Precautions. Supplemental oxygen is a fire hazard, and some hotels and residences do not allow its use. No one should smoke near an oxygen tank, and tanks should be stored safely, secured to a wall and away from heaters and furnaces.
Devices for Administering Oxygen
Oxygen is usually administered in one of three ways: using a nasal canula, a transtracheal catheter, or an electronic demand device.
Nasal Canula. Using a nasal canula, oxygen is delivered through a long, slender plastic tube that runs from the oxygen tank to small plastic prongs that fit in the nostrils. The tube can be very long when attached to a stationary tank in order to accommodate walking throughout a house, or relatively short when attached to a portable unit.
A reservoir pouch is a recent innovation added to this device that provides an extra rush of oxygen as a patient starts to inhale. This method is inexpensive and easy to use, but some patients are embarrassed by its appearance under their noses.
Transtracheal Oxygen. Transtracheal oxygen is delivered directly into the windpipe (trachea) through a catheter tube implanted by a surgeon. The device is inconspicuous, and compliance is excellent. The initial cost is high, but over time expenses are reduced because of more efficient oxygen usage. Long-term complications may include infection, dislodgment, and blockage by mucus, which can be very serious. Complications of the procedure itself occur in 3% to 5% of cases and include lung spasms and uncontrollable coughing.
Electronic Demand Devices. Electronic devices that sense the beginning of a breath and deliver a pulse of oxygen are also available, although they are complicated, expensive, and have a risk for mechanical failure. Newer units have a continuous flow bypass switch that allows delivery of oxygen if the battery has run down.
Continuous Positive Airflow Pressure (CPAP)
Continuous positive airflow pressure (CPAP) supplies a steady stream of air through a tube that connects to a small bedside machine. The patient wears a plastic mask, and the machine applies sufficient air pressure to prevent the tissues from collapsing during sleep. It is not an oxygen-delivery system, but is intended to improve airflow into the lungs. The device is sometimes uncomfortable, and noncompliance rates are high. Studies are mixed on its benefits, suggesting that certain patients, but not others, may be helped by it. More studies are needed. [For detailed information on this device, see In-DepthReport #65: Sleep Apnea.]
Oxygen Delivery in Emergency Situations
In emergency situations, oxygen may be delivered to the patient in various ways:
Intubation. When standard oxygen therapy does not meet the needs of the patient, endotracheal intubation may be required to deliver high concentrations of oxygen. With intubation, a tube is inserted down through either the nose or the mouth through which oxygen is administered.
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