Oxygen Therapy: An Overview

Overview of Oxygen Therapy

• Oxygen therapy supplements oxygen needs when normal breathing isn't enough due to certain lung conditions.
• It's recommended when blood oxygen levels are too low for proper body function.
• The session covers who needs it, referral process, assessment, prescription, equipment, education, risk assessment, communication, holidays, and follow-up

Who Needs Oxygen Therapy?

• Low oxygen levels can cause shortness of breath, fatigue, confusion, bluish skin, restlessness, drowsiness, and headaches.
• Conditions that may necessitate oxygen therapy:
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Interstitial Lung Disease (ILD)
  • Heart failure
  • Cystic fibrosis
  • Palliative care

Referral for Oxygen Therapy

• Patients are usually referred to the oxygen clinic by their general practitioner (GP) or hospital consultant and and an appointment is subsequently arranged.
• If recovering from a chest infection or flare-up, the oxygen assessment is deferred for six weeks post flare-up to ensure the test is done as close to the patient's baseline as possible, but discretion will be used for frequent flare-ups.

Oxygen Assessment

• Conducted in a hospital setting.
• Two procedures are carried out: arterial blood gas and six minute walk test.
• Blood sample from the wrist:
  • Measures the amount of oxygen in the blood.
  • Normal oxygen level: 11-14 kilopascals (kPa).
  • COPD cutoff: 7.3 kPa (for oxygen at rest).
  • COPD and heart condition cutoff: 8 kPa (for oxygen at rest).
• Six Minute Walk Test:
  • Patient walks on a flat surface for six minutes at their usual pace.
  • Oxygen levels are monitored using pulse oximetry.
  • Determines if oxygen levels drop during physical activity, requiring ambulatory oxygen if it drops below 90%.
• A reassessment is arrange three weeks after the initial assessment.

Oxygen Prescription

• Long-Term Oxygen Therapy:
  • Recommended if oxygen levels are less than or equal to 7.3 kPa.
  • Continuous use at home for a minimum of 15 hours per day, sometimes up to 24 hours.
  • Must be prescribed by a healthcare professional.
• Ambulatory Oxygen Therapy:
  • Supplementary oxygen used during exercise or activities.
  • Can be prescribed alongside long-term oxygen therapy.
• Titration:
  • Healthcare professional determines the flow rate and duration of use for both therapies.
  • Any changes to the prescription require consultation with the oxygen clinic.
• Approval Process:
  • Oxygen prescriptions for medical cardholders require approval from the HSE (Health Service Executive) community office to rent the equipment.
  • Non-medical card holders rent the equipment themselves but can claim money back through the Drugs Payment Scheme.

Types of Oxygen Equipment

• Oxygen Concentrator:
  • Extracts oxygen from the air.
  • Requires adequate room for air circulation; should not be placed in enclosed spaces.
  • Can deliver up to 95% oxygen at 1 liter per minute, but concentration drops to 84% at 4 liters.
  • Some models, like the Home Field, allow filling of ambulatory oxygen cylinders.
  • Economical for constant use.
• Portable Oxygen Cylinders:
  • Come in small and large sizes.
  • Used with a conserver device to extend oxygen duration.
  • Need to be refilled when empty, requiring patient to contact the oxygen supplier for replacement, and supplied with a backpack for easier portability
  • Oxygen cart makes it easier to carry portable oxygen cylinders.
• Portable Oxygen Concentrators:
  • Make their own oxygen using rechargeable batteries.
  • Used for ambulation only.
  • Suitable for use on airplanes if required

Oxygen Education

• Formal education is given to allay anxiety and ensure compliance.
• Covers all aspects of oxygen use:
  • Operating the equipment
  • Safety protocols
  • Cleaning
  • Turning off when not in use
  • Maintenance
  • Cylinder replacements (if applicable)
  • Fire risks and precautions
  • Storage
• Patients are advised that home oxygen, initiated at the time of discharge from the hospital, can be removed if follow-up assessments show improvement in oxygen levels on room air.
• Supportive written material and contact numbers are provided.

Holiday Oxygen

• Patients can still go on holiday.
• Contact oxygen clinic for advice before booking.
• Assessment may be required to determine fitness to fly.
• For holidays within Ireland, the oxygen clinic can request the oxygen supplier to lend an oxygen concentrator for the duration of the stay, if long term oxygen therapy is required.

Risk Assessment

• Oxygen should be used in a safe environment to avoid serious injury
• Considerations include:
  • Patient's ability to operate equipment safely
  • Adequate room for equipment
  • Presence of smokers in the household and their cooperation in not smoking around the patient using oxygen
• Failure to comply with safety advice can lead to withdrawal of equipment.
• Important safety measures:
  • Never smoke or allow smoking near oxygen.
  • Store equipment in a well-ventilated room away from heat sources and clutter.
  • Portable oxygen should not be carried under clothing or in airtight bags.
  • Ambulatory oxygen equipment requires air circulation around it to function properly.

Communication

• Contact oxygen clinic for advice on any questions or issues.
• Do not adjust the oxygen flow rate without professional advice as high concentrations over several days can be toxic.
• The GP is notified in writing when a patient starts oxygen therapy, to provide baseline information about the treatment.

Follow-Up

• First home visit is is recommended to be 4 weeks after starting oxygen therapy.
• Subsequent follow-up appointments at 3, 6, and 12 months.
• Blood gas and six-minute walk tests are carried out at each follow-up, with adjustments made to the prescription if necessary.
• In some cases, oxygen therapy can be discontinued if no longer necessary.

This session overviews oxygen therapy, a supplemental treatment for individuals with respiratory conditions. It's suited for those whose blood oxygen levels are insufficient. Key topics include patient eligibility, referral procedures, assessment, equipment, and safety.