oxygen therapy advice

5/25/2014 Respiratory Therapy Cave: Adult Oxygen Therapy Made Easy

http://respiratorytherapycave.blogspot.com/2010/08/oxygen-therapy-made-easy.html 1/38

About Lexicons RT Basics RT Wisdom Asthma COPD Philosophy Humor Links

T h u r s d a y , A u g u s t 5 , 2 0 1 0

Adult Oxygen Therapy Made Easy

If a patient is unable to oxygenate appropriately on room air, supplemental oxygen may beindicated. This Course should provide you with the wisdom you need to determine what oxygendevice to use (if any) and how much oxygen to give to your patient.

First we need some basic definitions:

Supplemental oxygen: Any device that provides more oxygen than what one would get breathingroom air.

Hypoxemia: This is when the oxygen in the blood is low, and is generally measured by a PaO2 of 60or less, or a SpO2 of 90% or less.

PaO2: This is the level of oxygen in the blood. It should be kept at 60 or better to avoid hypoxemia.It’s obtained by invasive Arterial Blood Gas (ABG) or estimated by SpO2.

SpO2: Also called oxygen saturation, pulse ox or sat. This is a non‐invasive measurement of theamount of oxygen inspired that gets to the arteries. A normal SpO2 is about 98%. Be aware that aperson’s normal SpO2 decreases with age and with some disease processes. The only way it can get to100% is with supplemental oxygen.

You can use your SpO2 to predict the PO2 using the 4‐5‐6, 7‐8‐9 rule as below:

SpO2 70% = PO2 of 40

SpO2 80% = PO2 of 50

SpO2 90% = PO2 of 60 (This is what you want to maintain for most patients)

Therefore, ideally, for most patients you will want the SpO2 to be 90% or greater, or as specified byhospital protocol, or specific physician order.

Fraction of Inspired Oxygen (FiO2): This is the percent of oxygen a patient is inhaling. Room airFiO2 is 21%. By applying supplemental oxygen, the FiO2 can go as high as 100%.Indications for Oxygen Therapy:

To correct hypoxemia

To reduce oxygen demand on the heart

Suspected or acute marcardial infarction (MI)

Severe trauma

Post anesthesia recovery

Low flow oxygen devices: These are oxygen devices where some room air will be entrained, andtherefore the exact FiO2 cannot be calculated, however it can be estimated.How much FiO2 is delivered to the patient is dependent on:

Liter flow set at the flowmeter

Respiratory rate and pattern of the patient

Equipment reservoir (stores oxygen)

The following are low flow oxygen devices:

1. Nasal Cannula: The nasal cannula is the most common oxygen device used and the mostconvenient for the patient. A nasal cannula at 2lpm is usually a good place to start.You may at times need to estimate the FiO2. How to estimate FiO2 on a nasal cannula? For everyliter per minute, the FiO2 increases by 4% as per the chart below:

1 lpm = 24%

2 lpm = 28%

3 lpm = 32%

4 lpm = 36%

5 lpm = 40%

6 lpm = 44%

The liter flow on a nasal cannula should never exceed 6lpm, as studies show doing so is of no addedbenefit to the patient. Also note that the prongs of a nasal cannula should face down.

A bubbler can be added to humidify the nose to prevent nasal drying and bleeds. This is automaticallyset up at flows greater than 4lpm, or as ordered by physician.

Nothing mandates that a healthcare worker put theircommon sense in their wall locker when they comeinto work. Every situation is unique, and the use ofjudgement at appropriate times is the hallmark of atrue professional. Anthony L. DeWitt, AARC Times

Wit and wisdom

29

Search

Search This Blog

Subscribe To

Posts

Comments

Respiratory TherapyCave

Promote Your Page Too

Facebook Badge

Blog Archive

Blog Archive

Join this sitewith Google FriendConnect

Members (187)More »

Followers

5000 B.C.‐1700 A.D.:Natural remedies forasthma inMesoamerica

5000 B.C.: Knowledgecomes to theAmericas

1900: The discoveryof epinephrine(adrenaline)

1700‐1940: "Theasthmatic pants intoold age."

460‐370 B.C.: Whatdid Hippocrates thinkabout asthma?

