Please be aware - this information is for healthcare professionals
Oxygen can be a useful tool in end of life care, but it is not always appropriate and some family or friends may misunderstand how valuable oxygen therapy might be at this point. So it is important to have a good overview of when it can be helpful, before talking to the patient or any family or friends involved in their care.
The person is breathless, will oxygen help?
Breathlessness can be caused by both physical and psychological issues. Oxygen does not always alleviate breathlessness and medication may be required. It’s important to note that oxygen is a medication and has to be prescribed. The patient’s GP should leave a prescription with a flow rate in the house and there should be paperwork from the provider. The paperwork will be known as a HOOF form (home oxygen order form).
How will it be used at home?
When oxygen is provided in a hospital setting, it is generally piped from a source away from the bedside. This is not possible in a person’s home so an oxygen concentrator will be delivered by a provider. They may also leave some small canisters for travelling with. Sometimes the flow rate is fixed to the prescribed rate so that it cannot be changed without a visit from the provider. The patient will be able to use either a mask and/or nasal ‘specs’ to take the oxygen. It is important to ensure that these are changed regularly to minimise infection risk and they can be washed in warm soapy water.
If the oxygen is turned up higher, will it be more beneficial to the patient?
Oxygen is prescribed at a specific flow rate for the individual situation. It should not be increased without authorisation from a qualified professional – even if the family ask for it to be increased. Too much oxygen can be detrimental and cause further breathing difficulties. Sometimes, when too much oxygen has been given, it accumulates around the body, which is called ‘dumping’. A reddened face can be an indicator of this. Note that people with chronic obstructive pulmonary disease (COPD) in an acute period may need a higher rate.
What are the risks associated with using oxygen?
Oxygen is highly flammable and there should be no smoking in any room where it is in use. Electric razors and spray cans can also cause sparking. Canisters should be stored away from direct heat and in an upright position.
Petroleum jelly can cause blistering of the lips if applied while oxygen is in use; this should be considered when managing dry skin
The mouth and nostrils can become dry, so good mouth care is very important.
If the face mask/nasal specs are in one position for a long period of time, there may be pressure damage. To avoid this, make sure they are moved regularly or gauze pads are in place to protect the skin where they are placed.
It is important to consider how the oxygen tank and tubing will affect the patient’s mobility. For example, the tubing may become wrapped around their ankles. Sometimes, a small dose of anticipatory medication is required prior to moving the patient to help them remain calm. Ensure that the person is not drowsy as a side-effect of the medication prior to mobilising.
In a home designed for household appliances, the introduction of medical equipment may mean that extension leads and multi-sockets are used. This could put extra strain on the power supply and could potentially be a fire hazard as well as a trip hazard.
Should I try to humidify the oxygen to prevent the mouth and nasal passages from drying?
There is evidence to show that humidifying oxygen in a piped environment has a beneficial effect on how moist the nasal airways are. However, the patient is likely to be receiving oxygen via a concentrator, which will already be humid from the ambient air in the room. Some people prefer to receive humidified oxygen as a personal choice, but it is not a necessity, and there is no cause for concern if it is not available. It is important to ensure that water is sterile or boiled and cooled and topped up.
What do I do if the person dies with the oxygen running?
As with all medication, nothing can be discontinued until death has been verified by a qualified person. If the family decide to turn off the machine, that is their decision.
Points to remember
- Oxygen is a prescribed drug and should not be increased past the prescribed dose by anyone.
- There are risks associated with using oxygen at home, including explosion with smoking, blistering with petroleum jelly, pressure damage on the face, strain on the power supply and mobility issues.
- Oxygen in end of life care does not necessarily extend life – it is used mainly for symptom management.
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