‘Covid-19 & Guidance for Oxygen self-use during homecare’, a simple, and effective pictorial booklet is an effort by Dr. Ravindra Khaiwal and Dr. Suman Mor to explain the use of oxygen during homecare. Parul catches up with Dr. Khaiwal from the Department of Community Medicine and School of PGI answer questions that will help both caregivers and patients.

What inspired you to write ‘Covid-19 and Guidance for Oxygen self-use during homecare’? What is the core philosophy of the effort?

Oxygen is a medicine and should be used only under professional medical guidance. People start hoarding oxygen without thinking that it may save the lives of others. We aim to create awareness on the issue. Please keep a watch for Covid-19 symptoms, isolate early, and do not hoard oxygen unnecessarily. Together we can fight and defeat Covid-19.

If you could explain terms such as blood oxygen levels, PaO2, SpO2, normal and below normal levels

Blood oxygen level shows the concentration of oxygen being carried by the red blood cells in the human body. The measurement of blood oxygen concentration is also called oxygen saturation level. It is symbolized by PaO2: When oxygen saturation level is measured using blood gas, and SpO2: When oxygen saturation level is measured using oxygen

Normal oxygen level measured using a pulse oximeter (SpO2) varies between 95-100 per cent, whereas typical arterial blood gas (ABG) oxygen levels range from 80 to 100 (mm Hg) for healthy lungs.

A pulse oximeter (SpO2) level below 95% or an ABG oxygen level below 80 mm Hg reflects below-normal oxygen level. This situation is termed hypoxemia and, if not treated, could lead to severe complications in human body tissues and organs.

How can we measure blood oxygen levels, and when should we seek medical help? Can early oxygen intervention help and save people from going to the hospital?

The blood oxygen level can be measured using arterial blood gas or a pulse oximeter. An arterial blood gas or ABG is an invasive blood test. ABG is an accurate test and apart from blood oxygen, it also allows us to measure other gases, including the pH (acid/base level). The ABG test is very accurate, but it is done by an invasive technique.

A pulse oximeter allows monitoring the blood oxygen level without any invasion or pain. A pulse oximeter is normally placed at the finger’s toe or earlobe. It measures the blood oxygen by sending infrared light into the capillaries of the finger and recording how much light is reflected by the gases.

If you have Covid-19 symptoms check oxygen level by using an oximeter, before taking a walk. Now, walk for six minutes without a break on an even surface with a pulse oximeter. Oxygen level may fall 1-2%, but if it falls below 3% or 93%, consult a doctor.

Are we seeing many cases of silent hypoxia in this wave? How can this be addressed?

Silent hypoxia or happy hypoxia is referred to what people get in the early stage of Covid-19. As highlighted in the booklet, as the oxygen level drops, you may start feeling shortness of breath, confusion, and other symptoms. Keep watching these signs and do not ignore them. We also request this for young people. If you monitor low oxygen level — change in lip color from natural to blue or persistent sweating — consult the Covid helpline or a doctor as they could be the early signs of silent hypoxia.

How can proning help enhance blood oxygen levels?

Proning is a medically accepted process to improve the distribution and exchange of oxygen in the lungs. A patient is safely placed from their back on to their abdomen (stomach), ie, having face down to improve breathing and oxygenation. It has been shown to be beneficial for Covid-19 patients with compromised breathing comfort, especially during home isolation.

What are the oxygen therapy devices patients can use at home and what precautions should one take. How does an oxygen mask and nasal cannula work?

Oxygen concentrators or oxygen cylinders are suggested for homecare, but must be used only as per a doctor’s advice. They usually can be used up for SpO2 level of 90-94. However, in case of no support, one can use concentrators for an oxygen level of upto 85 and visit a hospital as soon as possible.

A nasal cannula is a soft plastic tube with two small prongs, which helps to supplement oxygen requirements. This device can support the oxygen flow rate of up to 5 litres per minute. High flow rate results in drying of nasal passages, including nose bleeding.

Oxygen mask covers the patient’s nose and mouth to supply breathing oxygen safely from a source, eg, a cylinder. Medical masks are made up of plastic considering cost-effectiveness and safe disposal. Masks design help to improve the accuracy of the oxygen delivery even at high pressure.

Please share the precautions to be kept in mind for the use of oxygen concentrators, nasal cannula, oxygen face mask

An oxygen concentrator can be used at home and only in some cases, as per the doctor’s advice and under strict medical supervision, oxygen cylinders too may be allowed. However, if you have signs and symptoms of Covid-19, please visit the near Covid care center or consult at the Covid helpline and do not self-medicate.

The nasal cannula should be changed after every week. Oxygen concentrator filters must be cleaned weekly with warm soapy water. This prolongs the efficiency and life of the oxygen concentrator. Replace or clean oxygen face masks with warm soapy water after three days of use.

The nasal tubing should be replaced after four weeks. However, do not wash tubing from stationary equipment or cylinders and these should be replaced with a new one. The humidifier must be emptied at least once a day. Wash the bottle with soap and warm water, and ensure that soap is rinsed out thoroughly. Refill the humidifier bottle only with distilled water. The minerals present in tap water can damage your equipment.

How will these guidelines help asthma and COPD patients?

COPD and asthma patients also sometimes require oxygen therapy. The infographic booklet also has details about blood oxygen level, its monitoring, including the oxygen therapy devices (oxygen cylinders, oxygen concentrators) and their uses in pictoral format to ensure safe delivery of oxygen to COPD and asthma patients.

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