Disposables
and Aging
The symptoms of aging are yellowing and
stiffness. Skin oils
contribute to aging—cannula prongs turn yellow and the cannula
tubing across your cheeks becomes less pliable. Stiff tubing is unruly
and is susceptible to splitting and cracking. With age, humidifiers are
more likely to attract mold and mildew. They may become so brittle that
the top cracks when tightened against the jar.
|
Watch for telltale signs
of aging--yellowing and stiffness--and
establish a pattern for replacing all disposables. Keep
track of
replacement dates by either labeling the items or by noting disposal
dates
on a calendar. |
Frequency
of Replacement
The useful life of disposables is very short.
- Apria
Healthcare®
suggests cannulas and masks should
be replace every two weeks and supply tubing every three months. See
Apria's Respiratory Equipment Check
Form, CLN0014 (Rev. 09/01). There are other providers who
recommend replacement of supply tubing every month.
- SalterLabs®
suggests replacing humidifiers once a month.
- Transtracheal
Systems® suggests
replacing transtracheal
scoops every 45 days.
Exposure to oils,
the sun, and other factors can cause tubing to age more quickly. You
should change your cannula more often if you have an infection.
Managing
a Humidifier
Those who use humidifiers may find unwanted
water
droplets in the tubing. The
moisture from the humidifier condenses in the tubing and turns to
droplets when the tubing cools. This often occurs when the tubing lies
on a cold floor.
|
If you see droplets inside the supply tubing, dry it by running oxygen
through the tubing without the humidifier attached. Find the cause and
correct it. If all else fails, SalterLabs
offers the
#7000, inline water trap. Your oxygen provider should help you solve
this problem. |
It takes a steady hand to seal the jar to the
lid of a humidifier. You may think you have sealed it only to find that
some of the
oxygen you need is escaping from around the lid of the humidifier. The
humidifier package contains
instruction that describes a simple test—if you
know the meaning of the word
occlude.
If you have difficulty getting a proper seal, first try twisting the
jar backwards
until you feel a "snap," then twist it in the proper direction.
To verify the jar is
properly sealed to the cap of the humidifier, set the concentrator to 3
Lpm. Remove the tubing from the
humidifier port and close the port by placing your thumb over it. In a
few seconds you should hear a “screech” from the humidifier’s escape
valve, telling you there is a proper seal.
Alternatively, run your finger around the jar,
feeling the lips between the jar and its lid. If you feel no air
escaping and if the lips appear to be an equal distant apart, there is
a seal.
|
Managing
Leaks
It is wise to check for leaks in your supply
tubing when you suspect a leak, when you first install new tubing, and
if you have
pets who take a likening to it.
You can do this with a
Liter Meter™
(image),
which measures continuous flowing oxygen from its source
through the meter.
Jameson
Medical is one of several distributers who sells them for between
$18.95 for the 0 - 8 Lpm model to $29.95 for the 0 - 15 Lpm model.
To verify the integrity of
your tubing, first make a mental note of the
current oxygen setting on your concentrator. Then, replace the
connector
between your cannula and the tubing with a Liter Meter, being certain
that the "zero" end of the Meter is closer to the oxygen source. Hold
the Meter aloft with its "zero" end down and observe its reading.
If
the Meter reading is less than the setting on your concentrator, oxygen
is escaping somewhere between the two. The problem could be a breach in
the
tubing, a humidifier jar that is inadequately sealed to its top, or a
cracked humidifier top.
|
If you don’t have a
Liter Meter, you can
detect a breach in your tubing the same way you would find a leak in a
bicycle tire. Set the flow rate to 3
Lpm and close the open end with your thumb. Pass the tubing section by
section, passed your lips. You will feel the air escaping from a break
when you come across it.
Managing
Curling
Most supply tubing is "hollow bore" tubing and
tends to curl. Curling can be reduced by the following.
- Use several shorter segments of tubing connected with
swivel connectors. Whereas this gives the tubing greater opportunity to
uncurl without much effort on your part, it gives you more places to
look for the disconnect when oxygen stops flowing.
