Post on 18-Dec-2021
Welcome to the Specialized Medical Services Respiratory training webinar series!
SMS is your Long Term Care (LTC) facility single source for oxygen, medical equipment, respiratory care services and supplies nationwide.
This respiratory module is for reference purposes and designed to provide a basic understanding of Oxygen Equipment
commonly used in Long Term Care. It is still important to consult your local respiratory professional and
follow physician orders when applying respiratory treatment.
At the completion of each training module, a short post test will be offered, and with successful completion,
a training certificate recognizing your participation for your records.
Training Objectives
• Recognize the different types of oxygen equipment
• Understand how to operate each piece of equipment
• Select the right system for your patients’ needs
• Learn common troubleshooting techniques
Compressed Gas Cylinders
• Compressed Oxygen
• Stored under pressure in a vessel or tank
• Variety of tank sizes
Oxygen Concentrators
• Electrically operated devices
• Draw in air fromthe surrounding room
• Filter out the nitrogen
• Compress the remaining oxygen for patient use
• Deliver medical grade oxygen
Liquid Oxygen
• Compressed and cooled
• Converts oxygen to a liquid state
• Much larger storage ratio of oxygen
Types of Compressed Gas Cylinders
“Walk O2 About”
Aluminum E
With Integrated Regulatorand Handle
Standard Post Valve
Aluminum E
Toggle Valve
Walk O2 About
Regulator
Cylinder Wrench
“Walk O2 About”
Aluminum E
With Integrated Regulatorand Handle
Regulators & Flow Meters
• Regulator Types:• Continuous Flow
• Conserving
• Flow Meter Types:• Tube & Ball
• Click Style
Continuous Flow Regulators
E‐Cylinder Regulator with Click‐style Flow meter Adapter
H‐Cylinder Regulator with Standard Flowmeter and DISS
Yolk Style Regulator &Click Style Flow Meter
E‐Cylinder Regulator with Click‐style Flow meter Adapter
• Fits over the stem of an oxygen tank• Set prescribed flow rate
using adjustable dial• Flow rates: 1‐15 l/min. • Connector for oxygen
tubing• Pressure gauge
indicates available oxygen
Threaded Nut Regulator &Standard Flow Meter
H‐Regulator with Standard Flowmeter and DISS
• Connects with wrench
• Adapt a humidifier or “Christmas tree” adapter
• Flow rates: 1‐15 l/min.
• Pressure gauge indicates available oxygen
Conserving Regulators
• Increase cylinder range
• Pulsing: Delivers fixed volume per breath
• Demand: Triggered by patient demand
• Mechanical or battery‐powered
• Use pulse oximetry to check O2 adequacy
Attaching the Regulator
Step 1:
• Remove any protective sleeve from cylinder stem.
• Open the cylinder valve slightly by turning counterclockwise
• Close the valve tightly
Step 2:
• Slip the regulator over the cylinder valve and neck
• Line up regulator pins with cylinder holes
Step 3:
• Hand‐tighten the tee screw by turning clockwise
Turning ON Your Portable OxygenStep 1:
• Open the cylinder valve by turning counterclockwise.
