Understanding oxygen therapy - Chest Heart & Stroke Scotland

chss.org.uk

Understanding oxygen therapy - Chest Heart & Stroke Scotland

CHEST SERIES C2

UNDERSTANDING

OXYGEN

THERAPY


Chest, Heart &

Stroke Scotland, is

an independent

medical charity

which aims to

improve the quality

of life for people in

Scotland affected by

chest, heart and

stroke illnesses,

through medical

research, advice and

information and

support in the

community.

FUNDRAISING

CHSS is an independent Scottish medical charity. We

receive no Government funding and rely entirely on the

Scottish public to raise the £5 million a year we need to

help people with chest, heart and stroke illness throughout

Scotland.

RESEARCH

We are one of Scotland’s largest charitable funders of

medical research, with a programme worth over £600,000

a year. We fund research projects throughout Scotland into

all aspects of the prevention, diagnosis, treatment and

social impact of chest, heart and stroke illness.

PERSONAL SUPPORT GRANTS

We provide small grants to people in financial difficulty,

because of chest, heart or stroke illness, for items ranging

from disability equipment and household goods to respite

care and holidays. Applications are submitted through

local Social Work Departments, or health professionals.

VOLUNTEER STROKE SERVICE (VSS)

We give support to people whose communication skills

are impaired after a stroke. The VSS provides weekly

group meetings and home visits for patients.

CHSS NURSES

Our nurses provide independent practical advice and

support to those who have chest, heart and stroke

illnesses, their families, carers and health professionals.

There are dedicated nursing services in Fife, Grampian,

Highland, Lanarkshire, Lothian and Dumfries and

Galloway. There is also a Scotland wide nurse led Advice

Line (0845) 077 6000. Calls are charged at a local call

rate (out of hours answerphone). We have a wide range of

booklets, factsheets and videos on chest, heart and stroke

illnesses.

COMMUNITY SUPPORT NETWORK

CHSS provides support to affiliated chest, heart and

stroke clubs through the Community Support Network.

The clubs are independent and are run by local volunteers.

The groups provide a range of activities and offer people

support, stimulation and companionship in a friendly and

relaxed environment. Please ask for more information.

FOR FURTHER INFORMATION ABOUT ANY

OF THE SERVICES ABOVE PLEASE CONTACT

HEAD OFFICE BY PHONING 0131 225 6963 OR

VISIT THE CHSS WEBSITE: www.chss.org.uk


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

Where does oxygen come from

What happens if you don’t get enough

oxygen

Getting additional oxygen

How do I know if I need long term

oxygen therapy

Long term oxygen assessment

Who prescribes oxygen

How is oxygen provided

How is oxygen given

oxygen tubing

• nasal cannulae

oxygen cylinders

oxygen concentrator

• portable oxygen

oxygen conserver

• dry mouth lips and nose

• ear protection

What are the safety issues of using

oxygen therapy

How do I organise my oxygen therapy

away from home

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UNDERSTANDING

OXYGEN

THERAPY

Acknowledgement

CHSS would like to thank Pamela Vaughn

Specialist Respiratory Physiotherapist,

Dr Roger Carter Consultant Clinical Scientist and the

GGNHSB Respiratory Working Group.

1


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

WHERE DOES OXYGEN COME

FROM

Oxygen comes from air in the atmosphere

around us. Air is made up of a mixture of gases,

21% being oxygen. Every cell in the human

body is alive and requires fresh oxygen and

nutrients to be brought to them to survive.

Carbon dioxide is a gas waste product produced

by cells which has to be got rid of. The system

in the body that deals with this exchange of

gases is the respiratory system which basically

involves the lungs and other structures related to

them. The lungs are contained within the chest,

one on either side, with the heart in the middle,

and are protected by the rib cage. The purpose

of the lungs is to bring oxygen into the body

whilst removing carbon dioxide.

2


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

How does air get into the body

Air is brought into the lung through passages

from the nose and mouth. The process of

warming, moistening and filtering breathed in

air is continued throughout the system.

