Ambulatory Melanie Marshall Highly Specialist Physio Guy s and St. Thomas NHS Foundation Trust
Plan Introduction to ambulatory oxygen therapy equipment Outline the differences between Home Oxygen Order Forms (HOOF A and HOOF B)
Standard Cylinders Pro s Easy to alter flow-rate as required Easy to achieve higher flow-rates if patients require those (depending on cylinder provided) Con s Heavy & Bulky Medical looking If patient forgets to turn it off it empties
Pro s Relatively small & light Easy to alter flow-rate as required Easy to achieve higher flow-rates if patients require those (depending on cylinder provided) Con s Medical looking If patient forgets to turn it off it empties Some have round bottoms so don t stand up
Based on two advances: Oxygen concentrator technology Lower FiO 2 produced Cuvelier, 2002. Oxygen conserver technology Built-in to device Separate to device
Oxygen Cylinder and Separate Conserver Pro s Electrically triggered conserver therefore short delay Good conserving ratios Desirable flow waveform (short high flow bolus) Con s Adds to weight & tubes from the cylinder Tubing connections often temperamental and reinforcement clips require dexterity Noisy pulses put some patients off
Refillable Oxygen Cylinders Pro s No regular deliveries required just annual servicing and quarterly electricity readings Small cylinders Good High flow pulse of oxygen Con s Limited flow rates i.e. 2 litres continuous or 1-5 litres pulsed flow 1.4 litre cylinder weighs 2.4kg Certain amount of dexterity required Requires 2 electricity points Some patients reluctant to use due to electricity costs Insensitive trigger -e.g. some struggle to get O2 when talking Patients who need LTOT while cylinder is filling can t be on more than 2.5 litres LTOT (unless high flow concentrator provided)
Liquid Oxygen Pro s Dewar / mother-tank lasts 2-4 weeks therefore less deliveries required than when using cylinders Helios =1-6 litres pulsed / continuous flow oxygen Higher flow options can be provided on request (C1000T) weekender tank can be delivered for use on short breaks
Liquid Oxygen Con s Certain amount of dexterity & strength needed to fill flask If the patient doesn t have ground floor access / lift access provision depends on a risk assessment by provider Patient must have well ventilated place to store Dewar safely (not closed cupboard or near too many electric points) Helios can but other flasks can t be laid <45 degrees to horizontal
Portable Oxygen Concentrators Pro s Provide equivalent of 1 to 6 litres pulsed flow Provide an endless supply when plugged in to electricity Can be used to provide both LTOT & ambulatory Portable for holidays etc. Con s Limited battery life (e.g. Inogen One has maximum of 4 hours battery life on 1 litre) Relatively heavy (trolley available) Pulsed flow, therefore can t be used with NIV / CPAP machines overnight
Transportable Oxygen Concentrators Pro s Provide up to 6 litres pulsed or 3 litres continuous flow Provide an endless supply when plugged in to electricity Can be used to provide both LTOT & ambulatory Can be used with NIV / CPAP machines overnight Wheeled in trolley therefore don t have to carry it Portable for holidays etc Con s Dependent on battery life when not plugged in Can be noisy Can t be used easily with a walking aid Can be bulky Heavy (only relevant for steps and stairs)
HOOF A : Static O2 concentrator or static cylinder only. HOOF B : Variety of static and portable equipment Intended for use by specialist (HOS-AR) services only Need for exercise testing & follow-up Maintains locality records, concordance review etc (ie full HOS-AR) Restricted HOOF B access to clinicians who attend transition training sessions
69 year old lady with newly diagnosed with lung Cancer and COPD on recent hospital admission Weight 40 Kg, Height 152 cm, BMI=17.2 p0 2 7.0 on room air in clinic Prescribed LTOT and standard cylinders Highly active until diagnosis Housebound due to weight of cylinders and fast becoming depressed!!
Liquid oxygen was a life-saver for this lady She could carry it herself It got her out of the house again Her mood improved
Any Questions?