OXYGEN SYSTEMS

Oxygen Concentrator

An oxygen concentrator is an electrically powered device with a series of filters that extract oxygen from room air. Also, a backup system, usually a stationary compressed gas system, must always accompany a concentrator in case of power failure or other emergency. Regular household current is sufficient for its use. In limited cases, a humidifier bottle may be necessary to increase moisture to the oxygen as it passes through the tubing to the mask or cannula.

Common diagnoses:

• Chronic obstructive pulmonary disease (COPD)
  -- emphysema
  -- asthma
  -- chronic bronchitis
  
• lung cancer
• acute myocardial infarction
• acute pulmonary heart disease
• congestive heart failure
• viral pneumonia
• bacterial pneumonia
• bronchiectasis

Gaseous Oxygen

A stationary gaseous system consists of a regulator that attaches to a cylinder held securely by a stand. The regulator controls the rate of flow of oxygen to the patient using a flowmeter and indicates pounds of pressure in the cylinder with a pressure gauge. Tubing connects to the regulator on one end and attaches to a mask or nasal cannula on the other.

A portable gaseous system consists of a regulator, which also attaches to the cylinder. A regulator designed for portable systems may or may not control the rate of flow of oxygen. As with a stationary system, tubing connects to the regulator and to a mask or cannula. A portable unit also includes a cart or carrying case.

Liquid Oxygen

A stationary liquid oxygen system includes a reservoir in which oxygen is stored, a flowmeter, connecting tubing, and a mask or nasal cannula. As the oxygen moves through the coils of the system, it warms and returns to a gaseous state, allowing the patient to breathe the product. This system does not require electricity or need a motor to operate. These units must be filled by one of our patient service technicians on a biweekly or monthly basis. High liter flow or very active patients may require this system.

A portable liquid oxygen system is used in conjunction with the stationary system. A patient is taught to fill the portable directly from the stationary unit. The portable functions in much the same manner as the stationary system.

Common diagnoses:

• Chronic obstructive pulmonary disease (COPD)
  -- emphysema
  -- asthma
  -- chronic bronchitis
  
• lung cancer
• acute myocardial infarction
• acute pulmonary heart disease
• congestive heart failure
• viral pneumonia
• bacterial pneumonia
• bronchiectasis

RESPIRATORY EQUIPMENT AND SYSTEMS

Nebulizers

A small volume nebulizer consists of a compressor to which tubing is attached. The tubing is then connected to a nebulizer medication cup that is fitted with a mouthpiece or mask. Air blows through the tubing and mixes with the medication to form a mist that the patient breathes into the lungs through the mouthpiece or mask. This helps in the treatment of diseases such as pneumonia, chronic, bronchitis, emphysema and asthma.

An ultrasonic nebulizer transports a very dense mist to the patient. Water particles are nebulized by means of sound waves that produce finer particles of moisture. Small-volume, hand-held, portable, battery-operated ultrasonic nebulizers are also available.

Common diagnoses:

• Chronic obstructive pulmonary disease (COPD)
  --emphysema
  --asthma
  --chronic bronchitis
  
• cystic fibrosis
• lung cancer
• acute myocardial infarction
• acute pulmonary heart disease
• viral pneumonia
• bacterial pneumonia
• pneumococcal pneumonia

Respiratory Medications

For patients prescribed nebulized respiratory medications as described above, Apria Pharmacy Network, or APN, located in Oxnard, California and Folcroft, Pennsylvania, supplies those patients with respiratory medications by mail.

Diabetic Medications

Patients living with diabetes also have a convenient, safe way of receiving their testing supplies at home: Star Medical Rx, a member of the Apria Healthcare family of companies. Located in Riverside, Missouri, Star Medical Rx meets the nations' needs for diabetic testing equipment, medications and supplies.

Continuous Positive Airway Pressure (CPAP)

The CPAP system is an electronically operated unit that uses a motor and a blower to maintain the air flow necessary for treatment of obstructive sleep apnea (OSA). The CPAP system treats OSA by providing low-pressure airflow to the airways by means of a nasal mask that fits over the nose or nasal pillows, which are inserted into the nostrils. Air pressure holds the airway open, preventing the collapse of the palate and tongue over the air passage. This allows for normal breathing and uninterrupted sleep.

