About this resource

Last updated May 19, 2021

This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented.

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This content is a collaborative effort by representatives of multiple institutions, and this document and the information herein are intended and designed for educational purposes only. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

Disclaimer

This is a living document, created by created by nurses, physicians, respiratory therapists and other healthcare providers from multiple institutions and multiple countries via the OpenCriticalCare.org project.

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The goal of this document is to provide tools that can be locally modified to help healthcare providers learning to provide respiratory care for hospitalized patients.

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Table of Contents

Setup, operation and maintenance overview

General tips for portable oxygen concentrators

How to split one oxygen concentrator for multiple patients

How to connect two oxygen concentrators for one patient

How to Use This Document

Table of Contents

With collaborators & support from multiple institutions, including:

for more resources by

This work is licensed under a Creative Commons Attribution-NonCommercial-Sharealike 4.0 International License.

Infographic Attribution: CC-NC-SA The OpenCriticalCare.org Project

Images Attribution: CC-NC-SA Holly Sullivan and The OpenCriticalCare.org Project

Oxygen Concentrator: setup and operation

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This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

ALWAYS REVIEW MANUFACTURER’S MANUAL & RECOMMENDATIONS PRIOR TO USE

1. Position unit 0.5m away

from wall

• Avoid positioning near objects that may obstruct air inlet (e.g. curtains or the wall).
• Keep far away from fire ignition sources (e.g. smoking, cooking, etc)

2. Consider humidification bottle*

• *Often prescribed for flow rates >4 Liters per minute, though evidence of benefit is limited
• Must use distilled or sterile water
• Replace water and inspect bottle daily

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3. Attach oxygen device tubing

• Smooth bore oxygen tubing should connect to concentrator outlet (or the humidifier bottle if used)

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4. Inspect air inlet filter

• Ensure the filter is in place, clean and dry
• Usually on the back of the device
• Inspect the filter daily
• Remove & clean filter weekly (or more frequently if dusty environment) by washing with warm soap-water, rinse and dry with towel
• Consider having a spare filter to avoid interruptions in concentrator use while cleaning the filter

*Some devices have internal filters that require periodic changing (see user manual)

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5. Test alarms & power on

• Always check back of the device (and user’s manual) to ENSURE YOU HAVE THE CORRECT POWER SUPPLY (voltage and frequency) otherwise you may destroy the unit
• Consider a voltage stabilizer and backup power supply if frequent outages or flickering/dimming lights are common
• Avoid extension cords to minimize fire risk and tripping hazard
• For each new patient, with device unplugged, flip the power switch on and listed for continuous power failure alarm
• For each new patient, with the device plugged in, flip power switch on and listen for alarm test (which should self terminate) & sound of the compressor
• Some devices may require 2-20 min warm up to reach desired O2 concentration

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6. Adjust flow

• Follow your clinician’s advice (e.g. adjust flow to oxygen saturation by pulse oximeter of >90%)
• Turn the flowmeter nob counter-clockwise to increase flow
• Middle of the ball indicates the set flow rate
• DO NOT EXCEED the max rated flow for the device even if the flowmeter allows, this can damage the device
• Ensure you feel flow coming from flowmeter

7. Secure oxygen delivery

device

• Follow your clinician’s advice
• Usually a nasal cannula or simple face mask are used to deliver oxygen from a concentrator with output <10LPM)
• Inspect the tubing of the device to ensure no kinks, and listed for leaks (tighten or fix as needed)

More info on:

• Procuring O2 concentrators
• Splitting O2 concentrators
• Combining O2 concentrators

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v 2021.6

This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

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* The device shown is an example and not representative of all O2 concentrators.

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v 2021.5

4. Air Inlet filter

0.5 m

1. Spaced away

from the wall

5. Power cord

6. Flowmeter

DO NOT adjust

flow above max

rated output.

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2-3. Oxygen outlet

(humidification

bottle option

attached)

5. Power switch

Face mask

Nasal Cannula

Front

Rear

Tips for portable oxygen concentrators

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EQUIPMENT SELECTION

Air Inlet filter

Inspect daily and clean at ;east weekly with soap and water. You should be able to see through it when removed & holding to light. Must be dry before use.

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* The device shown is an example and not representative of all O2 concentrators.

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QUICK TIPS:

• Inspect & clean air inlet filter 1-2x weekly

(A second air filter is needed to ensure continuous

use while cleaning and drying one air filter)

• Replace humidifier water daily
• Inspect humidifier bottle outlet for obstruction daily
• Check tubing for kinks & leaks daily
• Ensure air inlet filter is not obstructed daily
• Check power and O2 concentration alarms with each new patient or power up

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Power supply

Ensure correct Voltage, frequency (hz), & outlet adapter. Consider backup supply and voltage stabilizer. If power fails, there is no output from a concentrator

Position

Always position the unit upright and keep the inlet filter away from walls, curtains and obstruction.

Flow meter

Ensure flow is on & avoid running concentrators beyond their max rated flow

Humidification

Recommended if >4LPM needed & requires clean water,

https://opencriticalcare.org/faq/?question=what-are-the-top-10-considerations-when-buying-an-oxygen-concentrator

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• Consider cable ties to secure connectors
• Avoid running at or above max rated flow
• Titrate O2 flow using a pulse oximeter as frequently as possible
• Avoid >15m of total tubing to the patient
• Oxygen can cause fires! Keep away from open flames, heat sources & smoking.

