Portable Oxygen: A User's Perspective

Managing & Replacing O2 Disposables


IMPORTANT: 
The information here provided is for educational purposes only and it is not intended nor implied to be a substitute for professional medical advice. Always consult your own physician or healthcare provider with any questions you may have regarding a medical condition.   

     Disposables associated with oxygen therapy include cannulas, supply tubing, masks, humidifiers, and transtracheal scoops.  Disposables age and must be periodically and replaced.  Your provider should re-supply you at no extra cost.

NOTE: Disposables your provider will also supply at no extra cost include batteries for conservers that require them and washers for the ports of compressed oxygen cylinders. It is recommended that you have replacements ready when you need them.


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Disposables and Aging
     The symptoms of aging are yellowing and stiffness. Skin oils contribute to aging—cannula prongs turn yellow and the cannula tubing across your cheeks becomes less pliable. Stiff tubing is unruly and is susceptible to splitting and cracking. With age, humidifiers are more likely to attract mold and mildew. They may become so brittle that the top cracks when tightened against the jar.

     Watch for telltale signs of aging--yellowing and stiffness--and establish a pattern for replacing all disposables. Keep track of replacement dates by either labeling the items or by noting disposal dates on a calendar.


Frequency of Replacement
     The useful life of disposables is very short.
  • Apria Healthcare® suggests cannulas and masks should be replace every two weeks and supply tubing every three months. See Apria's Respiratory Equipment Check Form, CLN0014 (Rev. 09/01). There are other providers who recommend replacement of supply tubing every month.
  • SalterLabs® suggests replacing humidifiers once a month.
  • Transtracheal Systems® suggests replacing transtracheal scoops every 45 days.
Exposure to oils, the sun, and other factors can cause tubing to age more quickly. You should change your cannula more often if you have an infection.


Managing a Humidifier
     Those who use humidifiers may find unwanted water droplets in the tubing. The moisture from the humidifier condenses in the tubing and turns to droplets when the tubing cools. This often occurs when the tubing lies on a cold floor.

      If you see droplets inside the supply tubing, dry it by running oxygen through the tubing without the humidifier attached. Find the cause and correct it. If all else fails, SalterLabs offers the #7000, inline water trap. Your oxygen provider should help you solve this problem.

     It takes a steady hand to seal the jar to the lid of a humidifier. You may think you have sealed it only to find that some of the oxygen you need is escaping from around the lid of the humidifier. The humidifier package contains instruction that describes a simple test—if you know the meaning of the word occlude.
     If you have difficulty getting a proper seal, first try twisting the jar backwards until you feel a "snap," then twist it in the proper direction.
     To verify the jar is properly sealed to the cap of the humidifier, set the concentrator to 3 Lpm. Remove the tubing from the humidifier port and close the port by placing your thumb over it. In a few seconds you should hear a “screech” from the humidifier’s escape valve, telling you there is a proper seal.
     Alternatively, run your finger around the jar, feeling the lips between the jar and its lid. If you feel no air escaping and if the lips appear to be an equal distant apart, there is a seal.

Managing Leaks
     It is wise to check for leaks in your supply tubing when you suspect a leak, when you first install new tubing, and if you have pets who take a likening to it. You can do this with a Liter Meter(image), which measures continuous flowing oxygen from its source through the meter. Jameson Medical is one of several distributers who sells them for between $18.95 for the 0 - 8 Lpm model to $29.95 for the 0 - 15 Lpm model.

     To verify the integrity of your tubing, first make a mental note of the current oxygen setting on your concentrator.  Then, replace the connector between your cannula and the tubing with a Liter Meter, being certain that the "zero" end of the Meter is closer to the oxygen source. Hold the Meter aloft with its "zero" end down and observe its reading.
     If the Meter reading is less than the setting on your concentrator, oxygen is escaping somewhere between the two. The problem could be a breach in the tubing, a humidifier jar that is inadequately sealed to its top, or a cracked humidifier top.
 
