Oxygen Concentrators 101

Selecting oxygen equipment for home use usually occurs during a time of stress and worry for either your health or that of a loved one. The team at RespShop is here to help you select the optimal equipment for your needs.

Everyone setting up oxygen for home use has the same initial questions. We have gathered them here and will answer them one by one. 

The air we breathe contains 21% oxygen. Oxygen is essential to life. It nourishes every cell in our bodies. The brain and heart are quick to notice if they are oxygen-deprived. 

Some disorders of the lungs and heart hinder oxygen delivery. Supplementary oxygen eases breathing for people with such disorders. It also improves endurance and cognition.

Supplementary oxygen is a drug that requires a prescription. Medicare has specific criteria in place to determine who qualifies for home oxygen.

Safety and efficacy are the prime objectives when setting up home oxygen therapy. Patient comfort and mobility are important secondary objectives. Comfort and mobility correlate highly with the consistency of use and quality of life.

Your home oxygen kit should include:

• An oxygen concentrator
• Supplies to get the oxygen from the oxygen source to the patient
• A pulse oximeter to monitor the efficacy of the oxygen
• A supply of oxygen tanks for travel and emergency use

Why can’t I just use oxygen tanks? Oxygen in tanks and liquid canisters requires careful attention. Tanks must be exchanged at regular intervals to avoid running dry. They may also leak, causing them to empty sooner than expected. Tanks and liquid canisters are bulky and can make it difficult to move about.

Oxygen concentrators, on the other hand, are factories of supplemental oxygen. They entrain air from the environment at a high rate. The air we breathe is 21% oxygen and 78% nitrogen. Argon, carbon dioxide and a handful of other trace gases make up the remaining 1%. 

An oxygen concentrator pushes the air it sucks up through filters and a sieve bed, scrubbing out the non-oxygen gases. By filtering out the nitrogen and other gases, the oxygen concentrator collects pure oxygen for delivery to the patient.

Since the oxygen concentrator continually generates oxygen, you do not have to worry about oxygen running out. Tanks and canisters need to stay close to the user and are cumbersome to carry or walk with. By adding oxygen extension tubing, you can go from room to room in the house without moving the concentrator.

Tanks and liquid canisters are essential to have on hand in case of power failures or mechanical issues. They are useful for short trips to visit a friend or go to the store.

To begin to answer that question, you need to know how much oxygen flow is needed.

• Most oxygen concentrators max out at five liters of flow per minute.
• Some concentrators can produce up to ten liters per minute.
• Patients may need a slightly higher flow rate from the concentrator than from a tank or hospital oxygen source.

Understanding flow and O2 percent on oxygen concentrators

When using supplemental oxygen in the hospital, it is common to hear clinicians talk about a flow rate and an FIO2. The flow rate is most often described in liters per minute.

• The oxygen coming out of a tank cylinder or liquid canister is 100% pure medical-grade oxygen.
  • It is equivalent to the oxygen piped into the walls of a hospital.
• The oxygen coming out of a concentrator is usually closer to 85%-95% oxygen.
  • It is not 100% because the scrubbing/filtering is not perfect.
• The technical specs in a product description tell you how close to 100% the delivered oxygen percent gets.

Product Examples

Note: LPM = liters per minute

3B Medical Stratus 5

• Flow: 0.5 to 5 LPM
• Uses a flowmeter that is adjustable for all increments between 0.5 and 5 LPM
• Oxygen percentage: 93 percent (plus or minus 3) at the max flow of 5 LPM. 

Philips Everflow

• Flow: 0.5 to 5 LPM
• Uses a flowmeter that is adjustable for all increments between 0.5 and 5 LPM.
• Oxygen percentage: 93 percent (plus or minus 3) at the max flow of 5 LPM.

Inogen at Home

• Flow: 1 to 5 LPM
• Uses a digital dial, adjustable only in increments of 1 LPM at a time (e.g., cannot set 1.5 LPM)
• Oxygen percentage: averages 90%, with a range of 87% to 96%, at all flow settings

Philips M10

• Flow: 1 LPM to 10 LPM
• Oxygen percentage: 92 @ 8-10LPM; 94 @ 3-7LPM; 92 at 1-4 LPM

Other criteria to consider:

• Dimensions
• Noise output (dBA)
• Weight

All concentrators generate white noise as the motors work constantly to suck up air. Most people get used to it and cease to notice it. If you are concerned about it bothering your sleep, locate the concentrator outside the bedroom door. 

