Safety Tips for Using Supplemental Oxygen Therapy

Key Takeaways

• More than 1.5 million Americans use supplemental oxygen.
• Home oxygen users should take precautions to minimize fire risks and tripping hazards and to be sure they are receiving the right oxygen dose.
• Home oxygen emergency plans should include backup power sources in case a power outage occurs.

While home oxygen therapy is typically safe and non-flammable, it does pose some safety hazards, as materials may burn more easily in areas with increased oxygen. Certain equipment accessories, like tubing, can pose tripping hazards, and oxygen users may face unique vulnerabilities during power outages. Additionally, because of the risks associated with too much or too little oxygen, home oxygen machines should only be used as prescribed by your health care provider.

According to the American Thoracic Society, more than 1.5 million Americans require home oxygen therapy. ^[1]Jacobs S, et al. American Thoracic Society. December 2018. Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/30499721/ Since supplemental oxygen is so widely used, understanding the potential concerns associated with its use is important for the safety of those relying on oxygen therapy and those around them. The following comprehensive guide will provide tips for home oxygen safety, equipment maintenance, fall prevention, and emergency preparedness.

What is home oxygen?

Low levels of oxygen in your blood can affect the health of your tissues and organs. In the short term, low blood oxygen levels can cause headaches, shortness of breath, or fatigue. In the long term, chronically low blood oxygen, or hypoxemia, can damage the heart, lungs, or other organs. Home oxygen systems deliver supplemental oxygen to people with lung diseases, sleep apnea, severe asthma, or other breathing difficulties compromising their oxygen levels.

Your health care provider may prescribe home oxygen therapy if you need more oxygen than your body can take in naturally. Home oxygen devices differ regarding oxygen output, portability, and power sources. Most home oxygen machines deliver your oxygen using a nasal cannula or thin tubing with two small prongs to fit into your nostrils. Yet, in rare instances, a facemask may be necessary to deliver a higher oxygen concentration.

Types of home oxygen systems

Home oxygen therapy comes in various forms, with smaller, portable devices allowing you to run errands or visit with friends. At the same time, larger machines can support your breathing all day and night.

Here are the main types of home oxygen systems:

• Home Oxygen Concentrators: Stationary oxygen concentrators are outlet-powered and provide a continuous oxygen flow. They purify the surrounding air and deliver it as concentrated oxygen, offering flow rates from 0.5 to 10 liters per minute (LPM). ^[2]Hardavella G, et al. Breathe Journal. September 2019. Oxygen Devices and Delivery Systems. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876135/
• Portable Oxygen Concentrators: These machines filter air to provide concentrated oxygen like in-home concentrators. Yet portable oxygen concentrators are battery-powered and lightweight for on-the-go use. They release oxygen in custom pulses matching the user’s breathing rate to conserve oxygen. Some machines offer a switch for continuous delivery. ^[2]Hardavella G, et al. Breathe Journal. September 2019. Oxygen Devices and Delivery Systems. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876135/
• Compressed Oxygen Cylinders: Also known as oxygen tanks, these devices store pressurized oxygen. Users may attach a regulator for continuous or pulse oxygen delivery. Compressed oxygen cylinders require refills and vary in size and portability.
• Liquid Oxygen Systems: Liquid oxygen systems store compressed oxygen for high-flow use at home or on the go. These include a stationary unit and a refillable portable reservoir. To prevent evaporation, avoid filling the portable reservoir well ahead of use. Liquid oxygen is also extremely cold, so be mindful to avoid touching its outlets or storage parts. ^[3]American Lung Association. Oxygen Therapy: Getting Started with Liquid Oxygen. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/getting-started-with-liquid-oxygen

Who needs home oxygen?

Sometimes called home oxygen therapy, home oxygen concentrators provide supplemental oxygen for people with breathing difficulties, lung infections, lung diseases, and other respiratory conditions.

The American Lung Association recommends home oxygen therapy for these conditions: ^[4]American Lung Association. Oxygen Therapy. May 5, 2023. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy

• Chronic obstructive pulmonary disease (COPD)
• Sleep apnea
• Severe asthma
• Cystic fibrosis
• Pulmonary fibrosis
• Heart failure
• Pneumonia

Home oxygen should only be used when prescribed by a doctor or health care provider and with strict adherence to the prescribed dosage. The FDA advises against taking too much oxygen, which can damage your lungs, while not getting enough oxygen can damage the brain, heart, and other organs. ^[5]U.S. Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy To prevent injury or risk, only allow trained professionals to assist you in operating home oxygen systems.