The path for air to enter the body starts at the

nose and travels through the larynx and trachea

to divide into two branches to supply the left

and right lung. These are called the left

bronchus and the right bronchus which further

subdivide and branch out into smaller and

smaller tubes called bronchioles. These tiny

passages end in tiny air sacs called alveoli. This

means ‘bunch of grapes’ in Italian, which is

exactly what they look like. There are over 300

million in a normal lung. Tiny blood vessels or

capillaries surround the alveoli and a special

thin membrane between the blood vessels and

the air sacs allows oxygen to pass into the blood

stream, and carbon dioxide to pass out into the

air sacs and be eliminated by breathing out.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

Trachea

(windpipe)

Bronchioles

Chest wall

WHAT HAPPENS IF YOU DON’T

GET ENOUGH OXYGEN

If there is a blockage in the air passages for any

reason, the alveoli (air sacs) may not be given

enough air to provide oxygen to the body. In

some types of lung disease the air sacs may

have been destroyed so although enough

oxygen is present it is more difficult for the

gases to pass into and out of the lungs.

Either reason can result in low oxygen levels.

This acts as a trigger to tell our body to make

more effort to breathe, to obtain the

necessary oxygen.

Diaphram

Direction

of airflow

Lung

Heart

The effort involved in trying to

obtain the extra oxygen

needed can result in tiredness

and breathlessness,

particularly after coughing

or activities such as

walking.

As well as breathlessness

too little oxygen can

interfere with other parts

of the body such as the

heart, causing ankle

swelling and fluid

retention. It can also

cause poor concentration,

sleepiness and irritability.

4

Diagram of the

respiratory system


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

GETTING ADDITIONAL OXYGEN

Studies have shown that for some people with

chest problems, breathing air with a higher

concentration of oxygen can help reduce some

of the symptoms caused by a lack of oxygen.

Some people may need only a small additional

amount of oxygen, and could be harmed by

getting too much oxygen. This is why everyone

should be individually assessed to find out if

they will benefit from oxygen therapy and how

much they require. Receiving additional oxygen

is called oxygen therapy.

Short and long term oxygen therapy

Some people may only need oxygen therapy for

short spells when their oxygen levels are low.

Oxygen therapy may be needed 24 hours per

day, this is known as continuous oxygen

therapy. In some instances with certain types of

lung condition, oxygen therapy may be

necessary for a significant proportion of the day

to have the desired benefits. This is called longterm

oxygen therapy (LTOT).

Improved quality of life

Some people don’t like the idea of having to

use oxygen for fear of becoming dependent on

it or of reducing their independence. Usually

oxygen therapy improves energy and so can

increase your level of activity. It may also

prevent or reduce some of the complications of

chronic lung disease.

Oxygen therapy is

not useful for

everyone and can be

dangerous if it is not

required, or

properly prescribed.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

HOW DO I KNOW IF I NEED LONG

TERM OXYGEN THERAPY

People can have breathlessness but still have

adequate oxygen levels. Alternatively, breathing

may be comfortable but oxygen levels may be

low and inadequate. So severity of

breathlessness is not a reliable way of deciding

if oxygen therapy will be helpful. The need for

oxygen therapy should be assessed by a hospital

specialist in respiratory medicine, who will look

at recent pulmonary function tests (breathing

tests) and at the levels of oxygen in your blood.

People who are still smoking should not be

prescribed oxygen as there is a risk of severe

facial burns and combustion.

Blood sampling

The level of oxygen in your body is measured

by a blood test. A sample is taken from your ear

lobe or from blood from an artery at your wrist.

The sample should be taken when you are

sitting at rest, at a time when you are feeling

well and free of infections. If this test shows the

oxygen level in your blood is low you may need

further assessment to see if oxygen will be of

benefit or not. This involves having trials of

oxygen therapy and monitoring the effect on the

oxygen and carbon dioxide levels in your blood.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

LONG TERM OXYGEN ASSESSMENT

(You are not eligible if you are still smoking)

Pulmonary function and blood tests

Low oxygen levels detected

Monitor

effect of

oxygen

therapy

Low oxygen levels not detected

You do not

need oxygen

therapy

OXYGEN TRIAL

Oxygen

1 hour at rest

Blood tests for oxygen

and carbon dioxide

Adjust oxygen level

2 hours at rest

Repeat blood test for oxygen

and carbon dioxide

If levels improved –

Suitable for long term

oxygen therapy

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

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WHO PRESCRIBES OXYGEN

GPs can prescribe cylinders for short-term use

only. For longer-term use, a specialist’s opinion

is required for the reasons already described. The

correct amount of oxygen will be determined at

your assessment and you should not make any

alterations to this unless you have had

instructions to do so from your hospital doctor.

