Oxygen: A User's Perspective
Questions & Answers
information here provided is for
educational purposes only and it is not intended nor implied to be a
substitute for professional medical advice. Always consult your own
or healthcare provider with any questions you may have regarding a
be a COPD reader who is surprised to have supplemental oxygen only at
night or may have a higher setting at night than in daytime. You might
think that it should not be
so, because you are more relaxed, you might think it would require less
night. Well, daytime and nighttime breathing are different for those of
who have COPD.
Those without COPD have nice dome-shaped diaphragms which move air in
and out of the lungs very efficiently, whereas our lungs are in a
constant state of over-inflation, causing our diaphragms to flatten and
be unable to ventilate our lungs without some help. It is the skeletal
muscles of the chest, shoulders, and abdomen that take over the job.
Ever notice when you are out of breath, you spread your hands and set
them on a table or on your knees? You are taking the stress out of your
shoulders and allowing these muscles to work more efficiently.
When you sleep, the skeletal muscles sleep also. This is particularly
true during REM (rapid eye movement) sleep. Your breathing becomes
shallow and breathing frequency decreases. (There are times at night
when my wife has laid her hand on me to be sure I am still breathing.
Perhaps your spouse has done the same.) You see, the work of breathing
is turned back to the flattened diaphragm, which is unable to
adequately do the job and ventilation of the lungs falls to as low as
half that during the daytime.
This is the first thing a doctor thinks about when you are diagnosed.
Perhaps you, like me, went on oxygen during the night only and wondered
why not also during the day? Now you know. You perhaps now understand
why doctors prescribe sleep studies--studies where you sleep in the
hospital connected to a oximeter.
Reform and O2 Users
( A reprint of the Letter
to the Editor by Peter M.
Wilson that appeared in the Fredericksburg Free-Lance Star, 10 December
In November 2003, the new Medicare bill passed both the U.S. Senate
and the U.S. House. Prescription cost has been the media focus about
this bill, so oxygen patients may not know how the changes will affect
Beginning in 2005, there
will be a reduction in Medicare
reimbursements to companies who provide oxygen and oxygen equipment,
meaning that these companies will be paid less and be expected to
provide the same level of services.
If you live in one of the
nation's 100 largest metropolitan
2007, expect your oxygen company to be chosen by competitive bidding.
This process will ensure that the lowest bidder will serve you.
I followed the several
years of demonstrations of competitive
bidding that Medicare conducted in Polk County, Fla. The purpose of the
demonstrations was to set aside any fear that oxygen providers or
patients might have about competitive bidding.
During the demonstrations,
services and the costs of
Polk County patients were compared with those of nonparticipating
patients in nearby Brevard County.
The good news from these
comparisons is that the co-pay of
County patients was 20 percent lower than that of Brevard County
patients. The bad news is that Polk County patients did not receive as
many home service calls and were less likely to be issued equipment
that would allow them to be mobile.
What troubled me the most
about the demonstrations was that
the companies from the first demonstration participated in the second.
Whether they were bought out, changed their names, or packed up and
left the county, I do not know.
What you can expect from
all this is an oxygen company to
with fewer and less well-trained employees. Prepare yourself by fully
understanding your medical condition and knowing how to manage oxygen
and the equipment that delivers it.
the Impulse Mode
Select conserver has two modes of operation.
Mode A provides alternate-breath technology when the conserver's
selection switch is in positions 1 (a 35 ml pulse on every fourth
inhalation), 2 (a 35 ml pulse on alternate inhalations), or 3 (a 35 ml
pulse on three of four inhalations). Mode B provides a pulse of 16.5
ml, 33 ml, or 49.5 ml, respectively, at each inhalation at these
settings. Both modes provide an every-breath pulse at switch positions
4 and 5--44 ml or 52 ml respectively in Mode A, and 82.5 ml or 99 ml
respectively in Mode B. For more information about the Impulse
Conservers & Cannulas.
To change mode:
- Turn conserver off.
- Open the battery compartment and remove battery.
- Locate the white switch in the center of the blue plastic
- Using a very small slotted screwdriver, move the switch to
the left for Mode A or the right for Mode B.
the Oxylite 301 to
have had two requests so far to provide the procedure for changing
the Oxylite 301 to continuous mode when its conserver (the Oxymatic)
procedure requires you to disconnect the tubing
from both sides of the conserver and connect this tubing together. By
so doing, the conserver is no longer between the regulator and the
oxygen cylinder, so the oxygen flow from the cylinder through the
regulator is continuous. I quote the instructions as they appear in the
the unlikely event of operational malfunction or
failure, the user will know that the Oxymatic conserver is not
the pulse of oxygen in the customary manner.
