How is oxygen delivered?
All oxygen equipment is supplied by one of four suppliers according to where you live in the UK.
All oxygen must be prescribed by a registered health care professional and ordered on a Home Oxygen Order Form (HOOF). You will be asked to sign a Home Oxygen Consent Form (HOCF). The HOOF is sent to the contractor providing oxygen in your area.
You will need to sign permission for your medical and contact details to be shared with the contractor. The company will then supply all the equipment you need to your home. An engineer will install the equipment and explain to you and/or a friend or relative how to use it.
You will receive your oxygen through one, or a combination, of:
- an oxygen concentrator – either portable or static for home use
- oxygen cylinders – large or small that contain oxygen as a gas
- liquid oxygen – this comes in a storage container. It is decanted and breathed in as a gas
All of these types of oxygen systems are available on the NHS once you have been assessed. Some people choose to purchase their own portable concentrators. It is important to consult a reputable provider and trial the device before you buy one.
Types of oxygen therapy
Nasal cannulae and face masks
You can breathe in the oxygen from its container either through nasal cannulae or a face mask. A nasal cannula can be used to deliver seven litres of oxygen per minute comfortably. If you need a higher rate of oxygen, humidified high-floe oxygen through a nasal cannula may be available. Discuss this with your respiratory specialist.
Nasal cannulae are made of plastic or silicone and are light weight. They are kept in place by looping the tubing around your ears. People generally prefer them because they are more comfortable and deliver oxygen continuously into your nose.
Tip: If you use a nasal cannula and your nose is sore, ask for softer tubing
Oxygen masks are held over your nose and mouth by plastic straps around your head. A simple face mask is useful if you have nasal irritation or nose bleeds.
You may find a face mask easier if you always breathe through your mouth. However, the face mask can feel uncomfortable and confining and is a little more conspicuous.
Venturi masks offer better control of oxygen concentration at certain flow rates and your health care professional might suggest one in specific circumstances, for example if you have high levels of carbon dioxide.
“It took time to get used to wearing a cannula and persistence to ensure I got cannulae that fit me properly and stay in my nostrils overnight. The oxygen supplier bought some in especially for me”
- Jan, 62, who has emphysema and uses oxygen over 15 hours through the day and at night
The oxygen concentrator is a machine, about the size of a bedside table, which you plug into your usual household electricity supply. It extracts oxygen from room air and delivers it to you by plastic tubing to a nasal cannula or to a face mask. Long tubing can also be fixed around the floor or skirting board, both upstairs and downstairs, so that you can have oxygen around your entire house.
Don’t limit yourself on oxygen tubing but remember there is a limit to the length of tubing that can be used with the home concentrators supplied through NHS.
Rooms where you have an oxygen concentrator should be well ventilated. Don’t worry; there will be plenty of oxygen left in the room for others to breathe!
The supplier of your oxygen service will reimburse money towards your electricity bill to pay for the supply that the concentrator uses. A back-up cylinder of oxygen is also provided in case of a power cut. An engineer will visit regularly to make sure the concentrator is working correctly.
Occasionally oxygen therapy might cause your nose to get dry or sore. Do not use Vaseline or any petroleum-based product to relieve this, since they can be flammable. Instead, ask your health care professional or pharmacist to advise you. A softer nasal cannula may be available.
Before you apply sun screen to your face, you should also check that the brand is suitable for use when wearing a nasal cannula.
Oxygen cylinders contain compressed oxygen. They are provided with tubing and a nasal cannula or a face mask, delivered to your home and replaced when empty.
They provide oxygen for variable lengths of time, up to eight hours depending on the size of the cylinder and the flow rate of oxygen you have been prescribed. These cylinders are generally used for emergencies or for back-up.
Tip: If you carry a cylinder on your back and get back ache, contact your provider. They may be able to give you a paediatric cylinder that is a little bit lighter.
Portable or ambulatory oxygen
Your specialist respiratory team may assess you for portable or ambulatory oxygen to see if using oxygen when you exert yourself helps. If you are already on long term oxygen therapy (LTOT) you may need to use oxygen when you go out. Depending on your supplementary oxygen needs, it may be possible for you to be prescribed:
- Portable oxygen cylinders
These oxygen cylinders weigh about two to three kilos (six to seven lbs) and come with a carrying case. The oxygen in them lasts for up to three hours, depending on the flow rate.
As with any oxygen equipment, portable cylinders must be used according to the manufacturer’s safety instructions to avoid a fire risk.
Some suppliers may have lighter weight cylinders available – ask if they would be suitable for you if you find the cylinders heavy. Your supplier may also be able to provide you with an oxygen trolley with wheels.
A conserving device is attached to a portable oxygen cylinder to make the supply last longer by giving you a pulse of oxygen only when you breathe in. Although this makes the oxygen last longer, it is not suitable for everyone as it cannot supply high levels of oxygen. Your health care professional can tell you if this device is suitable for you.
- Liquid oxygen
If you use portable oxygen a lot, or if you need such high flows that your cylinders do not last long, your specialist respiratory team may recommend that you use liquid oxygen in discussion with the company that provides your home oxygen. This is delivered and decanted into a tank in your home. This tank will be replaced by your supplier when it is nearly empty.
Liquid oxygen tanks must be housed in a very well-ventilated room, garage or shed, ensuring that there are no items around likely to catch fire. The tanks are used to fill portable oxygen cylinders, which contain a longer supply of oxygen than the usual portable cylinders. Liquid oxygen is very cold – take care when decanting it.
- If you find walking upstairs at home difficult, keep an interesting picture or verse half way up. When you get there stop, rest and recover - and enjoy the picture or verse.
- Bathroom activities can be exhausting. Use a towelling robe after a shower or bath, as you’ll use less energy than drying yourself with a towel. Plan how you can get oxygen the moment you need it. You could keep an extra cylinder to hand with tubing already attached so that all you need to do is switch it on.
- If you use ambulatory oxygen only, after you have finished walking, sit for a few minutes before disconnecting yourself from the oxygen.
Using your oxygen safely
You must use your oxygen equipment according to the manufacturer’s safety instructions to avoid a fire risk. No one should smoke near oxygen or use oxygen near a naked flame of any sort. For example, you should not use oxygen while cooking with gas.
Some hand creams and alcohol gels are not suitable for use alongside oxygen, since they may be flammable.
The local fire service may offer specific advice in relation to your home.
Most oxygen tubing has a fire break at the end of the tubing near your face that will stop oxygen in the event of a fire.
If you have difficulty with mobility or reduced sight, take care with oxygen tubing – if you are concerned about trips and falls, the community occupational therapist may be able to assess your home and offer assistance. Your GP or local health care team can arrange this.
Tip: Pay attention to the oxygen tubing when getting in and out of the car
Remember that oxygen is a medicinal product – too much oxygen can be dangerous. It is generally dangerous for you to alter the oxygen flow rate your equipment provides or change the type of mask you use unless instructed to do so by your health care professional. It has been prescribed for you after a very careful assessment.
Reviews of your oxygen therapy
Clinical guidelines for oxygen assessment and review of specific lung conditions will vary. If you have a respiratory tract infection or a flare-up, your health care professional will review your oxygen therapy promptly.
Depending upon the nature and stability of your condition your oxygen therapy may be reassessed every three to six months. If your oxygen was adjusted following a flare-up or lung infection you may be reviewed again within six weeks to see if any more adjustment is needed.
In some conditions, if your health care professional notices you are improving, it might be possible to stop your oxygen therapy.
If you experience new symptoms such as a headache, or you can’t think straight and are drowsier or sleepier, tell your health care professional. You might have too much carbon dioxide in your blood.