Breathing Easy: The Comprehensive Guide to Oxygen Equipment, Usage, and Maintenance

Millions of people live with chronic pulmonary diseases including sleep apnea, pulmonary fibrosis, pulmonary hypertension, COPD, pneumonia, cystic fibrosis, and pneumonia. And many people with pulmonary diseases need either temporary or long-term support from specialized oxygen equipment. Although oxygen is critical for life, for many people, transitioning to supplemental oxygen feels like a huge burden. This comprehensive guide to oxygen equipment will help you master the equipment which can help you enjoy your life.

This guide will help you understand the different types of oxygen concentrators, how to use them, and how to properly maintain them.

Importantly, walking freely, and enjoying time with your friends and family while suffering from a pulmonary disease is not a myth! You simply need to learn the basics and follow specific steps to maintain your health and stay active.

Comprehensive guide to oxygen equipment: Types of devices. 

There are three general types of oxygen therapy devices, each with their own benefits and quirks. Importantly, ask your doctor about which option is best for your needs.

Types of oxygen devices include the following:

Stationary oxygen concentrators. 

The stationary concentrator, which you plug into a wall socket, is widely used for indoor oxygen therapy for patients who need a high volume of oxygen.

Stationary oxygen concentrators work by pulling in ambient air (which is roughly 21% oxygen), scrubbing out the nitrogen through a molecular sieve, and delivering 90–95% pure oxygen to the user.

Benefits.

• They never run out of oxygen if they are plugged in to a working power source – no worrying about rechargeable batteries.
• They provide a large, uninterrupted volume of oxygen.
• It’s a cost-effective solution.

Concerns.

• They emit a loud noise.
• They generate a lot of heat.
• The large size (weight of up to 22 pounds) can make it hard to move it around the house, although the units have wheels.
• These electric systems will not work during a power outage. However, some come with back-up battery systems or a back-up tank of compressed oxygen.

Portable Oxygen Concentrators (POCs)

Importantly, POCs have revolutionized patient mobility. With POCs, oxygen is delivered through a lightweight, battery-operated mobile device that use electrical pumps to extract oxygen from the air, allowing the delivery of a continuous and unlimited supply of oxygen.

You can either plug them in or use batteries.

POCs typically provide Pulse Dose oxygen delivery, which uses a sensor to deliver a “bolus” (burst) of oxygen only when you begin to inhale. 

Benefits.

The positive aspects of POCs include:

• POCs are extremely versatile, giving you the freedom to go almost anywhere, anytime you want.
• Many models are FAA-approved for use on airplanes!
• The oxygen never runs out – you never have to refill a tank.

Concerns.

Limitations of POCs include the following:

• Smaller, lighter units produce a limited amount of oxygen (often 1 L/min or less).
• Pulse dose oxygen delivery only provides oxygen during parts of the breath – generally the beginning of inspiration.
• Generally, these cannot be used when continuous flow oxygen is required.
• POCs are expensive and may not be covered by insurance.

Notably, some models offer a modest battery that can die in 2 hours, although others have extended batteries that can last up to 12 hours. Importantly, the longevity of a battery charge depends on your prescribed oxygen flow setting, the delivery mode (pulse vs. continuous flow), the age of the battery, exposure to extreme temperatures, and how you charge and store the device.

Importantly, all oxygen concentrators approved or cleared by the FDA for sale or use in the US require a prescription. Although you may see ads for portable oxygen concentrators that don’t require a prescription, they may not meet your oxygen needs. Talk to your doctor before ordering a unit on your own.

Compressed oxygen systems.

These systems consist of steel or aluminum cylinder tanks filled with a finite, pre-pressurized supply of gas that is at least 99.5% pure oxygen. 

Benefits.

The cylinder has a regulator so you can control how much oxygen you get. Additionally, a regulator allows you to breathe in compressed oxygen when you inhale and stops the flow when you exhale.

Concerns.

• Once the gas in the tank is depleted, an oxygen supplier must replace or refill the cylinder.
• You must regularly check the gauge on the tank to allow enough time for the supplier to deliver refills or replacements,

Liquid oxygen systems.

