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University of Ibn Al-Nafis for Medical Sciences

Dr.Mohammed-Senan

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home oxygen therapy Respiratory Care medical education

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This document includes information about home respiratory care, home oxygen therapy, and tracheostomy care from the University of Ibn Al-Nafis for Medical Sciences. It contains a collection of notes for a 3ed year respiratory therapist student. The document is a set of presentation slides covering various aspects of home oxygen therapy.

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‫جـــــامعــة ابن النفيس للعلوم الطبية‬ University of Ibn Al-Nafis For Medical Sciences Respiratory Care science 4 Home respiratory Care lab 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS, RCP,FNIV, MsRC Respiratory Care A Life and Breath...

‫جـــــامعــة ابن النفيس للعلوم الطبية‬ University of Ibn Al-Nafis For Medical Sciences Respiratory Care science 4 Home respiratory Care lab 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS, RCP,FNIV, MsRC Respiratory Care A Life and Breath Career for You! Learning Objectives Setting and troubleshooting of home oxygen therapy equipment Bag valve mask ventilation and tracheostomy care of home care patient. Assessment of home environment suitable for respiratory car. JUn224 DrMohammmed Senana 3 JUn224 DrMohammmed Senana Lung Foundation Australia 4 Home oxygen The 12 things every home oxygen user should know 1. Oxygen therapy can help. Home oxygen therapy can help those with confirmed low blood oxygen by ensuring enough oxygen gets to vital organs. In some cases, home oxygen therapy can also make everyday life easier and more enjoyable. 1. Regular medical reviews are vital. It is important to have your oxygen prescription checked by a respiratory specialist at least once a year. Do not adjust your oxygen flow rate on your own. 2. Oxygen does not always relieve breathlessness. There are many reasons why people have trouble breathing. Home oxygen therapy may relieve shortness JUn224 DrMohammmed Senana 5 of breath for some people, but for many it does not. 3 Home Oxygen " The 12 things every home oxygen user should know 4. Oxygen is not addictive. Home oxygen therapy is not addictive and it will not weaken your lungs.. 5. There is a range of oxygen equipment available. There are two main types of oxygen equipment used. The most common is the oxygen concentrator which filters nitrogen out of the air to deliver almost pure oxygen. Gas cylinders filled with oxygen are also widely used and come in a range of different sizes. 6. Some oxygen equipment is funded. Many home oxygen users will qualify for government funded equipment. However, qualifying rules are different in every state. 7. Oxygen is safe to use but can make things burn more intensely. Do not put yourself or your oxygen equipment near any sources of extreme heat, flames, or devices which could cause a spark, including a lit cigarette or e-cigarette. JUn224 DrMohammmed Senana 6 3 Home Oxygen " The 12 things every home oxygen user should know 8. Continue on with everyday life. Although it may take a while to get used to your oxygen equipment, try to continue with your normal routines as much as possible. 9. Avoid smoking and being around smokers. Cigarette smoke is very damaging to the lungs. It is also important to avoid other people’s cigarette smoke. 10. Keeping active is good for your health. Regular physical activity is very important for those with lung disease to help you perform activities of daily living more easily. Activity does not need to be strenuous 11. Travelling with oxygen equipment is possible and requires planning. Some of the things to check before booking a trip are: 12. Plan what to do in an emergency, such as a power blackout. The most important thing to remember is to try to remain calm and not panic. JUn224 DrMohammmed Senana 7 3 Home oxygen Who needs home oxygen therapy ? Testing the oxygen levels in blood Specific blood tests are used to determine whether or not the body is getting the oxygen it needs. The most common test is arterial blood gas (ABG) test. This is A healthy person usually has an oxygen level above 85 (mmHg) at sea level. In people with lung disease the amount of oxygen in the blood may be lower. As long as the oxygen level is not