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MEDICAL OXYGEN is a brand name for Oxygen. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Hypoxia of any cause. As diluent for gaseous and volatile anaesthetic agents.
Verbatim from this product's MHRA label. Tap a section to expand.
Use in adults and children For respiratory use at concentrations of greater than 21%. Use in neonates When administering oxygen to neonates the inspired concentration of oxygen should not exceed 40%. 8). Use in the elderly When giving oxygen to elderly chronic bronchitic patients the inspired concentration of oxygen should only be raised by 1% increments and should not exceed 30%.
Instructions for use and handling of Medical Oxygen equipment 1. Cylinder valves should be opened momentarily prior to use to blow any foreign matter out of the outlet. 2. Ensure that the connecting face on the yoke, manifold or regulator is clean and the sealing washer or ‘O’ ring where fitted is in good condition.
3. Cylinder valves must be opened slowly. 4. Only the appropriate regulator should be used for the particular gas concerned. 5. Pipelines for medical gases should be installed in accordance with the conditions set out in HTM 02. 6. Cylinder valves and any associated equipment must never be lubricated and must be kept free from oil and grease.
Leaks 1. Should leaks occur this will usually be evident by a hissing noise. 2. Leaks can be found by brushing the suspected area with an approved leak test solution. 3. There are no user serviceable parts associated with these valves, do not attempt to correct any problems with leakage from any part of the valve itself.
Label any faulty containers, and return them to Air Liquide for repair. 4. Sealing or jointing compounds must never be used to cure a leak. 5. Never use excessive force when connecting equipment to cylinders. Use of Medical Oxygen cylinders 1.
Cylinders should be handled with care and not knocked violently or allowed to fall. 2. Cylinders should only be moved with the appropriate size and type of trolley. 3. When in use cylinders should be firmly secured to a suitable cylinder support.
4. Cylinders containing liquifiable gas must always be used vertically with the valve uppermost. 5. Medical gases must only be used for medicinal purposes. 6. Smoking and naked lights must not be allowed within the vicinity of cylinders or pipeline outlets.
7. After use cylinder valves should be closed using moderate force only and the pressure in the regulator or tailpipe released. 8. When only a small amount of gas remains in a cylinder, the cylinder valve must be closed. It is important to leave a small residual pressure in each cylinder after use, in order to protect the inside of the cylinder from contamination.
Different tissues exhibit different sensitivities to hyperoxia, the most sensitive being the lungs, the brain and the eyes.
Description of selected adverse events:
Respiratory adverse events: - At an ambient pressure, the first signs (tracheobronchitis, substernal pain and dry cough) appear as soon as after 4 hours of exposure to 95% oxygen. A reduced forced vital capacity can occur within 8-12h of exposure to 100% oxygen, but serious injuries require much longer exposures.
Interstitial oedema can be seen after 18h of exposure to 100% oxygen and can lead to pulmonary fibrosis. Respiratory effects reported with HBOT are generally similar to those encountered during normobaric oxygen treatment, but the time to symptom onset is shorter.
- With high concentrations of oxygen in the inspiratory air/gas, the concentration/pressure of nitrogen is reduced. As a result, the concentration of nitrogen in tissues and lungs (the alveoli) falls. If oxygen is taken up from the alveoli into the blood more rapidly than it is supplied in the inspiratory gas fraction, alveolar collapse can occur (development of atelectasis).
The development of atelectatic sections of the lungs leads to a risk of poorer arterial blood oxygen saturation, despite good perfusion, due to lack of gas exchange in the atelectatic sections of the lungs. The ventilation/perfusion ratio worsens, leading to intrapulmonary shunt.
- There may be a change in the modalities of ventilation control in patients with long-term diseases associated with chronic hypoxia and hypercapnia. 4). Central nervous toxicity: - Central nervous toxicity can be observed in HBOT settings.
Central nervous toxicity can develop when patients breathe 100% oxygen at pressures above 2 ATA. Early manifestations include blurred vision, peripheral vision decreased, tinnitus, respiratory disturbances, localised muscular twitching especially eyes, mouth, forehead.
Oxygen supports combustion and smoking should be prohibited when oxygen is in use and no naked flame should be allowed. High oxygen concentrations should be given for the shortest possible time required to achieve the desired result, and must be monitored with repeated checks of arterial gas pressure (PaO2) or haemoglobin oxygen peripheral saturation (SpO2) and clinical assessment.
g. patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, morbid obesity, chest wall deformities, neuromuscular disorders, overdose of respiratory depressant drugs). 8). In these patients, oxygen therapy should be carefully titrated; the target oxygen saturation to be achieved may be lower than in other patients and oxygen should be administered at a low flow rate.
