Nursing procedure

1. OXYGEN THERAPY
Dr. Walaa El- Leithey
PhD Medical Surgical Nursing
Alexandria University

2. Learning objectives:
 Define the oxygen therapy
 Discuss the type of c oxygen therapy
 List the purpose of using the oxygen
therapy
 Explain the procedure
 Demonstrate the procedure
 List Complication of oxygen therapy

3. Oxygen is in the air we breathe and is necessary
to live .The three basic nutrients without which
planet earth could not exist as a home for living
things are OXYGEN, LIGHT and WATER.
Oxygen is in the air we breathe and is necessary
to live .The three basic nutrients without which
planet earth could not exist as a home for living
things are

4.  Oxygen may be classified as an element, a gas,
and a drug.
Definition
 Oxygen therapy is the administration of oxygen at
concentrations greater than that in room air to treat or
prevent hypoxemia (not enough oxygen in the blood)
 The air that we breathe contain approximately 21%
oxygen

5. Purpose
 The body is constantly taking in O2 & releasing CO2.
If this process is inadequate, oxygen levels in the
blood decrease, and the patient may need
supplemental oxygen. Oxygen therapy is a key
treatment in respiratory care.
 The purpose is to increase oxygen saturation in
tissues where the saturation levels are too low due to
illness or injury.

6. Oxyhemoglobin Dissociation Curve
 Definition : A relationship between the amount of oxygen
dissolved in the blood and the amount attached to the
hemoglobin. This is called the normal Oxyhemoglobin
dissociation curve.
 Oxygen can be measured in two forms:
- partial atmospheric pressure of oxygen (PaO2)
- oxygen saturation (SaO2)
- calculated estimate of oxygen saturation (SpO2): an
indirect SaO2

7. Normal Oxyhemoglobin Dissociation Curve
97% saturation = 97 PaO2 (normal)
90% saturation = 60 PaO2 (danger)
80% saturation = 45 PaO2 (severe hypoxia)

8. Reference
ranges
Arterial blood Venous blood
pH 7.35 – 7.45 7.35 – 7.43
pCO2 35 – 45 mmHg 38 – 50 mmHg
pO2 80 – 100
mmHg
30 – 50 mmHg
HCO3- 22 - 26mM 23 – 27mM
O2 saturation 95 – 100 % 60 – 85 %

9. SHIFT TO LEFT
• Increase in pH
• Decrease in CO2
• Decrease in 2.3-DPG
• Decrease in temperature
SHIFT TO RIGHT
• Decrease in pH
• Increase in CO2
• Increase in 2,3-DPG
• Increase in temperature

10. Oxygen Flux and Requirements
The supply of oxygen is dependent upon the
hemoglobin (Hb), O2 saturation % (SaO2) and cardiac
output (Q).
"Oxygen flux" denotes the total amount of oxygen
delivered to the body per minute and is given by the
equation:
Oxygen flux = 1.34 x Hb in g/dL x (SaO2/100) x (Q in
mL/min)/100 = 1000 mL/min

11. Assessment of need
 Need is determined by measurement of inadequate
oxygen tensions and/or saturations, by invasive or
noninvasive methods,
 and/or the presence of clinical indicators.
• Arterial blood gases
• Pulse oximetry
• Clinical presentation

13. How to assess oxygenation ?
 Arterial blood gases
 Pulse oximetry
Errors in pulse oximetry
 Artificial fingernails
 Dark pigmentation
 Electrical
 Intravenous dyes
 Movement
•Nail Polish
•Pulsatile venous system
•Radiated light
•Edema

14. Indications of O2 therapy
1. Documented hypoxemia
In adults, children, and infants older than 28 days,
arterial oxygen tension (PaO2) of < 60 mmHg
or arterial oxygen saturation (SaO2) of < 90%
in subjects breathing room air or with PaO2
and/or SaO2 below desirable range for specific
clinical situation
In neonates, PaO2 < 50 mmHg and/or
SaO2 < 88% or capillary oxygen tension (PcO2) <
40 mmHg

15. 2- Severe respiratory distress (acute asthma or
pneumonia)
3- Severe trauma
4-Chronic obstructive pulmonary disease
(COPD, including chronic bronchitis,
emphysema, and chronic asthma)
4. Acute myocardial infarction
5. Short-term therapy (e.g., post-anesthesia
recovery)
6. Increased metabolic demands, i.e. burns,
multiple injuries, and severe infections.

