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MEDICAL EQUIPMENT INSTRUCTIONS

Oxygen Therapy

General Information

As we all know, breathing is an essential function of the body. We breathe oxygen into our body and exhale carbon dioxide. Oxygen is needed by the cells in the body to produce energy. Cells get the energy from a combination of the food we eat plus oxygen from the air we breathe. Food + Oxygen = Energy + Carbon Dioxide.

Oxygen is a drug that must be prescribed (ordered) by your physician if and when it is needed. Not every hospice patient will need additional oxygen. Administration of oxygen will not prolong life.

Oxygen is commonly delivered through an oxygen concentrator, as compressed gas or liquid oxygen. All three delivery systems are effective. There are also different types of equipment used by patients to receive oxygen. You may us a mask, which is worn over the nose and mouth, a nasal cannula that has two small prongs which are inserted into your nostrils, or if you have a tracheotomy, a small mask may be placed over your trach.

Prescription

Your doctor will write an order (prescription) for oxygen therapy, if needed. The order will tell you and the HospiceCare staff how much oxygen you need to receive per minute and how often you need to use it.

Your Oxygen Concentrator

What is an Oxygen Concentrator?

The Oxygen Concentrator has become the most convenient, reliable source for supplying continuous medical grade home oxygen to patient today. Regular room air consists of 21% oxygen, 78% nitrogen and 1% other gases. The Oxygen Concentrator takes room air and passes it through a molecular sieve material. This process separates the oxygen in room air from the other nitrogen gases. The end result is a continuous supply of high concentration medical grade oxygen delivered to the patient, when they need it, for as long as they need it.

How to Operate Your Oxygen Concentrator

On/Off Power Switch: Starts and stops the operation of the unit. When turning on your concentrator you will hear an alarm (beeping noise) and this noise lasts approximately 4 -10 seconds until the unit has done a self check. If beeping persists, notify HospiceCare of Southeast Florida.
Flow meter/Adjustable Knob: Controls and indicates the oxygen flow rate in liters per minute (lpm). To see the proper flow, turn the flow meter adjustable knob until the ball inside the flow meter centers on the flow line corresponding to the liter flow prescribed by your physician. To view the flow meter at the proper angle, look straight on, level with the ball. The line should be in the cent of the ball.
Your nurse will instruct you what number (liter flow) your doctor has ordered. Don't ever change the flow rate without instruction from the hospice nurse.
Air Intake Gross Particle Filter: Air enters the unit through the air intake gross particle filter located on the back or side of the oxygen concentrator. This filter removes dust particles and other impurities from the air.

MANUFACTURER RECOMMENDS THAT YOU WASH THE AIR
INTAKE FILTER WEEKLY.

Remove the filter and wash in a warm solution of soap and water. Rinse the filter and remove excess water with a soft absorbent cloth. Let air dry and insert the filter back into the unit.

Power Failure: If the electrical power goes off, your concentrator will start beeping. Turn the power off and use your back-up oxygen in case of power failure. For power surges, your concentrator will have to be re-set. On the front of the concentrator you will see a small black or white button, press to re-set your unit.

Where to Place Your Oxygen Concentrator

Locate the unit near an electrical outlet in the room where you spend most of your time.
Position the unit away from the curtains or drapes, heaters and fireplaces. Be certain to place the unit so all sides are at least 12 inches away from the wall or other obstruction.
Turn the unit so the operating controls are within easy reach and the air intake of the unit is not obstructed.