If you have just been discharged from hospital

after an infection you may not be prescribed

longer term therapy immediately. A review about

a month later, when your condition is more

stable, will allow proper assessment of long-term

oxygen requirements.

How many hours per day is long term oxygen

therapy

If it has been decided that you need long-term

oxygen therapy, it usually has to be used for at

least 8 hours per day to achieve the maximum

benefits. To achieve this most people use it

overnight and at quiet times during the day to

make up the 8 hours.

Continuous oxygen therapy

If you have been advised to use oxygen

continuously and you need to take a break from

it, it is best to do so while you are awake and

resting quietly, not while sleeping, walking or

doing any activities.

Oxygen and exercising

As you use more energy during exercise, you

may need extra oxygen to help you increase the

amount of exercise you can do. To find out if

you need more oxygen when exercising, an

assessment while you are exercising will need to

be carried out.


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

This is usually in the form of a timed walk test,

done with and without added oxygen.

If this is the case and the doctors agree, you

may have the opportunity of having oxygen

cylinders at home for use when you exercise.

Monitoring the need for oxygen therapy

Once it has been decided that you may benefit

from oxygen, you should have regular reviews

to ensure that:

• your oxygen levels are high enough

• you are using your oxygen correctly and often

enough

• you still require to use oxygen – it is not

unusual for people to discontinue oxygen

therapy once their condition has stabilised.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

HOW IS OXYGEN PROVIDED

In Scotland the Oxygen Therapy Service

organises oxygen in your home. When they

receive the prescription for oxygen from your

doctor they will put into place whatever oxygen

requirements you have.

The Oxygen Therapy Service covers the whole

of Scotland and can be contacted on:

Tel: 0131 275 6546

You will also be given a contact number for the

respiratory nurse.

Important Information

• Your oxygen must only be used at the rate the

doctor has prescribed.

• Never change the flow rate unless instructed

by a doctor.

• Always follow the recommendations and

advice provided with the oxygen.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

HOW IS OXYGEN GIVEN

Oxygen is administered through

plastic tubing attached to either a

facemask or nasal cannulae (prongs

that are inserted into the nostrils).

Oxygen tubing

Sufficient tubing is usually provided

with any oxygen appliance to allow

you to move around your home.

However, too much tubing increases

the chances of it getting caught in

furniture and becoming a tripping

hazard. It also increases the chances

of the oxygen being cut off due to kinking of

the tube. The oxygen tubing should also be of

the correct size, about 5mm in diameter, and the

connection to the flow meter should be snug.

Nasal cannulae

Nasal cannulae are most commonly used with

oxygen therapy at home. This consists of a two

pronged tube used to deliver oxygen into your

nostrils. The length of nasal cannulae tubing is

normally about 2 metres (6 feet) in length. The

part of the nasal cannulae that sits in your

nostrils can be washed; the rest of the tubing

should be wiped. Nasal cannulae allow for

continuous oxygen therapy when eating and

drinking, and also make it easier to talk.

The type of method used depends on the reason

why you require oxygen, and how active you

are and how much oxygen you will require

every day.

Using nasal

cannulae

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

Oxygen cylinder

A flow meter

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Oxygen cylinders

Oxygen cylinders are large steel canisters filled

with compressed oxygen. They come in a

variety of sizes ranging from large stationary

cylinders to small portable aluminium ones

weighing about 5lbs. Each cylinder will have a

regulator or flow meter attached to it that will

allow you to set your prescribed flow rate. The

size of the cylinder and the prescribed flow rate

will determine how long your cylinder will last.

If you are using oxygen for more than 8 hours

per day from cylinders, then you will be eligible

for an oxygen concentrator.

Supplying and changing the oxygen cylinders

Oxygen cylinders are delivered by community

pharmacies but can be heavy and awkward to

move. New patients being prescribed oxygen

therapy will be advised by their GP practice or

respiratory nurse of which local pharmacies are

able to provide this service. Instructions

regarding changing the flow meter from the

empty, used cylinder to a full cylinder (which

can be difficult for some people) will be

provided by the deliverer or by a respiratory

nurse – make sure you know how to do this.