too low (below 55 mmHg), the body can maintain normal function. Blood oxygen saturation. Ideally the blood should be at least 90% saturated with oxygen. Pulse oximetry. Physical assessment. JUn224 DrMohammmed Senana 8 5 Home oxygen Who may benefit from home oxygen therapy ? If tests show that blood oxygen saturation levels are adequate, then breathing in extra oxygen (through oxygen therapy) is not likely to benefit you. An oxygen pressure level above 60 mmHg is adequate for most normal functioning, as the blood is generally over 90% saturated with oxygen at this level of oxygen pressure. Home oxygen therapy is only beneficial for people with oxygen pressure lower than 55-60 mmHg. At these levels, the blood is often not adequately saturated with oxygen. This condition is referred to as hypoxemia. If tests show that your blood oxygen saturation levels are adequate, then breathing in extra oxygen is not likely to benefit you. JUn224 DrMohammmed Senana 9 5 Home oxygen Improvements in overall wellbeing If p.t have low blood oxygen levels, then home oxygen therapy may help them to feel more energetic, making everyday life easier. Some of the most common improvements oxygen users report include: Waking up feeling more refreshed in the morning Improved concentration Feeling less fatigued during the day. This is perfectly normal. Remember, oxygen therapy is still helping your body by delivering more oxygen to your vital organs JUn224 DrMohammmed Senana 10 5 Home oxygen JUn224 DrMohammmed Senana 11 5 Home oxygen How much oxygen is right for p.t? oxygen are prescribed for at least 18 hours a day, not everyone needs to be on oxygen for such long periods of time. When you should we advice use for maximum benefit. Examples of common prescriptions include Use oxygen for at least 18 hours a day. Use oxygen while sleeping. Use oxygen when exercising or being more active. How much oxygen p.t need? Flow rate is the term used to describe the level of oxygen you receive. different flow rates for different situations such as: - flow rate for normal awake hours. - flow rate for sleeping. - flow rate for when you are exercising JUn224 orSenana DrMohammmed being more active 5 12 Home oxygen How much oxygen is right for p.t? JUn224 DrMohammmed Senana 13 5 Home oxygen How much oxygen is right for p.t? JUn224 DrMohammmed Senana 14 5 Home oxygen Oxygen equipment options explained There are two main types of oxygen equipment used in home, 1- oxygen concentrators 2- oxygen cylinders. 1. Oxygen concentrators Home concentrator This is a machine about the size of a bedside table that concentrates oxygen by filtering the nitrogen out of the air. It is the most common source of oxygen delivery for people on long-term oxygen. It has a long tube that allows you to move more freely around the house. It requires electricity to operate. JUn224 DrMohammmed Senana 15 5 Home oxygen Portable concentrator Portable cylinder This is a smaller concentrator designed to be taken out of the home. Many are so light they can be carried in a bag or wheeled. They also contain their own power supply. These concentrators are fairly costly and normally require private funding. They are also available second hand. Most deliver oxygen in a pulsed dose, which means receive oxygen when breathe in, but not when breathe out. This is done to make the machine lighter and also to preserve battery life. JUn224 DrMohammmed Senana 16 5 Home oxygen 2. Medical oxygen cylinders Large freestanding or stationary cylinders These are occasionally provided as a back-up for people prescribed long-term oxygen therapy, in case there is a problem with their concentrator or a lengthy power blackout. Portable cylinders These are smaller cylinders that can be used when leaving the home. They can be wheeled, attached to a wheeled walker or wheelchair, or may be carried in a bag. Other equipment are 1-soft nasal prongs (sometimes called cannulae). 