Bi-Level Positive Airway Pressure (BiPAP) Without Rate

Some patients feel more comfortable with a bi-level unit such as the BiPAP-S The BiPAP-S delivers bi-level ventilation in the spontaneous mode. The patient initiates all breaths. No ventilator respiratory rate is set. Standard CPAP units maintain the same pressure while a patient inhales and exhales. A bi-level unit has different pressures for inhalation and exhalation. Many patients report that the bi-level unit's lower expiratory pressure makes it easier for them to exhale, so they feel more comfortable. To qualify for an intermittent assist device, there may need to be a documented unsuccessful use of CPAP.

Common diagnoses:

• insomnia with sleep apnea
• sleep disturbance
• respiratory insufficiency

Infant Apnea Monitor

Apnea monitors are used commonly for children who are at risk for Sudden Infant Death Syndrome (SIDS). This machine monitors each breath and heartbeat. An alarm goes off if the patient stops breathing for 20 seconds or if the heart rate slows down to below 80 beats per minute. Although monitoring equipment may vary in appearance, most models contain alarm lights, an audible alarm, a reset button and alarm limits set by the physician. Accompanying equipment includes an adequate supply of lead wires, permanent or disposable electrodes, and a belt to keep the electrodes in place.

Oral Suction

A suction machine creates a negative pressure like a vacuum. The machine pulls mucous and other secretions out of the patient's airway. It is used with disposable catheters to remove secretions in patients with compromised cough mechanism or tracheostomy. Suction may be done orally in the back of the mouth or through the trachea for patients with a tracheostomy.

Common diagnoses:

• lung cancer
• acute myocardial infarction
• acute pulmonary heart disease
• congestive heart failure
• quadriplegia
• cystic fibrosis
• cerebral palsy
• viral pneumonia
• bacterial pneumonia
• chronic bronchitis
• emphysema
• bronchiectasis
• asthma
• black lung
• asbestosis

Noninvasive Positive Pressure Ventilation (NPPV) Through Respiratory Assist Devices (RAD)

Therapeutic ventilators are designed specifically for mask-applied ventilation in the home. Noninvasive ventilation is an effective alternative to tracheostomy, offering increased comfort and great normalization of lifestyle. It is ideally suited for patients requiring intermittent non-life-support ventilation, such as nocturnal and/or partial daytime use. These machines provide an easier, more comfortable and less costly way to offer ventilatory support at an early stage without committing a patient to the lifestyle associated with tracheostomy.

Common diagnoses:

• amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• chronic respiratory failure consequent to COPD
• muscular dystrophy
• respiratory insufficiency
• Guillain-Barré  syndrome

Ventilators

A ventilator assists a patient who is unable to breathe on his or her own by expanding the chest and/or lowering the diaphragm. This process causes air to enter the lungs. The positive-pressure ventilator pumps air into the lungs. The negative-pressure ventilator reduces pressure in the chest causing air to flow into the lungs.

Common diagnoses:

• quadriplegia
• amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• muscular dystrophy
• chronic respiratory insufficiency
• respiratory failure
• upper-airway disease or injury

INFUSION THERAPIES

Routes of Administration

Peripheral line: This is the most common venous access device used for intravenous drug infusion. It is used when therapy is not expected to last more than two weeks. A peripheral line is not appropriate for infusing drugs with vesicant or caustic properties, such as chemotherapy agents. Vesicant/caustic drugs can cause pain, blistering and necrosis (cellular death) of surrounding tissues.

Peripherally inserted catheter: Peripherally inserted catheters generally include the mid-line and long-line. Both are alternatives to peripheral lines when therapies of moderate duration are required. A mid-line is generally long enough to reach halfway up the biceps, whereas a long-line reaches up to the curvature of the shoulder. These lines require specially trained personnel to place them.

Peripherally inserted central catheter (PICC): For long-term or vesicant drug therapy, a peripherally inserted central catheter is placed. This type of line usually requires an X-ray confirmation prior to infusion. Patients receiving long-term therapy or chemotherapy may have this type of line placed. This line requires specially trained clinical personnel to place them.