- Heat or stretch the tubing before using it. Some
readers report using hands and feet to stretch new tubing. Others
report that putting tubing in a clothes dryer or hot water reduces
curling. Success depends upon extending the tubing to its full length
and laying it on the floor before it cools—a daunting task. Whereas
these methods may temporarily straighten tubing, stretching and heat
damage tubing making it more susceptible to cracking and splitting.
To reduce curling and odor of new tubing, remove it from its packaging
24
hours before use, unwind it, and run oxygen through it for about 20
minutes.
To
unwind, hand one end of the
tubing to a friend to hold. Take two steps away from the friend and, as
you do so, release two loops
from the coil then rotate the coil laterally two revolutions. Repeat
this process until the tubing is unwound.
|
SalterLabs
has introduced safety channeled tubing. Safety channeled tubing
overcomes
some of the problems of hollow bore tubing. The tubing has three ribs
(or channels) inside. The ribs keep oxygen flowing,
unimpaired by kinks or by compression when caught between a door and
its sill. When safety channeled tubing is carefully unwound, as
described in the box above, it will behave
and lie close to the floor. Channeled tubing is highly reflective
making it more
visible.
|
You can see the tubing by selecting "Extension Tubing" from
the Products menu at the SalterLabs
website.The part numbers
are 2050 for 50 foot and 2021 for 21 foot channeled tubing. The part
numbers for hollow tubing of the same lengths are 2550 and 2521. |
For the visually impaired, SalterLabs also
offers bright green safety channeled tubing. The part number for 50
feet is 2050-G.
Cannulas
Several companies are manufacturing cannulas
that are reasonably comfortable.
Check out both
SalterLabs
and
SoftHose™
to see what is
available. Your
provider usually can cover the cost of
Salter Labs products but probably
not
SoftHose products.
Here is a tip from several members of COPD-Alert: Take
the weight of
your cannula off of your ears. Secure tubing at your hip with a holder,
like the BC100 (image),
normally used to secure security badges. Snap the strap around the
tubing and clip it to your clothing with some slack between the strap
and your cannula. You will find the cannula exerts less pressure on
your ears. If you clip the strap at your waist band or belt, your
tubing will follow you like a puppy dog and you will be less likely to
step on it..
You say you don't have a holder handy? Most
companies require security badges, so their personnel offices have
these holders. You can also purchase a package of 25 at Office
Depot for $6.
|
Jim from OK writes:
Have you checked out the new Salter #1606 TLC?
It is a cannula with E-Z
Wraps attached. |
Marnie Girl writes:
The softhose has become a necessity in my 02 use.I cannot stand the
old, stiff ones anymore. And they do not pull out at night as did the
other.I use the one with the small nose cannula, but not the mini.
But bewared before you try these soft cannulas, you get hooked on them
and it's almost impossible to go back to the Salters. I use the "micro"
around the house and the "light" with my gas portable. The light
dosen't make as much noise with the pulse does as the micro does. It
ought to be a law that all cannulas be made like "soft hose. |
Alternatives
to Cannulas
To replace oxygen delivery through the traditional cannula while
avoiding the need for a mask, I offer two suggestions for you and your
physician to consider.
- Oxymizer. The Oxymizer™
is a disposable conserver manufactured by Chad Therapeutics . It
is designed to be used with continuously flowing oxygen from a
concentrator or portable system. It accumulates oxygen during
exhalation in its reservoir so that the next inhalation is greatly
enhanced. It comes in two models-- the O224 (image) , which has
its reservoir in the face piece, and the P224 (image) , which has
its reservoir as a concealable pendant on the chest.
I used the P224 for several months and was satisfied
with it. At the time I was beginning to need more oxygen than my 5 Lpm
concentrator and 6 Lpm portable (continuous flow) could provide. I had
hoped that it
would increase the effectiveness of both so I wouldn't have to move
into the high-flow category. My expectations were greater than the P224
could deliver. One of the first things you will notice is that your
ears get better treatment. Also, the nasal prongs are thicker, reducing
the whistling of air. Since the Oxymizer is a disposable, it
is available at no cost are are other oxygen supplies.