A liquid oxygen tank holds 100% oxygen as a very cold liquid. All liquid oxygen systems consist of two essential components – the reservoir and the portable. The reservoir – a large tank weighing over 120 pounds – contains liquid oxygen. Users fill their portable liquid oxygen units with oxygen from the reservoir, which generally stays in the home.

When you release oxygen from the tank, it converts into a gas that you breathe in.  Interestingly, liquid oxygen systems are rarely used nowadays, unless patients need high flow rates of oxygen.

Benefits.

• Works efficiently.
• Portable (its cylinder is smaller than the compressed gas tanks).
• Lightweight.
• No batteries or electricity needed.
• No electronics that could break or become unreliable.

Concerns.

• Liquid oxygen can be dangerous. Accidental exposure can cause cryogenic burns (a burn from extremely cold temperatures) or frostbite.
• Oxygen evaporates from the unit over time, even if the unit is not used.

Importantly, if you hear a hissing sound, there may be a leak, pressure issue, regulator malfunction, or equipment wear and tear. This is a safety hazard that requires immediate attention.

Comprehensive guide to oxygen equipment: How to choose a device.

Firstly, talk to your doctor about which device best suits your needs.

Consider these factors when thinking about which type of oxygen system would work best for you:

• The amount of oxygen your doctor prescribes for you currently, and how your need for oxygen may increase over time.
• How often and for how long you would like to leave your house.
• Types of activities you wish to participate in while you are out of the house.
• Your size, strength and endurance versus the weight and portability of the equipment.
• The size and layout of your home (for example, do you need access to more than one level in your house).
• Whether you breathe through your nose or your mouth.
• Your dexterity – how easily can you manipulate controls and other small items.
• Your personal preferences.

When discussing options with your doctor, realize that device manufacturers may not provide uniform, detailed information on their devices, which makes it hard for doctors and patients to choose the best option.

Do your research.

Before choosing a device, make sure you learn the following:

• Amount of oxygen produced (capability) and available settings.
• As applicable, find out about the battery life (duration), size, weight, sound level, and how you will carry it or roll it.
• The manufacturer’s and seller’s ratings, warranty, and return, and repair policy.
• Complete manufacturer information provided with the owner’s manual, plus instructions on YouTube videos for models you are considering.

Importantly, understanding a device’s use and limitations is essential for effectiveness and safety.

Comprehensive guide to oxygen equipment: Getting the right interface.

Using oxygen correctly is more than just turning a dial. It requires understanding the interface between the machine and your body. Talk to your medical team to determine which type of interface is right for you – nasal cannulas or masks.

Units with nasal cannulas.

The nasal cannula, the most common interface, consists of two prongs that sit in the nostrils.

Because cannulas come in different sizes, it’s important to choose the best fit for your nostril size and shape. The nose piece should fit snugly into your nostrils without coming out, but it should not go too far back. When the right size is properly placed, it should feel comfortable without pinching or rubbing, which could indicate you have the wrong size.

Units with oxygen masks.

Masks are typically used by patients requiring higher flow rates (usually above 6 LPM) or those who find nasal cannulas too irritating.

There are several types of masks you can choose from, including:

• Simple face masks which cover the nose and mouth. These masks are generally used for short-term therapy.
• Open oxygen masks which are lightweight face masks with openings that improve oxygen delivery and comfort. One example is an OxyMask™.
• Non-rebreather masks which deliver high concentrations of oxygen for people who need oxygen quickly in emergencies like injury, smoke inhalation or carbon monoxide poisoning. It’s not available to use at home.
• Venturi masks which use color-coded valves to deliver a very precise percentage of oxygen. Importantly, these masks are often used in hospital settings for COPD patients sensitive to oxygen levels. However, these masks can be used at home under strict medical supervision for people who require highly accurate oxygen delivery.

Comprehensive guide to oxygen equipment: How much does it cost?

Fortunately, portable oxygen concentrators and other oxygen systems are considered durable medical equipment (DME) by Medicare, Medicaid, and most private health insurance plans. Importantly, for any coverage, you will need a prescription from your doctor for home use.