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More Resources

This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

• Many O2 concentrators are inadequate for patients with acute respiratory illness (e.g. COVID-19)
• Always choose a device in consultation with a healthcare provider
• Key considerations include maximum flow rate (~5-10 LPM), oxygen concentration at maximum flow rate (>82%), local power supply compatibility, durability, outlet pressure (>55 kPa), operating conditions (0-40 deg C, relative humidity 15-95%), alarms, & safety certification, among others
• Ensure access to spare parts for 1 year, delivery devices (e.g. nasal cannula or face mask) and if using humidification, then clean water is needed (ideally distilled, but sterile or cooled boiled water can be used)
• Review WHO Technical Specifications for Portable O2 Concentrators

KEY COMPONENTS:

ALWAYS REVIEW MANUFACTURER’S MANUAL & RECOMMENDATIONS PRIOR TO USE

Outlet connector

A tapered, barbed connector may be needed

v 2021.5

How to split one oxygen concentrator

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EQUIPMENT & SETUP OPTIONS

• Connect the oxygen concentrator(s) via a hose, to the flow splitter or Y-connector
• If using a flow splitter, place it on a stable surface or attach it to a wall near the patients
• Use ~5mm diameter silicone tube, and ensure equal lengths (resistance) for all segments of tubing
• Connect the exit of the flow splitter (or Y connector) via short silicone tubes of equal length to one-way valves (ensure correct alignment of valves in direction of desired flow)
• Connect the one-way valves via equally short silicone tubes to the humidifier (if used)
• Connect the humidifier to the patient with desired delivery device (e.g. nasal cannula or simple facemask)

Flow Splitter

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Humidifiers

(requires distilled or sterile water)

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One-way

check valve

O2 Concentrator

> 10 L/min

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If a patient is a suspected or confirmed to have an airborne or droplet disease, then a bacterial/viral filter should be placed between the check valve and humidifier (i.e. so the check valve, splitter and tubing to the concentrator remain clean).

ADDITIONAL CONSIDERATIONS:

• A flow splitter cannot deliver more oxygen than the max output of the concentrator.
• A low oxygen alarm may indicate need to reduce the flow to one or more patients (you are using too much flow).
• Changing the flow rate of any one patient on the splitter may affect the flow rates to other patients on the splitter. Thus, when titrating flow rates (or adding/removing patients from the splitter), check all flow meters and adjust as needed.
• If delivering humidified oxygen, always use distilled or sterile water. Do not attach the humidifier between the concentrator and the splitter.
• Limit total tubing length to <15m or as specified by the manufacturer.

This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

ALWAYS REVIEW MANUFACTURER’S MANUAL & RECOMMENDATIONS PRIOR TO USE

Silicone tube

(ideally autoclavable)

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Y - connector

or

v 2021.5

How to Connect Two Oxygen Concentrators

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To one patient for increased oxygen flow delivery

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SETUP OPTIONS

*If a patient is a suspected or confirmed to have an airborne or droplet disease, then a bacterial/viral filter should be between the humidifier and the Y connector

ADDITIONAL CONSIDERATIONS:

1. Outlet of two O2 concentrators Y-connector patient

2. Outlet of two O2 concentrators Y-connector humidifier patient

3. Outlet of two O2 concentrators Y-connector bacterial/viral filter humidifier patient (Shown below)

4. Outlet of each O2 concentrator O2 delivery devices (i.e. nasal cannula + face mask) devices placed on same patient

• Choose two concentrators with similar outlet pressure, and with desired combined flow output
• Ensure power supply can handle more than one concentrator
• Ensure tubing, connectors & delivery devices are clean
• Ensure secure connections (consider cable ties to secure tubing connections)
• Consider using humidifier if flows >4 LPM
• Always use distilled water or sterile (filtered) water; if unavailable avoid water with
• Avoid running above the max rated flow output
• If possible, check the flow rate and % oxygen after the Y-connector with an oxygen analyzer or your finger.
• If flow is less than expected, check for leaks at all connections

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This document is intended to be educational in nature and is not a substitute for clinical decision making based on the medical condition presented. You should not rely on this information to replace professional medical advice, diagnosis, and/or treatment, nor should this information ever be used as a substitute for either manufacturers’ instructions and guidance or clinical decision-making based on the medical condition presented. It is the responsibility of the user to ensure that all information contained herein is current and accurate, and the creators and hosts of this content make no claims or warranties as to the currency, accuracy, or suitability of this information for any purpose. Any reference to specific equipment, pharmaceuticals, or other medical devices in this document is not meant as an endorsement of such items, and you should consult manufacturers’ documentation prior using any such items that may be referenced here. The use of any information in this document is undertaken solely at your own risk, and the creators and hosts of this content shall not be liable for any damages, losses, or other injury caused by the use of any information in this document, nor for any reliance on the accuracy or reliability of such information.

Y - connector

Humidifier

(requires distilled or

sterile water)

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If available, consider bacterial/viral filter* or one-way check valve if available to keep tubing and splitter clean

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ALWAYS REVIEW MANUFACTURER’S MANUAL & RECOMMENDATIONS PRIOR TO USE

v 2021.5