Asthma History

Best CoughingTechniques for COPDPatients

Obamacare MayBenefit COPDPatients

May is AsthmaAwareness Month:Help Us Spread theWord

Asthma MayContribute to Bone

Loss Says Studies

How to Properly Takea BreathingTreatment

John's SharePosts

FCC moves to regulate Internet:washingtonpost.com/blogs/the-swit

Rick Frea @rtcave

Show Summary

rts and discharge planning: community.advanceweb.com/blogs/rc_6/arc

Rick Frea @rtcave

#asthma and Bone Loss - #asthma rmdy.hm/_0i via @HealthCentral

Rick Frea @rtcave

Types and Causes of Pneumonia - COPD rmdy.hm/_0f via

Rick Frea @rtcave

15 May

9 May

7 May

7 May

Tweets Follow

http://respiratorytherapycave.blogspot.com/

http://respiratorytherapycave.blogspot.com/p/about.html

http://respiratorytherapycave.blogspot.com/p/rt-lexicon.html

http://respiratorytherapycave.blogspot.com/p/rt-wisdom.html

http://respiratorytherapycave.blogspot.com/p/rt-wisdom_15.html

http://respiratorytherapycave.blogspot.com/p/asthma.html

http://respiratorytherapycave.blogspot.com/p/copd-wisdom.html

http://respiratorytherapycave.blogspot.com/p/rt-philosophy.html

http://respiratorytherapycave.blogspot.com/p/rt-humor.html

http://respiratorytherapycave.blogspot.com/p/links.html

http://kontactr.com/user/freadom

https://www.facebook.com/RespiratoryTherapyCave

https://www.facebook.com/RespiratoryTherapyCave

https://www.facebook.com/advertising

http://asthmahistory.blogspot.com/2014/05/5000-bc-1700-ad-natural-remedies-for.html

http://asthmahistory.blogspot.com/2014/05/5000-bc-knowledge-comes-to-americas.html

http://asthmahistory.blogspot.com/2014/05/1900-discovery-of-epinephrine-adrenaline.html

http://asthmahistory.blogspot.com/2014/05/1700-1940-asthmatic-pants-into-old-age.html

http://asthmahistory.blogspot.com/2014/05/460-370-bc-what-did-hippocrates-think.html

http://www.healthcentral.com/copd/c/52325/169270/coughing-techniques-patients

http://www.healthcentral.com/copd/c/52325/169060/obamacare-benefit-copd-patients

http://www.healthcentral.com/asthma/c/52325/169035/asthma-awareness-month-spread

http://www.healthcentral.com/asthma/c/52325/168824/asthma-contribute-bone-loss

http://www.healthcentral.com/copd/c/52325/168929/properly-breathing-treatment

http://t.co/1swPp5pVc2

https://twitter.com/rtcave

https://twitter.com/rtcave/statuses/467057960968257536

http://t.co/crRJGSO9rw


https://twitter.com/search?q=%23asthma&src=hash

https://twitter.com/search?q=%23asthma&src=hash

http://t.co/IZK7isqwsl

https://twitter.com/healthcentral


http://t.co/R19Wkh0naA










3. Non‐Rebreather Mask (NRB): This is a mask that ideally will bring in 100% Fio2 so long as theliter flow is 15 and there is a good seal between the mask and the patient's face. And all three one‐way valves are on the mask to prevent air entrainment.

For legal purposes, however, one flap is always removed just in case the oxygen gets shut off. Andtherefore the highest FiO2 you can get from an NRB is 75%. The bag acts as a reservoir for oxygen,and therefore allows device to provide higher FiO2s to the patient.

4. Partial Rebreather Mask (PRB): This is basically an NRB with both one‐way valves removed fromthe mask. The estimated FiO2 is 60‐65%. Flow should be set at 6‐15 lpm.

High Flow Oxygen Devices: These devices meet the inspiratory flow of the patient, and generateaccurate FiO2s so long as there is a good seal between the mask and the patient's face. The flows aresuch that the patient will not be entraining room air that will lower the FiO2. Respiratory rate andtidal volume of the patient have no effect on FiO2 delivered.

Ideally, the larger the entrainment port on the device the lower the FiO2, and the smaller theentrainment port the higher the FiO2. A major disadvantage is a mask is required, and this may be abit more uncomfortable than a nasal cannula.

