Oxygen Therapy

Indications

Administration

Patient advice

Oxygen use in the breathless patient

Indications

In the hospice setting oxygen use will take place under the following conditions; 

• Long-term oxygen therapy (LTOT) (>15 hours/day) 
  • Indications 
    • All patients assessed and diagnosed with COPD found to be in need of LTOT by a pulmonologist or a physician 
    • FEV1 of less than 1, 5 litre and FEV1% in conjunction with FEV1/FVC ratio of less than 70. 
    • Oxygen saturation level less than 90% 
• Short term oxygen therapy 
  • High concentration oxygen (60%) 
    • Indications 
      • Pneumonia, pulmonary embolism, fibrosing alveolitis, asthma, myocardial infarction 
  • Low concentration oxygen (<28%) ( to improve the breathlessness caused by hypoxia without worsening pre-existing CO2 drive) 
    • Indication 
      • COPD, interstitial lung disease, heart failure 

Administration

Oxygen can be delivered via: 

Nasal Cannula 

• A Nasal Cannula provides low flow oxygen to a patient who can breath spontaneously 
• Percentage inspired oxygen depends on the flow rate and the patient’s tidal volume 
• At 1 litre/min it provides 24% Oxygen 
• Increasing the oxygen flow by 1 litre/minute will increase the oxygen by approximately 4%. (Max 44% at 6 litres) 

Simple Face mask 

• This provides 40-60% oxygen at a flow rate of 6-10 litre/min 

Face mask with oxygen reservoir 

• This will provide 60-100% oxygen at a flow rate of 6-10 litre/ min 

Venturi Mask 

• The flow rate at percentage oxygen delivered is indicated on the mask 
• This provides accurate control

Oxygen can be supplied via: 

Oxygen cylinders 

• Can supply oxygen for up to 28 hours 
• Heavy and a fire hazard 
• Need no electricity 

Portable oxygen cylinders 

• Supply only 2-4 hours of oxygen 
• Ideal for transporting patients 

Oxygen concentrators 

• Safer and more portable 
• Patient has to pay for the electricity 

Patient advice

• The patient has to stop smoking 
• Oxygen is a fire hazard 
• Cannulas and prongs must be cleaned daily with soap and water 
• If oxygen concentrators are used, the cost of the electricity should be remembered 

Oxygen use in the breathless patient

Oxygen may help the breathless patient who is hypoxic, however most breathless cancer patient are not hypoxic and will not benefit from it physiologically. A trial of oxygen can be given for 15-30 min and the situation can be reassessed.