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Oxygen therapy
- 1. Joel PD RN Oxygen Therapy & Delivery System
- 3. Understanding O2 Sometimes, 21% of oxygen may not be enough to maintain adequate oxygen saturations. In these situations, supplemental oxygen can be administered via various oxygen delivery devices ranging from nasal prongs to invasive ventilation. This allows the concentration of oxygen to be increased, potentially increasing the FiO2 to 100%.
- 4. Understanding O2 PaO2/FiO2 ratio. The ratio of partial pressure arterial oxygen and fraction of inspired oxygen, sometimes called the Carrico index, is a comparison between the oxygen level in the blood and the oxygen concentration that is breathed.
- 5. Understanding O2 Oxygen, we all need it! We do not need a lot of it under normal circumstances, with 21% being the fraction of inspired oxygen (FiO2) of room air. FiO2 is defined as the percentage or concentration of oxygen that a person inhales. The air that we inhale on a day to day basis is made up of 21% of oxygen, 78% of nitrogen and 1% of trace elements such as argon, carbon dioxide, neon, helium and methane.
- 6. Understanding O2 oxygen therapy that requires an understanding of the relationship between oxygen flow rate and FiO2. In most clinical areas that require an FiO2 to be documented, you will be able to find a table that outlines an approximate correlation between oxygen flow rate and FiO2, similar to the table
- 8. Definition Oxygen therapy refers to supplemental oxygen given to people who, largely due to breathing disorders, aren’t able to get enough naturally.
- 9. Nature of oxygen Oxygen, a gas found in the air we breathe, is necessary for human life. Some people with breathing disorders can’t get enough oxygen naturally. They may need supplemental oxygen, or oxygen therapy. People who receive oxygen therapy often see improved energy levels and sleep, and better quality of life.
- 10. Indication Oxygen therapy is prescribed for people who can’t get enough oxygen on their own. This is often because of lung conditions that prevents the lungs from absorbing oxygen.
- 11. Indication Table chronic obstructive pulmonary disease (COPD) pneumonia asthma bronchopulmonary dysplasia, underdeveloped lungs in newborn heart failure cystic fibrosis sleep apnea lung disease trauma to the respiratory system
- 12. types of oxygen therapies oxygen gas liquid oxygen oxygen concentrators hyperbaric oxygen therapy
- 13. Types of oxygen therapies Oxygen gas can be stored in a portable tank. These are called compressed gas systems. A larger stationary concentrator is used within the home, and a smaller oxygen tank can be taken to use outside the home. The smaller tanks might be used along with oxygen-conserving devices so that the oxygen supply lasts longer. The oxygen is delivered in pulses, not continuously.
- 14. Types of oxygen therapies Liquid oxygen also can be stored in a portable tank. Liquid oxygen is more highly concentrated, so more oxygen can fit in a smaller tank. This is helpful for people who are very active, but it will evaporate if it isn’t used in a timely manner. These tanks are refillable. Both liquid oxygen and oxygen gas are available for home delivery in many locations.
- 15. Procedures 1. check for doctors order. 2. inform client of the procedure. 3. gather all materials, check for manufacturers specification.(mask, cannula, O2 tanks) 4. inspect material for any malfunctions or damages. 5. attachment of materials(eg. Cannula/mask to O2 tank).
- 16. Procedures 6. install cannula, or mask to client. 7. adjust flow meter as to the prescribe settings given by the doctor.
- 17. Oxygen Delivery System A variety of oxygen delivery device are available for administering oxygen therapy. Which device to use depends on the degree of hypoxia the patient is experiencing and any underlying respiratory diseases. It is also important to cosider the patient's age, LOC, presence of artificial airway, and environment when choosing an oxygen delivery device.
- 18. Nasal Cannula It is a thin tube with two small nozzles/ prongs inserted into nostrils. This device is used to administer oxygen to a breathing patients with minor breathing problems It can only provide oxygen at low flow rates, 1-6 litres/ min. It delivers a concentration of 24-40%. Flow rates greater than 4 liters per minute should also be used with a humidifcation system.
- 19. Nasal Cannula ADVANTAGES DISADVANTAGES Comfortable for patient Maximum estimated FiO2 .40. Ideal for claustrophobic patients. Not appropriate for patients in respiratory distress. Ideal for oxygen dependent patients requiring small amounts of oxygen and home use. Humidification (bubble bottle) not required up to 4 lpm.
- 20. Nursing Considerations Must be ordered in litres per minute (lpm), not FiO2 Flow rates greater than 6 lpm can be uncomfortable for patient. (Headaches, nose bleeds) Possible water in the catheter from the bubble bottle will be sprayed up the patient’s nose. (Turn flow on before applying to patient.)
