Oxygen Concentrators

Oxygen concentrators draw air in from your surroundings, remove nitrogen and other gases and deliver purified oxygen to the user. They can be stationary or portable.

Home or stationary concentrators deliver oxygen continuously and operate on electricity. Stationary concentrators can supply higher liter flows (currently as high as 10 liters per minute, depending upon the unit) and they won’t run out of oxygen if they are functioning properly, remain plugged in, and you don’t lose power. 

Because they need electricity to work, you will need to have a backup plan in case of a power outage. I live in a high fire and wind area with multiple power outages and rolling blackouts every year. For that reason, I have 3 E tanks to use as a backup. In addition, I have notified my electric company that I am on oxygen in case of outages, and I receive a discount to my electric bill to boot. Contact your local supplier to see what accommodations may be available to you in your area. 

Portable Oxygen Concentrators (POC’s) run on batteries, so they can be used anywhere, except in water and extreme temperatures. They typically come with both AC and DC chargers, that enable you to save your battery life if you are near an electrical outlet.

POC’s can be continuous; pulsed, meaning that it will only deliver oxygen upon inhalation; or have both options. Due to their size and relatively limited ability to generate oxygen, POC’s are not recommended for people who require more than 3 lpm of continuous flow .

Whether you are using a concentrator or tank, when you are using a device in pulsed mode, the numerical settings are not equal to the liters per minute (lpm) on a continuous flow device. In other words, a setting of 3 pulsed does not mean 3 liters per minute. To find out the actual amount being delivered; you would have to check with the individual manufacturer’s specifications or another reliable source. 

One of the best sources (if not the single-best source) for information on POC’s is the Pulmonary Paper’s annual Portable Oxygen Concentrator Guide, written by Ryan Diesem, RRT. This guide provides the most current POC descriptions and specifications in a useful chart that allows for easy comparisons between units. 

Another great resource on oxygen usage is Noah Greenspan’s Oxygen Manifesto series in the next chapter.

Liquid Oxygen 

Liquid oxygen is a type of delivery system where oxygen is compressed and cooled, first below freezing, then to a liquid. Then, once it is exposed to warmer temperatures, it converts back into gas. Most liquid oxygen systems can provide a high liter flow and do not require any electricity. Liquid oxygen systems usually consist of a portable device and stationary “reservoir” unit for storage, that you then use to fill your portable device. 

Unfortunately, liquid oxygen is not used much in the US, due to availability, cost, and insurance limitations. It is used more frequently in other countries like Canada and the UK. The portable unit is small and lasts much longer than the small oxygen tanks. 

Interfaces and Accessories for your oxygen delivery system

Nasal Cannulas and Oxygen Tubing 

A nasal cannula is the plastic tube that delivers oxygen from your oxygen device to your body via two small prongs that go just inside your nose. They are usually available in 4-foot and 7-foot lengths. You can also add extra extension tubing (usually 25 to 75 feet) so you can get around your home without moving your concentrator from room to room. There is also a swivel connector that attaches the cannula to the tubing to help eliminate kinking. 

Nasal cannulas are low concentration conduits and work well with liter flows of less than 6 liters per minute (lpm). If your lpm requirement is 6 or more, you will need high flow tubing and cannulas, or if that is not sufficient to maintain your saturation, you should ask your doctor about switching to a mask, especially during periods of vigorous (and even not-so-vigorous) activity or exercise.

You may hear varying recommendations on cleaning so check with your doctor or health care professional for specifics, but in general, cannulas should be changed every week if used constantly or every 2 weeks if used for only a few hours each day. Change even more frequently (at least daily) if you are sick. Tubing should be changed every month.

Simple Face Mask

A simple facemask covers the nose and mouth. Your doctor may prescribe a facemask instead of a nasal cannula if you require a higher oxygen concentration, extra humidity or can’t tolerate a nasal cannula. A simple mask should be cleaned twice a week with warm soapy water.

Non-Rebreather Mask

A non-rebreather mask also covers nose and mouth and has a plastic reservoir bag attached to the end that increases the concentration of oxygen delivered. This mask is useful for people that require a high continuous liter flow of oxygen as many with ILD do, especially during activity and exercise. 

Humidifier

A humidifier is sometimes recommended for oxygen flows at 4 lpm or more. I found the humidifier helpful when the weather was dry, and I was getting nose bleeds. It also helps sinus dryness. The type of humidifier you use will depend on your type of home oxygen and how much oxygen you need. Many of the home concentrators have a built-in space for holding the humidifier bottle. This plastic bottle is connected to your tubing. It is recommended you use distilled water (not tap) and clean each time before refilling.

