2. BY AHMAD YOUNES PROFESSOR OF THORACIC MEDICINE
Instructions To Patients Using positive airway pressure and oxygen concentrators
BY AHMAD YOUNES PROFESSOR OF THORACIC MEDICINE
Mansoura Faculty of Medicine

3. General instructions
Do not make any adjustment to your CPAP or bi-level unit.
CPAP and bi-level units are available in different models. However, all models have the same basic parts:
1- power switch to turn the unit off and on
2- An air outlet to which the tubing is connected
3- An air inlet where air is pulled into the unit through a filter (s) which removes dust from incoming air.

4. Ramp Feature
The ramp feature allows you to reduce the air pressure to a very low level as you begin to fall asleep.
Within an adjustable time frame, the pressure will automatically “ramp up” to your prescription pressure at a gentle rate that should not awaken you

5. Operating Your CPAP/Bi-Level Unit
1-Select a location near the bedside,
2-Place the CPAP/bi- level unit on a sturdy surface.
Do not place the unit above your head. You may pull on the tubing at night and pull the unit onto your head
3-Make certain there is air circulation around the unit and that the air inlet is not blocked by bedclothes, or furniture.
4- Do not place the unit near
a heat or cool source.
5- Do not place the unit on a pad or
carpet that could obstruct the flow
of air around or underneath the unit.

6. Operating Your CPAP/Bi-Level Unit
If the AC power cord is not permanently attached to your unit, plug its female end into the AC power inlet on the back of the unit. Plug the other end of the cord into an appropriate electrical power outlet.
Do not use an extension cord with your unit.
Do not plug the unit into an outlet
that has other major appliances
plugged into it

7. Operating Your CPAP/Bi-Level Unit
Connect your tubing to the air outlet on the CPAP/bi-level or humidifier,
Fill humidifier chamber with STERILE or DISTILLED water. If distilled water is not available, you may boil tap water for 20 minutes. Allow the water to cool before adding to the humidifier.
Please do not fill chamber beyond the fill line, this will prevent water from blowing into the circuit.
Never place medications into your chamber
Always remember to turn off the unit when
not in use, or when you are refilling
the unit.
A tubing 8 inch is connected directly to
the CPAP outlet port, and the other end
to the inlet port of the humidifier

8. ASSEMBLY OF HEADGEAR
There are many types of headgears which are used in conjunction with many types of mask
Place the headgear on your head adjust it to a comfortable fit using the Velcro tabs to hold it in place.
Make sure the mask has a snug fit you do not want it too tight but you also do not want air too leak out the sides
Each strap should be adjusted so that it form a secure fit, do not tighten one strap tighter then the next; all should be pulled to the same extent.

25. FINAL ASSEMBLY
Connect the tubing to your mask, The other end of the tubing should then be connected to the outlet of your unit.
Washing your face to remove excess facial oils will help to achieve a leak-free fit and prolong the useful life of the mask.
Turn the unit on. Adjust the mask until there are no leaks; again keep in mind all straps should be pulled to the same tension.
Once you have fit your mask or pillows and there are no leaks you may want to mark the straps with a marker to identify the position for future positioning.
Do not block the exhalation port on your mask circuit. The exhalation port may be located at the base of your mask or in a special attachment between your mask and tubing.

26. OXYGEN AND YOUR CPAP UNIT
Your oxygen may be administered via a port on the mask.
The small tubing from
your oxygen system is directly
connected to the port on
your nasal mask.
Keep the ports closed
unless using oxygen.

27. OXYGEN AND YOUR CPAP UNIT
Your tubing is connected to the large end on the tee adapter and the small tubing from your oxygen system is connected to the small nipple on the tee adapter.
Always turn your CPAP or bi-level
unit ON before turning ON the
oxygen flow.
Always turn OFF the oxygen before
turning OFF the CPAP or bi-level unit

29. Cleaning Your Humidifier
Note: If you have a heated humidifier, immerse only the water chamber in water or disinfectant.
Never immerse electrical appliances in any liquid.
Daily Cleaning
Step 1: Check water level everyday.
Step 2: Empty any remaining water
Out of the reservoir after each use.
Step 3: Wash your hands.
Step 4: Rinse with clean water and
allow to air dry

30. Cleaning Your Humidifier
Twice Weekly Cleaning
Step 1: Wash your hands.
Step 2: Soak the humidifier in soap and water for 30 minutes. Be sure the mixture completely covers and fills the humidifier.
Step 3: Remove the humidifier and shake out the excess solution.
Step 4: Rinse with clean water and allow to air dry.
NOTE: DO NOT immerse CPAP/bi- level unit in water.