Keeping your home safe for oxygen users

Regardless of the type of oxygen therapy you choose, it’s essential to follow safety guidelines. While oxygen fires are the most pressing concern, it’s also critical for oxygen users to use short, high-visibility tubing to avoid tripping hazards and to carefully monitor the settings on their home oxygen device to ensure they receive the correct flow of oxygen for their needs.

Oxygen fire safety

Supplemental oxygen is safe for medical purposes. While oxygen itself is not flammable, it can make flammable materials ignite faster and burn more rapidly. While using supplemental oxygen, always stay at least five feet away from an open flame or heat source. ^[6]American Lung Association. Oxygen Therapy: Using Oxygen Safely. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/using-oxygen-safely Avoid gas stoves or electrical appliances, and steer clear of flammable materials like plywood, fiberboard, wood, and foil.

You should also never smoke (cigarettes, vape pens, or otherwise) while using oxygen, and prohibit smoking nearby. It’s best practice to display “No Smoking” and “Oxygen in Use” signs indoors and at your home’s entrance to minimize risks. Home oxygen users should also regularly maintain smoke detectors and keep fire extinguishers nearby.

Keep your home oxygen unit away from:

• Smoking
• Oil/grease
• Gas stoves
• Aerosol sprays such as hairspray, cooking sprays ^[7]American Lung Association. Using Oxygen Safely. Found on the internet at https://action.lung.org/pf/OX3-Using_Oxygen_Safely/files/OX3-Using_Oxygen_Safely_Option2-2020-v2.pdf
• BIrthday cake candles and other open flames such as candles, lighters, and fireplaces
• Oil-based lotions, vapor rubs, and petroleum jelly (use water-based products instead) ^[7]American Lung Association. Using Oxygen Safely. Found on the internet at https://action.lung.org/pf/OX3-Using_Oxygen_Safely/files/OX3-Using_Oxygen_Safely_Option2-2020-v2.pdf
• Electrical appliances such as hair styling tools, electric razors, heating pads, and microwaves
• Alcohol such as liquor and alcohol-based sanitizers ^[8]Medline Plus. Oxygen Safety. January 2022. Found on the internet at https://medlineplus.gov/ency/patientinstructions/000049.htm

Storing and cleaning your oxygen system

Maintaining your oxygen unit is a critical safeguard against fires, health hazards, and other risks. Follow manufacturer and health care provider recommendations for operating, storing, and cleaning your home oxygen unit. The American Lung Association and U.S. Food & Drug Administration (FDA) outline best practices for storing home oxygen.

How to store home oxygen units

Improperly stored oxygen can damage your device and lead to oxygen concentration, where the gas accumulates and increases the risk of fire. Following best practices for oxygen equipment storage allows you to continue to use your machine safely and effectively. ^[5]U.S. Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy

What measures should be taken to store oxygen equipment properly? This checklist can help:

• Don’t block the concentrator’s vents
• Organize oxygen tubing to avoid tripping hazards
• Regularly check the system for alarms/notifications
• Always turn off your oxygen when you’re not using it
• Keep oxygen concentrators several inches away from curtains or walls
• Don’t set your cannula or mask on a chair or bed if the oxygen is turned on
• Never place anything on your oxygen concentrator, such as clothes or books
• Keep oxygen cylinders upright at all times
• Use cylinder stands to help reduce tip-over risks
• Don’t plug your oxygen concentrator into an extension cord, and don’t plug anything else into the same outlet
• Store oxygen in well-ventilated areas and never in enclosed spaces like car trunks or closets

How to clean home oxygen units

Home oxygen accessories like oxygen tubing, nasal cannulas or masks, and humidifier bottles require regular sanitizing. The American Lung Association recommends the following cleaning and maintenance schedule: ^[4]American Lung Association. Oxygen Therapy. May 5, 2023. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy

Falls prevention while on home oxygen

Falls are the leading cause of injury for older adults in the U.S., and most falls happen at home. ^[9]Centers for Disease Control and Prevention. Keep on Your Feet—Preventing Older Adult Falls. March 24, 2023. Found on the internet at https://www.cdc.gov/injury/features/older-adult-falls ^[10]Moreland B, et al. American Journal of Lifestyle Medicine. November 2021. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669898/ Given this risk, situate your home oxygen equipment with fall prevention in mind. Keep your oxygen cylinder upright in a stand and secure cords or tubing to prevent tripping hazards. Additionally, the American Lung Association recommends keeping your tubing under 50 feet in length, and never cutting your oxygen tubing. ^[4]American Lung Association. Oxygen Therapy. May 5, 2023. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy

Highly visible tubing helps prevent tripping, tube kinks and punctures, and oxygen flow obstructions. ^[11]National Library of Medicine. Nursing Skills: Oxygen Therapy Introduction. 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK593208/ Some oxygen tubing is designed for kink resistance or self-retraction. Consider wrapping bright-colored tape in intervals on transparent oxygen tubing for easy visibility while walking. Alternatively, high-visibility tubing (like bright blue and green) is available.

Hold and elevate the oxygen tubing to avoid tripping or tangling when walking around your home or standing up from a seated position.

General fall-prevention tips can also support your home oxygen fall-proofing plan:

• Install grab bars and handrails
• Keep rooms and steps clutter-free
• Use rubber-backed rugs and non-slip mats
• Try balance and strength-training exercises
• Keep items you use most often within reach
• With the help of family or friends, do a lighting audit of your home to ensure each room, hallway, doorway, and the top and bottom of stairs is well-lit

Emergency preparedness with home oxygen

Home oxygen users face unique challenges during emergencies—especially power outages since many oxygen concentrators rely on electricity. Home oxygen emergency plans should involve backup equipment, backup power, and strategizing with caregivers.

Align emergency plans with your network

Once you start home oxygen therapy, tell trusted family, friends, and neighbors. The more people who know you use an oxygen concentrator, the more prepared they can be for critical situations. Work with caregivers to establish emergency plans. Explain how they can assist you in a crisis, and show them how to operate your oxygen concentrator and backup system.

Prepare for power outages

Using an oxygen concentrator during a power outage is safe, but you’ll need an alternate power source if your unit runs on electricity. You can buy a backup power generator or ask your oxygen supplier to recommend portable, non-electric backup equipment options to keep in your emergency kit.

You should talk to your doctor about power outage backup plans and how much backup oxygen you need to keep on hand. ^[6]American Lung Association. Oxygen Therapy: Using Oxygen Safely. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/using-oxygen-safely

You should also ensure your phone number is updated with your electrical company to receive updates about unexpected and planned power outages. Some power companies give advance power-outage notice if they know you rely on a life-support device like home oxygen. ^[12]Safety Action Center. Emergency Planning Tips for People Who Rely on Electric or Battery Dependent Medical Devices. Found on the internet at https://www.safetyactioncenter.pge.com/articles/35-emergency-planning-tips-people-rely-electric-battery-dependent-medical-devices

Your fire department or electrical company may even be able to restore power to your home sooner during a power outage if they know you use life-sustaining medical equipment. ^[13]American Lung Association. Power Outages. March 28, 2023. Found on the internet at https://www.lung.org/clean-air/emergencies-and-natural-disasters/power-outages You can also ask your local fire and police departments and hospitals if you can use them as a backup if your backup systems fail. Consider registering with a Special Needs Shelter or Medical Needs Shelter in your region to help manage your oxygen access during prolonged power outages.

Keep written emergency resources

Always document emergency contacts and resources for quick access. A good strategy is to: ^[14]Pacific Americans with Disabilities Center. Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices. Found on the internet at https://adata.org/factsheet/emergency-power

• Keep a list of alternate power sources/providers
• Store emergency contact phone numbers in your phone and display somewhere central in your home
• Label all oxygen equipment with your name, phone number, and address
• Add laminated cards to your equipment with simple operating instructions
• Keep oxygen equipment instructions and a list of serial and model numbers for your medical devices in your emergency kit

Home oxygen emergency tips

The following advice can help in a critical situation:

