503 -CLIN LISTING - HOME OXYGEN Nov 2020.pdf

HOME OXYGEN CLIN LISTING

CLIN 0001

Delivery and Monthly Rental of concentrator with backup system consisting of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Concentrator will have flow rate capacity up to 5LPM. This set up is intended for the patient who is only prescribed for use at night.

Estimate quantity per month - 150

CLIN 0002

Delivery and Monthly Rental of concentrator with backup system consisting of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Concentrator will have flow rate capacity up to 10LPM. This set up is intended for the patient who is only prescribed for use at night.

Estimate quantity per month - 10

CLIN 0003

Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate flow regulator, (2) Oxysafe (or equivalent) fire safety devices, handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 5LPM. This set up is intended for the patient who is prescribed for use during the day and at night.

Estimate quantity per month - 450

CLIN 0004

Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate flow regulator, (2) Oxysafe (or equivalent) fire safety devices, handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 10LPM. This set up is intended for the patient who is prescribed for use during the day and at night.

Estimate quantity per month – 15

CLIN 0005

Monthly rental of gaseous Pulse Dose Conserving device to include carrying bag

Estimate quantity per month – 230

CLIN 0006

Cylinder Refill and Delivery, size "E" for CLIN 0003 or 0004 above. Aluminum (or metal of equivalent weight) tanks required.

Estimate quantity per month - 650

CLIN 0007

Cylinder Refill and Delivery, size "D" for CLIN 0003 or 0004. Aluminum (or metal of equivalent weight) tanks required.

Estimate quantity per month – 460

CLIN 0008

Cylinder Refill and Delivery, size "B" (M6) for CLIN 0003 or 0004. Aluminum (or metal or equivalent weight) tanks required.

Estimate quantity per month - 1100

CLIN 0009

Cylinder Refill and Delivery, size "M60" for CLIN 0001, 0002, 0003, or 0004 above. Aluminum (or metal or equivalent weight) tanks required as backup system.

Estimate quantity per month - 50

CLIN 0010

Delivery and Monthly Rental of Liquid Oxygen System (90-150 lbs.) with stationary unit, portable unit, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), backup system consisting of tank set up (M60 Cylinders Only), appropriate continuous flow regulator, stand, and the following when specified by the VA: mask (with tubing) and humidifier.

Estimate quantity per month - 5

CLIN 0011

Liquid Oxygen Per Pound For CLIN 0009

Estimate quantity per month – 3500 lbs

CLIN 0012

Helios liquid pulse dose conserver and carrying bag

Estimate quantity per month – 10

CLIN 0013

Delivery and Weekly or Monthly Rental of portable oxygen concentrator (such as a Focus, Eclipse or equivalent of either as designated by the VA) and all accessories including but not limited to nasal cannula (with tubing), two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), 2 sets of back-up batteries, handcart, and concentrator pouch/bag. This set up is intended for the patient who is traveling, or has other situations which require a portable concentrator.

Estimate quantity per month - 10

CLIN 0014

Respiratory Therapy Visit for the delivery or recovery of VA owned equipment including but not limited to the set up and troubleshooting for CPAP/Bi-Level Positive Airway Pressure (PAP)/Portable Oxygen Concentrator (POC), suction machines, air compressors, prescription change and/or additional components such as but not limited to Mask sizing/fitting, Heated Humidifiers, CPAP-A/BiPAP settings. Respiratory Therapy Visit for education to be completed upon initial set up and every 6 months for all active Home Oxygen and PAP patients.

Estimate quantity per month - 300

CLIN 0015

Nocturnal pulse oximetry study

Estimate quantity per month - 20

CLIN 0016

Rental Ventilator; Service includes maintenance and replacement supplies (as specified) and all of the following will be performed on a monthly Basis:

(a) Routine inspection per manufactures specifications.

(b) Ventilator settings flow sheet must include:

1. Check respiratory rate (set and actual;)(peep if applicable).

2. Check tidal volume (delivered and exhaled)

3. FI02

4. Pressure limit/peak pressure.

5. Alarm settings (high/low).

6. Mode.

(c) Check ventilator filters.

(d) Check humidification system.

(e) Check internal and external batteries & emergency backups.

(f) Check circuit

(g) Check hour meter (report when due for preventive maintenance).

(h) Comments/observations.

(i) Replacements items:

1. Filters (disposables).

2. Circuit.

3. Peep Valve.

4. Humidifier.

5. Resuscitation bag (as needed).

Estimate quantity per month - 6

CLIN 0017

Electrical Air Compressor capable of continuous use of up to 10 liters per minute to include large volume nebulizer, a large volume aerosol tubing and disposable trach masks.

Estimate quantity per month - 5