Home Oxygen Online TrainingThe purpose of the following programme is to provide you with the skills and knowledge to have an understanding of home oxygen equipment and recognise the BOC safety protocols regarding its safe operation and use.

As you work your way through this programme there are two links to BOC Safety Videos on Youtube, please make sure you view them both.

At the end of this programme there is a test with a 100% pass mark required. That pass will enable you to print a certificate of completion valid for one year. The test can be taken as many times as required to enable the pass.

Allow 60 minutes from start to finish.

Introduction

The air that most of us breathe consists of 21% oxygen, 78% nitrogen and 1% trace of other gases.

To be exact:-

Oxygen patients when using their oxygen supply can be consuming an oxygen purity of up to 99%.

Medical oxygen is registered as a controlled drug.

Oxygen itself whilst not explosive aides any fire and supports combustion. Just about any object when enriched with a high concentration of oxygen will burn.

Please view the following Youtube link …. https://www.youtube.com/watch?v=OSouYewJ2jw

All of BOCs safety protocols concerning the dangers of oxygen ignitions are contained within that video.

Emollient Hazards

Creams/Oils Fact Sheet:

1. Oxygen is an oxidising agent which can react with oil-based creams and greases causing an ignition. This applies to most greases including creams and lotions unless they are deemed oxygen compatible, and in this case would need to be water based products

2. It is important not to touch, handle or operate cylinders/liquid oxygen systems when hands are contaminated with oil-based creams/oils as:-

a. Could cause local ignition resulting in burns to you or othersb. Increases risk to BOC operatives when filling cylinders/liquid systems

3. Our recommendation would be to use water-based creams such as RoEezit® or K-Y Jelly but we recognise that this is not always possible, therefore if oil-based products need to be applied to the skin, the following action must be taken:

a. After applying cream/oil wash hands with soap and dry thoroughlyb. If using alcohol gel, apply to hands and ensure it is massaged in well and

allow for it to evaporate normally for approx. 2-3 minutes

4. On occasions there will be no substitute for prescribed cream-based topical medications, or medicated dressings/bandages therefore remember to apply the same rules regarding hand washing following application

5. It is important to remember that creams applied to the body will then be transferred to clothing, bedding, fabrics (anything touching the skin). In this situation the cream will impregnate the fabric but won’t absorb/evaporate in the same way as on the skin, therefore increasing the fire hazard

6. Regular washing of bedding, bed clothes, seat covers is essential to remove the accumulation of creams/oils and contaminants

7. Patients who continue to smoke incur significant additional risks, as oxygen enriched bedding and clothing, which is impregnated with creams/oils are more flammable when smoking resumes. Similarly, being near to someone who is smoking or exposure to any open flame or other potential cause of ignition will carry the same risks

Patients are prescribed their oxygen via a Home Oxygen Order Form (HOOF)

That HOOF is completed by a qualified medical practitioner. The person completing the HOOF will decide upon which type of oxygen modality the patient receives for use in their home. It is not BOC’s decision what type of equipment is installed.

There are various modalities which cover domiciliary (indoor oxygen) use and ambulatory (outdoor oxygen) use.

Domiciliary equipment:-

Concentrators and static cylinders

Ambulatory equipment:-

Ambulatory cylinders

Portable concentrators

Liquid oxygen (Lox)

Patients flow rates – litres per minute (LPM) are very different from patient to patient, they should always be strictly adhered to by the patient. The only person who can change the prescription and/or flow rate is a trained medical practitioner.

The above diagram is an example of a flow bar on a concentrator machine, 1,2 & 3 refer to LPMs.

It is exactly the same for the amount of hours the patient is prescribed to use per day (HPD).

Home Oxygen Equipment

Concentrators

An oxygen concentrator is an electrically powered machine that separates the oxygen from other gases that are present in the air to give a constant supply of high purity oxygen to a patient.The machine draws in the air from the room and then separates the oxygen from the other gases.  It then delivers the oxygen to the patient and releases the unwanted gases back into the atmosphere.Within the service provided by the BOC Homecare business, oxygen concentrator systems can be installed in a patient's private dwelling, schools, prisons and Healthcare institutions e.g. care or nursing homes.BOC service these concentrators every six months.There are various different types of oxygen concentrators some with different flow rates. All work in principal exactly the same way.The Airsep and Millenium machines require their gross particle filter removing and cleaning once a week (wash in warm water and allow to dry) – please see pictures below. This is absolutely critical to ensure the machine continues to function correctly.