Equipment Maintenance

Different types of oxygen equipment have different requirements for cleaning and overall maintenance. Some tasks can be done by the patient themselves and some require professional maintenance. Please be sure to check with your company and have a clear understanding of what the requirements and recommendations are for your unit…and then make sure you follow them. Think of your oxygen apparatus as life support equipment and act accordingly.

One to Grow On!

Try to choose a system that can grow with you if you anticipate that your oxygen needs may increase in the future. I invested in an expensive POC that at its highest setting just met my needs. I was attracted to its light weight, but I was able to use it for less than a year. This was before I knew about any of the pulmonary Facebook support groups, so if you are thinking of purchasing a unit, ask around first.

Where do I get my oxygen equipment and how is it paid for?

Your doctor may help you select an oxygen or DME supplier. Some insurance plans may designate which company to use and may have restrictions on the types of devices you can use and the number of tanks you can have. Yes, that is complete BS that your medical decisions are made by an insurance company and not your physician! That last sentence was from Noah.

You may also have certain restrictions on changing companies or devices based on insurance requirements. Yes. That is also a bunch of BS (again, Noah)! So, in selecting a provider, be sure to talk to them about their policies and procedures so you don’t inadvertently get locked into a situation or supplier that cannot or will not meet your needs. 

If you travel often, you may want to select a nationwide provider since they can deliver the supplies you need to the hotel or address you will be visiting.

Most insurance policies cover supplemental oxygen when the medical necessity for oxygen is demonstrated. I have Medicare plus a Medicare supplement, and everything is covered including accessories. And again, please note that payment (and all other) rules can vary by jurisdiction and insurance carrier. In Canada, oxygen supplies are covered by Provincial health plans. So, be sure you know the rules in your area.

Safety Tips

Note: Some of these safety tips may seem obvious. However, keep in mind that if they are being included, there is a reason. Please don’t become a statistic.

• Oxygen is not flammable, but it can act as an accelerant, causing fires to burn hotter and faster. This means, you must exercise extreme caution around open flames. If you have a gas stove, use extreme caution. Keep the flame low and keep your oxygen away from the flame.
• Don’t use oil-based or petroleum products near your oxygen. This includes any creams, lotions, or other products such as vapor rubs, petroleum jelly or oil-based lotions and creams. Use water-based products instead. 
• Notify your family, friends, and neighbors; as well as your local fire department, electric and phone companies that you use oxygen. This may be helpful in an emergency.
• Whether you use oxygen or not, DON’T SMOKE. If you must smoke, don’t smoke while using your oxygen. Avoid others who are smoking. 
• When fueling your vehicle, turn off your oxygen (and your vehicle). Or even better, have someone else pump your gas for you.
• Don’t store your oxygen in a confined space, like a closet or trunk. It is recommended that you keep at least 12 inches of open space around the unit. 
• Keep your liquid oxygen unit upright.
• Don’t use extension cords or plug anything into the same outlet as your oxygen.
• Turn off your oxygen when not in use. 
• Be careful not to trip over the tubing. 

Traveling with Oxygen

Before making any travel arrangements, discuss your plans with your doctor, RT, RN, PT, family, friends, YOUR OXYGEN/DME PROVIDER, and anyone else that might be involved or offer any insight into the road, ocean, or sky in front of you. Make sure you are all on the same page and that you are fit to travel safely. Speak with your doctor about the following key factors:

• How long will you be travelling for?
• Will you be traveling by car, bus, RV, train, plane, boat, or cruise ship?
• What will the weather be like at your destination and are you prepared for the possibility of extreme weather and other environmental conditions such as temperature extremes (hot or cold), humidity, altitude, or air pollution?
• The names of healthcare providers, hospitals, and DME providers, both at your destination and along the way.
• What supplies and what extra supplies will you need while you’re away?
• What medications, extra medications, and emergency medications, such as corticosteroids or antibiotics, might you need while you are away? Be sure to refill all your prescriptions before you go. 
• What should you do if you have trouble breathing or other medical issues?
• What medical, insurance and personal information you should take with you and is there any type of extra insurance that you might need to purchase?
• A letter of medical necessity, authorizing you to travel with oxygen and a copy of your oxygen prescription.
• Take extra copies of all necessary documentation and keep them in a separate bag.
• If you’re traveling alone, arrange to check in with a friend or family member so that person knows you’re alright. If you’re traveling with someone, make sure that person knows the medications you take and how to use your oxygen system. If using a POC, make sure they know how to recharge and change the batteries.

If your DME supplier is part of a national chain, ask for the contact information of a local office. Then contact that office 1 week before you arrive to make sure everything is in place or ready to go when you get there. If your DME supplier is independent, work with your contact person to find a local supplier in your destination city. If you’ll be staying at a resort or hotel, let the concierge know that oxygen and oxygen supplies will be delivered to your room and that it’s OK to sign for them.