The Treatment of Low Oxygen Levels – The Benefits and Safety

Oxygen is a gas found in the atmosphe it     enters the body through our lungs, and fuels all the cells in our bodies.

When examining the composition of human body, it consists of 11 elements, all of which are necessary for our bodies to function.   It is amazing to think that 65% of our body’s mass consists of Oxygen.

A hospice patient can experience changes in their levels of oxygenation level for a variety of reasons.

Regardless of the cause, you or loved one may benefit from supplemental oxygen support.  It is a comfort measure, and can improve the quality of life.  It is very common for the hospice doctor to order an oxygen concentrator at the start of care, and along with some back up tanks of liquid oxygen for travel or emergency.

Oxygen Concentrators are machines that pull room air into them, and condense the molecules to deliver an oxygen rich gas.   Some concentrators only go as high as 5 Liters per minute, while larger machines can produce up to 10 Liters per minute.  In most situations, the smaller concentrator is adequate,  and can be very beneficial.  The larger machine does require the use of mask.  Many people find a mask to be intrusive, and can create a sense of claustrophobia.

Oxygen output is not only measured in Liters per minute, but also by the percentage of oxygen being delivered.

General oxygen concentration in the air that we all share is 21%.  With every increase in liter flow, there is an increase in the concentration of oxygen.

  • 1 Liter per Minute –    24% Oxygen
  • 2 Liters per Minute –  27% Oxygen
  • 3 Liters per Minute –  30% Oxygen
  • 4  Liters per Minute – 33% Oxygen
  • 5  Liters per Minute  – 35% Oxygen


Oxygen at lower rates of flow is best delivered through a nasal cannula, but a simple mask can be used an alternative.

When there is a need for a higher rate of flow,  a simple mask at a setting of 6-10 Liters per minute, will deliver a concentration of 35-50% oxygen.   Occasionally there is a need for very high concentrations of oxygen.  It is possible to connect two 10 Liter concentrators together.   With a flow rate of 12-15 Liters per minute, a concentration of oxygen of 80-100% can be achieved with a specialized mask, called a non-rebreather.  BiPAP is occasionally used as well, and requires a machine and custom mask to regulate the oxygen flow.  Your hospice doctor and nurse will guide you on the best method for providing supplemental oxygen therapy.

In my experience, the need for such a high flow of oxygen in hospice care is limited.  It is only appropriate in the rare circumstance.  Delivering oxygen with an increased flow rate can be quite irritating to the patient, and could be considered as an overly aggressive intervention.

In patients with lung disease or COPD, there is an effort to keep the oxygen rate below 2 Liters per minute.  As this disease process progresses, these patient will develop what is referred to as a hypoxic drive.  In the healthy person, breathing is stimulated by the amount of Carbon Dioxide in blood stream, which is the byproduct exhaled and excreted during respiration.  With chronic lung disease, the body attempts to adapt to chronically high levels of Carbon Dioxide, and starts to depend on the levels of oxygen in the bloodstream to stimulate the respiratory drive.  If a COPD patient is being administered an oxygen rich gas, the lungs will relax and stop working as hard to breathe.  Over time, the weakening respiratory effort can accelerate the disease process.

The Humidification of Oxygen

The concept is moisten the air flow, and prevent irritation to the nose and throat.  There is a cup apparatus that connects directly to the machine, and is filled with water.   It is not always necessary to use the humidifier, but is recommended for use with higher flow rates.  The humidifier should only be used with a nasal cannula delivery system, and is beneficial when someone may be wearing oxygen 24 hours a day.  Using distilled water can prevent the collection of minerals in the oxygen tubing.  The water should be changed daily to prevent the growth of microorganism.  It is important not to overfill the cup, because the water can travel into the tubing, and will leak out of the nose piece.  One advantage of using a humidifier is that you can be assured the oxygen is working properly, when you can visualize the water consistently bubbling.

Liquid Oxygen

Most hospice doctors will order back up oxygen for patient to use for travel outside of the home.  They are also intended as an emergency back up for the oxygen concentrator, if it were to fail.  There is a regulator device that attached to the top of oxygen tank .  The nasal cannula connects directly to the regulator, and the black dial controls the rate of flow.  The green key on the top must be turned rotated to open and close the tank.  When oxygen is not in use, be sure to keep the tank in a closed position.   Special precautions should be used with these tanks to prevent them from being knocked over, because the pressure inside of them is so great.  They should be stored in an upright position, and can be placed in a rack to prevent them from tipping.