1. When using a standard cannula, simply disconnect
the cannula from the Oxymatic conserver connector, disconnect the
oxygen supply tube from the regulator, and attach the cannula tubing
directly in the regulator.
Oxymatic Model 301: Product Information and Instructions for
Use (Chadsworth, CA: Chad Therapeutics, Inc., November 11, 1994, p.
2. When using the shorter Oxymatic
cannula with the
"bayonet" fitting, disconnect both the cannula and the supply tube from
the Oxymatic conserver and join the two together with a twist motion as
illustrated (fig. 8).
would suggest that you first turn off the oxygen
before following the above steps. The process is very difficult as it
is. The presence of oxygen under pressure of 25 psi during the above
process makes the above task impossible. If you don't believe me, try
it with the oxygen on.
the above procedure periodically. Practice
as though there was an emergency, with no oxygen flowing. Practice
will reduce your stress should an emergency occur, and frequent
manipulation of the tubing will keep it from "freezing" at the
connections at both the regulator and conserver.
a cylinder empties two the five times faster on
continuous flow than on puolse flow. It would be helpful for you to
know just how quickly.
Regulators vs. Conservers
oxygen systems, portable or not, liquid or compressed, have a
"regulator." The purpose of the regulator is to release oxygen at a
factory set (or user adjustable) rate, measured in liters per
minute (Lpm). You can easily identify the regulator because it has
the gauge on it that shows when your tank is empty or full.
oxygen system, portable or not, liquid or
compressed, may have a device which releases oxygen in pulses. There
are many long names for this device with abbreviations such as DOD, OCD
Most people call it simply a "conserver."
conservers are a separate small box that is
in the tubing between the regulator and your cannula. Examples of
this type are Chad's Oxylite, AirSep's Impulse, and Invacare's Venture.
Others combine the regulator and conserver into a single unit which
fits over the neck of the cylinder. Examples of this type are AirSep's
Impulse Select, DeVilbiss's PulseDose, Mada Medical's Model OCD-2000,
VES International Texas's Portamate II, and Mallinckrodt's Companion CR
conservers are battery operated. Some, like the Oxymatic and the Impulse have a switch
which controls how often an inhalation will be recognized and oxygen
released (from one to four). Most have a switch which controls the
of oxygen released on an inhalation. The switch on these conservers
are numbered, the numbers corresponding to equivalent flow rates (in
Lpm) of continuous flow oxygen.
more information about conservers, see
Portable Oxygen: A User's Perspective.
cost of electricity to operate your oxygen concentrator may be a
medical deduction. Compute the cost then ask whoever prepares your tax
return. To compute the cost, do the following:
1. Look at the label on your concentrator. It states
the number of volts and amps the concentrator uses. My uses 115 volts
at 4 amps. I will use these amounts in this example.
2. Calculate the number of kilowatt
(KW) hours per
115 volts x 4 amps = 460 watts
W x .001 KW/W = .46 KW
46 KW x 24 H/day x 365 days/year
3. Multiply the above result by the
cost per KWH for
electricity. I called my electric company and they said 8 cents per
4,029.6 KWH/Y x $0.08/KWY = $322.37
What you should do.
- Clean the air filters weekly in running water.
- Clean the humidifier as frequently. (If you do not have a
humidifier and your flow rate is 3 lpm or higher, you probably should.
Besides adding moisture and reducing nasal and sinus dryness, the
also filters out those small particles, such as pollens, which are not
captured by the concentrator's filters.)
Make these activities a
regular task by setting aside a
certain day of the week to clean your filters and humidifier.
- Make certain that your oxygen provider checks your
concentrator once a a year if your concentrator has an oxygen sensor,
else every three months (1) to certify the flow rate is as
indicated, and (2) to verify the oxygen concentration is at 85 percent
(1) Your concentrator has an oxygen sensor if there is a indicator
light so labeled on its control panel. When oxygen concentration falls
below 85 percent, the indicator light will flash and an alarm
will sound. You should immediately have the concentrator replaced.
(2) Air from a concentrator can be 95 percent oxygen. Whereas the
concentrator can remove hydrogen and most other elements, it cannot
remove the argon. Thus, the concentrator changes air that is 21 percent
oxygen into air that is 95 percent oxygen and 5 percent argon. At some
flow rates, particularly at higher settings, the concentrator is less
efficient and produces air that is as low as 85 percent oxygen, which
is recognized as sufficiently pure by Medicare.