1. Venturi Mask: This mask is ideal for patients who are in respiratory distress with high tidalvolumes or high respiratory rate to guarantee a certain amount of oxygen.If a nasal cannula does not provide adequate oxygenation, Venturi Masks set from 28% to 40% areideal for COPD patients.

Modern Venturi masks come with one or more color coded caps, and whichever one you use thedesired liter flow for that particular cap is written right on the cap. The Venturi Masks used at MMC are set up as follows:

A. White cap:

35% FiO2 set lpm at 9



B. Green cap:

24% FiO2 set lpm at 3lpm



30% FiO2 set lpm at 6 lpm

The liter flow must be at least set at the recommended liter flow for any particular FiO2 that isdialed in. It's okay if it is set too high, yet if it's too low the patient may retain CO2 and the FiO2may not be lower than what you dialed in.

2. Aerosol set‐up: This device will deliver anywhere from 21 to 100% FiO2 depending on how it is setup. The desired flow to set the flow meter at is written write on the capUsually a humidity device is connected to the flowmeter, and wide bore tubing connects this to thepatient's mask Wide bore tubing acts as a reservoir to obtain higher FiO2s.

These are ideal for patients with tracheotomies because it allows for inspired air to be oxygenated,humidified and even heated if necessary. They can be hooked up to a simple mask, tracheotomymask, and even a t‐piece.

The flow may exceed the required flow, although if it is less the patient may retain CO2, and theFiO2 be lower than desired. On inhalation a mist should be seen coming from mask or reservoir.

3. High flow nasal cannula: An Fio2 of 21% to 100% may be maintained because the flow meets thepatient's spontaneous inspiratory demand. This is made possible due to thicker tubing and humidifiedoxygen.

Other oxygen devices you might see:

1. BiPAP: This is a discussion for another day. Still, pressure can be given by a non‐invasive maskover the patient’s face to improve ventilation, and to supply any FiO2 from 21% to 100%. These alsohave other means of improving oxygenation.

4. Ventilator: This is also a discussion for another day. Yet for patients whose oxygen demandsexceed any of the above devices, intubation and ventilation with a ventilator may be required. Thesecan supply any FiO2 from 21% to 100%, and also have other means of improving oxygenation.

Hazards of oxygen therapy:

Oxygen may suppress the respiratory drive for some COPD patients, and should be usedwith caution.

FIO2s greater than 60% for greater than three hours have been linked to increased risk forlung injury and other future consequences.

What device do you use? Where to start?

For most patients, you will start low and work your way up if needed

We usually start at 2lpm for most patients and adjust accordingly.

Already a member? Signin

rmdy.hm/_0f via @HealthCentral

Respiratory Therapy Cave:

Rick Frea @rtcave

7 May

Tweet to @rtcave

View My Stats

Stat Counter

http://dir.blogflux.com/cat/health.html

http://www.prchecker.info/

http://feeds.feedburner.com/RespiratoryTherapyCave

http://www.blogtoplist.com/health/

http://t.co/R19Wkh0naA

https://twitter.com/healthcentral



https://twitter.com/intent/tweet?screen_name=rtcave

http://www.statcounter.com/

http://my.statcounter.com/project/standard/stats.php?project_id=3166128&guest=1



Newer Post Older PostHome

Subscribe to: Post Comments (Atom)

Posted by Rick Frea at 10:50 AM

Labels: oxygen, oxygen therapy

If you have a patient in respiratory distress, you may want to start at 40%.

However, if the patient is in severe respiratory distress, or is the victim of a trauma, youmay want to simply start at 100% and decrease as appropriate

All patients suspected of chronic heart failure should be placed on 100% FiO2 and adjusteddown from there.

All patients who are suspected to be CO2 retainers should be started on 2lpm or, if inrespiratory distress, on a venturi mask set no higher than 40%.

Still, a majority of patients do quite well on 2lpm.

How much oxygen does a patient need?

Ideally, whatever oxygen device is needed to maintain a SpO2 of 90% or greater or as otherwisespecified by a specific oxygen protocol or physician order is indicated.