- 21. Simple Face Mask
- 22. Simple Face Mask It is a basic mask used for non-life-threatening conditions but which may progress in time, such as chest pain (possible heart attacks), dizziness, and minor hemorrhage. It is often set to deliver oxygen between 5-10 L/ min. The final oxygen concentration delivered by this device is dependent upon the amount of room air that mixes with the oxygen the patient breathes. The general oxygen concentration is between 35% and 50%
- 23. Simple Face Mask ADVANTAGES DISADVANTAGES Quick and easy to setup and apply. Nonspecific FiO2 (Dependant on patients inspiratory flows) Often found at the head of the bed in emergency areas. (eg. Emergency, Dialysis, PACU) Maximum FiO2 estimated at . 50 Not intended for long term use.
- 24. NURSING CONSIDERATIONS Flow rates set less than 5 lpm may cause CO2 rebreathing.
- 26. Non - rebreather Mask It is an effective method for delivering high concentrations of oxygen to a breathing patient. It is similar to the partial rebreathing mask except it has a series of one-way valves. Non-rebreather masks consist of a face mask with an attached oxygen reservoir bag and a one-way valve, which prevents the patient’s exhaled air from mixing with the oxygen in the reservoir bag.
- 27. Non - rebreather Mask Flutter valves on the side of the mask allow exhaled air to escape freely. As the patient breathes, he or she inhales oxygen from the bag. One valve is placed between the bag and the mask to prevent exhaled air from returning to the bag. There should be a minimum flow of 10- 15L/min. The delivered FIO2 of this system is 60-80%.
- 28. Non – rebreather mask ADVANTAGES DISADVANTAGES Fast and easy to set up. Delivers only one FiO2: 1.00 Can deliver high concentration oxygen in breathing patients. FiO2 is extremely variable. While theoretically capable of delivering an FiO2 of 1.00, realistically it is more likely between .60 and .80 due to air entrainment around the mask.
- 29. Nursing Considerations Reservoir bag must always remain inflated. If deflation occurs the oxygen flow may be too low. This is not a long term usage mask. The patient should be switched to a 100% aerosol mask at the earliest convenience.
- 30. Venturi Mask
- 31. Venturi Mask
- 32. Flow rate and O2 conc delivered using venture mask Nozzle Color code Flow rate (l/m) Conc of o2 % blue 3 24 yellow 6 28 white 8 31 green 12 35 pink 15 40 orange 15 50
- 33. Venturi Mask Administer oxygen via a Venturi provides high gas flow with a fixed oxygen concentration It provides much controlled oxygen delivery between 20 – 55%. Most reliable and accurate method for delivering a precise O2 concentration. Consists of a mask with a jet
- 34. Venturi Mask Excess gas leaves by exhalation ports. O2 flow rate- 4 to 15L/min. Can cause skin breakdown; must remove to eat. This type of oxygen delivery is advocated for patients with chronic hypercarbia(for the in management of moderate to severe hypoxemia.
- 35. Venturi Mask Advantages Administers a specific FiO2. (Determined by air entrainment adaptor on end of mask.) Quiet Disadvantages FiO2 only available according to mask adapters. .24, .28, . 31, .35, .40 and .50
- 36. Face Tents
- 37. Face tents It is compose of a soft mask that fits under then patient's chin and loosely covers the mouth and nose, with an adjustable strap to keep it in place.
- 38. Face Tents advantage It is convenient for people who are claustrophobic. It convenient for humidification & oxygenation. disadvantage Oxygen concentration cannot be controlled.
- 39. Oxygen Hood
- 40. Oxygen Hoods a clear plastic hood that fits over an infant’s head, to deliver a constant concentration of oxygen. as support in cases of mild respiratory event.
- 41. Oxygen Hoods Advantages Oxygen can be warmed and humidified without pressure Hoods can be used for infants of various sizes in different types of beds Good for short term use (a few days maximum)
- 42. Oxygen Hoods Disadvantages oxygen content of inspired gas may vary with hood position, amount of leakage and movement of the infant out from under the hood Noise levels may be high when liter flow is high Caregiver ability to visualize the infant’s face maybe be obscured due to fogging or condensation
- 43. Oxygen Hoods Carbon dioxide buildup if flow is low and the hood is well sealed and risk of positive pressure creation if the hood is well sealed and the gas flow is high High levels of humidity and condensation increase the risk of infection when hoods are used for extended periods.
- 44. Nursing Responsibilities 1. assess signs & symptoms of hypoxemia. 2. check doctors orders 3. positioning of patients. 4. open source of oxygen before insertion of oxygen device. This is to check malfunctioning of the device. 5. regulate flow of oxygen accurately. 6.place a no smoking sign at the bedside.
- 45. Nursing Responsibilities 7. avoid use of oil, grease, near the client receiving oxygen. 8. check electrical appliances before use. 9. sterile water on the humidifier. 10. provide good oronasal hygiene. 11. lubricate nares. 12. assess effectiveness of oxygen therapy 13. make relevant documentation.
- 46. Estimating FiO2 system O2 flow rate FiO2 (%) cannula 24-28 1-2 30-35 3-4 36-40 5-6 Simple face mask 44-68 5-10 NRM 60-80 10-15 venturi 24 2-4 28 4-6 35 6-8 50 10-15