Respiratory Care Guide

Respiratory Care is the health care discipline that specializes in the promotion of optimum cardiopulmonary function and health. Respiratory Therapists apply scientific principles to prevent, identify, and treat acute or chronic dysfunction of the cardiopulmonary system. Knowledge of the scientific principles underlying cardiopulmonary physiology and pathophysiology, as well as biomedical engineering and technology, enable respiratory therapists to effectively offer preventative care to, as well as assess, educate, and treat patients with cardiopulmonary deficiencies.

As a health care profession, Respiratory Care is practiced under medical direction across the health care continuum. Critical thinking, patient/environment assessment skills, and evidence-based clinical practice guidelines enable respiratory therapists to develop and implement effective care plans, patient-driven protocols, disease-based clinical pathways, and disease management programs. A variety of venues serve as the practice site for this health care profession including, but not limited to: acute care hospitals, sleep disorder centers and diagnostic laboratories, rehabilitation, research and skilled nursing facilities, patients' homes, patient transport systems, physician offices, convalescent and retirement centers, educational institutions, field representatives and wellness centers.

This page will cover the following types of respiratory qeupiment:

1. Oxygen Therapy
   • Oxygen Tanks
   • Oxygen Concentrators
   • Helpful Hints
2. Sleep Therapy (CPAP)
3. Aerosol Therapy (Nebulizer)
4. Pulse Oximeters
5. Mesothelioma

Oxygen Therapy

If you need Oxygen Therapy at home, it is important to learn how to use it and take care of your equipment. This information will help you get the most from your Oxygen Therapy.

Key points

• Breathing extra Oxygen can help you feel better and lead a more active life.
• You can travel even though you use Oxygen, but you will need to plan ahead.
• Oxygen is a fire hazard. It is important to follow safety measures to keep you and your family safe.

Oxygen Therapy is a way to increase the amount of Oxygen in the lungs and the bloodstream. It is sometimes used for people with diseases that make it hard to breathe, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or heart failure. Oxygen Therapy can make it easier to breathe and reduce the heart’s workload.

Some people need extra Oxygen all the time. Others need it from time to time throughout the day or overnight. A doctor will prescribe how much Oxygen you need, based on blood tests. He or she will tell you how much Oxygen to use per minute (flow rate) and how often to use it.

To breathe the Oxygen, most people use a nasal cannula (say "KAN-yuh-luh"), a thin tube with two prongs that fit inside your nostrils. Children and people who need high levels of Oxygen may need to use a mask that fits over the nose and mouth.

Oxygen can be delivered to your home in tanks, or cylinders, or it can be produced in your home by a machine called an Oxygen Concentrator. Your doctor will help you choose the source that fits your needs. A combination of methods may be the best choice. Some people use an Oxygen Concentrator at home, keep a large Oxygen tank on hand as a backup, and have small tanks for use outside the home.

Oxygen Tanks

Oxygen in tanks comes in two forms:

• Compressed Oxygen gas. Tanks of Oxygen gas come in several sizes. Small tanks can be carried when you leave home. Large tanks are heavy and are usually not moved after they are placed in the home.
• Liquid Oxygen. Oxygen takes up less space in liquid form than as a gas. Compared to tanks of Oxygen gas, tanks of liquid Oxygen weigh less and hold more Oxygen, so they may be a good choice for people who are active.

Oxygen Concentrators

Oxygen Concentrators are machines that take in regular air (which is about 21% Oxygen), remove the other gases, and produce Oxygen that is up to 95% pure. Most Oxygen Concentrators are about the size of a kitchen garbage can and weigh from 30 lb to 50 lb.

Oxygen Concentrators don't need to be refilled like Oxygen tanks do, so they may cost less and be more convenient. But unlike an Oxygen tank, an Oxygen Concentrator runs on electricity, so you will need an Oxygen tank as a backup in case the power goes out.

Portable Oxygen Concentrators are Oxygen Concentrators which have rechargeable internal batteries. Portable Oxygen Concentrators are lightweight and can be charged at home or in the car (with the car charger option). After charging Portable Oxygen Concentrators can be used, depending on setting, for up to about 8 hours. When traveling contact your airline and make sure that Portable Oxygen Concentrators are allowed on the flight. Some airlines accept certain manufacturer’s Oxygen Concentrators and not others.

Helpful Hints

After your doctor prescribes Oxygen and you decide on which source you will use, there are a few things to know about using Oxygen at home.

Basic instructions

• Do not change the setting on your Oxygen without talking to your doctor first. Turning the flow rate up or down could put you in danger.
• Keep track of how much Oxygen is in the tank, and order more in advance so you don't run out.
• Do not drink alcohol or take drugs that relax you, such as sleeping pills or sedatives. They can cause you to breathe too slowly.
• Call your doctor if you feel short of breath, restless or confused, very tired, or like you are not getting enough Oxygen.

If you use a nasal cannula:

• Wash the nasal prongs with soap and water 1 or 2 times a week. Follow the equipment provider’s instructions on caring for your equipment.
• Replace the nasal prongs every 2 to 4 weeks. If you have a cold or the flu, change them when your symptoms pass.
• Use a water-based moisturizer (such as Neutrogena Moisture) on your lips and in your nose to prevent drying and cracking. Read labels, and look for a product that lists water as the first ingredient. Petroleum-based products (such as Vaseline Petroleum Jelly) can plug the air holes in the cannula.
• Put a piece of gauze under the tubing to keep the skin behind your ears from chafing.