31. Cleaning Your Equipment
Mask Interface and Tubing
To lengthen the life of your equipment and supplies, it is important to inspect and clean all components regularly.
The masks, tubing and headgear should last approximately 6 to 12 months, but the actual life of the equipment can vary greatly.
Inspect all components daily and clean them as necessary.
Daily cleaning is recommended.
Caution: DO NOT clean any parts of the system with alcohol, cleaning solutions containing alcohol or any strong household cleaners

32. Cleaning Your Equipment
DAILY
Step 1: Wash your hands.
Step 2: With a soft cloth, gently wash the mask or pillows with a solution of warm water and a mild, clear liquid detergent (one-part white vinegar, and two-parts water solution).
Step 3: Rinse thoroughly.
If the mask still feels oily, repeat Step 2.
Step 4: Allow the mask or pillow to air dry.

33. Cleaning Your Equipment
WEEKLY
Step 1: Wash your hands.
Step 2: Soak tubing and filter (if applicable).
Hang tubing over door or shower rod to drain excess water.
Step 2: With a soft cloth, gently wash the mask frame, humidifier chamber, and mask headgear with a solution of warm water and a mild, clear liquid detergent
Step 3: Rinse thoroughly.
Step 4: Allow to air dry.

34. Cleaning Your Equipment
Note that slight readjustments to your headgear straps may be needed after repeated washings.
Never use bleach when cleaning your headgear or chinstrap.
Never iron your headgear or chinstrap.

35. Cleaning Your Equipment
Clean Your Unit Weekly Step 1: Unplug the unit before cleaning it. Never immerse the unit in water. Step 2: Using a cloth slightly dampened with water and wipe the outside of the unit. Step 3: Use a dry cloth to wipe the unit dry. Step 4: Make sure the unit is thoroughly dry before plugging it in again.

36. Filter Maintenance There are two types of filters
Disposable normally replaced 4 – 6 weeks, and the non-disposable cleaned
a minimum of once per week.
Please review the manufacturer’s
product literature for specific filter
maintenance instructions.
Never place a damp filter in your
CPAP or bi-level unit.

38. Information for CPAP Patients
CPAP device should be used every night and anytime that you sleep.
Since your sleep is now deeper and more restful than before, you may not need to sleep as many hours to be rested.
Try to go to bed and get up about the same time everyday. This will help your body to establish a regular sleep/wake cycle.
If you are on blood pressure medication, make sure all of your doctors are aware that you are using a CPAP or bi-level unit. Never change your blood pressure medication without your doctor’s approval.

39. Information for CPAP Patients
After a week or two of using your CPAP or bi-level unit, you should be less sleepy during the day.
Your snoring should be reduced or eliminated when you use your CPAP or bi-level unit. If a family member notices that you are beginning to snore loudly again while wearing the unit, You may need an adjustment to your CPAP pressure.
The noise of the machine may initially be bothersome to you and your bed partner. Generally, it is a matter of just getting used to it and usually will become less bothersome over time. If after several weeks it still bothers you, you can place the machine further away from you. (However, you should not use more than two lengths of tubing. The pressure may drop and the machine will become ineffective.)

40. Information for CPAP Patients
During the first few weeks of treatment you may experience some sneezing and perhaps a sensation of nasal obstruction. This is normal. Nasal congestion is the most common side effect of CPAP therapy. Many times this will resolve itself as you become accustomed to your CPAP unit. It may take up to four weeks.
NOTE: If dryness is occurring, please advise your therapist as you may need your humidity setting adjusted.
weight loss generally will improve your overall health and could allow your doctor to decrease the pressure of air used in your machine. If you gain weight, your doctor may need to increase the pressure of your CPAP unit.

41. Information for CPAP Patients
If you require surgery or hospitalization for any reason, make sure you inform your physician of your diagnosis and the need to use the CPAP machine with all sleep. You need to take your CPAP unit to the hospital so that you can use it during your hospitalization, especially when you are sedated before and after surgery.
You should be able to use CPAP all night long, every night.

