No doubt about it, when you find out that you need supplemental oxygen because your lung condition has worsened you feel overwhelmed and scared. These feelings are often intensified when you find out that you need to carry oxygen tanks. At home sure the tubing is burdensome and annoying, but when you need to go out and about you have to carry oxygen tanks and the thought of dropping it, changing out a regulator, or the tank exploding is terrifying!!! I am here to tell you that those thoughts and feelings are super normal yet once you become familiar with your oxygen tank you will gain more confidence and independence doing the everyday things like running errands, attending church service, and/or visiting friends. There has been a lot of conversation this week in pulmonary rehab about oxygen tanks due to the high temperatures that we have been experiencing in Virginia. I have had patients worried that their tanks would explode in their car, knocking over tanks in rehab, and unable to troubleshoot their tank regulators to see if they are working properly. This blog post is dedicated to those who use oxygen tanks. (I plan on writing a blog on portable oxygen concentrators “POCs” so stay tuned to BreatheLiveFit for that future post!) I find that this is a great place to start and all I want for my readers is for them to live happier, healthier lives and in order to do that they need to feel confident about being mobile with their portable oxygen tanks.
So let’s start by familiarizing yourself with the actual tank or cylinder. Portable oxygen tanks often aluminum (but can be steel) can come in an array of sizes. These tank sizes are named by letters. Most commonly you will find portable tanks in sizes C, D, and E. They do manufacture a few other sizes but for purposes of keeping this blog from being long winded… We will focus on three sizes. The C cylinder holds about 255 liters of oxygen and weighs approximately 5 1/2 pounds ,the D holds about 425 liters of oxygen weighing approximately 8.5 pounds and the E cylinder holds about 650 liters of oxygen and weighs about 13.5 pounds thus E is the largest. Who determines what size oxygen tank you will utilize is largely (at least in my neck of the woods) decided by the home care companies that coordinate and distribute the oxygen tanks. However, typically the more liter flow you require, the larger the tank that you will be supplied with. Make sense? You don’t want a small portable tank if you are requiring 4-6 liters per minute or else the duration that you can actually use that tank would be very short.
Getting to know your tank
At the very top of every oxygen tank is the valve nut that when turned opens the valve and allows the oxygen to come out. The “holes” that you will notice at the top are part of a Pin Index Safety System for medical gasses (PISS) that only allows regulators specifically designed for certain medical gasses like oxygen to be attached to the appropriate cylinder. These pin holes are where you are going to attach the your regulator to the oxygen tank. All oxygen tanks utilize regulators to deliver the oxygen, monitor tank volume with an attached pressure gage, and adjust the flow to the patient.
A few other items that you are going to require to use your oxygen tank are a post valve washer, a tank key, and of course an oxygen delivery device like a nasal cannula. I recommend that you have extra of these on hand. Many of my patients keep 4-5 extra washers, keys, and cannulas on hand at home as well as have a small supply bag in their car or purse that has one or two of these readily available. The washer will help you to prevent any leaks between the regulator and the tank itself. These little guys wear out frequently. The tank key is what you will attach to the valve nut in order to turn the tank on and off. Most of my patients attach this key to their ordinary key chain or to their purse or wallet.
When deciding on what regulator to use you will need to find out if you will require “continuous flow” oxygen or “pulse dose”. Your doctor will let you know after a brief walk test which type of flow you are able to tolerate. If your oxygen levels are adequate to use a pulse dose flow. This is good news. You will be able to utilize an oxygen regulator that will allow you to conserve the oxygen in your tank and will only pulse out when you take breath in. Another benefit to using an oxygen conserver on your tank is because the oxygen only delivers a short pulse you are able to breathe in more moisture from room air therefore it doesn’t dry your nasal passages quite as much as continuous flow. If you require a continuous flow of oxygen this isn’t the end of the world but this will require you to change out your oxygen tanks more frequently when in use. One of my favorite oxygen conserving regulators for portable use is the Bonsai brand. It’s fully pneumatic and gives you liter flows from 1-6 with two continuous flow options of 2 and 4. How this conserver works is that it senses a breath and delivers a pulse of oxygen within the first half of inspiration. These conservers are also pretty quiet which is a plus.
How to get comfortable with your tank.
The easiest way to become comfortable with your oxygen tank is to practice putting on the regulator and turning on the oxygen as well as turning off the oxygen and taking the regulator off. Sure, it probably would be easier to just have your spouse or family member do it for you, but the familiarization that you get by doing it yourself is going to really make a difference for you.
Here’s how you put the regulator on:
1. Take off any paper or plastic wrapper that has been placed on the tank.
2. Crack your tank and turn it off by placing your tank key on the valve post to quickly turn the flow to your tank on and off. (This will make a loud rushing noise so do it fast. “On then off quickly!”) The reason why you do this is to blow any dust or dirt that may have gotten in the tank valve.