Central venous catheter or central line: Central venous catheters are useful in patients receiving multiple long-term therapies, or patients who become debilitated with poor venous access due to their primary diagnosis. AIDS and cancer patients usually have central lines. Central lines allow the administration of high-calorie, high-protein solutions into a large central vein to treat patients who cannot otherwise be adequately nourished by parenteral means. The central line is used to infuse solution directly into the superior vena cava, the large vein that returns blood to the heart from the upper part of the body. Vesicants can be infused through a central line.

Central venous catheters are surgically inserted. Central lines include tunneled external catheters. They are called "tunneled" because the catheter is actually tunneled underneath the skin from the point of entry. The line exits the skin and is accessed externally.

Vascular access device or port: A vascular access device is a central line also inserted surgically under the skin in cases in which the patient requires long-term, but not continuous, therapy. The patient accesses the line by inserting a needle into the area where the port is implanted beneath the skin.

Subcutaneous: Subcutaneous administration is when medications are administered directly under the skin either by continuous infusions or bolus injections. Patients may easily be taught to administer their own injections.

Intramuscular: Medication is injected into the muscle tissue, where a large network of blood vessels allow for the absorption of medication.

Epidural/Intrathecal: These catheters are placed in the epidural or intrathecal space beside the spinal cord. These are primarily used for pain management and can be used in short- or long-term therapies.

Delivery Systems

The devices used to deliver medication, blood products, fluids and nutrition support are numerous and diverse. Descriptions of the major categories of infusion systems commonly used for the delivery of home intravenous therapies follow. The selection of one of these systems depends on various factors, including type of therapy, patient assessment, preference and potential risk.

Syringe: Manual IV Push via or Mechanical Syringe Pump

This is used primarily for anti-infective therapy. IV push is appropriate for use in patients who:

• require fluid restrictions (such as pediatric, cardiac or renal patients)
• can be taught how to safely administer over the required amount of time
• who have good mental and physical dexterity

Gravity Flow

Gravity flow is appropriate for patients who are receiving up to three doses of anti-infective therapy per day or simple hydration therapy. It is also the appropriate therapy for patients and their caregivers who can be taught to accurately and aseptically attach the IV tubing prior to infusion and who can safely count the required drops in the IV tubing. Good mental and physical dexterity is a must. Because of catheter pressure or body positioning, the flow of fluids is not guaranteed, however.

Elastomeric Pumping Systems

Rate-restricted infusion systems restrict flow rate by using tubing with a calibrated diameter. These devices are generally more expensive than others, but have the advantage of being small and lightweight. Some devices can be carried inside the patient's pocket while infusing medication into the IV line. These devices are used primarily for intermittent anti-infective or chemotherapy infusions.

The patient using this device needs much less training and can maintain activities of daily living while their medication is infusing.

Electronic Infusion System: Ambulatory

This system is used for total parenteral nutrition (TPN), antibiotic/anti-infective therapy, chemotherapy and pain management. Ambulatory pumps are lightweight, compact and portable. Patients for whom this system is most appropriate include those who:

• infuse more than three medication doses daily
• are active during infusion
• teceive therapy continuously for an extended period
• infuse large volumes
• require patient-controlled administration of the drugs to allow finer control of pain

Electronic Infusion System: Stationary

This system is used also for total parenteral nutrition (TPN), antibiotic/anti-infective therapy, chemotherapy and pain management. The pump is commonly used for infusion during the evening, when the patient is asleep or when ambulation during infusion isn't necessary (the pump is mounted on a pole that has wheels).

TYPES OF INFUSION THERAPY

Total Parenteral Nutrition (TPN): This is the intravenous infusion of nutrients such as amino acids, carbohydrates, fats, vitamins or electrolytes to patients who are unable to digest or absorb food via their gastrointestinal tract.

Common diagnoses:

• AIDS/HIV
• cancer (stomach)
• Crohn's disease
• ulcerative colitis
• inflammatory bowel disease
• short bowel syndrome

Antibiotic/Anti-Infective Therapy: This is the intravenous infusion of antibiotic drugs used to treat severe infections that do not respond to oral antibiotics. Antibiotic therapy is indicated when the immune system in its normal function fails to kill sufficient pathogenic microorganisms, which are then allowed to grow and cause disease.