42. Safety Precautions
1- Never try to clean the unit by placing it in water.
The electrical components will be damaged and
this can create a shock to the user the next time
it is plugged into an electrical outlet.
2- Never plug in the unit if it is wet or damp.
Moisture always increases the potential of
electrical shock.
3- Never plug your unit into an electrical
outlet that is being used to supply power to
another major appliance.
4- Never use your unit with an extension cord.
5- Never try to repair your CPAP unit

43. OXYGEN CONCENTRATOR

44. OXYGEN CONCENTRATOR
Your doctor has prescribed your oxygen to be used in the following manner:
____ liters per minute during normal activity.
____ liters per minute with sleep.
____ liters per minute when exercising.
____ liters per minute continuously.
Never increase your oxygen without the approval of your doctor.

45. YOUR OXYGEN CONCENTRATOR
An oxygen concentrator is an electrically operated device that separates the oxygen from the other gases in the air and delivers the concentrated oxygen to you.
At 2 liters per minute, the air that you receive from your concentrator is more than 90% oxygen.
All Oxygen concentrators models have the same basic parts:
1- Power switch to turn the unit on and off,
2- Flow selector that regulates the amount of oxygen you receive,
3- An alarm system that alerts you if the power is interrupted
4- if recommended, a humidifier bottle.
The oxygen is delivered to you through a nasal cannula.
The tubing on the cannula is attached to the outlet on the unit.
Sometimes, an extra length of tubing may be provided. This will allow you to move a farther distance from your concentrator

46. OPERATING YOUR OXYGEN CONCENTRATOR
Step 1: Check the number of prongs on the plug of your concentrator.
For Two-Prong Plugs:
Do not use an extension cord with the concentrator.
Do not plug the concentrator into an outlet that has other major appliances plugged into it.
For Three-Prong Plugs:
Use these instructions ONLY if you are sure that your outlet is grounded. If your outlet is not grounded, or if you are unsure, contact an electrician. Using an ungrounded outlet could result in a fire hazard or shock.
If your outlet is not a 3-prong, you may need to use a plug adapter.
When using a plug adapter, connect the ground screw.

47. OPERATING YOUR OXYGEN CONCENTRATOR
Step 2: Attach nipple adapter or water bottle to the concentrator outlet tube and attach the oxygen tubing to the nipple outlet.
Step 3: If a humidifier bottle is recommended, attach a bottle that is filled with distilled water.
Center the threaded cap on the humidifier bottle under the threaded outlet tube on the concentrator.
Turn the cap on the humidifier bottle until it is tightly screwed onto the outlet tube.

48. OPERATING YOUR OXYGEN CONCENTRATOR
Step 4: Turn machine ON. The alarm will sound for a few seconds until the proper pressure is reached.
Step 5: Adjust the oxygen flow rate by turning the liter control knob until the flow is at the prescribed number.
FLOWMETER WITH LITER TUBE:
Adjust the liter control knob until the middle of the indicator ball is at the prescribed number.
Never change this liter flow without instructions from your doctor.

49. OPERATING YOUR OXYGEN CONCENTRATOR
Step 6: Fit the nasal cannula to your face so that it is comfortable.
Insert the two prongs of the cannula into your nostrils. Make sure the prongs face upward and curve into your nostrils.
Slide the tubing over and behind each ear.
Adjust the tubing to fit comfortably under your chin by sliding the adjuster upward. Be careful not to adjust it too tightly.
Step 7: You should use your concentrator for the number of hours each day that your doctor has prescribed.
When you have finished using your oxygen:
1- Remove the nasal cannula.
2-Turn OFF the machine.

50. CLEANING AND MAINTENANCE PROCEDURES
Oxygen systems require very little cleaning. The only item that requires cleaning on your concentrator is the external filter and the cabinet. The cabinet can be washed with a damp cloth.
To prevent equipment contamination, effective cleaning procedure must be carried out on a routine basis.
Do all cleaning and disinfecting in a clean environment. Avoid doing it after vacuuming, under an open window, or in dusty, dirty ,smoky areas.

51. ONCE A WEEK: Step 1: Remove the filter.
Step 2: Wash in warm water and a non-lotion dish liquid.
Step 3: Rinse the filter thoroughly with warm water.
Step 4: Gently squeeze water from the filter, then pat dry with a clean towel.
Step 5: Reattach the filter when completely dry.