Most concentrators have wheels; read your product description to verify. All stationary concentrators are rather heavy. Concentrators that can offer the highest flows are the heaviest.

No, a portable oxygen concentrator cannot be your all-day, all-night solution. Portable concentrators are not engineered for around-the-clock use.

Here is why:

• Stationary concentrators have stronger motors intended for continual use.
• Stationary concentrators distill oxygen from the air about 10 times faster than portable concentrators.
• Stationary concentrators can reach higher flow rates with more oxygen percentage stability than portable concentrators.
• Maximum flows on portable concentrators are typically lower than on home units.

That said, a portable concentrator can be a remarkable tool to add to the oxygen tool kit. With a portable concentrator in tow, you can go whenever and wherever your heart desires. Portable oxygen lets people leave the house to travel, exercise, and do all the things that bring them joy.

When comparing portable oxygen concentrators, consider these four characteristics:

• Flow capacity of the concentrator
• Weight
• Dimensions
• Battery life/power supply

Flow characteristics of portable concentrators

Some portable concentrators have a continuous flow mode and a pulse flow mode. Others have only a pulse mode. Continuous flow is just what it sounds like: the concentrator continuously delivers oxygen (like a stationary concentrator does).

When the pulse flow is on, the concentrator only pumps out oxygen when the user breathes in.

• Pulse flow CONSERVES oxygen and reduces the work of the portable concentrator.
• Pulse flow CONSERVES battery life.

The percent of oxygen delivered during a continuous flow may differ from the percent of oxygen during a pulse flow. Pulse settings among brands are not equivalent.

When you are in the hospital or on a tank of oxygen, you set a flowmeter to a flow rate. Someone may say, you need 2 liters per minute of oxygen. If I put you in a tank, I set it to 2 liters of oxygen. If I put you on a concentrator with continuous flow, I set it to 2 liters of oxygen (or maybe slightly more).

When using pulse flow on a concentrator, the LPM analogy disappears.

• Concentrators have pulse settings, e.g., a range of 1-5.
• Pulse settings are not apples to apples with the liter-per-minute flow.
  • The technical guide can tell you which setting is approximately equivalent to the prescribed liter flow.
• Pulse flow rates are not equivalent between brands of concentrators.
• Pulse flow requires experimenting to find the best setting for the user.

Product Examples

Philips Simply Go

• Pulse flow and continuous flow modes
• Continuous flow rates: 0.5 liters per minute to 2 liters per minute
• Continuous flow oxygen percentage: 87%-96% range
• 6 Pulse mode settings
• Battery life 1 to 3 hours depending on flow settings
• Weight: 10 lbs.

Philips Simply Go Mini

• Pulse flow only – 5 pulse flow settings
• Pulse flow oxygen percentage: 87%-96% range (setting and respiratory rate dependent)
• Battery life
  • Standard battery: up to 4.5 hours at a pulse setting 2 and a respiratory rate of 20 breaths per minute (expect less battery life at higher settings)
  • Extended battery: up to 9 hours at a pulse setting 2 and a respiratory rate of 20 breaths per minute (expect less battery life at higher settings)
• Weight: 5 lbs. with the standard battery, 6 lbs. with the extended battery

Invacare Platinum Mobile Concentrator

• Pulse flow only
• 4 Pulse mode settings
• Battery life 3.5 hours on Pulse setting 2. 
• Weight 5 lbs.

Safe, enjoyable travel just takes some forethought and planning. Here is a packing list for a trouble-free excursion with a portable oxygen concentrator:

• Portable oxygen concentrator with a charged battery
• Bag or backpack for the portable concentrator
• AC cord
• DC cord
• Pulse oximeter
• Spare nasal cannula or oxygen tubing
• Fully charged spare battery
• Oxygen tank stowed away for standby emergency use

If you plan to fly, verify that your portable oxygen device meets the FAA requirements.