2-Oxygen conserving devices (OCDs) Pulsed dose is a battery- operated device attached to oxygen cylinder replacing a usual flow regulator. gives a burst of oxygen just when breathe in no out. 3- Oxymizer Conserving Devices DrMohammmed Senana 5 17 Home oxygen 1. Environment and Equipment safety Home oxygen therapy is very safe provided you follow some simple guidelines: Follow prescription (that flow rate and hours of use per day). Use only the oxygen equipment recommended. Secure cylinders to prevent them falling. Report any problems with the oxygen equipment to the supplier as soon as they occur. Do not attempt to repair your oxygen equipment. Ask your oxygen supplier for instructions on how to use the equipment in the home. They should also provide information on how to safely transport the equipment. If have been prescribed oxygen for 24 hours a day, you may need a back-up oxygen cylinder. Make sure you have smoke alarms in house. DrMohammmed Senana 18 5 Home oxygen 2. Things to AVOID Oxygen can make things burn quickly, so it is best to keep your oxygen equipment at least three metres from any sources of heat, naked flames, or something that could cause a spark. Here are some examples DO NOT smoke or allow others to smoke in your home or near your equipment. This includes e-cigarettes. DO NOT put yourself or your equipment near matches, candles, gas appliances or open fires. DO NOT transport unsecured cylinders in a vehicle. Things are SAFE It is safe to do most things while using your oxygen equipment. IT IS SAFE to use oil heaters, air conditioners and electric blankets. IT IS SAFE to wear oxygen equipment while taking a shower or bath, but remember that your concentrator is an electrical appliance and must not get wet. IT IS SAFE to wear your oxygen equipment DrMohammmed Senana while you exercise. 5 19 Home oxygen 3. Care of accessories Oxygen accessories play a vital role in the comfort and delivery of oxygen therapy. Always have spare nasal prongs and tubing available. Clean the ends of the nasal prongs at least weekly using soapy water and a soft cloth. You may need to do this more frequently if p.t have a lot of nasal secretions or an active infection. should change cannula once an active infection has resolved. Replace nasal prongs every four to six weeks. If they have become hard or brittle then replace them earlier. Oxygen tubing should be replaced if it becomes dirty, damaged or badly kinked. Accessories such as tubing and nasal prongs are available from oxygen supplier.. DrMohammmed Senana 20 5 Home oxygen 4. If irritation occurs Occasionally p.t may have some discomfort around the nostrils or behind the ears. Apply a nasal lubricant to just inside the nostrils two to three times a day. These products are available from most pharmacies. DO NOT use petroleum jelly (e.g. Vaseline) or petroleum based lubricants with nasal prongs, as they may be flammable and may irritate the lining of nose. These products may also cause the nasal prongs to deteriorate. Some oxygen suppliers may have a different shaped nasal prong you could try. Inform p.t about the alternative to nasal prongs that may use during the day. If you are having trouble with rubbing behind the ears or on the cheeks use cotton wool or gauze (available at a pharmacy) to wrap around the tubing. DrMohammmed Senana 21 5 Thank you for attention ,,, JUn224 DrMohammmed Senana 22 Have a great day DrMohammmed Senana JUn224 23 Tracheostomy Care TRACHEOSTOMY CARE University of Recommended checklist for going home with a tracheostomy tube Pittsburgh Medical Center Brand: ____________________ Size: ______________________ Information Disposable inner cannula ______ OR Non-disposable inner cannula ______ for Patients Cuffed ______ OR Cuffless ______ Fenestrated ______ OR Non-Fenestrated ___________ Home equipment supplier _________________________________________ Phone number _______________________ Extra tracheostomy tube of the same size Smaller size tracheostomy tube if doctor determines it is needed Guide (obturator) and any parts that go with the tracheostomy tube currently in place Suction catheters: Size _________ Suction machine with extension tubing arranged Normal saline or sterile water Tracheostomy care kits (including brush and pipe cleaners) Oxygen, if ordered Tracheostomy ties — twill tape or Velcro tracheostomy tube holders Syringe for cuff care Cotton-tip applicators Gloves — clean, disposable, and powderless Hydrogen peroxide 4 inch x 4 inch gauze dressings (NO cotton fillers), if needed Disposable inner cannulas (if you have a disposable inner cannula tracheostomy tube) Manual resuscitation bag, if ordered Humidifier Saline bullets for instillation, if ordered 4 continued Supplies for Cleaning Cleaning Your Trach Tube Cleaning the inner cannula of your trach tube is an important task. It should be done twice a day, or more often if needed, to keep it clean and free of secretions. 