Welcome to the Specialized Medical Services Respiratory training webinar series!

Transcription

1 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.

2 Oxygen Equipment Webinar Training Session

3 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

4 3 Primary System Types 1. Compressed gas (cylinder/tank) 2. Oxygen concentrators 3. Liquid oxygen

5 Compressed Gas Cylinders Compressed Oxygen Stored under pressure in a vessel or tank Variety of tank sizes

6 Oxygen Concentrators Electrically operated devices Draw in air from the surrounding room Filter out the nitrogen Compress the remaining oxygen for patient use Deliver medical grade oxygen

7 Liquid Oxygen Compressed and cooled Converts oxygen to a liquid state Much larger storage ratio of oxygen

8 Types of Compressed Gas Cylinders Standard Post Valve Walk O2 About Aluminum E With Integrated Regulator and Handle Aluminum E Toggle Valve

9 Creating a Tank System Regulator E Tank

10 Standard Post Valve Regulator Standard Post Valve Cylinder Wrench

11 Toggle Valve Regulator Cylinder Wrench Aluminum E Toggle Valve

12 Walk O2 About Walk O2 About Aluminum E With Integrated Regulator and Handle Cylinder Wrench Regulator

13 Regulators & Flow Meters Regulator Types: Continuous Flow Conserving Flow Meter Types: Tube & Ball Click Style

14 Continuous Flow Regulators E Cylinder Regulator with Click style Flow meter Adapter H Cylinder Regulator with Standard Flowmeter and DISS

15 Yolk Style Regulator & Click Style Flow Meter 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 E Cylinder Regulator with Click style Flow meter Adapter

16 Threaded Nut Regulator & Standard Flow Meter Connects with wrench Adapt a humidifier or Christmas tree adapter Flow rates: 1 15 l/min. Pressure gauge indicates available oxygen H Regulator with Standard Flowmeter and DISS

17 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

18 Compressed Gas Cylinder Holders

19 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

20 Turning ON Your Portable Oxygen Step 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

21 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

22 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

23 Compressed Gas Usage Chart in Hours Flow Rate Container Size 1 L/min 2 L/min 3 L/min 4 L/min 6 L/min 8 L/min 10 L/min H M E D C/M B/M

24 Cylinder Troubleshooting Problem Probable Cause Solution No oxygen flowing to nasal cannula Cylinder valve closed or flow meter on zero Empty cylinder Patient lack of awareness 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. Check pressure gauge for oxygen contents. If cylinder is empty, replace with full cylinder Place cannula prongs in clean glass of water to observe bubbles. Cylinder system making hissing noise and leaking Faulty cannula Loose connection Faulty regulator Regulator not attached properly Faulty or missing washer Faulty regulator Cannula tubing kinked or obstructed with moisture. Replace as needed Check all tubing connections Replace with back up unit. Turn off cylinder valve. Check position of regulator and retighten. Replace washer Replace with back up unit.

25 Oxygen Concentrators Electrically operated devices Draw in air from the surrounding room Filter out the nitrogen Store the remaining oxygen for patient use Two types: stationary & portable Stationary Concentrator with Cabinet Filter

26 Oxygen Concentrators Between 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% Stationary Concentrators without Cabinet Filter

27 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

28 Home fill Oxygen Concentrator Stationary concentrator + small cylinder Create a fill station Refilling times vary by size

29 Portable Oxygen Concentrator (POC) For travel and ambulatory use Limited power capacity Require battery packs for extended use

30 Concentrator Troubleshooting Problem Probable Cause Solution No power. Power failure condition causes an alarm to sound Power cord is not plugged in to the electrical outlet No power at electrical outlet Broken chord or plug Circuit breaker on concentrator unit activated Check power cord at electrical outlet for proper connection Check power source, wall switch, in house fuse or circuit breaker Replace unit immediately 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 Condensation collects in oxygen tubing when using a humidifier bottle Obstructed humidifier bottle, or leak present Defective nasal cannula or tubing Cannula and/or tubing loose Unit not properly ventilated Remove humidifier, confirm flow restored, replace or reconnect humidifier bottle Remove and check for kinks or obstruction, possibly moisture in tubing. Replace as needed Check cannula and tubing for tight connections 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

31 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

32 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/Portable System

33 Stationary Liquid O2 Components

34 Stationary Liquid O2 Components

35 Portable Liquid O2 Components

36 Filling Liquid O2 From 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

37 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

38 Portable Liquid O2 Components Hold carrying strap Depress release button Always hold portable unit with at least one hand

39 Portable Liquid O2 Components Contents Indicator Lift carrying strap to check oxygen fill levels Disengage plastic buckle for proper reading

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41 Liquid O2 Troubleshooting Problem Probable Cause Solution No oxygen flowing to nasal cannula or tubing Reservoir or portable empty Flow meter not turned on. Faulty cannula Check gauge indicator for oxygen contents. If reservoir or portable empty, replace with full unit. Check flow meter to make sure it is set at prescribed liter flow. Cannula tubing kinked or obstructed with moisture. Replace as needed Portable unit frozen to stationary Stationary unit frozen open and leaking liquid oxygen Portable unit leaking moisture/water Excess moisture build up on metal connections Ice crystals build up in male fill connection Frost build up on internal coils from high humidity in room, and/or warming of liquid 02 to gas causing water run off Make sure fill valve is closed Allow portable to remain attached for 30 seconds Attempt to disengage by pressing down on disconnect button Attempt to reattach portable to stationary, open and close portable fill valve to attempt to break loose ice crystals Move unit away from warm/high humidity areas Replace unit Monitor water accumulation on floor to prevent slipping risk

42 Know Your Patient Compressed 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

43 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

44 Sample Oxygen Therapy Orders Continuous 2 l/min. via nasal cannula, to maintain 02 sat level of 89% or greater Oxygen at 3 l/min via nasal cannula for SOB

45 Troubleshooting Test and clean equipment Track % of oxygen delivered and flow levels Preventative Maintenance Supplies Change Frequency

46 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

47 Informational Resources Contact SMS at AARC clinical reference materials Manufacturers clinical material Air Gas Air Sep Caire Cardinal Health NFPA 99 CGA Chad Industries Invacare Western Medical

48 Thank You! Take our post session quiz and print your certificate of completion