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. Oxygen Equipment Webinar Training Session 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 3 Primary System Types 1. Compressed gas (cylinder/tank) 2. Oxygen concentrators 3. Liquid oxygen Compressed Gas Cylinders • Compressed Oxygen • Stored under pressure in a vessel or tank • Variety of tank sizes 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 Liquid Oxygen • Compressed and cooled • Converts oxygen to a liquid state • Much larger storage ratio of oxygen Types of Compressed Gas Cylinders “Walk O2 About” Aluminum E Standard Aluminum E With Integrated Regulator Post Valve and Handle Toggle Valve Creating a Tank System Regulator E Tank Standard Post Valve Regulator Cylinder Wrench Standard Post Valve Toggle Valve Regulator Cylinder Wrench Aluminum E Toggle Valve Walk O2 About “Walk O2 About” Regulator Aluminum E With Integrated Regulator Cylinder Wrench and Handle Regulators & Flow Meters • Regulator Types: • Continuous Flow • Conserving • Flow Meter Types: • Tube & Ball • Click Style Continuous Flow Regulators E‐Cylinder Regulator with Click‐style Flow meter Adapter H‐Cylinder Regulator with Standard Flowmeter and DISS 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 E‐Cylinder Regulator with • Pressure gauge Click‐style Flow meter Adapter indicates available oxygen 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 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 Compressed Gas Cylinder Holders 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 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 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 ‘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 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 114 57 38 28 19 14 11 M60 28 14 9.5 7.1 4.7 3 2 E 11 5.5 3.7 2.8 1.8 1.4 0.92 D 6.7 3.3 2.2 1.6 1 ‐ ‐ C/M9 5.2 2.6 1.7 1.3 0.5 ‐ ‐ B/M6 2.6 1.3 0.87 0.5 ‐ ‐ ‐ Cylinder Troubleshooting Problem Probable Cause Solution No oxygen Cylinder valve Check cylinder valve to make sure it is open. Pressure gauge flowing to nasal closed or flow indicator. Check flow meter to make sure it is set at prescribed liter cannula meter on zero flow. Empty cylinder Check pressure gauge for oxygen contents. If cylinder is empty, replace with full cylinder Patient lack of Place cannula prongs in clean glass of water to observe bubbles. awareness Faulty cannula Cannula tubing kinked or obstructed with moisture. Replace as needed Loose connection Check all tubing connections Faulty regulator Replace with back up unit. Cylinder system Regulator not Turn off cylinder valve. Check position of regulator and retighten. making hissing attached properly noise and leaking Faulty or missing Replace washer washer Faulty regulator Replace with back up unit. 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 & Stationary portable Concentrator with Cabinet Filter Oxygen Concentrators • Between 30‐45 lbs. • Wheels for transport • Remain at bedside • Add tubing for mobility • New units don’t require external cabinet filters • Available with oxygen purity monitors Stationary Concentrators • Available in low and without Cabinet Filter high flow units (0‐10 LPM) • Deliver in purity range of 86‐95% 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 Home‐fill Oxygen Concentrator • Stationary concentrator + small cylinder • Create a “fill station” • Refilling times vary by size Portable Oxygen Concentrator (POC) • For travel and ambulatory use • Limited power capacity • Require battery packs for extended use Concentrator Troubleshooting Problem Probable Cause Solution No power. Power failure Power cord is not plugged in Check power cord at electrical outlet for proper condition causes an alarm to the electrical outlet connection to sound No power at electrical outlet Check power source, wall switch, in‐house fuse or circuit breaker Broken chord or plug Replace unit immediately Circuit breaker on Press (do not hold in) the circuit breaker reset button concentrator unit activated 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 Obstructed humidifier bottle, Remove humidifier, confirm flow restored, replace or or leak present reconnect humidifier bottle Defective nasal cannula or Remove and check for kinks or obstruction, possibly tubing moisture in tubing. Replace as needed Cannula and/or tubing loose Check cannula and tubing for tight connections Condensation collects in Unit not properly ventilated Make sure unit is positioned away from curtains, oxygen tubing when using drapes, or hot air registers/heaters. a humidifier bottle Intermittent alarm sounds Equipment malfunction Turn unit off. Switch to reserve oxygen supply. Contact service provider 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 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 Stationary Liquid O2 Components Stationary Liquid O2 Components Portable Liquid O2 Components 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 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 Portable Liquid O2 Components • Hold carrying strap • Depress release button • Always hold portable unit with at least one hand Portable Liquid O2 Components Contents Indicator • Lift carrying strap to check oxygen fill levels • Disengage plastic buckle for proper reading Liquid O2 Troubleshooting Problem Probable Cause Solution No oxygen flowing to nasal Reservoir or portable empty Check gauge indicator for oxygen contents. cannula or tubing If reservoir or portable empty, replace with full unit. Flow meter not turned on. Check flow meter to make sure it is set at prescribed liter flow. Faulty cannula Cannula tubing kinked or obstructed with moisture. Replace as needed Portable