Using an Oxygen Concentrator Safely at Home

The golden rules in one place

1. Use the flow and hours the doctor prescribed, and never change them yourself. 2. No smoking and no flames near oxygen, ever. 3. Keep the machine's vents and filter clear. 4. Keep a backup oxygen source and know how to use it. 5. Check the person, not just the machine. 6. Call the doctor for any change in breathing, and 112 for an emergency.

Setting up the machine

• Place it on a hard, level floor, with about 30 cm of free space on all sides, in a well-ventilated room.
• Keep it away from curtains, bedding, walls and furniture that block air flow.
• Keep it away from dust, damp, kitchens, gas stoves and incense.
• Plug it directly into an earthed wall socket. Avoid long extension leads and shared multi-plugs, and never run it from a socket that already powers a heater, geyser or air conditioner.
• Fix a No Smoking, No Flames, Oxygen in Use sign on the door, in the language of the household.
• Lay the tubing so it does not cross walkways. Tape it along the wall or use a clip so people do not trip. See falls risk assessment at home.
• Keep the supplier's phone number, the doctor's number and 112 near the machine.

Starting the machine

1. Check that the intake filter is in place and clean. 2. If a humidifier bottle is prescribed, fill it to the marked level with the type of water the maker or doctor recommends, commonly distilled or boiled and cooled water, and attach it firmly. 3. Connect the oxygen tubing to the outlet or the humidifier, and the cannula or mask to the tubing. 4. Switch on the machine and wait for any start-up period; some take a few minutes to reach full purity. 5. Set the flow knob to the prescribed number and read it at eye level, with the ball or marker aligned to the line. Many flow meters have a float; read at the centre of the ball or its top, as the manual shows. 6. Feel for gas at the end of the cannula, or watch for bubbles in the humidifier, to confirm flow. 7. Place the cannula or mask on the person correctly. See nasal cannulas and oxygen masks: choosing and caring for them.

If an alarm sounds on start, do not ignore it. Check the manual.

Never change the prescribed flow

It is common for families to turn up the flow when the person looks breathless. Do not. In some people, notably those with long-term lung disease who retain carbon dioxide, too much oxygen can cause drowsiness, headache and dangerous breathing problems. A target oxygen level, often written as a range, goes with the prescription. If your parent seems more breathless than usual, do the following instead:

• Sit them upright and help them rest; see breathlessness: positions and breathing techniques that help.
• Check that the machine is on, the tubing is not kinked or disconnected and the cannula is in place.
• Check their oxygen reading on an oximeter, mindful of its limits; see pulse oximeters: how they work and how to use one.
• Call the doctor or follow the written action plan; see building a COPD action plan with your doctor.
• Call 112 if they are severely breathless, blue around the lips, confused, drowsy or in chest pain.

For more about prescriptions, see oxygen flow rates and prescriptions: what families should know.

Fire safety

Oxygen does not burn, but it makes anything that burns do so faster and fiercer. A spark can ignite clothing, bedding or hair soaked in oxygen-enriched air. Many house fires with home oxygen involve a smoker or a flame.

• No smoking by anyone, in the room or in the home, while oxygen is in use. This includes visitors, and applies to bidis, cigarettes, hookahs and pipes. If a family member smokes, they should do so outdoors, well away, and not near the person on oxygen.
• No open flames such as candles, diyas, agarbatti, camphor, matches, lighters, gas stoves, tandoors and oil lamps in the same room or near the tubing. Keep at least two metres from them. Take particular care during festivals, pooja and Diwali, when lamps and crackers are common; see how to celebrate a risk-free Diwali with elders.
• No heaters, geysers or hot objects within the distance the maker states.
• No oil, grease, petroleum jelly, hair oil, balm or alcohol-based sanitiser on the face, hands or connections. These can ignite. For dry lips or nose, ask the doctor or pharmacist about a water-based product.
• No static or sparks: avoid wool or nylon blankets near the face when possible, and keep electrical equipment in good condition.
• Do not cook close to a person on oxygen and keep the tube out of the kitchen. Switch off the machine or move the person away if cooking requires a flame in an adjoining room, as advised by the supplier.
• Install a smoke alarm in the room or corridor, test it monthly and keep a fire extinguisher suitable for home use. Plan an escape route. See smoke and gas safety for older adults and safe use of oxygen and electrical equipment.
• If a fire starts, switch off the machine, remove the cannula, get everyone out and call 112 or the fire service. Do not fight a fire that is spreading.

Tubing and the cannula

• Use the tubing length recommended by the maker. Do not join several lengths or extend it beyond the limit, because the flow can fall and the risk of tripping rises.
• Check for kinks, cracks and tight bends daily. A pinched tube blocks oxygen without any alarm in some models.
• Replace tubing, cannulas and masks at the intervals the maker or supplier recommends, or when they are discoloured, stiff or damaged. Keep spares.
• Tuck the tube behind the ears and under the chin comfortably. Check the nose and ears daily for soreness; padding can help. Report skin damage.

The humidifier bottle

Not everyone needs a humidifier. At low flows oxygen is usually comfortable without one, but some people with a dry nose or throat benefit, as advised by the doctor or supplier. If used:

• Use the water type the maker advises, commonly distilled or boiled and cooled water.
• Empty, wash and refill it daily with fresh water; do not top up old water.
• Wash the bottle with mild soap and rinse well, and air-dry, following the manual. Replace it at the recommended interval.
• Never fill beyond the maximum line.
• Keep it upright and secure.

A dirty bottle can breed germs that are breathed into the lungs. See a cleaning schedule for breathing equipment.

Filters and cleaning

• Intake filter: usually a foam or fibre pad on the machine. Wash it weekly in warm soapy water, rinse and dry fully before replacing, or as the manual says. In dusty, smoky cities or during construction, clean it more often. Never run the machine without a filter.
• Exterior: wipe with a damp cloth. Do not spray liquids into vents or use harsh chemicals.
• Service: have the machine serviced as the maker or supplier advises, and check oxygen purity if possible.
• Dust control: avoid sweeping dry in the room; use a damp mop.

Alarms: what they mean

Alarm types vary, but typically include:

• Power failure: the machine has lost electricity. Switch to backup oxygen at once and check the socket and the plug. See oxygen at home and power cuts: a backup plan.
• Low oxygen purity: the machine is not making enough oxygen. Switch to backup and call the supplier. Do not keep using the machine.
• Low flow or blocked flow: check for kinked tubing, a blocked cannula, a loose connection or a full humidifier.
• High temperature or overheating: make sure the vents are clear, then switch off and let it cool. If it persists, use backup and call.
• Service due: call the supplier.

Do not silence an alarm and carry on if the person is unwell.

Checking the person

The machine is only half the story. Watch for:

• Breathing: rate, effort, speaking in short sentences.
• Colour: lips and fingertips that turn blue or grey.
• Alertness: unusual sleepiness, confusion or headaches in the morning.
• Oxygen reading, if the doctor advised an oximeter; see pulse oximeter accuracy.
• Skin, nose and ears: dryness, soreness or nosebleeds.

Keep a log of oxygen readings, symptoms and any machine problems. See keeping a health record at home.

When to ask a professional

Ask the doctor for a written oxygen prescription, target range, hours of use and rules for exertion and sleep, and a plan for what to do in a flare-up. Ask the supplier for training and a service schedule. Ask a pharmacist or nurse to check your technique with the oximeter. Call the doctor if breathlessness increases, if your parent is more drowsy, or if the nose, ears or skin are sore. Call 112 if your parent has severe breathlessness, blue lips, confusion, chest pain or collapse, if the machine fails and backup oxygen is not available, or if there is a fire.