Important Safety Rules

Put up “No Smoking – Oxygen in Use” signs in your home.
In the event of an alarm, contact HospiceCare of Southeast Florida.
This device manufactures oxygen, which promotes rapid burning. Do not allow smoking or open flames, candles, gas stoves, cigars, pipes, lighters, incense, heaters, etc. within (5) feet of : (a) this device or (b) the back-up cylinder. Do not use products like cleaning fluids, paint thinner, aerosol sprays, grease, oil, or petroleum-based products on or near the unit.
If you use an oxygen concentrator, notify your electric company so you will be given priority if there is a power failure.
Disconnect the power cord from the electrical outlet before you clean or wipe down the oxygen concentrator.
Do not leave nasal cannula under bed coverings or chair cushions. If the unit is turned on but not in use, the oxygen will make the material combustible. Turn unit off when not in use.
Electrical Shock Hazard: Do not remove covers of the unit. Only trained technicians can maintain the inside of this unit.
If using an extension cord or power strip with this unit, it must be UL approved with a larger diameter than the cord on the concentrator. Cords should be secured to floor with duct tape or similar material to guard against “trip and fall” hazards.

Note: If you are prescribed 24 – hour continuous oxygen, use your Portable Oxygen “E” Tank whenever you need to turn off your oxygen concentrator.

Nasal Cannula or Mask

Replace your nasal cannula or oxygen mask every two (2) weeks. HospiceCare of Southeast Florida will leave two (2) nasal cannulas or oxygen masks during time of delivery. Your nurse will bring you additional oxygen supplies every fourteen (14) days.

Humidifier Bottle (Only When Prescribed)

Change water in humidifier daily. Maintain at least 2 inches of water in the bottle at all times. Refill using distilled water. Water level indicators are printed on the bottle.
Do not overfill. Overfilling will result in water accumulating in the tubing.
Clean humidifier every 7-10 days in a solution of 1–part, distilled white vinegar and 3–parts hot water solution (or follow the cleaning instructions provided by your DME company). Rinse with hot water and dry.
Carefully connect humidifier to concentrator to ensure a tight fit.
Replace humidifier bottle every month.

High-Humidity Trach & Aerosol Face Masks

Fill humidifier with distilled water to line.
Attach humidifier to compressor outlet.
Be sure that fittings to compressor are tight. Also check to ensure that reservoir is firmly tightened to lid of humidifier.
Turn on compressor.
A fine mist should be seen from humidifier. Leave the setting on the humidifier at 50% for adequate mist output.
Connect tubing to humidifier, place patient on mask.
Be sure to keep drain bag lower than the compressor and the patient so that tubing will drain properly. Empty drain bag using small port at bottom of bag when full.

Cleaning

Rinse out humidifier with 1-part solution of white, distilled vinegar and 3-parts water solution every 3-4 days (or follow the cleaning instructions provided by your DME company). Change humidifier, tubing, drain bag, and mask every 10-14 days.
Masks may be cleaned with soapy water or vinegar solutions as well.

How To Use Your Portable Oxygen

Portable “E” Back-Up Tank

Each oxygen back-up system includes:
1. An Oxygen E-Tank, which will supply approximately 5 hours of oxygen at approximately 2 liters per minute (lpm). Please review flowchart for additional information.
2. A cart with wheels for transportation.
3. A regulator which indicates oxygen flow rate in liters per minute (lpm) and quantity of oxygen in the tank.
4. Oxygen tubing connected to nasal cannula.
To operate your back-up tank:
1. Open the plastic tubing and connect the tubing to your regulator.
2. Turn on your oxygen by adjusting the easy to use and easy to read regulator to the flow rate you were using on the concentrator. Adjustable knob indicates the flow rate from 1-8 liters per minute (lpm). Adjust knob to correspond with prescribed liter flow.
3. Place the nasal cannula in your nose and place the tubing behind your ears.
4. Relax and breathe normally with closed mouth.

It is important to check the pressure gauge of your cylinder regularly to avoid running out of oxygen. The following chart will assist you in determining when to order more oxygen cylinders.