Make sure you keep an adequate supply of

cylinders.

Oxygen concentrator

Dolby Medical are contracted by the NHS to

provide oxygen concentrators and are

responsible for the ongoing servicing,

maintenance and repair of concentrators in

addition to the initial supply. They have a 24

hour Freephone number to ensure any problems

are dealt with as soon as possible.

Tel: 0800 833 531


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

An oxygen concentrator provides a reliable

source of oxygen supply for people who require

more than 8 hours of oxygen a day.

It is a mechanical device which operates from

the mains electricity supply and functions by

taking air from the room, and passing it through

a filter that absorbs other gases and so

concentrates the amount of oxygen it contains,

producing approximately 93% pure oxygen. It

produces a continuous supply of oxygen and so

takes away the need to store and change the

many cylinders necessary to provide sufficient

oxygen every day.

The oxygen is then provided through a

facemask or nasal cannulae in the same way as

from an oxygen cylinder.

A typical oxygen concentrator is approximately

16” wide by 14” deep and is 28” high and

weighs around 50lbs. All concentrators have

wheels on the base to facilitate

movement, although once installed in the

home there is rarely a need to change

their location. Standard concentrators

deliver a range of flows from 1 to 5

litres/min.

However machines are available to

provide up to10 litres/min for high

demand users or for lower rates as little

as 0.1 litres/min. There is a built in flow

meter attached to the concentrator,

allowing the prescribed flow rate to be

set.

Oxygen concentrator

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

The concentrator is usually placed in an agreed

position in the home, which is well ventilated

and away from furniture and walls. The noise of

it running can be distracting to some, so it

should be sited somewhere where it will not

disturb sleep for either the patient or other

members of the household. Enough tubing will

be attached to the concentrator to allow the

patient to walk from one end of the house to the

other. If long lengths of tubing are likely to be a

hazard, it is possible to arrange what is known

as a ‘fixed installation’. This reduces the risk of

tripping on the tubing, or it becoming obstructed

or damaged.

Provision and maintenance

On delivery you will be shown how to use the

concentrator and given instructions regarding

caring for it.

Oxygen concentrators have an air inlet and a

filter, so make sure that nothing covers this to

allow fresh air into the concentrator. The filter is

easily removed and should be washed on a

weekly basis, rinsed and thoroughly dried

before reinserting. The concentrator should

never be used unless this filter is in place.

In case of machine failure or power failure a

compressed oxygen cylinder is provided, set to

provide the flow rate as prescribed for you.

Dolby service engineers will maintain and

check the concentrator every three months.

They will provide any replacement

masks/cannualae and tubing required.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

They will also take readings from the hour

counter attached to the concentrator that

monitors how it is being used. The readings are

communicated back to the Oxygen Therapy

Service who process a refund of the cost of

electricity used.

You will be given the 24 hour Freephone

contact number for any enquiries.

Portable oxygen

This can be prescribed for patients who are on

long term oxygen therapy and are mobile

enough and wish to leave the house on a regular

basis. The cylinders are lightweight and small

enough to be portable. Your respiratory nurse /

physician will facilitate this after an assessment

is made.

Oxygen conserver

An oxygen conserver does as its name suggests,

it conserves oxygen. It is normally attached to a

portable oxygen cylinder, to extend the life of

the cylinder. It does this by only releasing

oxygen when you breathe in; unlike the usual

system that provides oxygen continuously. By

only releasing oxygen as you breathe in, you

still achieve your prescribed amount of oxygen

but no oxygen is wasted from the cylinder when

you are breathing out. This means that the time

your cylinder will last for will be greatly

extended. As conserver systems are not

available on prescription, they have to be

purchased privately which can be quite costly.

Your respiratory service may have one available

or may be able to access charity or endowment

funds to help with the cost.

Portable oxygen

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

Dry mouth, lips and nose

Oxygen therapy tends to dry up the mouth, lips

and nose, however it is given:

• take frequent sips of water

• use a non-paraffin based moisturiser on your

face

• apply water based lubricating jelly to nose

and lips. Do not use hydrocarbon based

lotions such as Vaseline.

Ear protection

Another common problem is sore ears where the

tubing or strapping sits. This can cause quite a

nasty sore. Oxygen tubing protectors can be

obtained through the Oxygen Therapy Service

or from your Dolby service engineer.