• FAA-approved portable concentrators sold after 2016 have a red label indicating they are safe for use on aircraft.
• A list of older models that are FAA-approved can be found here: https://www.faa.gov/about/initiatives/cabin_safety/portable_oxygen/ 

Learning to set the equipment up safely and correctly goes a long way to feeling confident in the oxygen equipment’s function.

• Choose a space for the concentrator that is near an electrical outlet
• Position the concentrator so that the air inlet is free from any obstruction
• Learn where the on/off button is
• Learn how to set the flow rate
• Learn how to attach the humidifier bottle
• Learn how to connect the oxygen tubing

Pro Tip: Notice the air bubbles in the humidifier water bottle when the concentrator is turned on. That’s a sign that oxygen is flowing from the concentrator to the oxygen tubing!

Monitoring

Built-in alarms

All oxygen concentrators have alarms that will indicate if they fail. Some devices also have an oxygen analyzer that monitors the delivered oxygen percentage and alarms if the percentage drops too low. 

On the Philips Respironics EverFlo, this feature is called the Oxygen Percentage Indicator (OPI). The EverFlo is available with or without the OPI feature. 

Oxygen percentage alarms add peace of mind if the user is particularly ill, but it is not essential for most people.

Learn to assess the user

Changes in the effort of breathing, cognition, dizziness, and fatigue are all signs that a user may need more oxygen than they are receiving.

A pulse oximeter is a painless way to check someone’s oxygen levels. Pulse oximeters fit over the finger and measure the levels of oxygen in the blood. The pulse oximeter reports a value known as the SpO2 or oxygen saturation level. 

The physician should tell the patient and caregivers what an appropriate pulse oximetry value is for that patient. Oxygen saturation levels may drop during activity and sleep. Consequently, some people need higher flow or pulse dose settings during those times.

If equipment stops working, or the power goes out, immediately switch to tank oxygen.

Uninterrupted delivery of supplemental oxygen is imperative. There must be a backup plan for oxygen delivery in the case of device failures or power outages as well as a travel plan. 

The typical home setup for oxygen therapy at a minimum includes both a stationary concentrator and oxygen tanks for this reason.

Some portable oxygen concentrators can run on batteries. It is advisable to know the battery life of portable concentrators and to keep spare batteries and power supplies in case of malfunctions.

Best practices:

• Keep an oxygen tank near the stationary concentrator
• Keep spare cannulas, masks, and tubing on hand in case of breakage
• Know the battery life of a portable concentrator 
• Notify local EMS that your household has a home oxygen user so that in the case of prolonged power outages or other disasters, they know where to triage support first.

Q: Do you have Oxygen Machines for pediatric use?

A: The 5l stationary oxygen concentrators have a minimum lpm of 0.5

Q: What is an ideal Oxygen Concentrator for use in a motor home (an RV)?

A: That is directly related to the prescription. 

Q: Will insurance pay for an oxygen concentrator?

A: Yes, but always check with your provider so you are making an informed choice.

Q: What maintenance is required for an oxygen concentrator?

A: Keep it well-ventilated; cleaning the vent and filter is optional.

Q: How often does an oxygen concentrator need to be cleaned?

A: Once a month, depending on dust.

Q: How do you clean a portable oxygen machine?

A: Wipe off with a clean soft cloth.

Q: How often do you change the water in an oxygen concentrator?

A: Only use distilled water with bubble bottles. Replace monthly. Wash weekly

Q: How often do I change the air hose and cannula on my oxygen compressor?

A: Tubing should be replaced monthly, and cannulas weekly.

Q: Can I order an oxygen concentrator for my pet?

A: Yes, with your vet’s prescription.

Q: How do I know if my oxygen concentrator is working?

A: Check pressure set, feel pressure on cheek or eyelashes, and check SP02 with a monitor.

Q: Why does my oxygen concentrator keep alarming?

A: Tubing is pinched. Replace it.

Q: Can you use an oxygen concentrator without a filter?

A: No. 

Q: How long do oxygen concentrator filters last?

A: Internal filters should be replaced yearly.

Q: How do I clean my nose cannula?

A: Replace weekly or after any infection.

Q: How do you keep the oxygen hose in your nose?

A: Cannulas have an adjustment.

Q: Do you have pediatric nasal cannulas?

A: No.