Airsep

Millennium

There are other types of concentrators to, such as the Everflo, this particular machine does not have a gross particle filter for the patient to change – The A3 concentrator is also the same in this respect.

Everflo

Sysmed

V3

All concentrators should be kept clean by using a damp cloth and then wiping dry. Do not use any form of cleaner or detergent. Avoid getting any moisture into vents; switches etc.

Patients should change their cannula at least every four weeks

Masks should be kept clean and can also be replaced when required.

Concentrators must have at least a 30cm gap around the machine at all times to enable its correct operation.

All concentrators are installed with a backup cylinder supply – these are for emergency use only

All concentrators have audible alarms and warning lights. In principal for all concentrators, if your machine alarms check the following………..

1. Do you have power in the home ? i.e power cut – have you tried another power socket ?

2. Have you changed/cleaned the gross particle filter recently – if applicable? ( Millenium/Airsep and Sysmend)

3. Have you changed your cannula ?4. Check your flow bar - is it registering 0 ? If so make sure your tubing

isn’t trapped or try turning the flow to your prescribed flow rate.5. Does your machine have a 30cm gap around it? Never cover your

machine with anything.6. If you cannot resolve an alarm or you have an amber light displayed ring

0800 136603

Patients/carers must never tamper with any installation as set by the BOC technician.

Any problems should be reported to the BOC Patient Service Centre on 0800 136603

All concentrators at first install with a patient will have free line tubing from the machine to the patient to enable their supply of oxygen and allow them to walk around their dwelling.

This free line can be no longer than 15 metres in maximum length and will be tailored to the patient’s requirements by the BOC technician on installation.

It will be made no longer than the furthest point the patient needs to reach within the home

It is only designed for internal use

A firebreak as seen in the earlier video is fitted at the machine and patients end of the free line tubing for concentrators and just at the patients end for all other equipment.

BOC recognises the free line tubing is a high risk trip hazardPlease view the following Youtube link… https://www.youtube.com/watch?v=-tyjBm-0Jr4

BOC offers a fixed installation to help reduce the trip hazard; however it is not suitable for every type of patient.

Transportable and portable concentrators are available for HOOF prescription.

The transportable concentrator is a domiciliary machine designed to be portable in its requirements i.e caravan, weekend break etc

It delivers a 1 to 6 flow setting, 1 to 3 on constant and 1 to 6 on demand ( the patient triggers the delivery on inhalation)

The portable concentrator is designed to be an ambulatory concentrator

It delivers a 1 to 5 on flow settings and is demand only

For both of these machines the flow setting does not correspond with the LPM flow settings of a concentrator. The patient’s clinician will prescribe the setting for the patient on both machines.

One firebreak is fitted at the patients end prior to the mask or cannula

Ambulatory cylinders are supplied with a carry bag but a trolley is also available for CD/DD type cylinders.

Cylinder Set Up

1 Remove the tamper evident seal.

2 Attach the tubing and cannula, or mask to the fir tree outlet of the regulator.

3 Make sure the flow control knob is set to '0'/'OFF'.

4 Slowly turn the 'open/close' handwheel (located on the side of the cylinder) anti-clockwise to fully open.

5 Turn the regulator to the prescribed flow rate, which is indicated on the top control knob.

6 Check for leaks on the hose connection.

7 Check for flow of oxygen from the cannula/mask.

8 If there is no flow check contents gauge

To Close the Cylinder Valve

1 Turn the 'open/close' handwheel clockwise to close hand tight.

2 You will hear a hissing sound for a few seconds while residual gas is released.

3 Wait until all the residual gas has stopped flowing and turn the regulator to the '0'/'OFF' position.

Changing an Integral Valve Cylinder

1 Close the cylinder valve, using reasonable force only.

2 Release the pressure in the attached equipment by selecting a flow and allowing the gas to vent to atmosphere.

3 Set the flow to '0'/'OFF' on the regulator.

4 If the cylinder is empty, remove the attached equipment and either refit to a new cylinder or store the equipment in a clean location.

5 Keep the cylinder valve closed when the cylinder is being returned to BOC.

Do not empty cylinder

The patient/carer should be advised not to discharge or empty cylinders after use, as residual pressure in the cylinder helps prevent the ingress of dirt and moisture.

