The Purple Book

Respiratory support

Patients who require additional Oxygen will usually be discharged from hospital with both Oxygen cylinders for emergency use and an Oxygen concentrator, both of which are supplied by Air Liquide:

For Patients:

• South West : 0808 143 9999
• Mobile : 03301235469 24hrs
• Email: alhomecare.patientsupport@nhs.net

For Healthcare professionals:

• Telephone: 0808 202 2099
• Mobile : 03301235469 24hrs
• Email: alhomecare.hcpsupport@nhs.net
• Webportal: https://www.airliquidehomehealth.co.uk/hcp

Video of setup of concentrator supplied by Air Liquide: https://youtu.be/vXgblb6askQ

Weaning protocol

Weaning of Oxygen supplementation will be done in a step wise and structured fashion in order to facilitate consistency and safety. The central features of the pathway are to assess and modify in 3 time periods - Morning, Afternoon and Evening, as well as 3 phases of recovery – Non-Exertional, Exertional and Sleep.

For consistency and uniformity, 3 time periods should be discussed with the patient to allow involvement and confidence with the process. Target saturation and initial flow rate will be identified and recorded in the care plan at time of VW admission.

For those on Long Term O2 Therapy (LTOT) weaning will proceed to USUAL O2 flow rate rather than to AIR.

This weaning phase should be carried out while the patient is NOT active, or only minimally active such as moving about a single room only.

• A period agreed with the patient to avoid clashes with waking times and early morning routine. Ideally, this should be in the morning.
• Patient is asked to sit comfortably for 5 minutes and submit SpO2 reading
• If target saturation values met, reduce O2 flow rate by 0.5LPM
• Oximetry reading should be reviewed after 30mins
  • if asymptomatic and saturation remains stable at or above target, assess saturation at mid-day review
  • patient to be advised to increase O2 flow at any time symptoms return and to report to CRM

• A period agreed with the patient to avoid clashes with any afternoon routines. Ideally, this should be before 1800hrs.
• If target saturation values met, reduce O2 flow rate by 0.5Lpm
• Oximetry reading should be reviewed after 30mins
  • if asymptomatic and saturation remains stable at or above target, assess saturation at Evening review.
  • patient to be advised to increase O2 flow at any time should symptoms return and to report to CRM

• A period agreed with the patient to avoid clashes with evening meal and other early evening routines. Ideally, this should be an hour or so prior to sleep time to allow for advice for that evening and before sleeping.
• If target saturation values met, maintain O2 flow at this rate for the evening but increase by 0.5Lpm for sleep.
• patient to be advised to increase O2 flow at any time should symptoms return and to report to CRM

This weaning phase assumes weaning has been successful at rest and the patient now remains at or above target saturation value on AIR at rest.

• The 1st Exertional wean test should be the Morning time agreed above
• If this 1st test fails, a 2nd test may then be repeated in the same way at the Afternoon time agreed above
• if the 2nd test fails, the next test will be the following Morning test

• This activity should be simple, slow and non-exertional about the home for 5mins and not involve stairs or climbing
• If asymptomatic and at or above target saturation value on oximeter at 5mins, patient to be advised to undertake this level of activity for the remainder of this period without supplemental O2
• if symptomatic or target saturations not met, test to be repeated next day. Supplemental oxygen may be considered (referral to CRT) if failure continues.

• This activity should be tailored to the usual capacity of the patient essentially as return to normal daily activities of the patient prior to this illness.
• If asymptomatic and at or above target saturation value on oximeter at 5mins patient likely reached end of weaning process.

• During Phase 1, patient to use O2 supplementation at 0.5Lpm above daytime use while sleeping
• During Phase 2, patient to use O2 supplementation at 0.5Lpm while sleeping
• When Phase 2 Normal activity achieved without O2, patient now weaned.