- Oxyarm. The
July issues of both the Pulmonary
Paper and News from NHOPA
reported on Atlantic
Medical Specialtie's Oxyarm™ (image).
The Oxyarm, an alternative
to a cannula, looks like a telephone headset and delivers oxygen with
no physical contact with the ears or nostrils. The manufacturer claims
that it is
designed for both
mouth and nose breathers, it produces no nasal or sinus irritation, it
allows for easy Talking, Eating and Drinking, and it is odourless and latex
free.
- Scoop. "Scoop" is
what most of us call transtracheal oxygen (TTO). About a
year ago, I when I went through the
ten-minute surgical procedure that left me with a tiny hole in my
trachea. Like 16,000 others, I now bypass my nose and receive oxygen
directly into my wind pipe. Through this hole I insert a small
catheter, called a SCOOP™, which I remove and replace daily with a
clean one.( Click
here
to see an image of two SCOOPs next to two cleaning rods.)
I have been very happy with the scoop for the year I
have had it. My only regret is not switching to the SCOOP when I first
learned about it, more than 2 years prior.
What are the differences?
- A humidifier which requires filling every
other day is necessary.
- I have to remove the old SCOOPand replace with
a clean one once a day. For you, it may be more or less often. I also
run sterile water down my SCOOP twice a day. This brings up the mucus
balls (or "plugs") that the scoop tends to dry into small semisolid
objects. All this I can get use to.
- With the scoop, I do loose the sensation of oxygen
entering my body. I
cannot feel it as it enters and fills my trachea, even at 15 Lpm.
Therefore, I am not
aware that my tubing has accidentally become unhooked or my cylinder
has run dry. The sound of oxygen passing through my nose is no longer a
clue for me.
The surgery is covered by
Medicare and probably by your insurer.
Supplies, including two SCOOPs and cleaning materials, are available
quarterly through your oxygen provider at no cost. The only thing not
included is the antibacterial soap, which you will find at your local
grocery.
The surgery is done in a hospital on an outpatient basis and takes
about 10 minuites. Because of setup and the long wait for an Xray
afterwards, it usually takes the morning. You will want to have
the procedure done near home. The first six weeks are a "curing" period
during which you need to return to the hospital weekly to have the
SCOOP removed and replaced. Thereafter, you are responsible for SCOOP
care.
Should you change your mind,
simply remove the SCOOP and put on a
cannula. The surgical opening will heal quickly, leaving you with a
small scar.
You can learn more about
transtracheal oxygen therapy (TTOT) by
visiting
Transtracheal
Systems, Inc. At the
Patients
page
can get
additional information or to speak directly with a respiratory
therapist by contacting their Technical Services Department at
rt1@tto2.com, or
calling 303-790-4766, or toll free in the US 1-800-527-2667
. Also, visit Efforts which as comments
from readers as well as links to professional sources.
Credits
Over the years I have heard my readers
complain about tubing.
“My
oxygen stops flowing when it kinks or an outside door is closed on it.”
“It will not lay down on the carpet so I trip on it.”
“It curls fresh
out of the package and continues to curl as I use it.”
“I step on it
and it practically take my ears off.”
I dedicate this article to them with the hope
that they have better
lives because of it. A special thanks to the following users who
provided me with some of
the valuable insight you find in this article. They include Martin,
Fay, Clare from Dallas, Bill from Oregon and Kathy from Ohio, all
subscribers and
members of
COPD
Support, Inc.
|
Click
here
to see a list of other feature stories.
|
© 2004 Copyright
Peter M. Wilson, Ph.D.
Founder of PortableOxygen.org
You have permission to
print this document for your personal use. You also have permission to
print, copy, and distribute this document to oxygen users and their
caregivers