Portable “E” Back-Up Tank Flow Chart (Approximate)

Gauge Reading	Hours @ 1 Liter	Hours @ 2 Liters	Hours @ 3 Liters	Hours @ 4 Liters	Hours @ 5 Liters	Hours @ 6 Liters
1500 lbs	7.5	3.75	2.62	1.87	1.5	1.3
1500 lbs	7.5	3.75	2.62	1.87	1.5	1.3
1000 lbs	5	2.5	1.75	1.25	1	.875
500 lbs	2.5	1.25	.875	.625	.5	.437

Transporting and Using your Portable “E” Back-Up Tank Safety

Do not smoke in vehicles and never around your oxygen equipment.
Securely fasten your oxygen tank in the back of the vehicle. Secure the tank with a seat belt.
Do not transport or store your tank in the trunk of your vehicle.
Do not leave your oxygen tank in your vehicle during warm weather, even for a short period of time.
Always remove the oxygen tank upon returning home. Do not store the oxygen tank in the vehicle.
Do not allow smoking or open flames, candles, gas stoves, cigars, pipes, lighters, incense, etc. within five (5) feet of the back-up cylinder. Do not use grease, oil, or petroleum-based products on or near the unit.
Do not leave the nasal cannula under bed coverings or chair cushions. If this unit is turned on but not in use, the oxygen will make the material combustible. Turn off unit when not in use.

H-Tank

H-Tanks are large non-portable tanks. H-tanks are most frequently ordered for emergency back-up for HospiceCare patients who use oxygen due to the potential for our patients to experience a short power outage for assorted reasons or a longer loss of electrical power due to a tropical storm or hurricane. H-tanks are preferred to the smaller E-tanks because they can be relied on to last for a significantly longer period of time. (Days rather than hours). The H-tank will be delivered and set up in your home. It should not be moved by anyone other thank the equipment company. Do not place the tank outside, on a patio, or in a garage. It should be in or near your bedroom.

How to Operate Your H-Tank

Open the plastic tubing and connect the tubing to your regulator.
Use wrench, as directed, to allow oxygen from cylinder to flow to regulator.
Turn on the oxygen by adjusting the easy to use and easy to read regulator to the flow rate you ere using on the concentrator. Adjustable knob indicates the flow rate from 1-8 liters per minute. Adjust knob to correspond with prescribed liter flow.
Place the nasal cannula in your nose and place the tubing behind your ears.
Relax and breathe normally through your nose. (If patient is breathing through their mouth don't be worried. Oxygen is still being delivered for comfort).

PSI

2200

2000

1800

1600

1400

1200

1000

800

600

400

200

L
P
M

2 Days
7 Hrs

2 Days
3 Hrs

1 Day
21 Hrs

1 Day
16 Hrs
48 Min

1 Day
12 Hrs

1 Day
7 Hrs

1 Day
2 Hrs

20 Hrs
54 Min

15 Hrs
42 Min

10 Hrs
24 Min

5 Hrs
12 Min

1 Day
12 Hrs

1 Days
9 Hrs

1 Day
7 Hrs

1 Day
3 Hrs

1 Day
9 Hrs
36 Min

20 Hrs
54 Min

17 Hrs
23 Min

13 Hrs
54 Min

6 Hrs
54 Min

3 Hrs
24 Min

1 Days
4 Hrs

1 Days
2 Hrs

23 Hrs
30 Min

20 Hrs
54 Min

18 Hrs
18 Min

15 Hrs
16 Min

13 Hrs

10 Hrs
24 Min

7 Hrs
48 Min

5 Hrs
12 Min

2 Hrs
36 Min

Hand-Held Nebulizer/Compressor
Therapy and Cleaning Instructions

THERAPY INSTRUCTIONS

Connect power cord to grounded outlet.
Connect all tubing and nebulizer assembly to compressor.
Mix medication and place in nebulizer.
Be sure to keep nebulizer in upright position so that medication will not spill and will aerosolize.
Turn compressor on.
Place mouthpiece in mouth.
Inhale in slow, deep breaths; hold briefly, and then exhale slowly.
Continue treatment until all medication is used (10 to 15 minuets, average).
Turn compressor off.
Follow cleaning instructions carefully.