16


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

WHAT ARE THE SAFETY ISSUES

OF USING OXYGEN THERAPY

• Oxygen on its own will not explode, but it

will feed a flame, so it is of prime importance

that extra care is taken when using and

storing oxygen in the home, and when using

portable oxygen outside.

• No oil or grease should be applied to any part

of the oxygen equipment. No oil-based

moisturisers should be used on the skin of the

nose or face, such as petroleum jelly; instead

a water-based product should be used, such as

aqueous cream.

• There should be no smoking around oxygen

by anyone as clothing and hair can easily be

ignited.

• Oxygen should be stored in a well-ventilated

room, away from open or gas fires, water

heaters or any other source of heat or flame.

• Oxygen cylinders should be stored upright

and if possible in stands. Cylinders are under

high pressure and a crack in them can be

dangerous.

• When travelling with an oxygen cylinder in

your car it should be safely secured in an

upright position.

• If you are intending to travel on public

transport such as buses, taxis, airplanes or

ferry with your oxygen you must check their

regulations before travelling as different

transport methods have different regulations.

Oxygen is safe

when used

correctly.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

18

HOW DO I ORGANISE MY

OXYGEN THERAPY AWAY FROM

HOME

Having to use oxygen therapy doesn’t

necessarily mean that you can’t go on holiday. It

does however require more planning and

organisation.

If you are staying with friends or family then

using your oxygen therapy while there should be

easier. If however, you are staying at a hotel or

guesthouse you will need to check on booking

that they will allow you to keep and use oxygen

therapy in their premises.

If you use an oxygen concentrator at home, you

should contact the Oxygen Therapy Service in

the first instance to arrange oxygen for your

holiday. They will do this by contacting the

relevant service provider at your destination.

Within Scotland, Dolby Medical will make

arrangements to provide you with a concentrator

when requested to do so by the Oxygen Therapy

Service.

You should not attempt to take your own

without consulting your supplier.

The Oxygen Therapy Service covers the

whole of Scotland and can be contacted on:

Tel: 0131 275 6546

Using portable oxygen

If you wish to use portable oxygen during your

holiday, again you should contact the Oxygen

Therapy Service. Portable cylinders, as with

most oxygen cylinders, can only be filled by

authorized licensed producers. Portable oxygen

cylinders can potentially be taken on a flight


U N D E R S T A N D I N G O X Y G E N T H E R A P Y

with you as long as they are empty and carried

in the hold.

However connections for filling vary between

the UK and other countries so it may not be

possible to get private cylinders filled.

Fitness to fly

If you are considering flying you will need to

check first with your G.P. or Respiratory

Consultant that you are fit to fly and you may be

required to have a ‘fitness to fly’ assessment.

This involves some breathing tests that mimic

the air pressures in an aircraft cabin, allowing

the doctors to see how your body will react in

the air. If you do need oxygen in-flight, this can

be supplied by the airline, however the charges

and availability of this service varies.

Advanced planning is very important. The

CHSS Factsheets F6 Holidays and F13 Air

travel contain more detailed information to

help you.

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U N D E R S T A N D I N G O X Y G E N T H E R A P Y

Phone/Textphone the Chest,

Heart & Stroke Advice Line for

confidential, independent advice

from one of our nurses.

The line is open

Monday – Friday

9.30 – 12.30 and 1.30 – 4.00

0845 077 6000

Charged at local call rate.

Out of hours answering machine.

Email: adviceline@chss.org.uk

Fax: 0131 220 6313

20

The information contained in this booklet is based on

current guidelines and is correct at time of printing.The

content is also put out to peer, patient and expert review. If

you have any comments about this booklet please contact

Lorna McTernan, Health Information Manager, at the address

on the facing page.


CHEST PUBLICATIONS

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C1 Living with COPD

C2 Understanding oxygen therapy

Take Control of Asthma - by the National Asthma Campaign

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F1 TB: Information about tuberculosis

F6 Holidays

F7 Insurance companies

F8 Suggested book list

F13 Air travel for people affected by chest, heart and

stroke illness

F18 How to conserve your energy

F23 Living with stress and anxiety

F24 Healthy eating

F26 Understanding help in the community

F30 Just move

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