1. Wash your hands well and apply clean gloves. 2. Pour two bowls of sterile water. 3. Cough or suction if needed. This clears the airway of secretions. Take a few deep breaths. 4 Cleaning the Inner Cannula: 1. Loosen the inner cannula by twisting to unlock or by pinching the sides, depending on the type. 2. Hold the flange with one hand. Using your other hand remove the inner cannula by steadily pulling out and down. toward your chest until it is out. 3. Place the inner cannula in the first bowl of sterile water. 4. Use a pipe cleaner, folded in half, an applicator stick, or trach brush to gently clean the inner cannula and to remove mucus and dried secretions. 5. Put the inner cannula in the second bowl of sterile water and rinse well. 6. Shake water off the inner cannula. Do not dry it. Moisture will make the inner cannula slide back in the trach tube easily. 7. Slide the inner cannula back into the trach tube and lock into position. The two dots should line up together. 8. Wash bowls thoroughly and leave to dry in a clean place. If using a trach brush, wash in mild detergent, rinse with sterile water, and leave to dry. Throw away pipe cleaners, applicator sticks and paper cups. 9. Remove and discard gloves. Wash your hands. 5 Caring for Your Stoma Clean the stoma, or area of skin around the outer cannula twice a day, and as often as needed to keep it clean and dry. If you wear a trach dressing, change it whenever it gets soiled and when you clean your stoma. You will need: A clean facecloth Sterile water Q-tips® or cotton-tipped applicators. Trach dressings if you are using them. Cleaning Around Your Stoma 1. Choose a comfortable position, such as sitting in front of a mirror. 2. Take off your old dressing if present. 3. Wash your hands well. 4. Wet gauze or Q-tip with sterile water. Gently clean the outer cannula and skin around it by moving outward from the stoma site. 5. Q-tips® may be used for “hard-to-get” areas, such as under the trach flange. 6. Look closely at your stoma site. Call your health care provider if you notice any redness, swelling, irritation, bleeding, green discharge, or food. 7. Use a cotton-tipped applicator to put on ointment (if you are using ointment). 8. Put on a new pre-cut dressing. Insert the dressing below the flange so that the open end is up towards your head. 6 Changing the Tracheostomy Ties You will need to remove and replace your trach ties when they get soiled (dirty). It is a good idea to do this with your health care professional until they say it is safe for you and your helper to do it yourselves. You will need: Velcro trach holder Mirror Scissors Someone to help you Pre-cut tracheostomy dressing Steps for Changing Pre-Made Tracheostomy Holders (Velcro Ties) 1. Wash your hands for at least 45 seconds. 2. Remove your tracheostomy dressing if you have one. 3. Have someone hold your tracheostomy by gently holding the bottom of the flange against your neck (it is possible to cough out the tracheostomy tube). 4. Remove the old Velcro trach holder. 5. Thread the ‘hook’ fastener through the holes on the flange and reattach to the fuzzy side of the holder. 6. Wrap the new Velcro trach holder around the back of your neck. 7. Thread the other ‘hook’ end through the other opening in the flange and attach. 8. Adjust the fit of the holder so you can fit 2 fingers in between the holder and your neck. 7 Clearing Secretions Suctioning of the trachea takes secretions from your airway when you cannot cough them up. Suctioning should be done only when needed, to make breathing easier. If you are doing home suctioning, you will need: Suction machine Suction catheter (tube) – the right size for your trach Sterile water (see recipe for sterile water, Appendix B) or sterile saline for rinsing catheter Sterile saline ampules for instilling Solid inner cannula (if tracheostomy is fenestrated A bowl or disposable cup A mirror Gloves Now you are ready to suction. Steps for Suctioning 1. Ensure suction machine is assembled and functioning. Lay all materials needed out on a clean work surface. 2. Wash hands. 3. Put on a pair of clean disposable gloves. 4. Sit comfortably in front of a mirror. 5. Pour 1 cup of saline (salt water) or sterile water into 1 plastic container. 6. Turn on the suction machine. 7. Connect the suction catheter to the suction tubing. 