CLEANING INSTRUCTIONS/NEBULIZER

Completely disassemble after last treatment of the day.
Wash all parts in hot, soapy water (mild liquid dish detergent).
Rinse all parts in clean, warm water.
Soak all parts in solution of 1-part distilled, white vinegar to 3-part water for 30 minutes (or follow the cleaning instructions provided by your DME company).
Rinse all parts in warm, running water.
Shake excess water from all parts and allow to air dry on paper towel.

IMPORTANT

Rinse and dry nebulizer and mouthpiece after each treatment and allow to air dry on paper towel. Do not leave medication in nebulizer from one treatment to the next. Poor or infrequent cleaning may result in lung infections. Nebulizer sets are considered disposable and should be replaced when discoloration or leaking occurs.

Aspirator/Suction Machine
Therapy and Cleaning Instructions

THERAPY INSTRUCTIONS

Connect power cord to grounded outlet.
Connect all tubing to machine.
Connect suction catheter (oral suction only) to tubing.
Turn machine on.
Follow suction instructions as prescribed by your nurse (suction should be applied intermittently. Suction periods should be brief (no longer than 8-10 seconds). The suction will automatically stop when the liquid reaches the “full” level in the bottle.

EMPTY SUCTION BOTTLE

Shut off unit using power switch and unplug the power cord
Remove the lid from the collection bottle
Empty the contents into the bathroom toilet
Rinse bottle with water, emptying into toilet
Replace lid on bottle
Re-connect power cord

CLEANING INSTRUCTIONS/COLLECTING UNIT AND TUBING

Clean daily in hot, soapy water.
Rinse with warm water.
Clean tubing using 1-part distilled, white vinegar to 3-part tap water (or follow the cleaning instruction included from your DME company). Suction cleaning solution through tubing into collection unit to cut mucus in tubing and to freshen collection unit.
Discard solution.
Rinse tubing with clean water by repeating above procedure.
Rinse collection unit with clear water.
Allow all parts to air dry.

Fully Electric Hospital Bed

The hospital bed is divided into five parts:

The Bed Frame
The frame of your bed id constructed to hold a maximum of 350 pounds safely. For patients over that limit, a special bed may be required.
The Head & Foot Boards
The bed ends have wheels on the bottom of them. The foot end will have a wheel lock. You can lock the wheels by pressing the lock “on” with your foot. The lock should always be “on” unless the bed is being moved for housekeeping purposes.
The Mattress
Your hospital bed comes with a mattress size 36” by 80”. This is longer than a standard twin size bed. It is recommended that you purchase hospital bed, fitted sheets. However, you can use a full size bed flat sheet and tuck the excess under the mattress. The mattress is not waterproof, therefore, if the patient is incontinent, it is recommended to use either blue pads or a vinyl mattress cover to protect the mattress. It is also recommended to turn your mattress every 15 days to keep it feeling comfortable to your patient.
The Bedside Rails
The bedside rails are used to keep the patient from rolling off the bed. They are not to be used as a device to restrain the patient. To operate the rails, raise one end upward until that end locks into place, and then do the same for the other end. To lower the rail, release one end of the rail by pushing or pulling the latch (depending on your rail style) and lowering that end. Repeat the process for each end of each rail.
The Hand Controls
There is a manual crank located between the mattress and the springs. This crank is used if you have a power failure and need to change the position of the patient. When using the crank, connect it to the motor by pushing the end of the crank into the end of the motor that you desire to change. The middle motor does not have a slot so you can connect the crank into the slot located in the lower center of the foot board.

CAUTION: Do not operate the electric bed with an extension cord smaller than
14-gauge wire and be sure to use a grounded wire. 2-prong adapters are
acceptable if they are grounded properly.

Safety Issues with Hospital Beds & Bed Rails

Although side rails were once used routinely by patients and caregivers when a hospital bed is placed in the home, health care professional are now re-examining the use of bed rails following recent reports of patient injury and even death of patients who slipped and became trapped or entangled with bed or mattress. The Food and Drug Administration, which has regulatory responsibility for restraints and side rails, reports: Potential benefits of bed rails include:

Aid in turning and repositioning the patient within the bed
Provide a handhold for getting into and out of the bed
Provide a feeling of comfort and security
Reduce risk of patient falling out of bed when being transported
Provide easy access to bed controls and personal care items.

