basics of oxygen therapy
DESCRIPTION
Going back to basics.TRANSCRIPT
BASICS OF OXYGEN
THERAPY
Oxygen Therapy for Adults in the Acute Care Facility for Chronic
and Acute conditions
By:
CLAIRE VELASQUEZ – CONSTANTINO
REGISTERED RESPIRATORY THERAPIST
Learning objectives:
Define the oxygen therapy and its indications
Discuss the type of oxygen therapy
List the purpose of using the oxygen therapy
Explain the procedure
Demonstrate the procedure
List Complication of oxygen therapy and hazards
DEFINITION
• Oxygen therapy is the administration of oxygen at concentrations greater than that of ambient air.
• Intent of treating or preventing the symptoms and manifestations of hypoxia.
• Is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care.
INDICATIONS• Head trauma or acute head injury• Acute TachypneaRespiratory rate increased from normal (RR)
normal range 12 – 24 breaths per minute (bpm)
Significant respiratory rates increasing to more than 30 bpm
Visible with a Hemodynamic monitor or an ordinary monitor
Acute Tachycardia• Heart Rate increased from normal (HR)
Increased Myocardial work
Normal range 60 – 100 beats per minute (bpm)
Significant heart rate increasing to more than 110 bpm
Visible with a Hemodynamic monitor or an ordinary monitor
Acute Hypoxemia
Oxygen Saturation level is decreased (desaturation)
Normal range for saturation 90-100 SpO2
Significant decrease of oxygen saturation level below 85.
Visible with a Hemodynamic monitor or an ordinary monitor or can be internally checked via ABG.
CONTRAINDICATIONS
THERE ARE NO CONTRAINDICATIONS
WHY?
BUT…. KEEP IN MIND
•High levels of oxygen in the blood and tissue can be helpful or damaging depending on circumstances
COMPLICATIONS/PRECAUTIONS
Oxygen should be handled with precautions :
SIDE EFFECTS
OXYGEN IS A DRUG
Absorption Atelectasis
Atelectasis - refers to the partial or complete collapse of the lungs.
• Absorption Atelectasis Refers to the condition where the reduction of nitrogen concentration in the lungs causes a collapse.
WHY?
Absorption atelectasis
A B A B
100% O2
oxygennitrogen
PO2 =673
PCO2 = 40
PH2O = 47
A B
After ~15 minutes,
blood N2 is depleted.
Poorly ventilated &
well perfused units (A)
become atelectactic.
The air you breathe contains nearly 78% of nitrogen.
nitrogen - helps keep the alveoli open and prevents the collapse of the alveoli.
Hospital settings:
surgery and general anesthesia, large amounts of oxygen are usually administered. This decreases the nitrogen concentration in the air and leads to absorption atelectasis.
Patients who had gone heart or lung surgery and abdominal surgery?
WHY?
Oxygen Induced Hypoventilation
• Suppression of ventilation
• Can lead to increased CO2 and carbon dioxide narcosis
Oxygen Toxicity
Occurs due to inspiration of a high concentration of oxygen for a prolonged period of time.
Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.
More evident in infants especially prematurely delivered. (retinopathy of prematurity and in some fibrotic lung –stiffness develops to pulmonary fibrosis) in adults is mostly coincides with oxygen induced hypoventilation in copdpatients.
PRECAUTIONS – FIRE HAZARD..
Signs and symptoms of oxygen toxicity
-Non-productive cough-Nausea and vomiting-Substernal chest pain-Fatigue-Nasal stuffiness-Headache-Sore throat-Hypoventilation-Nasal congestion-Dyspnea-Inspiration pain
GOALSREVERSE ALL THE INDICATIONS
EQUIPMENT
LOW FLOW DEVICES ?
HIGH FLOW DEVICES?
How do you
DIFFERENTIATE
WHAT IS: LOW FLOW
The delivery of oxygen to the patient with variability of concentration
ORThe oxygen concentration is not determined only
estimatedOR
The FI,O2 is influenced by breath rate, tidal volume and pathology.