3. Next place your regulator (with your valve washer between the tank and regulator) on the top of your tank aligning the pins with the pin holes at the top of the tank. The valve washer will help you to create a seal between the two.
4. Tighten the regulator to the tank using the hand crank typically provided by the manufacturer and on the side of the regulator.
5. Use your key to slowly turn the tank valve post on (Righty Tighty, Lefty Loosey”= Turn right - On, Turn left - Off) If you hear nothing but silence, your regulator is working and is sealed appropriately to the tank. If you hear oxygen spraying out turn the valve off and tighten your regulator with the hand crank a bit more. Then try to turn the tank on again. If you still hear oxygen spraying out, turn the tank off, remove the regulator and put it back on again making certain that the pins are aligned correctly and that the washer is centered over the valve opening. After reaffixing the regulator to the tank, try opening the valve again to see if you have a perfect seal.
6. Once you have a perfect seal, verify you have a full tank by checking the pressure gage of the regulator (typically 2000-2200 psi is considered full) and adjust the flow knob to the desired setting and it is ready for use! Whoo Hooo!
To take the regulator off
1. Turn the valve at the top of the tank to “off” by turning the key to the right.
2. Watch the pressure gage to make sure it falls to zero.
3. Use the hand crank and loosen the regulator in order to remove it from the tank.
The other way to get comfortable with your portable oxygen tank is to use it! Try short outings at first that are close to home. Be sure to check the pressure gage on your cylinder from time to time to make sure you aren’t getting too low. Change the tank once you get to about 200 psi or close to the “red zone.” It is a good idea to sit while you are changing your tank. Don’t rush or stress out during this process as this can make you more short of breath. Stay calm and take your time while changing your tanks. Once you get use to being away from home and using/changing your tank, you will feel more confident to extend your outings.
When traveling with your oxygen tanks
Secure your oxygen tanks in your vehicle so that they don’t roll around and bump into each other or other objects. Crack a window in the vehicle (2-3 inches) when parked to increase ventilation. Find a shady place to park and avoid leaving them in direct sunlight. Do not store cylinders in the trunk of a vehicle.
How to care for your nasal cannula
Avoid letting your nasal cannula touch the floor or any unclean surfaces. I have often recommended using an inexpensive sunglass case or a toothbrush cover to store it in when not in use. If it should hit the floor you can use a mild cleaner or an alcohol prep to wipe it off. You should replace your cannula every 2-4 weeks and more frequently if you notice visible discoloration. It should never appear yellowed or be hard to the touch.
Never smoke or allow anyone else to smoke around oxygen. Post NO SMOKING signs in every room of your home where oxygen is in use.
Keep your oxygen cylinders at least 10 feet away from any heat source, including gas stoves, lift fireplaces, wood burning stoves, candles, lighters or other types of open flame.
Avoid using lotions, creams or other home care products containing petroleum. Choose water-based products instead. I love Ayr products. They are water based and they have a saline spray as well as a water based gel perfect for adding moisture to dried nasal passages.
Store oxygen canisters safely and securely in the upright position, away from any type of heat source and in an approved oxygen storage cart or other device designed to store home oxygen. Oxygen tanks can become projectiles is the valve is damaged. I see a few of my patients carrying their tank by the regulator and/or without a bag or cart to protect it.
Make sure once you get home and connect to your home concentrator that you turn the valve off to your tank. This will prevent any unintentional pressure loss from your tank as well as reduce the risk of home fires.
As I mentioned before, it is best to familiarize yourself with your oxygen equipment and the safety checks established by your home oxygen supply company. If you don’t understand how something works, ask for more information and a demonstration.
Inform your power company that you are oxygen dependent. Many companies offer oxygen-dependent patients priority service or even a generator when their power goes out. Find out what steps you need to take to get this type of service.
Only use your oxygen as prescribed by your physician
Keep a sufficient supply of full cylinders in your home in case of an emergency. Call to order more cylinders when your supply gets down to two cylinders or about 20% of the amount you received at your first delivery. Some home care companies will set you up with automatic delivery. If you feel as though you need more tanks, you should let them know. If you know you are going to be taking a trip or doing anything where you will be spending an extended amount of time away from home. Let them know in advance how many tanks you will need so that you can feel prepared. Some companies have “sister locations” or franchises in other states and may ben able to deliver tanks to your destination.
Have a working smoke detector. Check the batteries regularly. Keep a working fire extinguisher within easy reach and be sure everyone knows how to use it.
Thanks for reading!
Remember: We are in this TOGETHER!
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