Your insurance plan may cover these costs:

• Purchase or rental of the oxygen equipment itself.
• Tubing or a mouthpiece.
• Oxygen contents.
• Device servicing, maintenance and repairs.

Ask your insurance provider to give you a detailed explanation of what is covered and what is not covered, and what percentage of the costs you will be responsible for. Make sure to ask about supplies and maintenance costs.

If you don’t have insurance coverage, you must pay for a device yourself. Expect to pay $2,000+ for a new POC device, and $1,000+ for a used device. You can also rent a device by the month. Notably, features such as its weight, oxygen output, and battery life can impact the cost.

Comprehensive guide to oxygen equipment: Tips for nasal cannula users.

Properly caring for your skin and your cannula can make you more comfortable.

Unfortunately, many people wear cannulas backward. Make sure the prongs curve downward towards the throat, following the natural path of the nasal passage.

Once you have the cannulas in correctly, loop the tubing over your ears and use the sliding bolster to tighten it under the chin. Importantly, never tighten the tubing behind your head – this can cause the prongs to dislodge during sleep.

Minimizing irritation from cannulas.

Using a nasal cannula can irritate or dry out your skin, nose, and lips. These tips can make you more comfortable:

• Use a water-based lotion to soothe your lips and nose. Importantly, water should be the first ingredient on the lotion’s label.
• Avoid products that contain oil, such as petroleum jelly, because this can plug the holes in your cannula.
• Use saline spray if the inside of your nose feels dry.
• If the tubing irritates the skin behind your ears, try putting ear wraps or a piece of gauze between the tubes and your skin. Also, you can ask your oxygen equipment provider for foam cushions to relieve discomfort behind your ears.

Take proper care of your cannula.

Take the following steps to properly care for your cannula:

• Wash the prongs (the part that goes inside your nose) with soap and water once or twice a week.
• Replace the cannula every 2 to 4 weeks, or more often as needed. However, if you have a cold or the flu, don’t change the prongs until your symptoms are gone.

Comprehensive guide to oxygen equipment: Tips for mask users. 

If you use a mask, proper hygiene is your first line of defense against skin breakdown and infection. Unlike a cannula, which is replaced frequently, masks are often used for longer periods and require consistent attention.

How to prevent skin irritation and face marks?

The constant pressure of a mask against the bridge of the nose and the cheeks can cause “pressure sores.” To minimize irritation, you must properly manage the pressure, friction, and moisture. Importantly, follow these steps:

Regular cleaning.

Because skin oils and sweat accumulate on the silicone seal of the mask, regularly wash the mask with mild, unscented dish soap and warm water. Wash the mask a minimum of two times a week, but you might want to wash it daily. Never use bleach or harsh chemicals, which can degrade the material and irritate your lungs.

Always keep the mask dry.

After washing, let your mask air-dry completely. A damp mask is a breeding ground for mold and bacteria.

Don’t overtighten the straps.

Overtightened straps can cause soreness on your face. Work with your doctor or respiratory therapist to understand the correct tightness that will maximize performance while minimizing discomfort.

Use a physical barrier.

To avoid soreness, you can use a small cloth barrier under the straps that cause you discomfort. You can ask your oxygen equipment supplier for foam cushions to relieve discomfort behind your ears.

Comprehensive guide to oxygen equipment: Tips for CPAP users.

CPAP users can develop painful red marks, sores, acne, and rashes, particularly people with sensitive skin. The following tips can reduce your discomfort.

• Work with your doctor to choose the right CPAP mask for your face and medical needs. Interestingly, newer CPAP masks have fewer contact points and less plastic exposed to your face which can improve comfort.
• Work with your doctor to make sure your mask fits properly. Your mask should be just tight enough to create a firm but comfortable seal over your face.
• Keep your face and mask clean by washing your face before bed every night. Additionally, clean your CPAP mask – including the cushion, headgear, and frame – with mild soap and warm water every day.
• Replace your CPAP mask when it shows signs of wear, including dryness, stiffness, cracking, and discoloration.
• In addition to cleaning your mask, regularly clean your CPAP machine. Follow the guidelines for your machine.
• If you suspect the silicone cushion is irritating your skin, ask your doctor about masks made from skin-friendly materials, such as breathable memory foam.
• If you have irritated skin, ask your doctor if a mask liner would help. Additionally, you can try barrier creams and petroleum-free moisturizers to relieve irritated skin. But make sure you wash it off before using your mask.