- Check the time counter on your concentrator. If its above
20,000 hours, it is time for your oxygen provider to recalled your
concentrator and have its compressor rebuilt.
After each maintenance
visit by your provider, set up an
appointment for the next one, marking your calendar accordingly.
A reader from
Colorado wrote asking about the transtracheal delivery of oxygen.
anyone have experience with
this new treatment? I would appreciate any and all
feedback. Especially, the pros and cons, and any potential side
effects. Lastly, does anyone know if Medicare pays for this?
I responded as
Transtracheal oxygen therapy is the delivery of oxygen
directly into the lungs by a small, flexible catheter which passes from
the lower neck into the trachea or windpipe. The transtracheal
delivery of oxygen is not new but has been around for
quite a while. It is a
well-established method started more than 20 years ago that is used by
more than 16,000 oxygen users around the world. Both the surgery and
supplies are covered by Medicare.
The manufacturer is Transtracheal
Systems, Inc The system is called transtracheal oxygen (TTO)
and it catheter is referred to as the "Scoop." Here
is what it
looks like from the outside.(image). The most successful
candidates for the Scoop are those who manage their
health well.Your best source of information is directly from the
Transtracheal Systems website.
I have had a Scoop
for more than two years. It took me that long to
decide to do it. (Unlike many of our youths, I guess I think a long
time before I voluntarily have my body pierced.) The surgery is quick
and painless, requiring a morning of outpatient work in a hospital.
Most of the morning is spent waiting in line for the post operational
There are two procedures for surgery. If your mother uses the one I
had, here is what will happen. For the next six weeks after surgery
your mother would return to the hospital once a week to have the Scoop
replaced. During these weeks she would clean it in place with a
solution and brush. So, plan for weekly trips.
After this "maturity" period, she will be doing the "remove and
replace" procedure once or twice a day. Removing one Scoop and
replacing it with a clean one is very easy. The only problem with R/R
is attaching the chain in the back of the neck--something your mother
will be more talented at than I.
The frequency of R/R depends on the individual, and is usually dictated
by the accumulation of mucus and plugs. Plugs are the mucus that is
dried by the oxygen passing out the the Scoop. They tend to adhere to
the Scoop, requiring patience while removing it, particularly when R/R
is not done frequent enough. My experience is R/R twice a day with a
lung infection and otherwise, once a day.
The surgery is Medicare covered as are all the supplies. She will buy
only antibacterial soap. Quarterly, she will receive two Scoops,
tubing, and saline solution.
There is one study that shows increased lung infections among Scoop
users. It appears as though all doctors remember this study above all
the others which praise the device. The device does require regular
maintenance and should only be used by someone with good personal
It is effective, making use of ALL the oxygen from the source (no blow
back around the nose). Gone are the dry and bleeding noses and ears.
And, she won't believe how "normal" she looks with only a tube coming
out from her waistband.
The surgery procedure is so well written that almost any surgeon can
do it, although, as a person who doesn't like to be a barber's first
customer, I would suggest someone with experience. The patient
instructions, and telephone and email help from the company, are the
best done that I have seen.
The only downside are the six weekly trips to the hospital right after
surgery. Hopefully, it is closely. If
she doesn't like the Scoop, remove it and the surgery will heal in a
short time, leaving a small scar.
Another reader asked a
series of questions about the Scoop. I
responded, imbedding my answers after each question.
How do you keep
infection down on the hole in your neck? Like a
pair of lips, the hole closes over the Scoop. Mucus fills in any
openings so it is not open to the elements.
2. How do you handle traveling with the scoop? Any long
traveling? Just take along supplies.
Need a clean sink and a mirror to
remove/replace and clean.
3. Can you use liquid O2 with it or just compressed O2? Either one.
You can use a conserver with it.
4. You can shower but not take a bath. Is that right? No. Both bath
and shower are okay (see #1)
5. How often do you need a checkup with whoever to make sure it is
correctly inserted? It never moves.
Some folks grow a flap of skin that
tries to close the opening and visit with the surgeon periodically to
have it removed.
6. How often do you need to get a new supply of supplies? Quarterly
you get two Scoops, two sets of tubing, and bronchosalien solution.
Replace disposables every 45 days. As with cannulas and other tubing,
they are completely covered by Medicare or your insurancecome from your
oxygen provider at no cost.
7. What type of Doctor did you use for the scoop? and how long
take? Pulmonary specialist. It takes
8. Can you use the concentrator with it? Yes. Compressed and liquid
oxygen as well.
9. How do you handle the ever-present stepping on the hose,
tripping on the hose and jerking it, getting it caught under furniture,
etc.? A chain about your neck holds
the Scoop in position, regardless.
