Guide to Prescribing Home Oxygen
L. Petty, M.D.
to Prescibing Home Oxygen
to Successful Treatment
Considerations in Selecting Equipment
Thomas L. Petty, M. D.
KEYS TO SUCCESSFUL TREATMENT
Patient compliance with the initial LTOT prescription is always an
issue. Both the physician and the equipment provider should reinforce
education and understanding of the need for continual compliance. Many
patients are embarrassed to be seen in public, particularly a patient
using a cannula. For highly active patients, transtracheal catheters can
be considered. Generally, the more inconspicuous patients can appear the
more likely they are to reestablish a more normal lifestyle.
Home Care Provider Participation
The Home Care Provider (HCP) plays an important role in a patient’s
long-term oxygen therapy. There are a number of services that should be
provided by a HCP. The Joint Commission on Accreditation ofHealthcare
Organizations (JCAHO) is a regulatory body that evaluates some of these
services. JCAHO participation is voluntary, and the provider pays to have
the accreditation evaluations, usually every three years. Most HCP’s will
offer 24-hour emergency service and be available through an answering
service. This allows the patient to have a contact in the event of an
emergency such as a power failure or equipment malfunction. The HCP should
also provide the patient with a backup system or extra cylinders in the
event of inclement weather. This is particularly important if the patient
is on an oxygen concentrator and there is a chance of extended power
outages. When patients are on liquid oxygen the reservoir itself serves as
a back up system since liquid oxygen does not use electricity to
The HCP is responsible for billing the patient’s insurance and the
patient for any portion they are accountable for. Additional
responsibilities of the HCP include patient/caregiver education in proper,
safe use of equipment and maintenance and cleaning of any semidisposable
accessories. The HCP must also provide the patient with an appropriate
amount of disposable items such as cannulas and humidifiers at no
additional cost to the patient.
Proper Selection of the Equipment
Care should be given to selecting the best type of oxygen equipment to
fit the individual patient’s needs. Patients frequently resist changing
oxygen modalities once they have initially adapted and become comfortable
with the characteristics of the equipment. Encumbering potentially active
patients with ill-suited oxygen delivery systems is counterproductive. A
portable E cylinder and a cart are satisfactory for backup and infrequent
use outside the home but can substantially hinder a patient who is highly
ambulatory in his attempts to regain his lifesryle.
Weight and duration of oxygen flow are primary factors in selecting an
ambulatory system. The Fourth Consensus Conference on Oxygen Therapy
differentiated between portable and ambulatory oxygen systems. Portables
are easily moved oxygen devices that are not designed to be carried and
weigh above 10 Ibs. E cylinders mounted on carts typify these. Ambulatory
systems are defined as systems weighing less than 10 Ibs., designed to be
carried and lasting 4 hours or more at 2 EPM. These are normally small
aluminum cylinders with oxygen conservers or small liquid oxygen
Most patients find 8.5 Ibs. a practical weight to carry, but smaller
framed patients may be better served with a unit in the 5 Ib. range. Most
ambulatory systems in the 5 Ib. range use a conserver to increase
duration. Care should be taken in selecting conservers to make sure that
the desired oxygen saturation of >90% is achieved during activities of
daily living and during sleep. Pulse type conservers deliver a fixed
volume each time they are triggered. If the I:E ratio of the patient
varies from that assumed by the designers, the volume received will not be
equivalent to continuous flow at the same liters per minute (LPM) setting.
The more oxygen a conserver claims to save, the less it delivers.
Verification of conserver performance during a particular activity of
daily living is recommended via pulse oximetry measurement while the
patient is using the device.