Potential risks of bed rails may include:

Strangulation, suffocation, bodily injury or death when patients or parts of their body are caught between the rails or between the bed rails and the mattress
Injuries from falls are often more serious when patients climb over the rails, rather than just falling out of bed
Skin bruising, cuts, and scrapes may occur
Agitated behavior is sometimes produced when bed rails are used as a restraint
Patients may feel isolated or unnecessarily restricted
Prevents patients who are able to get out of bed from performing routine activities like going to the bathroom or retrieving something from another part of the room

The FDA stresses that there are other effective ways to increase the safety of patients in hospital beds. These include:

Using the beds that can be raised and lowered close to the floor to meet the needs of both patients and their caregivers
Keep the bed in the lowest position with the wheels locked, except when the patient is actually receiving care
If the patient seems likely to fall out of bed, place meats on the floor next to the bed. Take care not to crate a greater risk by using mats that may slip or present some other hazard.
Use aids, such as a trapeze, to transfer the patient and for moving the patient in the bed
Monitor bed-bound patient frequently
Think about the reasons a patient might want to get out of bed and offer periodic help with such needs as hunger, thirst, going to the bathroom, restlessness and pain
Offer food and fluids on a regular schedule, provide frequent opportunities for toileting, provide a calming presence by being with the patient as often as possible, and intervene to relieve or prevent pain before it becomes upsetting to the patient

If bed rails are used perform an ongoing assessment of the patient's physical and mental status. Closely monitor patients who are at risk for falls. Consider the following as well:

Lower one or more section of the bed rail, such as the foot rail
Use the proper size mattress or a mattress with raised foam edges to prevent patients from being trapped between the mattress and the rail
Reduce gaps between the mattress and the side rails

Special Instructions:

Alternating Pressure Pad

Your alternating pressure pad is divided into three parts:

The Pump
The pump should be hung on the foot board and plugged in a standard 110V household outlet.
The Connecting Tubing
The connecting tubing should be kept from binding when the bed is raised and lowered. Connect the tubing to the pad. It does not make any difference which tube goes to which side.
The Pad
The pad should be placed with the proper side up. This is usually marked on the flap. To inflate the pad the patient can be on or off the pad, however, it is recommended that the patient be off the bed. Turn the setting to the highest point for about fifteen (15) minutes and then adjust for comfort.
Thin foam can be placed over the vinyl pad for more comfort. After the pad is inflated, perform a hand check as follows:
1. With the patient on his or her back, slide your hand, flat and palm up, between the air pad and mattress directly under the patient's buttocks.
2. Wait for full inflation of the air pad directly above your hand. If you cannot feel the patient's body in direct contact with your hand, the system is operating correctly.
3. If, during full inflation of the pad, the patient's body is in direct contact with your flat hand, the system is not operating properly. Adjust the pressure control to a higher setting. Wait five (5) minutes and repeat the hand check. If the hand check fails, check that the pad hoses are not kinked (bent), contact HospiceCare of Southeast Florida for further instructions.

Cleaning Procedures

Soap and water can be used to wipe off the pad and pump; however, DO NOT CLEAN THE PUMP WHILE IT IS PLUGGED IN.

Over Bed Table

Light upward touch with spring loaded locking handle allows table to elevate freely. Light downward touch on tabletop locks table into position. Do not overload the table with excessive weight or place heavy items to any one side. Items should be distributed evenly across the surface, examples; food, reading materials, medicines. Never adjust the height of the table with contents on it.

Commode

Height should be adjusted so the two side grab handles are even with the patient's hip. Adjust commode to the desired height by pressing in the push button and sliding the leg upward or downward until the button is fully engaged in the desired hole. Make sure all legs are adjusted to the same height. Do not place the commode in the bathtub or on any uneven surface.

You may use your commode bedside the bed or placed over the toilet.