Use the clip on the tubing to connect it to your waist band--because of
this, tubing is out of the way when you walk..
10. How about your exercise program? Same as ever.
As I say at the
beginning of my website " Someone once said,
|We are all alike until
we take our first breath. For most of us the significance of this
statement does not register until we must deal with a system which
supplies us with oxygen in pulses.
Catherine, Martin, Mary
and Nick, as indicated below,
understand this and are seeking answers, as their messages to the COPD
for October 14th and 15th
indicate. I really appreciate what you four have said.
There are many more folks out there who are still working things
out in their minds and aren't ready to articulate it yet.
I hope you won't mind if I
respond to your messages here with
my own observations. I have no more expertise at these matters than
you, it is just I have done more research and talked to more folks.
Catherine in La. wrote,
"There really is no difference to
amount of 02 that I'm getting on either unit [Helios portable or direct
connect to the reservoir] set on # 3. One is click, pause click pause
& etc. and other is continuous flow.".
Actually Catherine, there
is a difference. Like water over a
dam, continuous flow can be measured directly. But, turned into
a pulse, it must be measured and calibrated indirectly, through a
person or a breathing machine. Here is how, in simplest terms, the
calibration marks for pulsating flow get on your conserver. The
financed a study where 5 to 10 COPD patients sit around with a
continuous flow, and an oximeter. The subjects are given continuous
liter flow at one setting (say, 2 Lpm). The oximeter reading is duly
noted. The subjects are give a varying pulse sizes (measured in
which is adjusted until the oximeter reading is the same as continuous
flow (here, 2 Lpm). The conserver is "notched" accordingly, and you
on the conserver a setting in ml the "is equivalent to" 2 Lpm of
flow. The study continues and other notches are duly noted.
The result you see is your
conservers rotating selection
switch with numbers 1, 2, 3, 4, 5 and 6 marking pulses in ml which are
said to be settings that are "equivalent to" 1, 2, 3, 4, 5, and 6
Lpm of continuous flow. What the actual output is depends on the
manufacturer. One manufacturer uses multiples of 10 ml; that is, the
settings are for 10,20, 30, 40, 50, and 60 ml. How convenient. Others
use multiples of 9.25, 18.5, and 23 ml.
I have talked to some
manufacturers about the "equivalence to"
numbering and they say if they had this to do over, they would not have
tried to equate continuous flow to pulsating flow. They knew
all along that dosage was a matter between doctor and patient with
help from RTs, but they hoped to make matters simpler for physicians.
What they unknowing did was to stress some users--users who believe
the world is perfect and the settings must be the same on both, and if
they are not, then there is something wrong---with them, with the
their doctor, or their oxygen provider. Such thinking can only lead to
a dysfunctional relationship between this user and his/her
Note that in no instance
here have we said which liter flow
any of the subjects need, so we go to Martin of Southern California who
wrote, "The measuring of the Helios flow is not the same for every
user. People breathe differently. This is why the supplier sends a
therapist out to measure your 0-2 saturation while wearing the Helios."
Exactly, Martin---and pay
no attention if the setting for
continuous flow at home is different from the pulsating flow on your
conserver. It should be set with consultation with your RT under the
circumstances you will use it. Remember, when you go out with a
portable, there is greater variability than at home. You walk
differently, are dressed differently, and weigh more (oxygen,
pocketbook, coat, etc.).
And this leads nicely into
what Mary in PA said, "The only
problem with this Helios output bit is the medical team doesn't know
that much about it."
I like the way that Mary
refers to her "medical team" which
is what each one of us has who has a chronic illness. If is also good
know the role and, particularly, the limitations of each member, so you
who can give you the best information. I'll bet none of the folks on
Mary's team is required to know about portable oxygen systems to
jobs. There is some shared expertise among team members, but most of
is focused. Don't ask your provider's delivery person about COPD and
ask your physician about pulse rates of portable equipment.
And Nick follows up Mary
with, "How do I even know that my
concentrator, and pulse device on the portable cylinders, are even
working right and delivering the right amount of o2. What all should
the RT be checking, and how often?"
This is exactly the
question you should go with to your oxygen
provider's manager. How often is my concentrator/portable equipment
checked and for what? Is it periodically replaced? When should I
be tested and retested with this equipment? Remember, your provider
is a service company (they rent, not sell) and you are a customer, a
very valued customer. Chronic customers are great because providers can
write off the equipment quickly and begin making a profit early on.
M. Wilson, Ph.D.
Founder of PortableOxygen.org
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modified: July 20, 2012