     If you don’t have a Liter Meter, you can detect a breach in your tubing the same way you would find a leak in a bicycle tire. Set the flow rate to 3 Lpm and close the open end with your thumb. Pass the tubing section by section, passed your lips. You will feel the air escaping from a break when you come across it.


Managing Curling
     Most supply tubing is "hollow bore" tubing and tends to curl. Curling can be reduced by the following.
  • Use several shorter segments of tubing connected with swivel connectors. Whereas this gives the tubing greater opportunity to uncurl without much effort on your part, it gives you more places to look for the disconnect when oxygen stops flowing.
  • Heat or stretch the tubing before using it. Some readers report using hands and feet to stretch new tubing. Others report that putting tubing in a clothes dryer or hot water reduces curling. Success depends upon extending the tubing to its full length and laying it on the floor before it cools—a daunting task. Whereas these methods may temporarily straighten tubing, stretching and heat damage tubing making it more susceptible to cracking and splitting.
     To reduce curling and odor of new tubing, remove it from its packaging 24 hours before use, unwind it, and run oxygen through it for about 20 minutes.
     To unwind, hand one end of the tubing to a friend to hold. Take two steps away from the friend and, as you do so, release two loops from the coil then rotate the coil laterally two revolutions. Repeat this process until the tubing is unwound.

     SalterLabs has introduced safety channeled tubing. Safety channeled tubing overcomes some of the problems of hollow bore tubing. The tubing has three ribs (or channels) inside. The ribs keep oxygen flowing, unimpaired by kinks or by compression when caught between a door and its sill. When safety channeled tubing is carefully unwound, as described in the box above, it will behave and lie close to the floor. Channeled tubing is highly reflective making it more visible.

     You can see the tubing by selecting "Extension Tubing" from the Products menu at the SalterLabs website.The part numbers are 2050 for 50 foot and 2021 for 21 foot channeled tubing. The part numbers for hollow tubing of the same lengths are 2550 and 2521.

     For the visually impaired, SalterLabs also offers bright green safety channeled tubing. The part number for 50 feet is 2050-G.


Cannulas
     Several companies are manufacturing cannulas that are reasonably comfortable. Check out both SalterLabs and SoftHose to see what is available. Your provider usually can cover the cost of Salter Labs products but probably not SoftHose products.

     Here is a tip from several members of COPD-Alert: Take the weight of your cannula off of your ears. Secure tubing at your hip with a holder, like the BC100 (image), normally used to secure security badges. Snap the strap around the tubing and clip it to your clothing with some slack between the strap and your cannula. You will find the cannula exerts less pressure on your ears. If you clip the strap at your waist band or belt, your tubing will follow you like a puppy dog and you will be less likely to step on it..
     You say you don't have a holder handy? Most companies require security badges, so their personnel offices have these holders. You can also purchase a package of 25 at Office Depot for $6.

Jim from OK writes:
     Have you checked out the new Salter #1606 TLC? It is a cannula with E-Z Wraps attached.

Marnie Girl writes:
The softhose has become a necessity in my 02 use.I cannot stand the old, stiff ones anymore. And they do not pull out at night as did the other.I use the one with the small nose cannula, but not the mini.
But bewared before you try these soft cannulas, you get hooked on them and it's almost impossible to go back to the Salters. I use the "micro" around the house and the "light" with my gas portable. The light dosen't make as much noise with the pulse does as the micro does. It ought to be a law that all cannulas be made like "soft hose.


