and replace nasal cannula when the prongs become stiff.
    4. The tapes securing the nasal cannula should be changed every day. Gently remove the tape, and the nasal adhesive part should be replaced.
    5. Ears and cheeks should be properly protected to prevent pressure injury.
  7. When using an oxygen mask:
    1. The mask should cover the patient’s mouth and nose, and the lower end of the mask should cover the lower jaw. Adjust the elastic band around the patient’s head, and secure it on the ears.
    2. Ears and cheeks should be properly protected to prevent pressure injury.
  8. Note adverse effects in long-term oxygen treatment: such as nasal mucosal damage, skin redness or damage, uncorrected hypoxemia or oxygen poisoning. In patients with chronic obstructive pulmonary disease, excessive oxygen can inhibit respiratory drive, causing respiratory depression. So the accumulation of carbon dioxide cannot be discharged.
  9. Oxygen therapy equipment (including oxygen tank, oxygen concentrator and respirator) should be properly placed and kept away from fire. The oxygen tanks must be kept upright, secured, away from heat and flame.
 
References
  1. Copur, A. S., Fulambarker, A., Molnar, J., Nadeem, R., McCormack, C., Ganesh, A., & Hamon, S. (2015). Role of anemia in home oxygen therapy in chronic obstructive pulmonary disease patients. American Journal of Therapeutics, 22(5), 361-6. doi: 10.1097/MJT.0b013e3182785f7c
  2. Freeman, J. F., Deakyne, S., & Bajaj, L. (2017). Emergency department-initiated home oxygen for bronchiolitis: a prospective study of community follow-up, caregiver satisfaction, and outcomes. Academic Emergency Medicine, 24(8), 920-929. doi: 10.1111/acem.13179
  3. Hardinge, M., Annandale, J., Bourne, S., Cooper, B., Evans, A., Freeman, D., & McDonnell, L. (2015). British Thoracic Society guidelines for home oxygen use in adults. Thorax, 70 (Suppl 1), i1-i43. doi: 10.1136/thoraxjnl-2015-206918
  4. Hazenberg, A., Kerstjens, H. A. M., Prins, S. C. L., Vermeulen, K. M., & Wijkstra, P. J. (2014). Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs. Respiratory Medicine, 108(9), 1387-1395. doi: 10.1016/j.rmed.2014.07.008
  5. Moriyama, M., Takeshita, Y., Haruta, Y., Hattori , N., & Ezenwaka, C. E.(2015). Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy. Rehabilitation Nursing, 40(1), 40-51. doi: 10.1002/rnj.119
  6. Murphy, P. B., Rehal, S., Arbane, G., Bourke, S., Calverley, P. M. A., Crook, A.M.,  & Hart, N. (2017). Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. The Journal of the American Medical Association, 317(21), 2177-2186. doi: 10.1001/jama.2017.4451
  7. Ortega, R. F., Díaz, L. S., Galdiz, I. J., García, R. F., Güell, R. R., Morante, V. F., & Tàrrega, C. J. (2014). Continuous home oxygen therapy. Archivos de Bronconeumologia, 50(5), 185-200. doi: 10.1016/j.arbres.2013.11.025
  8. Su, C. L., Lee, C. N., Chen, H. C., Feng, L. P., Lin, H.W., & Chiang, L. L.(2014). Comparison of domiciliary oxygen using liquid oxygen and concentrator in northern Taiwan. Journal of the Formosan MedicalAssociation, 113(1), 23-32. doi: 10.1016/j.jfma.2012.03.013
  9. Yáñez, A. M., Prat, J. P., Álvarez-Sala, J. L., Calle, M., Díaz -Lobato, S., García-Gonzalez, J.L., & de Lucas, P. (2015). Oxygenation with a single portable pulse-dose oxygen-conserving device and combined stationary and portable oxygen delivery devices in subjects with COPD. Respiratory Care, 60(3), 382-7. doi: 10.4187/respcare.03470
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    Update
    2018-04-25 00:00:00