To Replace a Cylinder

1 Make sure the 'open/close' handwheel of the empty cylinder is fully closed.

2 Detach the hose and cannula or mask from the outlet of the regulator.

3 Remove the plastic protection seal from the 'open/close' handwheel of the full cylinder and if fitted, remove the plastic outlet protection cover.

4 Follow Cylinder Set Up

Competency

The patient/carer should show competency in the above procedures by carrying out a practical demonstration after training.

Storage

Ensure cylinder valve is closed

Store in a well ventilated area

Ensure cylinders cannot fall over and hurt anyone else

Transportation

Remember even the light cylinders are heavy

Ensure you are safe to lift them and apply manual handling principles

Do not try to carry too many at once

Where possible use the bag for transportation of the cylinder

In a vehicle store extra cylinders in the boot, always secure your cylinders in your vehicle

Never carry static cylinders in your vehicle

Never use the cylinder when it is on red as there is a contamination risk as well as the risk of disruption to the supply

Characteristics In liquid form, oxygen is light blue in colour and translucent.

Flows like water.

Hazards • Fire / Explosion • Cryogenic – cold burns, frostbite• Pressure • Oxygen Enrichment

• Physical Hazards, Slips, Trips and Falls • Tampering and Unauthorised Access • Biological Hazards • Compatibility with other equipment • Storage Location

The mother unit requires specific location requirements. It must preferably be stored outside in a well ventilated secure area.

There is a certain dexterity and physical fitness required to fill the portable unit from the mother unit. Not all patients are suitable for its use.

The mask and cannula are always prescribed by the clinician; BOC cannot provide what isn’t prescribed.

Again these must be prescribed by the clinician.

Test – 100% pass mark required for certificate

1. How often should the patient/carer clean/replace the gross particle filter on some concentrators?a. Monthlyb. Dailyc. Weeklyd. Bi-monthly

Answer c

2. How often is it recommended the patient/care replaces the cannula?a. Weeklyb. Monthlyc. Dailyd. Bi-monthly

Answer b

3. For naked flames what is the minimum distance a patient with oxygen can be from it ?a. 1 metreb. 1.5 metresc. 6 metresd. 3 metres

Answer d

4. BOC recommends only two moisturizers safe to use with oxygen patients, what are they?a. E45 and Savlonb. Vaseline and Cetaphilc. Aloe Vera Gel and Jelly Creamd. KY Jelly and RoEzit

Answer d

5. Can you carry static cylinders safely in a patients vehicle?a.Yesb. No

Answer b

6. How many minutes must a patient wait after coming off their oxygen prior to smoking?a. 5 minutesb. 20 minutesc. 60 minutesd. 0 safe to smoke straight away

Answer b

7. What is the minimum distance a patient using oxygen can be to a heat source?a. 1.5 metresb. 2 metresc. 3 metresd. 2.5 metres

Answer a

8. When should a patient/carer use the emergency back up cylinder?a. Power cutb. Concentrator alarmingc. For use in another roomd. To visit with

Answer a and b

9. Can a patient/carer request from BOC any different equipment to what they have prescribed?a. Yes – they can have what they wantb. No – it must be prescribed by a clinician

Answer b

10. Under what circumstances can a patient/carer change the oxygen flow from what has been prescribed?a. Because they are short of breathb. They feel like having more

c. The patients clinician or medical practitioner has instructed them to do so

d. The patient can select whatever they want

Answer c

11. Is there any possible danger to a patient of having too much oxygen?a. Yesb. No

Answer a

12. What is the main function of an oxygen concentrator?a. It’s a machine that stores and makes its own oxygenb. It’s an electrically powered machine that separates the oxygen from

other gases that are present in the air to give a constant supply of high purity oxygen to a patient.

c. It’s a machine that produces oxygen from cylinders stored inside the machine

Answer b

13. What job does the fitted firebreak perform in the event of the patients tubing catching fire?a. It stops the tubing fire progressing any further down the tubing by

shutting down the oxygen supplyb. It will cause the concentrator to switch offc. It stops the patient from catching fire

Answer a

14. With a free line from a concentrator, how many firebreaks should be fitted?a. 1b. 2c. 3d. 4

Answer b

15. The firebreak has a directional arrow on it, which way should it be fitted ?a. It doesn’t matter so long as it is fitted

b. Towards the patient with the flow of oxygenc. Away from the patient against the flow of oxygen

Answer b

16. What is the maximum length concentrator free line tubing can be?a. 10 metresb. 12 metresc. 5 metresd. 15 metres

Answer d