Safety tips

Oxygen is a fire hazard. It will make a flame burn hotter and faster. It is very important to follow the steps below to keep you and your family safe.

• Never smoke or let anyone else smoke while you are using Oxygen. Put up "no smoking" signs, and be aware of people smoking near you when you are outside your home.
• Keep Oxygen at least 6 ft away from flames or heat sources such as gas stoves, barbecue grills, space heaters, candles, and fireplaces.
• Do not use cleaning fluid, paint thinner, aerosol sprays, or other flammable products while you are using Oxygen.
• Keep a fire extinguisher at home within easy reach, and tell your fire department that you have Oxygen in the house.
• Keep Oxygen tanks upright. Make sure they do not fall over and get damaged.

Travel tips

Plan in advance to make sure your trip goes well.

• Talk to your doctor about whether it is safe for you to travel, and ask about any precautions you should take. Get at least one copy of your Oxygen prescription, and take it with you on the trip.
• Before the trip, tell the travel company (airline, cruise ship, train, or bus) that you use Oxygen. It’s important to talk to your travel company well in advance, because they may have requirements that can take some time to fulfill. Traveling with Oxygen can be done if you plan ahead.
• Learn how to use a portable Oxygen tank, and know how long it will last. Bring refills if needed.

Now that you have read this information, you are ready to start using Oxygen at home.

Talk with your doctor

If you have questions about this information, take it with you when you visit your doctor. You may want to mark areas or make notes in the margins where you have questions.

Sleep Therapy (CPAP)

CPAP: Is continuous positive airway pressure. CPAP is an effective treatment for obstructive sleep apnea (OSA).

At first, CPAP patients should be monitored in a sleep lab to determine the appropriate amount of air pressure for them. The first few nights on CPAP tend to be difficult, with patients experiencing less sleep. Many patients at first find the mask uncomfortable, claustrophobic or embarrassing. CPAP is not a cure and must be used every night for life. Non-compliant patients experience a full return of obstructive sleep apnea and related symptoms.

CPAP patients during sleep wear a face mask connected to a pump that forces air into the nasal passages at pressures high enough to overcome obstructions in the airway and stimulate normal breathing. The airway pressure delivered into the upper airway is continuous during both inspiration and expiration.

Nasal CPAP is currently the best treatment for severe obstructive sleep apnea. CPAP is safe and effective, even in children. Tissues are prevented from collapsing during sleep, and apnea is effectively prevented without surgical intervention. Daytime sleepiness improves or resolves. Heart function and hypertension also improve. And, importantly, the quality of life improves.

Continuous Positive Airway Pressure (CPAP) provides one constant air pressure all through the night

Automatic Positive Airway Pressure (APAP) therapy automatically varies the pressure all through the night and from night to night. It actively responds to the continuous changes in the upper airway of your patient.

Bilevel Therapy (VPAP, BiPap) provides a higher pressure when the patient inhales, and a lower pressure when they exhale.

Aerosol Therapy (Nebulizer)

A Nebulizer is a device used to administer medication to people in forms of a liquid mist to the airways. It is commonly used in treating cystic fibrosis, asthma, and other respiratory diseases.

Nebulizer pump air or Oxygen through a liquid medicine to turn it into a vapor, which is then inhaled by the patient.

As a general rule, doctors generally prefer to prescribe inhalers for their patients, not only because these are cheaper and more portable, but are often less potent and carry less risk of side effects. Nebulizers, for that reason, are usually reserved only for serious cases of respiratory disease, or severe attacks.

Newer, compact ultrasonic Nebulizers are also available. These Nebulizers use vibrating micro-mesh to produce the vapor. Nebulizers of this variety are rather expensive, and the micro-mesh is very delicate and sensitive to dust and debris.

Use & Attachments

Nebulizers usually accept their medicine in the form of a concentrated liquid, sometimes viscous. These medicines are frequently steroids, and the reason they are inhaled instead of ingested is to limit their effect to the lungs and respiratory system only. Otherwise, that amount of steroid saturated throughout the body would be toxic. This liquid is loaded into the machine for use.

Bronchodilators such as salbutamol (albuterol USAN) are often used and sometimes additionally ipratropium.

Usually, the vaporized medicine is inhaled through a tube-like mouthpiece, similar to that of an inhaler. This has the added benefit of increasing portability, as well as allowing surrounding air to mix with the medicine, decreasing the unpleasantness of the vapor. The inhaling apparatus, however, is sometimes replaced with a standard rubber face mask, similar to that used for inhaled anaesthesia, for ease of use with young children or the elderly.

After use with steroids, the person who used the Nebulizer must rinse his or her mouth because those steroids can cause yeast infection of the mouth (thrush). This is not true for bronchodilators; however, patients may still wish to rinse their mouths due to the unpleasant taste of many bronchdilating drugs.

Pulse Oximeters

A Pulse Oximeters is a medical device that indirectly measures the Oxygen saturation of a patient's blood (as opposed to measuring Oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmograph. It is often attached to a medical monitor so staff can see a patient's oxygenation at all times. Most monitors also display the heart rate. Portable, battery operated Pulse Oximeters are also available for home blood Oxygen monitoring.

Mesothelioma

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.