52. CARE OF YOUR HUMIDIFIER BOTTLE
If you are using a humidifier bottle with your oxygen concentrator ,you will need to check the water level in the jar frequently.
When the water runs low or the bubbling stops, you need to refill the jar.
You should use your back up oxygen system while refilling and cleaning your humidifier bottle.

53. Refilling the Humidifier Bottle
Step 1: Turn the oxygen concentrator OFF.
Step 2: Unscrew the jar from the humidifier bottle lid.
Step 3: Discard any water remaining in the jar.
Step 4: Rinse bottle under a strong stream of warm tap water. Allow water to run for three minutes before rinsing. Shake off the excess water.
Step 5: Refill the jar with distilled water to the fill line.
DO NOT OVERFILL THE BOTTLE.
Too much water in the bottle will cause water to collect in your oxygen tubing.
Step 6: Screw the water bottle back on the humidifier bottle tightly. Be certain the jar is screwed on straight.
Cross threading will cause oxygen to escape out of the top of the jar.

54. WEEKLY CLEANING AND DISINFECTION
It is very important to clean your humidifier bottle to prevent infection.
weekly.
Step 1: Turn the oxygen concentrator OFF.
Step 2: Remove the humidifier bottle.
Step 3: Wash the entire humidifier bottle in a solution of dish liquid and warm water.
Step 4: Rinse the bottle thoroughly. Shake off excess water.
Step 5: Mix one part vinegar and four parts water. Soak for 20 minutes in the solution.
Step 6: Rinse bottle in warm tap water. Allow water to run for three minutes before rinsing.
Step 7: Shake bottle to dry.
Step 8:Replace your humidifier bottle as instructed.

55. CARE OF YOUR OXYGEN TUBING
Once or twice during the day, you remove the cannula and wipe it clean with a damp cloth.
You should replace your nasal cannula every two weeks.
Replace your tubing every 90 days.
Do not use alcohol or oil-based products on or near your cannula.

56. CARE OF YOUR OXYGEN TUBING
Occasionally, if you are using a humidifier bottle, moisture may accumulate inside your oxygen tubing. If this becomes uncomfortable, you should try the following procedure:
Step 1: Remove the humidifier bottle from the outlet tube on the concentrator.
Step 2: Attach a nipple adapter to the outlet tube.
Step 3: Remove the oxygen tubing from the humidifier bottle and attach it to the nipple adapter.
Step 4: Allow the oxygen to run directly through the tubing. Within a few minutes the tubing will be dry.
Step 5: When tubing is dry, disconnect it, remove the nipple adapter, reconnect the humidifier bottle to the concentrator and reattach the oxygen tubing to the humidifier bottle.
Step 6: Recheck the liter flow gauge to make sure the oxygen is flowing at the prescribed level.

57. SAFETY PRECAUTIONS HEAT
Store oxygen equipment at least ten feet away from open flames, space heaters, large windows or any source of heat.
GREASE
Never grease or oil your oxygen equipment. Keep equipment and tubing away from all flammable materials such as oil ,grease, Vaseline, hair lubricants, hand lotions and aerosol sprays.
SMOKING
Do not permit smoking in the same room as your oxygen equipment.
Place NO SMOKING signs on all exterior doors of your residence
FURNITURE POLISH
Clean the concentrator surface with a damp cloth.
Never use wax, spray or furniture polish.

58. SAFETY PRECAUTIONS EXTENSION CORD
Do not use an extension cord with the concentrator.
ELECTRICAL OUTLET
Never plug the concentrator into an outlet that is being used to power other major appliances. Do not use an "octopus" adapter with your concentrator.
CONCENTRATOR PLACEMENT
Keep the concentrator at least 10 to l5 cm away from drapes, bedspreads, walls or any other item that might block the inlet ports.
If the concentrator is too noisy, place it in an adjacent room

59. SAFETY PRECAUTIONS COOKING SAFEGUARDS
It is best to use a microwave oven or make other arrangements but if you must cook, you can:
Step 1: Secure the cannula over the ears and behind the head instead of under the chin.
Step 2: Secure oxygen tubing to the side of your clothing at the waist with a large safety pin. This method will keep the oxygen tubing away from the source of heat.
NOTE: Do not bend down close to the burner.

60. Oxygen simplified EverFlo concentrators

61. Parts of Your Concentrator

62. Operating Instructions
Make sure that the device is at least (10 to l5 cm) away from walls, furniture, and especially curtains that could impede adequate airflow to the device.
Do not place the device near any heat source.
After reading this entire manual, plug the power cord into an electrical outlet.