16. Indications of O2 therapy Cont.
 Pulmonary hypertension
 Acute myocardial infarction (heart
attack)
 Oxygen may also be used to treat
chronic lung disease patients during
exercise .

17.  Goal directed approach
- post operative (thoracic/abdominal
surgery)
- post extubation
- conscious state/coughing
- redistribution of fluid
- positioning

18. Cautions For Oxygen Therapy
Oxygen toxicity –
can occur with FIO2
> 50% longer than 48
hrs
Danger of fire
Infection

19. Three clinical goals of O2 therapy
1. Treat hypoxemia
2. Decrease work of breathing (WOB)
3. Decrease myocardial Work

20. FACTORS THAT DETERMINE WHICH SYSTEM
TO USE
1. Patient comfort / acceptance by the Pt
2. The level of FiO2 that is needed
3. The requirement that the FiO2 be controlled
within a certain range
4. The level of humidification and /or
nebulization
5. Minimal resistance to breathing
6. Efficient & economical use of oxygen

21. Methods
of oxygen
administration:

22. Classification of Oxygen
Delivery Systems
 Low flow systems
 contribute partially to inspired gas client
breathes
 Ex: nasal cannula, simple mask , non-re
breather mask , Partial rebreather mask
 High flow systems
 deliver specific and constant percent of
oxygen independent of client’s breathing
 Ex: Venturi mask,, trach collar, T-piece

23. Low flow O2 delivery system
 Nasal cannula
 Simple face mask
 Partial rebreathing mask
 Non - rebreathing mask
Fio2 depends on O2 flow, patient factors and
device factors

24. Nasal cannula
 Simple plastic tubing + prongs
 Flow from 1-6 LPM of O2
 Fio2 ranges from 24-44% of O2
1 - 24%
2 - 28%
3 - 32%
4 - 36%
5 - 40%
6 - 44%

25. Methods of oxygen administration:
1- Nasal cannula

27.  Correct placement
 No nasal obstruction
Advantages Disadvantages
 Inexpensive Pressure sores
 well tolerated, comfortable Crusting of secr.
 easy to eat, drink Drying of mucosa
 used in pt with COPD Epistaxis
 used with humidity

28. Low flow O2 delivery system
 Nasal cannula
 Simple face mask
 Partial rebreathing mask
 Non - rebreathing mask
Fio2 depends on O2 flow, patient factors and
device factors

29. The simple Oxygen mask
Simple mask is
made of clear,
flexible , plastic
or rubber that can
be molded to fit
the face.

30. The placing of mask over the patient’s face
increases the size of the oxygen reservoir beyond the
limits of the anatomic reservoir ;therefore a higher
FiO2 can be delivered.
Simple face mask
The oxygen flow
must be run at a sufficient
rate, usually 5 lpm or
more to prevent
rebreathing of exhaled
gases.

31.  Advantages: simple, lightweight, FiO2 upto 0.60,
can be used with humidity
 Disadvantages: need to remove when speak, eat,
drink, vomiting, expectoration of secretions, drying /
irritation of eyes, uncomfortable when facial burns /
trauma application.

32. Low flow O2 delivery system
 Nasal cannula
 Simple face mask
 Partial rebreathing mask
 Non - rebreathing mask
Fio2 depends on O2 flow, patient factors and
device factors

33. The partial rebreather mask:
 The mask is have with a
reservoir bag must remaine
inflated during both
inspiration & expiration
 It collection of the first
parts of the patients'
exhaled air.
 It is used to deliver oxygen
concentrations up to 80%.