• Pressure gauge needle will register O2 amount
• Full D or E cylinder: 2000 PSI
Step 2:
• Click Style: Adjust the liter flow control knob to the prescribed setting
• Thorpe Tube Style: Upright position to set and read indicator ball
Step 3:
• Connect delivery device to oxygen outlet
• Set the liter flow at the prescribed setting
Turning OFF Your Portable Oxygen
Step 1:
• Remove delivery device from patient
Step 2:
• Close cylinder valve clockwise all the way to stop flow
• Pressure gauge needle will drop to zero
Step 3:
• Turn the liter control knob to zero
‘Walk‐02‐Bout’ Operation
Step 1:
• No need to turn a valve on
• Easy‐to‐read pressure gauge always registers
oxygen amount
Step 2:
• Adjust flow control dial at top of regulator to
prescribed liter flow
Step 3:
• Connect delivery device to oxygen outlet port
Step 4:
• Turn flow control dial to zero when not in use
Step 5:
• Replace cylinder as needed
Compressed Gas Usage Chart in Hours
‐‐‐0.50.871.32.6B/M6
‐‐0.51.31.72.65.2C/M9
‐‐11.62.23.36.7D
0.921.41.82.83.75.511E
234.77.19.51428M60
111419283857114 H
10 L/min8 L/min6 L/min4 L/min3 L/min2 L/min1 L/min
Flow Rate
ContainerSize
Cylinder Troubleshooting
Problem Probable Cause Solution
No oxygen flowing to nasal cannula
Cylinder valve closed or flow meter on zero
Check cylinder valve to make sure it is open. Pressure gauge indicator. Check flow meter to make sure it is set at prescribed liter flow.
Empty cylinder Check pressure gauge for oxygen contents. If cylinder is empty, replace with full cylinder
Patient lack of awareness
Place cannula prongs in clean glass of water to observe bubbles.
Faulty cannula Cannula tubing kinked or obstructed with moisture. Replace as needed
Loose connection Check all tubing connections
Faulty regulator Replace with back up unit.
Cylinder system making hissing noise and leaking
Regulator not attached properly
Turn off cylinder valve. Check position of regulator and retighten.
Faulty or missing washer
Replace washer
Faulty regulator Replace with back up unit.
Oxygen Concentrators
Stationary Concentrator with Cabinet Filter
• Electrically operated devices
• Draw in air fromthe surrounding room
• Filter out the nitrogen
• Store the remaining oxygen for patient use
• Two types: stationary &portable
Oxygen Concentrators
Stationary Concentrators without Cabinet Filter
• Between 30‐45 lbs.
• Wheels for transport
• Remain at bedside
• Add tubing for mobility
• New units don’t require external cabinet filters
• Available with oxygen purity monitors
• Available in low and high flow units (0‐10 LPM)
• Deliver in purity range of 86‐95%
Operating Your Oxygen Concentrator• Plug power cord into room
outlet
• Set the I/O power switch to the “I” position to turn the unit on.
• Low O2 concentration indicator remains on until concentration reaches minimum requirements.
• Set O2 flow on prescribed flow line
• Check intake filter daily for lint build‐up
Home‐fill Oxygen Concentrator
• Stationary concentrator + small cylinder
• Create a “fill station”
• Refilling times vary by size
Portable Oxygen Concentrator (POC)
• For travel and ambulatory use
• Limited power capacity
• Require battery packs for extended use
Concentrator TroubleshootingProblem Probable Cause Solution
No power. Power failure condition causes an alarm to sound
Power cord is not plugged in to the electrical outlet
Check power cord at electrical outlet for proper connection
No power at electrical outlet Check power source, wall switch, in‐house fuse or circuit breaker
Broken chord or plug Replace unit immediately
Circuit breaker on concentrator unit activated
Press (do not hold in) the circuit breaker reset button
If circuit breaker trips again or the power alarm continues to sound after unit is turned on, replace equipment.
Limited or no oxygen flow Flow control knob on zero Confirm flow control knob set at prescribed liter flow
Obstructed humidifier bottle, or leak present
Remove humidifier, confirm flow restored, replace or reconnect humidifier bottle
Defective nasal cannula or tubing
Remove and check for kinks or obstruction, possibly moisture in tubing. Replace as needed
Cannula and/or tubing loose Check cannula and tubing for tight connections
Condensation collects in oxygen tubing when using a humidifier bottle
Unit not properly ventilated Make sure unit is positioned away from curtains, drapes, or hot air registers/heaters.
Intermittent alarm sounds Equipment malfunction Turn unit off. Switch to reserve oxygen supply. Contact service provider
Liquid Oxygen• Larger ratio of oxygen when converted to gas
• Variety of storage for stationary and mobile uses
• Bulk tank can directly supply patient rooms at care facilities
Liquid Oxygen• Stored in smaller reservoirs than the bulk tanks
• Stationary and portable unit create a patient specific system
• Stored at minus‐300 degrees Fahrenheit.