Additionally, if you see signs of pink mold (or other colored mold) clean the tank with a mixture of water and vinegar or hydrogen peroxide. Check your users manual for instructions.

Comprehensive guide to oxygen equipment: Tips for humidifiers.

If you use a device with a humidifier to prevent airways from drying out, follow these guidelines:

• Empty it at least once a day.
• Wash the bottle with soap and warm water, making sure all the soap is rinsed out.
• Refill the bottle with distilled water. Importantly, do not use tap water, as the minerals in it can damage your equipment.

The “Pink Slime” warning.

If you see a pinkish tint in your humidifier bottle, that is Serratia marcescens bacteria, which can cause respiratory issues. Dump the water immediately, soak the bottle in water mixed with either vinegar or hydrogen peroxide – check with user’s manual.

Comprehensive guide to oxygen equipment: Precautions for safe usage.

Keep away from heat and flames.

Follow these tips from Lung.org to avoid dangerous issues:

• Don’t smoke and don’t let others smoke near you. If needed, post “No Smoking” and “No Open Flames” signs in and outside your home.
• Keep sources of heat and flame at least 5 feet away from where your use or store your oxygen unit.
• Never use oxygen while cooking with gas.
• Don’t use any electrical appliances such as hair dryers, curling irons, heating pads and electric razors while wearing oxygen.
• If you use an oxygen system while sleeping, consider using 100% cotton bedding which is less likely to cause static electricity.
• Always keep a functioning fire extinguisher nearby.

If you must cook, use an electric slow cooker or microwave. And don’t remove your oxygen mask to cook without your doctor’s approval.

Importantly, keep a functioning fire extinguisher nearby at all times. Additionally, regularly check your smoke alarms to make sure they are in good working order. Set reminders on your calendar to change the batteries.

Avoid volatile beauty products.

Although many of these products are widely used, they can be dangerous near oxygen systems. Follow these tips from Lung.org to stay safe:

• Don’t use aerosol sprays (for instance, air fresheners or hairspray) near the oxygen unit. Importantly, aerosols are very flammable.
• Avoid flammable creams and lotions such as vapor rubs, petroleum jelly or oil-based hand lotion. Instead, use water-based products.
• Never put oil on the oxygen unit, and don’t use it with oily or greasy hands.
• Don’t use alcohol-based hand sanitizers unless you thoroughly rub them into your skin and let your hands dry completely before handling oxygen equipment.

Safely store your system.

Follow these tips from Lung.org to safely store your oxygen systems:

• Always keep your liquid oxygen unit upright – never lay it on its side.
• Store your device and/or tanks in well-ventilated areas. Don’t store your oxygen in an enclosed space, such as a closet or trunk.
• Do not trip over the tubing. To prevent accidental falls, use high-visibility tubing (bright green or purple) rather than clear.
• Never cut your tubing or use more than a 50-foot-long piece.
• Do not use an extension cord to plug in your concentrator. Additionally, do not plug anything else into the same outlet.
• Turn off your oxygen when you’re not using it. Moreover, don’t set the cannula or mask on the bed or a chair if the oxygen is turned on.
• Keep oxygen concentrators several inches away from walls or curtains and never place anything over your concentrator.

Prepare for power outages.

If you rely on a stationary concentrator, a power outage is a medical emergency. Follow these steps so you are ready for power outages:

Keep backup batteries charged.

If you use an oxygen concentrator, keep at least one extra set of fully charged batteries handy in case your power goes out. Importantly, have enough batteries available to run your oxygen concentrator for a few days.

Keep a backup tank.

You should always have at least one large “H” or “M” cylinder tank in your home that does not require electricity. Ensure the regulator is attached. And make sure you know how to turn the key.