WHY?
Depending on:
- Breathing pattern
• If the breathing is fast or labored what happens to the concentration of oxygen?
• How do we know that the patient is having labored breathing just by looking?
• And what do we do first as medical practitioners? –A. call the doctor?–B. Increase the oxygen?
• Breathing pattern is slow
• What happens to the concentrations of oxygen being delivered?
• Is it going to be higher even were giving a small amount?
• Will the concentration of oxygen were giving be the same?
WHY?
LOW FLOW OXYGEN DELIVERY
DEVICES
NASAL CANNULA
HOW TO USE?
disposable.
plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source.
- The standard nasal cannula delivers an inspiratory oxygen fraction (FIO2) of 24-44% at supply flows ranging from 1-6 L·min-1.
- The formula is FIO2 = 20% + (4 × oxygen litreflow). The FIO2 is influenced by breath rate, tidal volume and pathophysiology.
- The slower the inspiratory flow the higher the FIO2.
Delivers 24 to 44% oxygen at 1 to 6 L/min
• 1 = 24
• 2 = 28
• 3 = 32
• 4 = 36
• 5 = 40
• 6 = 44
FACTSADVANTAGES
Patients are able
to talk and eat with
oxygen in place
Easily used in home setting
DISADVANTAGESmay cause irritation
to the nasal and pharyngeal mucosa
if oxygen flow rates are above 4 liters/minute Variable FIO2
NURSING INTERVENTION
Check frequently that both prongs
are in clients nasal nares
Never deliver more than 2-3
L\min to patients with chronic lung
disease if patient doesn’t need it.
SIMPLE OXYGEN MASK
Simple mask is made of clear, flexible , plastic or rubber that can be molded to fit the face.
It is held to the head with elastic bands.
Some have a metal clip that can be bent over the bridge of the nose for a comfortable fit
O2 inlet
Exhalation
ports
• Open ports for exhaled gas
• Air entrained through ports if O2 flow through does not meet peak inspiratoryflow
• 5 – 10 liters per minute
• < 5 liters will not flush CO2 from mask
• 40 – 60% FIO2 approximately depending on the pattern of breathing.
FACTSADVANTAGES
• Can provide increased
delivery of oxygen for
short period of time
• The face mask is indicated in patients with nasal irritation or epistaxis.
• It is also useful for patients who are strictly mouth breathers.
DISADVANTAGES-Tight seal required to deliver higher concentration
- Difficult to keep mask in position over nose and mouth
-Potential for skin breakdown due(pressure, moisture)
- Uncomfortable for pt while eating or talking.
- Obtrusive, uncomfortable and confining.
- It muffles communication, obstructs coughing.
NURSING INTERVENTION
Monitor client frequently to check
placement of the mask.
Support client if claustrophobia is concern
Secure physician's order to replace mask
with nasal cannula during meal time
PARTIAL REBREATHING MASK
• Mask is a simple mask with a reservoir bag.
• Same as the Non re-breathing bag but..without a one way valve.
• Low flow, medium concentration
• 50 – 70%
• 8 – 12 liters per minute
• Bag should remain at least 1/3 full during inspiration
• Allow the mixture or oxygen and carbon dioxide in the mask.
Partial Rebreather mask
Exhalation
ports
O2
Reservoir
• O2 directed into reservoir
• Insp: draw gas from bag & ? room air
• Exp: first 1/3 of exhaled gas goes into bag (dead space)
• Dead space gas mixes with ‘new’ O2 going into bag
• Deliver ~60% O2
FACTSADVANTAGES
- Can inhale room air through openings in mask if oxygen supply is briefly interrupted.