Alternatives to Cannulas
To replace oxygen delivery through the traditional cannula while avoiding the need for a mask, I offer two suggestions for you and your physician to consider.
  • Oxymizer. The Oxymizer™ is a disposable conserver manufactured by Chad Therapeutics . It is designed to be used with continuously flowing oxygen from a concentrator or portable system. It accumulates oxygen during exhalation in its reservoir so that the next inhalation is greatly enhanced. It comes in two models-- the O224 (image) , which has its reservoir in the face piece, and the P224 (image) , which has its reservoir as a concealable pendant on the chest.  
I used the P224 for several months and was satisfied with it. At the time I was beginning to need more oxygen than my 5 Lpm concentrator and 6 Lpm portable (continuous flow) could provide. I had hoped that it would increase the effectiveness of both so I wouldn't have to move into the high-flow category. My expectations were greater than the P224 could deliver. One of the first things you will notice is that your ears get better treatment. Also, the nasal prongs are thicker, reducing the whistling of air. Since the Oxymizer is a disposable, it is available at no cost are are other oxygen supplies.
  •  Oxyarm. The July issues of both the Pulmonary Paper and News from NHOPA reported on Atlantic Medical Specialtie's Oxyarm (image). The Oxyarm, an alternative to a cannula, looks like a telephone headset and delivers oxygen with no physical contact with the ears or nostrils. The manufacturer claims that it is designed for both mouth and nose breathers, it produces no nasal or sinus irritation, it allows for easy Talking, Eating and Drinking, and it is odourless and latex free.
     
  • Scoop. "Scoop" is what most of us call transtracheal oxygen (TTO). About a year ago, I when I went through the ten-minute surgical procedure that left me with a tiny hole in my trachea. Like 16,000 others, I now bypass my nose and receive oxygen directly into my wind pipe. Through this hole I insert a small catheter, called a SCOOP™, which I remove and replace daily with a clean one.( Click here to see an image of two SCOOPs next to two cleaning rods.)
    I have been very happy with the scoop for the year I have had it. My only regret is not switching to the SCOOP when I first learned about it, more than 2 years prior.

    What are the differences?
    • A humidifier which requires filling every other day is necessary.
    • I have to remove the old SCOOPand replace with a clean one once a day. For you, it may be more or less often. I also run sterile water down my SCOOP twice a day. This brings up the mucus balls (or "plugs") that the scoop tends to dry into small semisolid objects. All this I can get use to. 
    • With the scoop, I do loose the sensation of oxygen entering my body. I cannot feel it as it enters and fills my trachea, even at 15 Lpm. Therefore, I am not aware that my tubing has accidentally become unhooked or my cylinder has run dry. The sound of oxygen passing through my nose is no longer a clue for me. 
The surgery is covered by Medicare and probably by your insurer. Supplies, including two SCOOPs and cleaning materials, are available quarterly through your oxygen provider at no cost. The only thing not included is the antibacterial soap, which you will find at your local grocery.

The surgery is done in a hospital on an outpatient basis and takes about 10 minuites. Because of setup and the long wait for an Xray afterwards, it usually takes the morning. You  will want to have the procedure done near home. The first six weeks are a "curing" period during which you need to return to the hospital weekly to have the SCOOP removed and replaced. Thereafter, you are responsible for SCOOP care.

Should you change your mind, simply remove the SCOOP and put on a cannula. The surgical opening will heal quickly, leaving you with a small scar.

You can learn more about transtracheal oxygen therapy (TTOT) by visiting Transtracheal Systems, Inc. At the  Patients page can get additional information or to speak directly with a respiratory therapist by contacting their Technical Services Department at rt1@tto2.com, or calling 303-790-4766, or toll free in the US 1-800-527-2667. Also, visit Efforts which as comments from readers as well as links to professional sources.


Credits
     Over the years I have heard my readers complain about tubing.

“My oxygen stops flowing when it kinks or an outside door is closed on it.”
“It will not lay down on the carpet so I trip on it.”
“It curls fresh out of the package and continues to curl as I use it.”
“I step on it and it practically take my ears off.”

     I dedicate this article to them with the hope that they have better lives because of it. A special thanks to the following users who provided me with some of the valuable insight you find in this article. They include Martin, Fay, Clare from Dallas, Bill from Oregon and Kathy from Ohio, all subscribers and members of COPD Support, Inc.




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© 2004 Copyright 
Peter M. Wilson, Ph.D. 
Founder of PortableOxygen.org

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