8. If you are instilling sterile normal saline, do it at this point. 9. To moisten the catheter, dip it into the plastic container with saline (salt water) or sterile water. 10. Keeping your thumb off the side opening in the catheter, slowly insert the catheter into your tracheostomy tube about 4 to 5 inches. 8 11. Cough. This helps loosen the mucus. 12. To suck out the mucus, place your thumb over the side opening in the catheter. Slowly pull out the catheter, rotating the catheter as you pull it out. 13. Take a moment to catch your breath. 14. Rinse catheter and suction tubing of mucus by sucking up some saline (salt water) or sterile water. 15. Suction again if you need to. 16. Once finished discard disposable suction catheter in the garbage. 17. Wash the plastic containers well. Leave them to air dry in a clean place. 18. Wash your hands for at least 45 seconds. If your secretions are too thick to suction, try putting a small amount of sterile normal saline into your tracheostomy tube before suctioning (this is called “instilling”). Cleaning The Suction Machine After completing suctioning, be sure to clean the equipment and replace the tubing according to the instructions that come with your suction machine. 9 TRACHEOSTOMY CARE University of The resuscitation bag Reasons to use a resuscitation bag Pittsburgh Medical Center The resuscitation (re-suss-i-TAY-shun) to give larger breaths that will help bag is a football-shaped bag that can loosen mucus plugs in the lungs Information for Patients help give breaths of air and oxygen to provide more oxygen before and to a person who needs help breathing after suctioning or is unable to take breaths on his or to help with breathing if shortness of her own. When the bag is squeezed breath is getting worse between the hands, the air leaves the to give breaths and oxygen bag and enters into the person’s lungs. Patients who use a breathing machine The exhaled air flows out of the lungs, (ventilator) can use a resuscitation bag if through the windpipe (trachea), and they need to disconnect from the breath- through a special exhalation valve in ing machine, or if there is a power failure the resuscitation bag. or problem with the breathing machine. Parts of the resuscitation bag If a person’s breathing stops, call 911 Bag: The bag holds the air and immediately and begin to use the oxygen. When squeezed, a breath resuscitation bag. goes into a person’s lungs. Tracheostomy connector: The tracheostomy connector connects the resuscitation bag to the person’s tracheostomy tube. Exhalation valve: When the bag is released, exhaled air moves from the lungs, out through this valve. Oxygen port: This port allows extra oxygen to be added to each breath. exhalation valve oxygen port bag tracheostomy connector 21 continued TRACHEOSTOMY University of How to use the resuscitation bag Providing oxygen Pittsburgh Medical Center Assisted breathing You may need to give oxygen in addition Information 1. A  ttach the tracheostomy connector to assisted breaths if: for Patients to the tracheostomy tube. the doctor has prescribed it 2. S  queeze the bag until about 1/3 there is increased shortness of breath to 1/2 the air is forced out, then If breathing stops, call 911 immediately. release the bag. To give oxygen: Look at the chest when squeezing the bag. The chest should rise and 1. Attach the oxygen tubing from the fall with each bag breath. oxygen supply to the oxygen port located on the resuscitation bag. Give a breath large and deep enough so the person feels comfort- 2. If you are giving extra oxygen, turn the able. You may need to squeeze the oxygen supply on, setting the flow rate bag with 2 hands. to a maximum of 15 liters. If the person is breathing on his or 3. If you are giving the prescribed amount her own, try to match the delivered of oxygen, set the oxygen flow to_____. breaths with the person’s own 4. Deliver breaths as described above. efforts. As soon as the person starts to inhale, squeeze the bag. When you are finished using the resus- Give a breath every 4 to 5 seconds, allowing the bag to refill after each citation bag with oxygen, be sure to breath. If the person is short of reconnect the oxygen source as directed breath, then deliver breaths at a or turn off the oxygen. faster rate, still allowing for the bag to refill, about 12 to 16 breaths per minute. 22 continued

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