E 3 Oxygen Concentrator

This equipment is mainly important for breathing problems as in Breathing problems of a neonate and young infants.

Subsection of this chapter:

  1. Clinical Problem
  2. Assessment
  3. Management
  4. Infection Prevention
  5. Complications
  6. Care & Maintenance
  7. Troubleshooting & Repair

NEST360°. Newborn Essential Solutions and Technologies-Education – Clinical Modules: Oxygen Therapy. (June 2020). License: CC BY-NC-SA 4.0.

Clinical Problem

An oxygen concentrator is used on its own when oxygen needs to be delivered to one or two patients. Concentrators may also be used to share oxygen between multiple patients using a flow splitter or used with other treatment devices such as continuous positive airway pressure devices.

Supplemental oxygen is indicated for sick children, especially those with hypoxia (SpO2<90%) which has many clinical causes. Possible causes are outlined in Oxygen Therapy: Clinical Problem.

Assessment

Oxygen concentrators (2.1) provide a source of oxygen at flows from 2 to 10 litres per minute (L/min). Maximum flow delivered per device depends on the model and can range from 5, 8 or 10 L/min.

Oxygen concentrators are one of the most commonly used sources of oxygen therapy, concentrating 85-95.5% oxygen from ambient air using two sieve beds made of a substance that captures nitrogen.

Oxygen concentrators may provide oxygen via two types of flow:

In intermediate care neonatal units, concentrators with continuous oxygen delivery are preferred for most applications. Common components of an oxygen concentrator are outlined in 2.2.

Neonatal patients should reach SpO2 levels of 90 – 95% by 15 minutes after birth. (Alert 2.1) If oxygen is needed it is recommended to give between 0.5-1 L/min.2 Whilst on oxygen, regular monitoring should be conducted using a pulse oximeter to ensure that this saturation range is maintained for the duration of treatment. Ideally, patients suffering from severe respiratory distress should have continuous pulse oximetry monitoring throughout care.2


? ALERT 2.1: SpO 2 & Safe Oxygen Delivery
When making this recommendation the following resources were considered:
  • According to the Textbook of Neonatal Resuscitation (NRP),
    7th Ed., “After birth, the oxygen saturation gradually increases
    above 90%. However, even healthy term newborns may take
    10 minutes or longer to reach this saturation” (p. 77).1
  • Target peripheral oxygen concentrations (SpO 2) for newborns
    vary depending on age and clinical condition. However, most
    authorities agree that saturations between 90-95% minimises
    the complications associated with both low and high oxygen
    levels including death, neurodevelopmental impairment and
    Retinopathy of Prematurity. 3-6

Management

Management of an oxygen concentrator covers how to use the device in a variety of settings, including set up for a patient, patient preparation & commencement, care whilst on the device & removal of the patient from the device.

SETTING UP FOR A PATIENT

  1. Plug oxygen concentrator’s power cable into the oxygen concentrator (3.1a) & into wall and turn on power at socket. Turn on concentrator. (3.1b)
  2. Set flow to desired rate. If machine has not been turned on, allow to run for 5 minutes or until indicator light (3.2) shows that concentrator is providing appropriate concentrations of oxygen for treatment. Check that no alarms sound on the machine.
  3. Assess whether your patient requires humidified flow. If oxygen needs are greater than 4 L/min, connect a humidifier.2,11
  4. Connect correctly sized nasal prongs to oxygen port on machine (3.3) or to humidifier (if using).
  5. Test that oxygen flow has begun by placing your finger near the nasal prongs, ensuring that flow commences. This can also be tested by the submerging the nasal prongs in clean water and checking for bubbles (3.4), also known as the Bubble Test.11

Infection Prevention

Routine and adequate cleaning of medical devices is critical to prevent hospitalacquired infections in newborn care units. If devices and equipment are not disinfected or reprocessed promptly or adequately between patients, they may pose a significant infection risk.

GENERAL INFECTION PREVENTION

  1. Housing of the oxygen concentrator should be cleaned according to ward guidelines for disinfecting surfaces.

DISINFECTION AFTER USE

  1. Turn off and unplug the oxygen concentrator, if not using with another patient. If reusing tubing, immediately begin hospital protocol for disinfection as outlined in Oxygen Therapy: Infection Prevention.
  2. Disinfect the oxygen flowmeter controls using gauze and 70% alcohol. (4.1)
  3. Housing of the oxygen concentrator should be cleaned according to ward guidelines for disinfecting surfaces. Flowmeter controls and LEDs should be cleaned using 70% alcohol after every use.

Complications

Introduction of equipment in newborn care units poses clinical and device complications for patients. Awareness of potential complications is critical to maximise patient safety.

DEVICE COMPLICATIONS

  1. Inadequate oxygen concentrations: If the oxygen concentrator indicates inadequate concentrations of oxygen (5.1), machine maintenance is needed. Replace the concentrator if possible; if not available, increase monitoring frequency to ensure clinical stability until concentrator can be replaced or maintained.

