Question

so the question is about oxygen safety we see increase in use of oxygen usage for copd patient in the home setting discuss what types of safety concerns are there with sending patient home on oxygen after short stay in the hospital.

Answer 1

COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe and disease gets worse over time. Cigarette smoking is the leading cause of COPD. Others are long-term exposure to other lung irritants such as breathing of second hand smoke, air pollution, chemical fumes, or dust.

COPD causes lung and airway damage which affects functioning capacity of lungs and resulting low oxygenation of blood. Main symptoms are coughing with production of large amount of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

Sometimes, patients with mild form of COPD need short-term oxygen therapy to help improve blood oxygen levels when they have flare of symptoms due to respiratory infection, pollutants and allergens. In these cases oxygen therapy is discontinued once patient have recovered.

Some patients with COPD may only need oxygen during certain times, like when they are being active or sleeping.

Other patients with COPD may need to have long-term oxygen therapy (LTOT). Long-term means that they need to receive oxygen for 15 to 24 hours every day. This is more common during the later stages of the disease.

Main safety concerns in patients requiring oxygen therapy at home are related to

· Lack of understanding about mechanism of hoe oxygen works and possible risk of overuse with increased risk of complications resulting from that.

· Lack of knowledge about working of equipment, and adjustments and back up required

· Fire hazard

· Risk of side effects

Oxygen therapy is prescribed based on results of by arterial blood gas test and pulse oximetry test. Rate of oxygen administration is decided on basis of results of these tests not on the basis of breathlessness experienced by the patient.

First patient and care providers need to be educated about pathogenesis of disease (changes in lungs and airway by disease) that how oxygen therapy works.

Explain them that oxygen therapy will only increase percentage of oxygen in the air patient will inhale, will not relieve breathlessness or breathing difficulty.

So adhere to prescribed oxygen flow rate. Do not increase the flow rate hoping that it will relieve breathing difficulty. It will harm instead (oxygen induced hypercapnia).

Administration of high-flow oxygen concentrations has been associated with higher mortality in comparison with a more tailored approach of oxygen therapy. A titrated oxygen administration to achieve an oxygen saturation of between the 88% to 92% results in less respiratory acidosis and better outcome. So advise about monitoring pulse oxygen saturation by portable device.

Inform about change in oxygen requirement during different activities and modifications required. Patient need more oxygen during exercise or activity than during sleep or at rest.

Patients who are starting oxygen therapy at home will need a pulmonary rehabilitation program means learn about equipment set up and use.

Teach patient and care givers about different methods for delivering oxygen into a patient’s lungs: nasal cannula, face mask and tracheostomy along with pros and cons of each. A nasal cannula is the most common way to receive oxygen. Patients who need a larger supply of oxygen may need to use a face mask.

Portable oxygen delivery unit for oxygen administration at home are supplied in different kinds of equipment: compressed oxygen gas, liquid oxygen, and oxygen concentrators. Educate patient and significant others about the advantages and disadvantages of each one of them.

· Compressed oxygen is a gas that comes in portable metal cylinders of various sizes wheeled around for ease of carrying. Patients using them need regular deliveries of oxygen to their homes. This need to be ensured.

· Liquid oxygen is delivered in large containers from which small portable containers can be filled. Liquid oxygen turns into a gas when it flows out of the container. Regular deliveries of oxygen to their homes need to be ensured.

· Oxygen concentrators remove oxygen from the air by filtering out other gases. This means that they do not need to be refilled. But because they depend on electricity to filter the air, patients need a 24 hours power back-up.

As main cause of COPD is smoking, and studies have shown that nearly one forth of patients continue to smoke after diagnosis too. Prescribing long term oxygen therapy at home for these patients who is a current smoker is a real challenge. Pure oxygen is fire hazard. There is therefore increased risk of death or sustaining devastating head and neck burns. It is important for patients to take measures to make sure that they are safe. Some of the most important safety tips while using oxygen are:

· Never smoke or be around anyone who is smoking

· Stay at least 5 feet away from any flame, such as a gas stove or candle

· Never use oxygen therapy in a small or enclosed space

Some patients who use oxygen therapy may have side effects like dry or bloody nose, irritated skin around the cannula or mask, tiredness or drowsiness, morning headaches. Patients should talk to their doctor about any side effects they are experiencing. Most of these side effects can be relieved by:

· Changing the oxygen delivery equipment

· Adjusting the amount of oxygen

· Changing how often oxygen is used

· Using a humidifier or nasal spray