Oxygen Tank Safety Precautions and Usage in Occupational Therapy

Introduction

As a therapist, if you have never worked with or been around oxygen (o2) tanks, they can be quite intimidating. While the risks of injury and death are there, if proper precautions are taken, you can be confident that you, your patient, and their caregivers are safe. OTs also play a role in educating patients and their caregivers on breathing, oxygen use, and safety precautions not only for ADLS, but with reintegration into the community with IADLs (including storage and use in car), return to work, and so on.

Oxygen Delivery Methods

You would likely encounter oxygen tanks most often in the hospital and in skilled nursing facilities. You may encounter oxygen tanks in homes for home health as well. However, the logistics and difficulty in getting oxygen tanks replenished when they run out make them less convenient than an oxygen compressor device. Long term oxygen users, such as people with COPD will likely have an oxygen concentrator at home. These devices carry much less risk compared to oxygen tanks as there is no highly concentrated pressure inside of a potentially large projectile.

In the hospital, the preferred method for oxygen delivery is through the hospital’s oxygen fixtures located on the wall at the head of the bed. From a therapy standpoint, they are the preferred method as they do not “run out” like an oxygen tank would.

An occupational therapist may encounter patients on:

• Room air (no oxygen)
• Supplemental oxygen via nasal cannula
• Oxygen mask
• Bipap/Cpap
• High flow oxygen via nasal cannula (HFNC) or oxygen mask

If a patient is having dyspnea, they would likely be on higher flow, e.g. 6 liters/min (LPM) or more. While this may not seem like a lot relative to high flow oxygen, if your tank is running low – oxygen can run out during your session. However, this is not the end of the world. Troubleshoot the problem or ask for assistance. Patient’s often can make it back to their room or can take a rest break (standing, sitting).

Scenarios

– In the hospital (acute care & acute rehab), in skilled nursing, at home.

– Patient is “sat’ing” <90% (non-COPD) or <85% (COPD) and you have an oxygen tank available.

– Outpatient patients often manage their own oxygen and are ambulatory.

– If patients are on oxygen masks (non-rebreathers), you probably would not be mobilizing them on an O2 tank.

– Activities

• Mobilizing patient out of bed to walk around the room (and tubing to wall is too short)
• Using the bathroom
• Walking in the hallway or outside
• Doing therapy in the gym, activity room, simulated IADLs
• Taking a shower

Safety Precautions

• Keep oxygen tank away from open flames and heat sources.
• While in use, keep away from aerosols (hair spray, paint), oil-based creams or lotions, petroleum-based products (vaseline).
• No smoking or allowing others to smoke; post signage outside the home for visitors prior to entry.
• Store properly (e.g., upright, as the tank can roll away).
• Keep out of reach of pets and children.
• Ensure smoke detectors are functional.
• Inspect all parts for damage prior to use.
• Manage tubing to reduce injury or tripping hazard.
• Store in a well-ventilated area, e.g., not the closet (unless well-ventilated).

Considerations

• Oxygen tubing length
• Monitoring respiration and signs of increased dyspnea or altered cognition.
• Having a pulse oximeter to test during and after exertion.
• Being within reach of a vitals machine.

Use

Consider becoming trained on how to use an oxygen tank, regulator, wrench, tubing, nasal cannula, etc. on the job first.

Using a new oxygen tank

Be sure not to point tank at self or anyone while installing or removing the regulator.

1. Gather all supplies (tank, regulator, wrength, oxygen delivery extension tubing (optional), nasal cannula, tank cart with wheels).
2. Observe and follow precautions as mentioned above.
3. Check for any signs of damage to the tank or other parts.
4. Remove plastic seals (that mark them as new) from oxygen openings and discard. These are often bright-colored & circular such as green, similar to how a new fire extinguisher is sealed with plastic tabs.
5. Check to see that regulator has an “O” ring/washer – often black colored.
6. Turn flow regulator to 0 (off).
7. Slide regulator on top of valve post and align regulator with oxygen tank holes.
8. Hand tighten T-handle on regulator (do not over tighten).
9. Use a wrench to open valve (counter-clockwise) 1 full turn.
10. Listen for any leaks. There should be no major leaking sound. If leak is present, close the valve with wrench (clockwise), loosen T-handle and recheck the alignment of the regulator as well as the position of the o-ring. O-rings may be damaged or missing. Try another regulator if you have one.
11. If no leaks, check the gauge for the amount of oxygen available inside. If empty, undo these steps, store the oxygen tank in the used section, and find a new tank.
12. Place the tank on rolling oxygen tank cart with wheels for ease of mobilizing with the patient.
13. Insert tubing into regulator oxygen outlet (looks similar to the “Christmas tree” on the oxygen fixtures on the hospital walls).
14. Place nasal cannula on patient (prongs facing DOWN inside nose).
15. Open O2 the same LPM as on the wall.
16. Ask patient if the oxygen delivery is sufficient and working.
17. Periodically monitor oxygen gauge for how much oxygen is left.

Changing out a tank (removing regulator)

When empty or near empty.

1. Turn off oxygen to 0.
2. Using a wrench, turn the tank on/off valve clockwise until closed.
3. Open the oxygen flow regular control from 0 to “Bleed” out any excess oxygen remaining.
4. When the gauge reads empty, turn the flow regulator back to 0.
5. Remove the regulator by loosening the T-handle.
6. Follow the above steps to install the regulator and tubing on a new tank.

Tips

• Consider having an extra helper (or co-treating) to bring the oxygen tank on the cart.
• Otherwise, one hand will be required if alone to pull the oxygen tank cart.
• If pushing a wheelchair and bringing an oxygen tank on a cart, one hand can be used to push a wheelchair and another to pull the oxygen tank OR have the patient who is seated in a wheelchair help “push” the oxygen tank as you push them together in the wheelchair. If there is room, the oxygen tank may be supported on a wheelchair (depending on the patient’s habitus) leg rest partially as well.
• If not comfortable bringing a patient (or due to patient’s habitus, obesity) on a wheelchair and an oxygen tank, consider temporarily disconnecting oxygen and bringing oxygen tank to the destination first, e.g. patient shower room, and coming back for the patient on the wheelchair and making 2 trips.
• If the patient is on IV and O2, but is stable, ask the nurse if IV can be temporarily disconnected so you will not have the added burden of the IV pole.
• Remember to reconnect the patient back to hospital wall oxygen so you do not drain the oxygen tank empty. (It will not last very long either!)
• Encourage therapeutic breathing (“in through your nose”).