Care & Maintenance

Users are responsible for basic first-line care and maintenance to ensure equipment lasts to their potential lifetime.

POWER SOURCE

Oxygen concentrators may be powered via mains or grid power with a voltage protector in line, or a rechargeable battery, depending on model.

WARD LOCATION

The concentrator should be located in a clean, dry, well-ventilated space close to any oxygen splitters that are in use and in a location that is easily viewed and accessed by neonatal staff. The back of the concentrator should be 30 – 35 centimetres away from the nearest wall to ensure that airflow can be sucked into the concentrator.

USER PREVENTIVE MAINTENANCE

Oxygen concentrators typically have two filters that should be cleaned as part of preventive maintenance:

Bacterial (internal) and gross particle (external) filters should be checked weekly, with cleaning provided every 2 weeks or more frequently as needed. Never put a wet filter in place on an oxygen concentrator.

The oxygen concentrator should be turned on and allowed to run for at least 15 minutes every week if it has not been in use. Sieve beds within concentrators can become contaminated with ambient water molecules if not regularly used; turning on the concentrator will prevent this contamination.

Due to concentrator wear, maximum flow (L/min) while maintaining appropriate oxygen concentration may decrease over time by as much as 3 L/min. If oxygen concentration at maximum flow begins to decrease or the low oxygen concentrator indicator light consistently shows at high flow rates, alert your maintenance department to organise and conduct repairs. All preventive maintenance and cleaning should be recorded in a logbook.

Troubleshooting & Repair

Although users are not responsible for repairing their devices, there are steps that may be taken to troubleshoot first-line errors that may occur before contacting maintenance or engineering support.

1 The device does not turn on
  • Check that the power cable is securely attached to the concentrator, the cable is plugged completely into the socket, and the socket is turned on.
  • If the concentrator still does not turn on, push the reset button (7.1) on the front of the concentrator.
  • If the concentrator still does not turn on, contact your maintenance department.

2 The device turns on, but no flow is produced
  • Connect a Christmas tree nozzle to the oxygen port. (7.2)
  • If flow still cannot be felt, check the port for debris or blockages. If debris are seen, clean using an ear swab or forceps wrapped in gauze soaked in 70% alcohol. (7.3)
  • If flow still cannot be felt, contact your maintenance department.


3 The device turns on, but a ‘Low Oxygen’ indicator is displayed or audible
  • Check the gross particle and bacterial filters for dust and debris. If dust and debris are present, replace the filters with spare, clean filters. Allow the machine to run for 10 minutes.
  • If the alarm still sounds, check that your set flowrates (L/min) are within the maximum machine specifications. If they exceed the machine requirements, readjust your settings to within the specifications and monitor the alarm and light indicator.
  • If the low oxygen concentration alarm still sounds, reduce the flow further. If the low oxygen concentration alarm still sounds after reducing the flow to more than 50%, contact your maintenance department.

References

  1. Textbook of Neonatal Resuscitation (NRP), 7th Ed. (American Academy of Pediatrics, 2016).
  2. Oxygen therapy for children. (World Health Organization, 2016).
  3. Bancalari, E. & Claure, N. Oxygenation Targets and Outcomes in Premature Infants. JAMA 309, 2161 (2013).
  4. Cummings, J. J., Polin, R. A. & Committee on Fetus and Newborn. Oxygen Targeting in Extremely Low Birth Weight Infants. Pediatrics 138, e20161576 (2016).
  5. Manja, V., Lakshminrusimha, S. & Cook, D. J. Oxygen Saturation Target Range for Extremely Preterm Infants: A Systematic Review and Meta-analysis. JAMA Pediatrics 169, 332 (2015).
  6. Polin, R. A. & Bateman, D. Oxygen-Saturation Targets in Preterm Infants. New England Journal of Medicine 368, 2141–2142 (2013).
  7. Walsh, M. Oxygen Delivery Through Nasal Cannulae to Preterm Infants: Can Practice Be Improved? Pediatrics 116, 857–861 (2005).
  8. Locke, R. G., Wolfson, M. R., Shaffer, T. H., Rubenstein, S. D. & Greenspan, J. S. Inadvertent administration of positive end-distending pressure during nasal cannula flow. Pediatrics 91, 135–138 (1993).
  9. Sreenan, C., Lemke, R. P., Hudson-Mason, A. & Osiovich, H. High-Flow Nasal Cannulae in the Management of Apnea of Prematurity: A Comparison With Conventional Nasal Continuous Positive Airway Pressure. Pediatrics 107, 1081–1083 (2001).
  10. Curless MS, Ruparelia CS, Thompson E, and Trexler PA, eds. 2018. Infection Prevention and Control: Reference Manual for Health Care Facilities with Limited Resources. Jhpiego: Baltimore, MD.
  11. World Health Organization. Technical specifications for oxygen concentrators. (World Health Organization, 2016).