Common diagnoses:

• osteomyelitis
• AIDS/HIV-related infections
• abscesses
• cellulitis/soft tissue infection
• chronic urinary tract infection
• endocarditis
• Lyme disease
• sepsis
• pneumonia
• wound infections

Chemotherapy: This is the treatment of disease by means of chemicals that have a specific toxic effect on disease-producing microorganisms or that selectively destroy neoplastic tissue. It is the primary method for treating cancers. Each class of chemotherapy agent works differently on cancer cells. Therefore, most regimens include multiple drugs. Most chemotherapy agents are very toxic and may cause nausea, vomiting, bone marrow depression and hair loss. This is because chemotherapy affects not only the cancer cells but also these tissues.

Common diagnoses:

• AIDS/HIV
• Malignant neoplasms (cancer)
• lymphomas
• leukemias

Pain Management: This is a way for patients with chronic pain (a secondary problem for many diseases) or acute pain because of surgery or injury to manage it with narcotic medications at home. Because oral analgesics may not control severe pain, narcotic analgesics can be given several ways, including subcutaneously, intravenously, epidurally or intrathecally (within the spinal canal). Most patients with severe pain have a high constant level of pain with multiple severe episodes during the day, which is effectively controlled using these medications and this technology.

Common diagnoses:

• malignant neoplasms (cancer)
• intractable pain due to terminal cancer and AIDS, end-stage COPD
• pain due to traumatic injury
• pain due to surgery

Hydration Therapy: This is required when a patient becomes so dehydrated because of inadequate oral intake that fluids must be administered directly into the bloodstream. The most common solutions are dextrose and/or saline solutions with electrolytes.

Common diagnoses:

• HIV/AIDS
• malignant neoplasms (cancer)
• hyperemesis (excessive vomiting due to pregnancy or other disease states)

Enteral Nutrition: This is the administration of nutritional formula to the functioning portion of a patient's gastrointestinal tract. Enteral nutrition is considered a reasonable and necessary alternative to parenteral nutrition for patients with a functional GI tract, but for whom regular oral feeding is impossible. Enteral nutrition is often referred to as tube feeding. An enteral formula consists of carbohydrates, proteins, fats, minerals, vitamins and electrolytes that are commercially prepared in liquid form. Patients on enteral therapy have a tube placed into the functioning portion of their digestive system. They may have a nasogastric tube ("NG Tube") passed through the nose and into the stomach, a gastrostomy tube ("G-Tube") passed through an opening into the stomach, or a jejunostomy tube ("J-Tube") that is passed through an opening into the second portion of the small intestine.

Common diagnoses:

• malignant neoplasms (cancer)
• malnutrition
• GI fistula
• malabsorption
• inflammatory bowel disease
• short bowel syndrome
• motility disorders

HOME MEDICAL EQUIPMENT

Apria Healthcare provides a wide range of home medical equipment to help improve the quality of life for patients with special needs. Basic categories of equipment are:

• ambulatory equipment, such as canes, crutches and walkers
• hospital room equipment, such as hospital beds and bedside commodes
• bathroom equipment, such as bath and shower benches, elevated toilet seats and toilet, tub or wall grab bars
• phototherapy systems, cabinets, blankets or wraps for babies with jaundice
• support surfaces, such as pressure pads and mattresses, for patients at risk for developing pressure sores or decubitus ulcers

Ambulatory Equipment

The single point cane has a length of wood or aluminum tubing with a handle used to steady a person's gait. The length is related to the person's height. The cane must fit the patient at the correct hand height from the ground when the person is standing.

The quad cane has four rubber-tipped prongs extending from an adjustable aluminum staff. This cane provides more stability than a regular straight cane. The small base quad cane is used by patients who need support and who can climb stairs. The large base quad cane is used by patients who need more support and who are unable to climb stairs.