• Regularly test backup equipment
• Avoid areas with open flames or potential gas leaks
• Test smoke and carbon monoxide detectors regularly
• Keep backup oxygen and portable equipment in your home emergency kit
• Keep the oxygen unit’s shut-off switch nearby for quick access during emergencies ^[12]Safety Action Center. Emergency Planning Tips for People Who Rely on Electric or Battery Dependent Medical Devices. Found on the internet at https://www.safetyactioncenter.pge.com/articles/35-emergency-planning-tips-people-rely-electric-battery-dependent-medical-devices
• When oxygen is in use, always use battery-powered lanterns or flashlights rather than gas lights to reduce fire hazards ^[12]Safety Action Center. Emergency Planning Tips for People Who Rely on Electric or Battery Dependent Medical Devices. Found on the internet at https://www.safetyactioncenter.pge.com/articles/35-emergency-planning-tips-people-rely-electric-battery-dependent-medical-devices
• Always monitor your oxygen tank’s gauges and make sure to give your oxygen supplier ample time to deliver refills ^[4]American Lung Association. Oxygen Therapy. May 5, 2023. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy

You should also be careful during severe weather. It’s generally safe to shelter indoors during a thunderstorm, but lightning can travel through electrical systems. About one-third of lighting-strike injuries occur indoors. To avoid electrocution, consider switching to a battery-powered oxygen concentrator during storms or investing in a whole-house surge protector. ^[15]Centers For Disease Control and Prevention. Lightning Safety Tips. June 7, 2022. Found on the internet at https://www.cdc.gov/disasters/lightning/safetytips.html

Looking for more guidance? Consult the American Lung Association’s recommendations for what to do during a power outage. Our Disaster Assistance for Older Adults resource center also shares more emergency preparedness tips.

Bottom line

Home oxygen safety is extremely important for supplemental oxygen users. Closely follow your health care provider’s recommendations for home oxygen therapy, and adhere to your oxygen supplier’s instructions for operating equipment safely. Make sure to regularly clean and maintain your equipment.

Taking precautions can reduce risks of fires, tripping hazards, oxygen toxicity (lung damage that happens from breathing in too much supplemental oxygen), and other dangers. It’s also important to develop a home oxygen emergency preparedness plan. Always keep extra oxygen and backup equipment with you, and identify alternate power sources to use during a power outage.

Ensure caregivers and close connections know you use supplemental oxygen and understand your needs. Your social network, in addition to community resources, can help in emergency situations. Inform your power company and local emergency service departments you use life-sustaining medical equipment in your home. Preparing ahead of time and prioritizing home safety can help ensure the best results for home oxygen users.

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

1. Jacobs S, et al. American Thoracic Society. December 2018. Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Found on the internet at https://www.atsjournals.org/doi/10.1513/AnnalsATS.201809-627WS
2. Hardavella G, et al. Breathe Journal. September 2019. Oxygen Devices and Delivery Systems. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876135/
3. American Lung Association. Oxygen Therapy: Getting Started with Liquid Oxygen. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/getting-started-with-liquid-oxygen
4. American Lung Association. Oxygen Therapy. May 5, 2023. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy
5. U.S. Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy
6. American Lung Association. Oxygen Therapy: Using Oxygen Safely. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/using-oxygen-safely
7. American Lung Association. Using Oxygen Safely. Found on the internet at https://action.lung.org/pf/OX3-Using_Oxygen_Safely/files/OX3-Using_Oxygen_Safely_Option2-2020-v2.pdf
8. Medline Plus. Oxygen Safety. January 2022. Found on the internet at https://medlineplus.gov/ency/patientinstructions/000049.htm
9. Centers for Disease Control and Prevention. Keep on Your Feet—Preventing Older Adult Falls. March 24, 2023. Found on the internet at https://www.cdc.gov/injury/features/older-adult-falls
10. Moreland B, et al. American Journal of Lifestyle Medicine. November 2021. A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669898/
11. National Library of Medicine. Nursing Skills: Oxygen Therapy Introduction. 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK593208/
12. Safety Action Center. Emergency Planning Tips for People Who Rely on Electric or Battery Dependent Medical Devices. Found on the internet at https://www.safetyactioncenter.pge.com/articles/35-emergency-planning-tips-people-rely-electric-battery-dependent-medical-devices
13. American Lung Association. Power Outages. March 28, 2023. Found on the internet at https://www.lung.org/clean-air/emergencies-and-natural-disasters/power-outages
14. Pacific Americans with Disabilities Center. Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices. Found on the internet at https://adata.org/factsheet/emergency-power
15. Centers For Disease Control and Prevention. Lightning Safety Tips. June 7, 2022. Found on the internet at https://www.cdc.gov/disasters/lightning/safetytips.html