5). 2). 8). It is recommended to start resuscitation of term or near term neonates with air instead of 100% oxygen. In preterm, the optimal concentration of oxygen and oxygen target are not precisely known. Supplemental oxygen, if required, will then be closely monitored and guided by pulse oximetry.
Hyperbaric oxygen therapy (HBOT):
Hyperbaric oxygen therapy should only be administered by qualified staff and in specialised centres aware and equipped for insuring appropriate precautions for hyperbaric use. The pressure should be increased and reduced slowly in order to avoid the risk of pressure damage (barotrauma).
Confinement anxiety and claustrophobia can occur during the HBOT session chamber. The benefit/risk ratio of HBOT should be thoroughly evaluated in patients with claustrophobia, severe anxiety, psychosis.
Respiratory disorders:
Because of the decompression, at the end of the hyperbaric session, the gas volume increases while the pressure in the chamber decreases that may lead to partial pneumothorax or aggravation of an underlying pneumothorax. In a patient with an undrained pneumothorax, decompression could lead to the development of a tension pneumothorax.
4)
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Continuation of exposure can lead to vertigo and nausea followed by altered behaviour (anxiety, confusion, irritability), and finally generalized convulsions. The hyperoxia-induced discharges are believed to be reversible, causing no residual neurological damage, and disappearing upon reduction of the inspired oxygen partial pressure.
Eye toxicity:
Progressive myopia has been reported in cases of multiple hyperbaric treatments. The mechanism remains obscure but an increase refractory index of the lens was suggested. Most cases were spontaneously reversible. However, risk of irreversibility increased after more than 100 therapies.
After stopping HBOT, reversal of myopia was usually rapid for the first few weeks and then continued more slowly for periods ranging from several weeks to as long as a year. The threshold of number of HBOT sessions, periods or duration cannot be estimated.
It was ranged from 8 to more than 150 sessions. Pediatric population In premature neonates who have been subjected to high oxygen concentrations, retinopathy of prematurity (retrolental fibroplasia) may occur at concentrations greater than 40%.
4). Adverse events related to HBOT procedure: - Undesirable effects of HBOT are barotraumas or consequences of multiple and rapid compressions/decompressions. Most of them are not specific to the use of oxygen and can occur in patients under oxygen as well as in attending healthcare professionals under hyperbaric ambient air.
). - Due to the relatively small size of some hyperbaric chambers, patients may develop confinement anxiety that is not due to a direct effect of oxygen. ) Metabolism and nutrition disorders Hypoglycemia in diabetic patients * The development of cataracts has been reported in patients undergoing prolonged courses and/or frequently repeated sessions of HBOT (> 150 sessions).
Some cases of de novo/new cataract have been observed. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal […]
3). Moreover, considering the risk of gas expansion during the decompression phase of HBOT, the benefit/risk ratio of HBOT should be thoroughly evaluated in patients with insufficiently controlled asthma, pulmonary emphysema, chronic obstructive pulmonary disease (COPD), recent thoracic surgery.
Diabetic patients:
Blood glucose decrease during HBOT session has been reported. Hence, it may be preferable to monitor blood glucose before HBOT session in diabetic patients.
Coronary diseases:
The benefit/risk ratio of HBOT should be thoroughly evaluated in patients with coronary diseases. In patients with acute coronary syndrome or acute myocardial infarction who also require HBOT, such as in case of CO intoxication, HBOT should be used cautiously because of the vasoconstriction potential of hyperoxia in the coronary circulation.
Ear, nose and throat disorders:
In relation to the compression/decompression of HBOT, caution and thorough assessment of the benefit/risk ratio of HBOT are required in patients with sinusitis, otitis, chronic rhinitis, laryngocele, mastoid cavity, vestibular syndrome, hearing loss and recent middle ear surgery.
Relating to hyperoxia induced by HBOT, the benefit/risk ratio of HBOT should be thoroughly evaluated in patients with: • History of seizure, epilepsy • Uncontrolled high fever Risk of fire: Oxygen is an oxidizing product and promotes combustion.
). Only water-based products should be used on the hands and face or inside the nose while using oxygen. • Risk of fire in medical environment: this risk is increased in procedures involving diathermy, defibrillation and electro conversion therapy.
• Fires can occur at valve opening (frictional heating). Thermal burns have occurred related to accidental fires in presence of oxygen.
Handling of the cylinders:
Caretakers and all people who handle medicinal oxygen cylinders should be warned about the need to carefully handle cylinders to prevent damages to the equipments, especially the valve. Equipment damage may cause obstruction of the outlet and/or wrong information displayed on the manometer or digital display with regards to remaining oxygen content and flow delivery leading to insufficient or lack of oxygen administration.