63. OperatingIn structions

64. If you are not using a humidiffer, connect your nasal cannula to the Oxygen Outlet Port, Step A
If you are using a humidifier, follow the steps below:
1-Open the filter door on the back of the device
2. Remove the humidifier connector tube from the back of the door and replace the filter door
3. Fill your humidifier bottle .
4. Mount the filled humidifier on the top of the EverFlo device inside the velcro strap
5-Tighten the velcro strap around the bottle and secure it so it is held firmly in place.
6-Conncct the humidifier connector tube to the Oxygen Outlet Port.
7-Connect the other end of the humidifier connector tube to the top of the humidifier with the elbow in the tubing facing the front,
8-Connect your cannula to the humidifier bottle .

65. Press the power switch to the On position
Press the power switch to the On position. Initially, all the LEDs will illuminate and the audible alert will beep for a few seconds. After that time, only the green LED should remain lit. you can begin breathing from the device immediately even though it typically takes l0 minutes to reach oxygen puriry specifications .
Adjust the flow to the prescribed setting by turning the knob of the flow meter until the ball is centered on the line marking the specific flow rate.
When you are not using the oxygen concentrator press the power switch to the Off position

66. Cleaning Maintenance Warning: It is important to unplug the device before you perform any cleaning.
Periodically. use a damp cloth to wipe down the exterior case of the EverFlo device.
Warning: Do not remove the covers of the device. Servicing must be referred to an authorized and trained Respironics home care provider.

68. Instructions for Pulse Oximeter
Pulse oximetry is a noninvasive monitoring technique used to estimate the measurement of arterial oxygen saturation (SpO2) of hemoglobin.
Oxygen saturation is an indicator of the percentage of hemoglobin saturated with oxygen at the time of the measurement.
Several different types of pulse oximeters are available. The most popular are fingertip pulse oximeters and portable handheld .

69. GO2 Fingertip pulse oximeter

70. Cautions
The pulse oximeter might misinterpret excessive movement as good pulse strength. Limit finger movement as much as possible when using the device.
Do not put the device on the same hand/arm when using a blood pressure cuff or monitor.
The pulse oximeter has no alarms.
Do not place the pulse oximeter in liquid or clean it with agents containing ammonium chloride or isopropyl alcohol.
High levels of dysfunctional hemoglobin (caused by sickle cell anemia, carbon monoxide, etc.) could affect the accuracy of the measurements.

71. Cautions
Do not use the pulse oximeter for more than 30 minutes without relocating the device to another finger.
Do not tamper with, or hang lanyard from the flexible circuit.
Radios and cell phones or similar devices may affect the pulse oximeter and should be kept at least 2 meters away from the device.
Remove the battery if the pulse oximeter will be stored for more than 30 days.

72. Applying the GO2 to Your Finger

73. Applying the GO2 to Your Finger
Do not press the GO2 against any surface and do not squeeze or hold it together.
The internal spring provides the correct pressure; additional pressure may cause inaccurate readings.
The GO2 automatically turns on when a finger is inserted.
When a finger is inserted, the GO2 performs a brief self test.

74. Reading Your Results
The amount of oxygen in your blood, displayed as %SpO2;
and
Your Pulse Rate, beats per minute.
The Pulse Quality indicator displays the strength of the pulse rate signal. Bars will display after the , indicating pulse signal strength the greater the number of bars indicates a greater pulse quality signal strength .
If you are not getting a pulse rate reading and your pulse quality indicator is weak, warm the finger or reposition to another finger.

75. While the GO2 is formulating its reading immediately after activating the device, the sensor disconnect indicator will appear. The sensor disconnect indicator also appears when you remove your finger to indicate the pulse signal is not detected or when there is excessive motion. If this symbol does not turn off while your finger is in the device, reposition your finger or switch to a different finger.

76. The Battery indicator symbol shows the battery strength
The Battery indicator symbol shows the battery strength . Replace the battery when this symbol begins to flash.

77. The following conditions reduce the performance of the pulse oximetry:
- flickering or very bright light;
weak pulse quality (low perfusion);
low hemoglobin;
arterial catheters;
nail polish, and/or artificial nails; and
any tests recently performed on you that required an injection of intravascular dyes.