- Not as drying to mucous membranes
DISADVANTAGES
- Requires tight seal
- Eating and talking difficult, uncomfortable
-
NURSING INTERVENTION
Set flow rate so mask remains two-
thirds full during inspiration
Keep reservoir bag free of twists or
kinks
Prevents the reservoir bag to collapse
or be empty
Prevents anyone to squeeze the
bag while on the patient.
NON REBREATHING MASKthe one-way valve closes and all of the expired air is
deposited into the atmosphere, not the reservoir bag.
This mask provides the highest concentration of oxygen
(95-100%) at a flow rate 8-15 L/min.
It is similar to the partial rebreather mask except two one-way valves prevent conservation of exhaled air.
Non-Rebreathing Mask
• Valve prevents exhaled gas flow into reservoir bag
• Valve over exhalation ports prevents air entrainment
• Delivers ~100% O2, ifbag does not completely collapse during inhalation
O2
Reservoir
One-way valves
FACTS
ADVANTAGESDelivers the highest possible oxygen concentration
Suitable for pt breathing spontaneous with sever hypoxemia
DISADVANTAGES- Impractical for long term Therapy
- Malfunction can cause CO2 buildup
-- suffocation
Expensive
Feeling of suffocation
Uncomfortable
NURSING INTERVENTIONMaintain flow rate so reservoir bag collapses only slightly during inspiration
Check that valves and rubber flaps are function properly (open during expiration )
Monitor SaO2 with pulse oximeter
Never allow anybody to squeeze the bag empty
Non-rebreathing system
Reservoir
Gas source
Room air
Expiratory
gas
To patient
One way valves
Estimating FiO2
O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2
Nasal cannula Oxygen mask Mask with reservoir
1 0.24 5-6 0.4 6 0.6
2 0.28 6-7 0.5 7 0.7
3 0.32 7-8 0.6 8 0.8
4 0.36 9 0.80+
5 0.4 10 0.80+
6 0.44
HIGH FLOW DELIVERY DEVICES
Or
FIXED
DELIVERY SYSTEMS
AIR ENTRAINMENT DEVICES• High flow device (o2 concentration)
• Entrains air through side ports to achieve high flows
• Variable entrainment ports and/or jets adjust FIO2
• Air Entrainment or Venti Masks
• Manufacturer recommends liter flows for each FIO2
The Venturi SystemRoom air dilutes the oxygen entering
the tubing to a certain concentration
The amount of air drawn in is determined by the size of the orifice (jet adapter).
Applying the Bernoulli principle
How does it work?
exhaled gas
oxygen
room air
VENTURI MASK
Oxygen from 24 - 50%
At liters flow of 4 to 15 L/min.
The mask is so constructed that there is a constant flow of room air blended with a fixed concentration of oxygen
Is designed with wide- bore tubing and various color - coded jet adapters.
Each color code corresponds to a precise
It is high flow concentration of oxygen.
Oxygen concentration and a specific liter flow.
FACTSADVANTAGESDelivers most
precise oxygen
concentration
Doesn’t dry
mucous membranes
(humidity)
DISADVANTAGESuncomfortable
Risk for skin irritation
produce respiratory depression in COPD patient with high oxygen concentration 50%
NURSING INTERVENTION
Maintains on the patient’s face all the time.
Makes sure that the flow from the flow meter is appropriately on the level prescribed.
Produce respiratory depression in COPD patient with high oxygen concentration 50%
TRACHEOSTOMY COLLAR
Directed into trachea
Is indicated for chronic o2 therapy need
O2 flow rate 8 to 10L
Provides accurate FIO2
Provides good humidity.
Comfortable ,more efficient
Less expensive
FACTSADVANTAGES
• Delivers high concentrations of oxygen directly to the lungs.
• Stable and not moved when the patient is moved or cleaned.
• Maintains saturation levels.
DISADVANTAGES• Viscosity of secretions
• Ability to cough and expectorate
• Clinical status
• Systemic hydration
• Patient compliance
• Method of humidification in use
• if any of the above list remain a problem the current method of humidification may be inadequate
NURSING INTERVENTIONS
• Suctioning
• Maintains patent bronchial airway
• Make sure the tracheostomy site is clean and uninfected
• Check the cuff pressure if needed to be inflated or the trach tube is properly secured.