To use as a bedside commode: Make sure the commode is adjusted to the desired height. Lift commode seat. Place commode pail into the frame. Lower the seat. The commode is ready for use. Patient should place both hands on the commode handles whenever getting on or off of it. When finished, raise seat and remove bucket and empty contents. Wash, clean and replace.

To use over the toilet: The commode will fit over most toilet bowls and function as a raised toilet seat and safety frame. When fitting the commode over a toilet bowl, the pail and lid should be removed. The splash shield should be left in place and the back bar (if included) should be removed.

Folding Walker or Walker with Wheels

Pull open walker until you hear it locking into position. Height will be adjusted by our staff so that the handle is even with the patient's hip. Always keep both hands on the handles and lift or wheel the walker and place it in front of you, then walk up to it.

Universal Straight Cane or Quad Cane

Straight Cane can be used universally for a left or right handed patient. Quad Cane has a lower adjustment tab for left or right handed use. Height will be adjusted by our staff so that the handle is even with the patient's hip.

Patient Lift

Used to lift the patient from the bed, wheelchair, commode, etc…The lift will lock and release by hydraulic pressure and the base will widen for additional stability and close to slide under a chair, etc.

Hydraulic Lifts & Slings

Using Your Equipment:

Before lifting patient, spread base legs fully outward with lever next to mast
Adjust sling straps or chains to proper height
Slide into position near patient being careful of swinging hanger
Once patient is in sling, lift just enough to clear surface & allow swivel

Special Procedures:

Patient lying down
- Roll patient away from you
- Lay sling (patient side up) on surface where patient was laying
- Adjust position of sling to line up with patient's buttocks and torso
- Roll patient back to lying position over sling
- Roll lift into place, and then lower boom to attach straps or chains to sling
Lifting from a seated position
- Stand in front of a chair facing the patient
- Lean patient forward so your body supports their weight
- Hold sling by top. Allow remainder of sling material to drop behind patient to the seat of the chair
- To position the sling material under the patient's buttocks:
  1. Lean patient to one side
  2. Reach underneath the patient's raised buttocks
  3. Firmly grasp sling material and pull toward patient's leg
  4. Repeat for other leg by switching the patient to lean in the opposite direction
  5. Once sling is properly positioned, roll lift into position and attach chains or straps
Lifting from floor
- Repeat as for patient lying in bed
- Check for pinch points on patient where the sling makes weight-bearing contact. Do this before rolling the lift away from the “transfer from” surface.
- When moving lift (occupied) push slowly and smoothly towards “transfer to” surface.

Trapeze

Large “L” shaped bar attached to headboard of hospital bed. The trapeze is not designed to support the fully body of the patient. The patient uses the trapeze to assist in sitting up and changing positions in bed. The trapeze can be adjusted by use of an “S” shaped hook in the chain links to make the trapeze easier to use for the patient.

Wheelchair-Standard

Always apply wheel locks before getting in or out of wheelchair. Lower foot plates, then release brakes to roll wheelchair as needed. To fold up chair, lift the seat and the chair will fold for easy storage.

Wheelchair-Companion/Transport

This chair is used for patient who do not have the ability to roll themselves. Always apply wheel locks before getting in or out of the companion chair. Lower foot plates then release wheel locks to allow chair to be pushed. To fold up chair, lift the seat and the chair will fold for easy storage.

Wheelchair-Elevating Leg Rests

This wheelchair is made for the patient who must elevate his/her legs. Always apply wheel locks before getting in or out of wheelchair. Lower foot plates and then release wheel locks to roll wheelchair as needed. To fold up chair, lift the seat and the chair will fold for easy storage.

Wheelchair-Removable Arms

This wheelchair is made for the patient who has no lower body strength to stand. It allows patients easier access from the wheelchair to a commode, bed, etc. Always apply wheel locks before getting in or out of the wheelchair. Lower foot plates and then release wheel locks to roll wheelchair as needed. To fold up chair, lift the seat and the chair will fold for easy storage.

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