Oxygen supplementation for uncomplicated acute coronary syndrome is no longer routinely indicatedand should only be applied only if the oxyhemoglobin saturation is less than or equal to 94 percent. The old recommendation was to place all patients complaining of chest pain on 4lpm with the beliefthat it would increase oxygen to the heart and decrease work of breathing. I'm simply noting thishere because some physicians prefer to stick with the old recommendations, and that's fine.

Sedatives, analgesics (like Morphine) and anesthesia may also depress respiratory drive, and thesepatients are often placed on oxygen. The amount used is usually 2‐3 lpm via nasal cannula, howeverthis depends on the patient, physician, or protocol.

How to determine if oxygen therapy is working:

You know oxygen therapy is working when:

SpO2 improved to patient normal (or as determined by physician)

Respiratory rate improves

Patient tidal volume is not erratic

Patient notes improved work of breathing

Pulse is normal or improved or improving

Blood pressure is improved or improving

Underlying condition is improving, or whatever occurred to cause the hypoxemia

How long with an e‐cylinder last?

So you want to use an e‐cylinder to take a patient to x‐ray and you want to know if you have enoughoxygen in the tank to make it there. You can use the following formula: e‐cylinder time remaining = .30 (PSI) / LPM

Related Links:

Oxyhemoglobin Dissociation Curve

ABG Interpretation Made Easy

How to know if a patient is a CO2 retainer

Why do people breathe?

Recommend this on Google

Post a Comment

1 comment:Aiesha Grant said...

Thanks so much for providing this valuable resource! I'm taking resp care procedures lab and itis very fast paced! As we often have to work in groups and travel to four different stations toset up different equipment, practice on mannequins etc. This article was well‐written andwell‐organized so I was able to better understand the application of what I was doing. Alsohelped clarify the names of some equipment and even gave me a nice trick for rememberingSpO2 and Po2. I will never forget the 456,789 rule. =)

September 8, 2012 at 11:20 PM

The following wit created by various RTs.

Motivational Posters

FOOM

http://respiratorytherapycave.blogspot.com/2010/08/your-rt-queries.html

http://respiratorytherapycave.blogspot.com/2010/08/how-to-know-when-to-call-doctor.html

http://respiratorytherapycave.blogspot.com/

http://respiratorytherapycave.blogspot.com/feeds/3974706189911469411/comments/default

http://www.blogger.com/profile/01132949384071592216

http://respiratorytherapycave.blogspot.com/2010/08/oxygen-therapy-made-easy.html

http://respiratorytherapycave.blogspot.com/search/label/oxygen

http://respiratorytherapycave.blogspot.com/search/label/oxygen%20therapy

http://respiratorytherapycave.blogspot.com/2010/07/oxyhemoglobin-dissociation-curve.html

http://respiratorytherapycave.blogspot.com/2008/11/abg-interpretation-made-easy.html

http://respiratorytherapycave.blogspot.com/2010/03/heres-how-to-know-if-patient-is-co2.html

http://respiratorytherapycave.blogspot.com/2008/06/hypoxic-drive-theory-why-do-we-breathe.html

http://www.blogger.com/share-post.g?blogID=7423880838207203660&postID=3974706189911469411&target=email

http://www.blogger.com/share-post.g?blogID=7423880838207203660&postID=3974706189911469411&target=blog

http://www.blogger.com/share-post.g?blogID=7423880838207203660&postID=3974706189911469411&target=twitter

http://www.blogger.com/share-post.g?blogID=7423880838207203660&postID=3974706189911469411&target=facebook

http://www.blogger.com/share-post.g?blogID=7423880838207203660&postID=3974706189911469411&target=pinterest

http://www.blogger.com/comment.g?blogID=7423880838207203660&postID=3974706189911469411

http://onebreathcloser.com/

http://respiratorytherapycave.blogspot.com/2010/08/oxygen-therapy-made-easy.html?showComment=1347160824159#c2687656490119028712



Float Away

Thomas



O‐buterol

Bullshituterol



Just what the doctor ordered

Hospitalists



For more motivational posters click here

http://keepbreathing.wordpress.com/rt-motivational-posters/



Respiratory Therapy Cave 2007‐2014. Template images by Airyelf. Powered by Blogger.

http://www.istockphoto.com/googleimages.php?id=2597369&platform=blogger&langregion=en

http://www.blogger.com/

oxygen therapy advice

Documents