Get listed as a home that uses oxygen. 

Importantly, call your electric and telephone companies and your local fire department to register as a “Life Sustaining Equipment” household. Fortunately, this puts you at the top of the priority list for power restoration.

Consider a generator.

Buying a backup generator can eliminate oxygen issues during power outages.

Properly maintaining your equipment is the key to keeping your device in good operating order and for reducing risk of device-related health issues. Read the manufacturer’s recommendations on cleaning and maintenance, and consider the following suggestions from American Lung Association:

• Every week, wash your nasal cannula, clean your air filter and wipe the outside
  of your concentrator with soap and warm water.
• When you refill your humidifier bottle, wash it with soap and warm water,
  rinse well and then refill it with distilled water.
• Every 2–4 weeks, replace your cannula or mask. However, you should change it every time you get sick.
• Each month, replace your air filter.
• Every 2 months, replace your tubing.
• Every year, have your oxygen supply company service your concentrator.
• If you use a transtracheal catheter, ask your doctor how/when to clean it.

Comprehensive guide to oxygen equipment: Know when to call the doctor.

Firstly, ask your doctor what symptoms or issues would require a phone call or office visit, and what symptoms would require emergency medical attention. Write these items down for future reference.

Additionally, consider the following recommendations from MedlinePlus:

The emotional side of oxygen therapy.

The hardest part of oxygen therapy isn’t the treatment itself. Instead, it’s the devices that make you look different. Many patients struggle with the feeling that others are watching or judging them.

To help you adapt emotionally, remain focused on the fact that oxygen can help you:

• Feel less breathless while doing activities.
• Have more energy and be more physically active.
• Have an improved quality of life.
• Sleep better.

Additionally, don’t be afraid to reach out for support from mental health professionals and fellow patients. Consider these suggestions from Lung.org (The American Lung Association):

• Call their free Lung Help Line at 1-800-LUNGUSA (1-800-586-4872) or visit Lung.org/helpline to talk with a medical professional.
• Participate in a pulmonary rehabilitation program. Importantly, trained respiratory therapists can help answer your questions about oxygen and teach you how to stay active.
• Get support from others who share in your struggles:
  • The American Lung Association’s Better Breathers Club provides in-person or virtual meetings led by trained facilitators that offer educational and supportive connections.
  • The American Lung Association’s Patient & Caregiver Network provides nationwide online patient support programs. You can connect to others also living with lung disease, and learn more about living with lung disease.
• Connect with other patients facing lung disease in one of their free online support communities.

Traveling with oxygen: Tips for the road and sky.

With today’s technology, you don’t have to stay home just because you use oxygen. However, you must plan with military precision.

Preparing for air travel.

Most importantly, you can only travel with FAA approved POC devices. Unfortunately, the FAA does not keep a list of approved devices. Instead, you must look for a label on your device that states the manufacturer has determined that the device conforms to all applicable FAA requirements for use on aircraft.

Equally important, remember you cannot bring oxygen tanks on a plane!

Most airlines require you to have enough battery life for 150% of your flight time (to account for delays). For instance, if your flight is 4 hours, you need 6 hours of battery.

To avoid issues, always carry a signed letter from your doctor stating your flow rate and the necessity of the device.

Staying safe on car trips. 

For smooth, safe travel, pay attention to where you store your oxygen cylinder or POC.

Never leave oxygen cylinders or a POC in a hot car. Heat can cause pressure to build in tanks or damage the sensitive electronics in a concentrator.

Additionally, always ensure tanks are upright and secured in the backseat. A loose oxygen tank in a car accident becomes a heavy, high-pressure projectile.

Learn more…

In addition to the tips provided in our comprehensive guide to oxygen equipment, read these posts:

• Managing a Respiratory Disorder: Tips for Patients and Families.
• What You Need to Know About Medical Device Recalls.
• How Safe are Medical Devices?

I wrote this in collaboration with Sleeprestfully.com — delivering premium respiratory & oxygen equipment backed by 20 years of trusted industry expertise.