Oxygen Administration During Physical Therapy

APTA's Guide to Physical Therapist Practice delineates the physical therapist's scope of practice in the management of patients/clients who require oxygen to improve ventilation and respiration/gas exchange. However, confusion exists as to the physical therapist's role in the administration of oxygen when prescribed by a physician. Specifically, APTA members have reported that their authority has been questioned by managers or other providers when performing tasks such as disconnecting the oxygen from the wall unit and re-attaching it to a cylinder, or adjusting the oxygen level within the parameters set by the physician. This resource is intended to assist in answering questions and provide resources for information on issues related to oxygen administration during physical therapy interventions.

APTA is unaware of any regulations that prohibit the use of oxygen for patient/client management if it is prescribed and if parameters set by the physician are maintained. Physicians often specify the oxygen flow rate in their orders. Any deviations from prescribed dosages require an updated order from the physician under these circumstances. Alternatively, physicians may prescribe maintenance of a specific oxygen saturation (SpO2) level during rest and activity (eg, "maintain SpO2 > ____%"). In these situations physical therapists may titrate the oxygen flow to maintain patients/clients at or above this threshold saturation value. Physical therapists discussing the oxygen needs of their patients/clients with physicians should request orders using an SpO2 threshold in order to ensure safety and effectiveness during physical activity and exercise.

If you encounter situations where physical therapists are challenged on oxygen administration/use, ask for the rule/regulation that states this specific restriction.

Resources

The following resources related to oxygen administration may be useful:

FDA

According to the Food and Drug Administration import alert #66-37 published on 10/12/2011, the FDA generally regards oxygen to be a prescription drug. FDA recognizes that there are many circumstances under which it would be impractical to insist that oxygen be administered only under the supervision of a physician.

Oxygen units may be marketed without a prescription when used for emergency resuscitation and when administered by an individual who is authorized, certified, or licensed by state authorities. Such units must deliver a minimum flow rate of 6 liters of oxygen per minute for a minimum of 15 minutes (90 liters). Labeling for emergency oxygen for OTC use may not contain references to any medical conditions, disorders, or diseases.

Reference: Import Alert #66-37: http://www.accessdata.fda.gov/cms_ia/importalert_187.html and CPG Sec. 435.100 Compressed Medical Gases: http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074381.htm.

Guide to Physical Therapist Practice

In APTA's Guide to Physical Therapist Practice, supplemental oxygen is listed as a procedural intervention within the scope of physical therapist practice under Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment (supportive device) to improve ventilation and respiration/gas exchange.

APTA Position Statement

Pharmacology in Physical Therapist Practice (.pdf) 

State Practice Acts

Physical therapy practice acts and physical therapy board regulations are silent on the administration of oxygen. However, some state/jurisdiction licensing authorities have provided official interpretive opinions/statements on this issue. Check with your state/jurisdiction licensing authority to determine if your state board has an official statement or opinion regarding the administration of oxygen. To contact your state licensing board, follow this link: http://www.fsbpt.org/licensing/index.asp.

If you have further questions, please contact the APTA Department of Practice by e-mail at practice-dept@apta.org or by phone at 703/706-3176.

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Guide to PT Practice