What is oxygen therapy:
Common 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 their 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.
 
Preparation steps for 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 online websites of oxygen equipment companies.
  3. Patient can either rent or buy an oxygen tank or an oxygen concentrator and 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 patient’s needs.
  6. Assure if the equipment is functioning properly, the patient can use it properly, and the caregivers can operate it smoothly.
  7. Request regular maintenance from the vendors as long as the patient is discharged.
  8. Inpatient with disability certificate and clinical physician’s verification for the need of medical device(s) (ex., oxygen concentrator) can consult specialist physician in related medical field(s). After evaluation, the specialist physician will prescribe a medical certificate to apply for the medical device(s). Inpatient’s caregiver shall submit the medical certificate to the city district office to apply for subsidy.
 
Precautions for home oxygen therapy:
  1. The doctor will write a prescription of oxygen flow rate for patient, who must use the flow rate prescribed by the 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 there are 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 oxygen does not run out. 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, for 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 it 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 over 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 pulmonarydisease, excessive oxygen can inhibit respiratory drive, causingrespiratory depression. Thus, the accumulation of carbon dioxidecannot be discharged.
  9. Oxygen therapy equipment (including oxygen tank, oxygen concentrator, respirator, etc.) should be properly placed and kept away from fire. The oxygen tanks must be kept upright, secured, and away from heat and flame.
 
References
  1. Frith, P., Sladek, R., Woodman, R., Effing, T., Bradley, S., van Asten, S.,…& Phillips, P.A. (2020). Pragmatic randomised controlled trial of a personalised intervention for carers of people requiring home oxygen therapy. Chronic Respiratory Disease, 17, 1-11. doi:10.1177/1479973119897277
  2. Lacasse, Y., Tan, A.M., Maltais, F., & Krishnan, J.A. (2018). Home oxygen in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 197(10), 1254-1264. doi:10.1164/rccm.201802-0382CI
  3. Lacasse, Y., Krishnan, J.A., Maltais, F., & Ekström, M. (2019). Patient registries for home oxygen research and evaluation. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1299-1304. doi:10.2147/COPD.S204391
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