• Make sure adequate humidification is present to prevent further complications
Additional devices for high flow
• T-PIECE ADOPTOR
Used on end of ET tube
Prove when weaning from
ventilator
is accurate FIO2
Provides good humidity
ASSEMBLY
Technique of oxygen administration
RationalSteps
provide a baseline data for
future assessment
Oxygen may depress the
hypoxia drive ( decrease
respiratory rate , alliterate
mental states
Check the physician order.
Assesses physical condition
Assess vital signs ,
Assess level of consciousness
Assess the laboratory results,
especially the ABG analyses,
Assess risk of CO2 retention
with oxygen administration
Wash hands.
Prepare equipment
plastic nasal cannula
connection tube
Administering oxygen by nasal cannula
RationalSteps
Humidification maybe
not be ordered if the flow
rate is <4 /l/min
To be sure you are
performing the procedure
for the correct patient.
To gain his cooperation.
This position permits
easier chest expansion and
hence easier breathing.
To prevent dehydration
of mucous membrane.
Humidifier filled with distilled
water .
Flow meter
No smoking signs
Identify the patient.
Explain procedure to the
patient.Assist the patient to a semi-
fowler's position if possible.
Attach the oxygen supply tube
with humidification to the
cannula , face mask.
RationalSteps
Low flow
1 L\min=24%
2 L\min=28%
3 L\min=32%
4 L\min=36%
5 L\min=40%
6 L\min=44%
To facilitate oxygen
administration and comfort
the patient.
To reduce irritation and
pressure and protect the skin.
Allow 3-5 L oxygen to flow
through the tubing.
Place the prongs in the
patient's nostrils and adjust it
comfortably.
Use gauze pads both behind
the head or the ears and under
the chin and tighten to comfort.
RationalStepsTo provide optimal
delivery of oxygen to
patient..
Oxygen dries the mucous
membrane and cause
irritation
Adjust the flow rate to the
ordered level.
Encourage patient to breath
through his nose with his mouth
closed.
Assess the patient nose and
mouth and provide oronasal care
at least every 8 hours.
Administering oxygen by Face Mask
RationalSteps
Ensure pt receive flow sufficient to meet respiratory demand & maintain accurate concentration oxygen
Produce the flow rate ( 5 -10/min) Attach the oxygen supply tube to
the mask .
Regulate the oxygen flow.
Position the mask over the
patient's nose and mouth.
And fit it securely, shaping the
metal band on the mask to the
bridge of the nose.
RationalSteps
There is danger of
inhaling powder if it is
placed on the mask.
Remove the mask
and dry the skin every
2-3 hours if the oxygen
is running
continuously.
Don't powder
around the mask.
Wash your hands.
Administering oxygen by:
• The partial re-breather mask
• The non-rebreather mask
• The venturi mask
RationalSteps
to ensure correct air / oxygen mix
Attach tubing to flow meter Show the mask to pt & explain
procedure Turn on oxygen flowmeter &
prescribed rate ( usually indicated on mask )
Place mask over pt nose & mouth under chin
Evaluation:
Breathing pattern - regular and at normal rate.
Color - nail beds, lips, conjunctiva of eyes -pink
No confusion, disorientation, difficulty with cognition.
Arterial oxygen concentration or hemoglobin within normal
Oxygen saturation within normal limits.
Assessment. Identify the type of oxygen equipment and
oxygen source in your facility
Hospitals – O2 inlet or O2 cylinders (E type)
in clinics – O2 inlet or O2 cylinders (E type)
Documentation:Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow rate.
Patient observation.
Add oronasal care to the nursing care plan
THANK YOU FOR LEARNING WITH ME
HAVE A PLEASANT DAY