‐300F
Reservoir/PortableSystem
Filling Liquid O2From Stationary to Portable
• Use a clean, dry, lint‐free cloth to dry connectors
• Check contents indicator on stationary unit
• Hold portable unit with both hands
• Lower it onto matching recessed area in stationary unit
• Press straight down to ensure connectors engage
Portable Liquid O2 Components
• Move vent valve lever to the open position
• Loud hissing will result
• Sound change and white vapor mean it’s time to close vent valve
• Fill times vary
• If vent valve fails to close, press release button on stationary unit
Portable Liquid O2 Components
• Hold carrying strap
• Depress release button
• Always hold portable unit with at least one hand
Portable Liquid O2 Components
• Lift carrying strap to check oxygen fill levels
• Disengage plastic buckle for proper reading
Contents Indicator
Liquid O2 Troubleshooting
Problem Probable Cause Solution
No oxygen flowing to nasal cannula or tubing
Reservoir or portable empty Check gauge indicator for oxygen contents.If reservoir or portable empty, replace with full unit.
Flow meter not turned on. Check flow meter to make sure it is set at prescribed liter flow.
Faulty cannula Cannula tubing kinked or obstructed with moisture. Replace as needed
Portable unit frozen to stationary
Excess moisture build up on metal connections
Make sure fill valve is closedAllow portable to remain attached for 30 secondsAttempt to disengage by pressing down on disconnect button
Stationary unit frozen open and leaking liquid oxygen
Ice crystals build up in male fill connection
Attempt to reattach portable to stationary, open and close portable fill valve to attempt to break loose ice crystals
Portable unit leaking moisture/water
Frost build up on internal coils from high humidity in room, and/or warming of liquid 02 to gas causing water run off
Move unit away from warm/high humidity areasReplace unitMonitor water accumulation on floor to prevent slipping risk
Know Your PatientCompressed Gas Cylinder
(E Portable)Compressed Gas
Cylinder
(H Stationary)
Oxygen Concentrat
or
Liquid Oxygen (Portable)
Patient Type
• Ambulatory & active
• Stable condition• Able to carry cylinder• Understand system• Know when O2 is low and needs replacement
• Stationary • Requires high flow rate
• Other high flow system not available
• Stationary• Stable Condition
• Ambulatory
• Stable condition• Able to carry portable
Pulse (Intermittent) vs. Continuous Flow Oxygen
•Consult medical director or respiratory therapist
Humidification
•Minimal clinical benefit
•Best used for patients at flow rates of 4LPM or greater
•Creates a threat of moisture accumulation in the nasal cannula and connective tubing
Steps to Follow
• Identify patient’s need
• Verify MD prescription; delivery system, liter flow, duration
• Use appropriate equipment and delivery device, based on need and MD order
• Monitor efficacy for benefit and continued need
• Follow best practice and safety guidelines
Sample Oxygen Therapy Orders
• Continuous oxygen @ 2 l/min. via nasal cannula, to maintain 02 sat level of 89% or greater
• Oxygen at night @ 3 l/min via nasal cannula for SOB
Troubleshooting
• Test and clean equipment
• Track % of oxygen delivered and flow levels
• Preventative Maintenance
• Supplies
• Change Frequency
Session Review
• 3 types of oxygen systems and components– Compressed gas cylinders or tanks
– Oxygen concentrators: stationary or portable
– Liquid oxygen
• When to use each type, and for what patients
• Troubleshooting advice
Informational Resources• Contact SMS at 1‐800‐786‐3656
• AARC clinical reference materialswww.aarc.org
• Manufacturers’ clinical material• Air Gas
• Air Sep
• Caire
• Cardinal Health
• NFPA 99
• CGAwww.cganet.com
• Chad Industries
• Invacare
• Western Medical