Underarm crutches are lengths of wood or aluminum tubing joined in a narrow "V" shape. The wide end is padded and fits in the underarm of the patient. These crutches are usually used as a pair to support the weight of someone with an injured leg or foot. The size and length of the crutch is related to the standing height of the patient.

Forearm crutches are lengths of reinforced aluminum tubing topped with guides for the patient's forearms. The patient passes his or her hands through the guides and grips the handles affixed to the tubing. These are crutches are usually used to steady the gait of a person with a neuromuscular disease or birth defect.

The adjustable folding walker has an aluminum tubular frame with four adjustable legs to accommodate the patient's height. The walker has handgrips to aid the patient, who positions himself or herself into it, gaining three-sided support while stepping forward.

An adjustable non-folding walker has an aluminum tubular fame with four adjustable legs to accommodate the patient's height. The walker has handgrips to aid the patient. To utilize the walker, the patient positions himself or herself into it, gaining three-sided support while stepping forward.

A folding wheeled walker is similar to the folding walker except that it is equipped with wheels. This feature allows a person to glide if he or she isn't strong enough to lift the walker.

A standard wheelchair has non-removable, full-length arms, footrests (usually adjustable) and wheel locks. It will generally accommodate patients 5 feet 5 inches to 6 feet tall weighing 110 to 200 pounds. A narrow wheelchair is slimmer than the standard wheelchair and may be used to fit through more narrow doorways.

A hemi-wheelchair has a lower seat than the standard wheelchair to allow a person to propel with his or her feet. This wheelchair is used by people not tall enough to be able to place their feet on the ground while in the chair.

A lightweight wheelchair is lighter than the average standard wheelchair and is used by people who lack the upper-body strength to propel himself or herself in a standard wheelchair.

A heavy-duty (or bariatric) wheelchair is used by people who weigh more than 250 pounds.

A reclining wheelchair has a high back, a headrest and an extension, and the back reclines to various degrees.

Hospital Room Equipment

A manual hospital bed is used by patients who require changes in body positioning not feasible in an ordinary bed. It allows the patient's head to be elevated and the knees to be flexed by using a hand crank. The height of the bed cannot be adjusted.

A semi-electric bed is used by a patient who requires immediate and/or frequent changes in body positioning because of pain, difficulty breathing or other issues. The type of bed is helpful when patients are left alone so that they can make their own position adjustments. The head and knee sections are adjusted by a power hand control, but the height adjustment is manual.

A full electric bed, needed by patients who require frequent changes in body position, allows a person to make positions without adjustments. The head and knee sections and the height of the bed are adjusted by a power hand control.

A bedside commode is an apparatus with four legs that supports a toilet seat and a removable pail for easy cleaning. It is used by people who have difficulty getting to the bathroom.

Bathroom Equipment

Bath and shower benches provide comfort and make bathing easier.

A tub transfer chair is used to transfer a patient from a wheelchair to a tub. A portion of the bench, which has a back and four adjustable legs, is outside of the tub and the other portion is set inside.

An elevated toilet seat is a safety item that sits on the rim of a toilet, making it easier for users, such as seniors, to get on and off the toilet.

Toilet, tub and wall grab bars give a patient extra security in the bathroom.

Phototherapy Systems

The Bililight is a one-piece cabinet containing special fluorescent lightbulbs to treat hyperbilirubinemia (jaundice) in newborns. The baby is placed in the cabinet with eye protection while the light breaks down bilirubin.

The Biliwrap is a blanket or wrap with a built-in light source that allows the baby to be held by a parent or other caregiver during treatment.

Support Surfaces

A person who must always use a wheelchair is at risk for developing pressure sores, or decubitus ulcers. Unless the person repositions herself or himself frequently, decubitus ulcers can develop within a few hours.

Elderly patients are most likely to suffer from pressure sores. Also highly susceptible are bedridden patients whose skin may be sensitive because of nervous or circulatory conditions and those for whom paralysis makes change of position impossible. Included in this group are patients with stroke, cancer, AIDS, diabetes, peripheral vascular disease or quadriplegia.

Among the products that may be ordered for the patient are:

• an alternating pressure pad with pump
• dry pressure mattress
• air pressure mattress
• gel pressure mattress
• air-fluidized bed