When to Use Supplemental Oxygen

When someone is visibly demonstrating symptoms of shortness of breath.  This can include an increase in the rate of breathing and increased respiratory effort.

With noticeable changes in oxygenation, like very pale skin, and lips and nailbeds are no longer pink, sometimes with a bluish appearance.

During the treatment phase of respiratory infections, especially with an increase in coughing and chest congestion.

When someone’s oxygen level is low. Your hospice nurse will use a device called a pulse oximeter, which measures the percentage of oxygen present in the capillary flow of the nailbed.   If someone’s oxygenation level is less than 90%, then supplemental oxygen  may be a recommended.

Oxygen therapy can benefit patients suffering from congestive heart failure.  Not only does it help with episodes of chest pain, but it is can support the heart by reducing the work of the muscle.  These patients will have an increased energy level and potentially slow the progression of the disease.

 Safety Considerations 

  • Keep a distance of at least 10 feet from any type of open flame, and of course no smoking.
  • As an added precaution, signs can be placed in the home stating that oxygen is in use, and smoking is prohibited.
  • When using lotions, creams, or chapsticks be sure that they are water-based.  Petroleum based products like Vaseline are known to be flammable.
  • Sparks from items like hair dryers, electric blankets, electric razors, or friction toys can pose a fire risk.
  • Ensure that smoke detectors are present in the home, and are working properly.  Testing them periodically to ensure that the batteries are working is highly recommended.
  • Use caution with oxygen tubing to prevent falls or injuries while walking.

Oxygen therapy is a very important aspect of hospice care.  If you or loved one is having shortness of breath or having respiratory problems, this intervention can provide some much needed relief.  Your hospice nurse with guide you on the appropriate use of supplemental oxygen and possible safety concerns.

I hope that you found this information useful.  Feel free to leave a comment or ask a question.


  • S McFadden July 5, 2017 at 4:24 am

    Highly informative article. Thanks for providing such an in depth discussion!

  • Amy July 5, 2017 at 5:12 pm

    Thank you for posting such a valuable article. My dad recently passed away but he was using the pulse oximeter as well as the larger oxygen concentrator. It is important to understand all the values and percentages of oxygen, and to use the water to hydrate the flow. Your post really served to explain all of this in a great way.

    • Heather Williams RN CHPN July 7, 2017 at 5:21 pm

      My condolences to you and your family for your loss. Losing a parent can be tough, it sounds like you were able to participate in the care of loved one, that is good. I am pleased that you found this post helpful.
      Take Care, Heather

  • GeorgeS July 22, 2017 at 7:02 am

    This article is very helpful! You have explained everything about the treatment of low oxygen levels in detail. I believe that this article will help a lot people, because the information in it is comprehensive and important. I like how you’ve stated that a person suffering from low oxygen levels in his body, must stop smoking. Many ill people neglect that fact, and they believe that nicotine is not the main cause of their lung issues. I believe that such people should educate themselves, and your website is the right place.

    • Heather Williams RN CHPN July 22, 2017 at 2:44 pm

      Thank you very much George. Yes, I agree with you about smoking causing health problems. In hospice we don’t pressure people to quit smoking if it brings them comfort. Oxygen is highly flammable, and when in use, smoking in the vicinity can be dangerous.
      Take Care,

  • Darmendra September 22, 2017 at 9:28 pm

    Thank you for the information I found it really useful.
    I did not have any idea how the oxygen works on patients, but you explain it very well.
    I just have a question.
    Does a doctor has to order the oxygen treatment to get the machine? Or anybody that suffer shortness of breath can buy it without a prescription?

    Thank you.

    • Heather Williams RN CHPN October 12, 2017 at 3:33 pm

      I am glad that you found it useful, thank you. Anyone can pay cash and purchase an Oxgyen Concetrator without a prescription. It always recommended to use supplemental oxygen under the direction of a doctor, especially in condsideration for someone with a diagnosis of COPD. When Oxygen is prescribed by a physician, the cost of the O2 concetrator is offset with their insurance benefit. In Hospice, there is no cost to the patient for an O2 concentrator, insurance covers 100% while they are receiving services. I hope that helps.
      Take Care, Heather


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