Home Oxygen: Prescribed Flow, Fire Safety, and Warning Signs
Teach oxygen as a medication: use the prescribed flow rate and hours, and do not change the flow without a prescription. No smoking or vaping in the home, and keep equipment at least 10 feet (3 m) from open flames, gas stoves, and candles. Increased dyspnea, confusion, or cyanosis requires a call or 911; morning headache or unusual sleepiness in COPD requires a call to the provider.
Who needs this teaching
Every client discharged with home oxygen from a concentrator, cylinders, or liquid oxygen, and every household member. Oxygen is not flammable, but it supports combustion. In an oxygen-enriched environment, materials ignite more easily and burn hotter and faster. Smoking during oxygen use is the leading cause of home oxygen fires and facial burns.
The priority teaching points
- Oxygen is a medication. Use the prescribed flow rate in L/min for the prescribed hours, including during sleep and exertion when ordered. Do not change the flow rate without a prescription. In clients with chronic hypercapnia, excess oxygen worsens carbon dioxide retention. When a pulse oximeter is used, follow the prescribed SpO2 range, such as 88 to 92% for a client at risk of hypercapnia. Normal SpO2 is 95 to 100%.
- No smoking and no open flames. No one smokes, vapes, or uses e-cigarettes in the home. Keep oxygen equipment at least 10 feet (3 m) from open flames, gas stoves, candles, fireplaces, and matches. Post "No smoking: oxygen in use" signs on entry doors. Keep smoke alarms working and a fire extinguisher available.
- No petroleum-based products. Do not use petroleum jelly or oil-based creams on the lips, nose, or face. Use a water-based lubricant for dryness. Use a humidifier bottle when prescribed.
- Equipment safety. Secure cylinders upright in a stand or cart. Store them in a ventilated area away from heat sources. Plug a concentrator directly into a wall outlet, not into an extension cord or power strip. Turn the oxygen off at the source when not in use.
- Fall prevention. Oxygen tubing is a trip hazard. Keep tubing out of walkways, and coil excess tubing. Teach the client to watch the tubing when turning or using stairs.
- Skin integrity. Cannula tubing causes pressure injury over the ears and irritation of the nares. Inspect behind the ears and the nares daily. Pad the tubing over the ears with gauze or foam covers.
- Emergency preparedness. Notify the electric company and the local fire department that the home uses oxygen. Keep a full backup cylinder for power outages and the supplier's 24-hour phone number.
- Changes in oxygenation. Increased dyspnea, restlessness, confusion, and cyanosis indicate hypoxemia. Check the tubing, connections, and supply first, then call. Morning headache or unusual daytime sleepiness in a client with COPD indicates carbon dioxide retention; report it to the provider.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Morning headache or unusual daytime sleepiness in COPD | Severe shortness of breath after the equipment is checked |
| Increased shortness of breath with usual activity | New confusion or difficulty arousing the client |
| Redness or skin breakdown behind the ears or at the nares | Cyanosis of the lips or nail beds |
| Nosebleeds or marked nasal dryness | Any fire: leave the home first, then call |
Teach-back questions
- "What flow rate is prescribed for you?"
- "How far do you keep your oxygen from the gas stove?"
- "What do you use for dry lips or a dry nose?"
- "What will you use if the power goes out?"
- "What do you check first when you feel more short of breath?"
Teaching tips
- Teach the whole household, including visitors who smoke.
- Ask the home health nurse to check the home for flame sources, extension cords, and tubing paths.
- Write the flow rate, hours, and supplier number on the handout.
- Have the client turn on the equipment and read the flowmeter.
Read more on NCLEXPace
- Fire, Electrical, and Radiation Safety in One Article
- Respiratory Map: COPD, Asthma, Pneumonia, PE, and Chest Tubes
- COPD vs Asthma on the NCLEX (and Why Oxygen Orders Differ)
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Obstructive Pulmonary Diseases.
- Jacobs SS, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(10):e121-e141.
- Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of Nursing. 10th ed. Elsevier; 2021; Chapter: Oxygenation.
Why this matters for the NCLEX
Teaching is effective when the client states, "I keep my oxygen at the prescribed rate and call my provider if I feel more short of breath," and "I use a water-based gel for my dry nose." Statements requiring further teaching include, "I turn up my oxygen when I feel short of breath," "My husband smokes only in the kitchen," and "I use petroleum jelly on my lips."
Frequently asked questions
Is oxygen flammable?
No. Oxygen supports combustion. Materials ignite more easily and burn hotter and faster in an oxygen-enriched environment.
Does the client increase the flow during more shortness of breath?
No. The client uses pursed-lip breathing, checks the equipment, and calls the provider. The flow changes only by prescription, unless the prescription includes a separate rate for exertion or sleep.
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