Home Oxygen

Liquid Oxygen

Liquid Oxygen system store oxygen at 273Fahrenheit in a tank that is called a dewar. As the oxygen passes through warming coils it becomes gaseous. The flow can vary from ¼ to 15L/min. The standard liquid oxygen tank lasts for a week at 2L/min and is refilled as needed. The main advantage of the liquid system is that small lightweight tank can be filled from the stationary system that allows the system to be ambulatory. The small tanks last for 8 hours with a flow rate of 2L/min and they are fairly heavy; the smaller units last correspondingly less time.

The other advantages of the liquid system included quitnes and no need for electricity. The system is more costly than other oxygen system the convenience makes it the best choice for the child who wants to be able to travel away from home. If the flow rate is than 4L/min, refill need to be made frequently. There is continued evaporative loss so that there is some wastage. Reimbursement for liquid system  may be less than optimal for DME company.

Oxygen Concentrator

This is an electrical device that removes nitrogen from room air and delivers oxygen to the patient at rates of ¼ to 6L/min. The concentrator is quite large and noisy and does require electricity to function. The advantage over the liquid system is that there is no need to refill. Running the unit increases the monthly utility bill by approximately $27. It is most useful for patient who use oxygen only at night or for those who remain in bed.

Compressed Oxygen Systems

The compressed oxygen tanks used is in the hospital may be used int the home. The largest is the H tank which last for two days at 2L/min. The H tank is useful as a back-up for the concentrator. It is not good as a primary source because of the need of replace tank every few days. Smaller tank are E and D tanks. The D tanks are small enough to carry in a shoulder bag. The E and D tanks are useful for people who only spend a limited time away from home. Cylinders and tanks containing compressed gas are the most economical method of delivering oxygen. The container must be supported either by a chain or in a base of cart. The tanks must be placed or stored away from any heat source.

Some devices are equipped to conserve oxygen to extend usage. These include the reservoir cannula, the pulsed-dose system, and the transtracheal oxygen system. The reservoir canulla stores the continuously following oxygen during expiration so that a bolus is available for the next inspiration. Pulsed-dose systems deliver an increased amount of oxygen during the beginningof inspiration and can reduce the amount of oxygen utilized overall. Transtracheal oxygen systems have not been used much in pediatrics. They involve insertion of  a catheter into the trachea percutaneously (from the neck), which delivers oxygen directly into the trachea.

Oxigen is delivered to the airway by facemask or by cannula. The nasal cannula can be connected to the source by tubing that can be as long as 50 feet to allow some mobility. Oxygen masks are less used in the home than in the hospital. They can deliver higher concentrations of oxygen than cannulae. The simple mask requires a high flow rate (5-10L/min) and the non-rebreather and Venturi need even higher flow rates. The pescription for oxygen usually will define the flow rate and the duration (number of hours). On occasions, oxygen will be required only during sleep and activity. It is useful to evaluate whether the oxygen can be discontinued for brief periods (e.g., during a shower or when eating). Continuous pulse oximetry is usually not recommended in the home because of the frequency of false alarms. It is helpful if there is intermittent checking of oxygen saturation to maintain an appropriate level.

Pediatric Respiratory Home Care

The respiratory care practitioner (RCP)  provides an important role in home care for many pediatric patients.It is usual for the RCP  to have at least 1 year of acute care experience before working with home care.Experience in pediatrics is necesary as this crompises an important  part of home care.It is important that RPCs providing home care be licensed (states have different regulations).The main papulation receiving home care is the patient who is being discharged from the hospital and still requires ongoing care.Many patient are serviced by home care companies and many of the companies are durable medical equipment (DME) vendors. The RCP who is employed by the DME company will select, deliver, and set up the equipment in the home. The family will be educated in the requirements for monitoring and maintaining the equipment. The treating physician is responsible for prescribing the therapy. The RPC spends much of the time during the home visit teaching the family the safe and effective use of the equipment. A treatment plan is individualized and documentation is important. Appropriate follow-up is indicated.
Medicare does not reimburse for the RPC service whereas they will do so far nurshing visit. As a result, many companies utilize nurses to do the evaluation and education for patients on medicare.
RPCs employed by hospital are often part of the discharge planning team that orders specific home care treatments for children. Team members also include nurses and social workers who are responsible for evaluating the suitability of the caregivers and the home environment before the plan is initiated. The home environment needs to be evaluated for safety againts fire or other hazards, particularly if home mechanical ventilation is to be used. One of the issues includes the electrical system, as there may be various appliances connected to the same electrical circuit. Awareness of the amperage of the appliances reduces the chance that circuit will be overloaded. It is necessary to check the fuse boxes. Some older homes have inadequate circuits breakers and inappropriate fuses. Space for equipment and circuits is necessary and they need to be placed so that there is safe distance from heaters or any source of flame. Functioning smoke detectors are essential and fire extinguishers should be available and accesible.
Categories of home respiratory equipment include:
Category I : no prescription needed.
Category II : Prescription needed but the equipment is not considered life supporting. This includes oxygen delivery devices, nebulizers, suction machines, and oxiometers.
Category III : Prescription needed and equipment is considered life supporting. This include apnea monitors, pressure support for respiratory failure, and invasive or non-invasive mechanical ventilation.