34. Partial rebreathing bag
Advantages: FiO2 delivered >0.60 is delivered
in mod. to severe hypoxia, exhaled oxygen
from anatomic dead space is conserved.
 Disadvantages: insufficient flow rate may lead to
rebreathing of CO2,claustrophobia;drying and
irritation of eyes

35. Low flow O2 delivery system
 Nasal cannula
 Simple face mask
 Partial rebreathing mask
 Non - rebreathing mask
Fio2 depends on O2 flow, patient factors and
device factors

36. Non-rebreathing bag

37. The non rebreather mask
 This mask provides the highest
concentration of
 oxygen (95-100%) at a flow rate6-15
L/min.
 It is similar to the partial rebreather mask
 except two one-way valves prevent
conservation of exhaled air.
 The bag is an oxygen reservoir

38. High flow O2 delivery system
 Venturi mask
 Face tent
 Aerosol mask
 Tracheostomy collar
 T-piece

39. VENTURI VALVE

40. Color FiO2 O2 Flow
Blue 24% 2 L/min
White 28% 4 L/min
Orange 31% 6 L/min
Yellow 35% 8 L/min
Red 40% 10 L/min
Green 60% 15 L/min
Venturi valve

41. Venturi mask

42. Face tent Tracheostomy collar

43. Pediatric oxygen delivery system
 Oxygen hood

44. Oxygen hood

45. Oxygen tent

46. Transtracheal oxygen

47. T-piece
 Used on end of ET
tube when weaning
from ventilator
 Provides accurate
FIO2
 Provides good
humidity

48. Long-term oxygen therapy

49.  Long-term oxygen therapy (LTOT) improves survival,
exercise, sleep and cognitive performance.
 Reversal of hypoxemia supersedes concerns about
carbon dioxide (CO2) retention.
 Arterial blood gas (ABG) is the preferred measure and
includes acid-base information.
 Oxygen sources include gas, liquid and concentrator.
 Oxygen delivery methods include nasal continuous flow,
pulse demand, reservoir cannulae and transtracheal
catheter.

50.  Physiological indications for oxygen include an
arterial oxygen tension (Pa,O2) <7.3 kPa (55 mmHg).
The therapeutic goal is to maintain Sa,O2 >90%
during rest, sleep and exertion.
 Active patients require portable oxygen.
 If oxygen was prescribed during an exacerbation,
recheck ABGs after 30–90 days.
 Withdrawal of oxygen because of improved Pa,O2 in
patients with a documented need for oxygen may be
detrimental.
 Patient education improves compliance

51. In-patient oxygen therapy-COPD
 The goal is to prevent tissue hypoxia by maintaining
arterial oxygen saturation (Sa,O2) at >90%.
 Main delivery devices include nasal cannula and Venturi
mask.
 Alternative delivery devices include non-rebreathing
mask, reservoir cannula, nasal cannula or transtracheal
catheter.
 Arterial blood gases should be monitored for arterial
oxygen tension (Pa,O2), arterial carbon dioxide tension
(Pa,CO2) and pH.

52.  Arterial oxygen saturation as measured by pulse
oximetry (Sp,O2) should be monitored for trending
and adjusting oxygen settings.
 Prevention of tissue hypoxia supercedes CO2
retention concerns.
 If CO2 retention occurs, monitor for acidaemia.
 If acidaemia occurs, consider mechanical
ventilation.

53. Monitoring oxygen therapy
Oxygen therapy should be given continuously and
should not be stopped abruptly until the patient has
recovered, since sudden discontinuation can wash-out
small body stores of oxygen resulting in fall of alveolar
oxygen tension. The dose of oxygen should be calculated
carefully. Partial pressure of oxygen can be measured in
the arterial blood. Complete saturation of hemoglobin in
arterial blood should not be attempted. Arterial PO2 of 60
mmHg can provide 90% saturation of arterial blood, but if
acidosis is present, PaO2 more than 80 mmHg is required.
In a patient with respiratory failure, anaemia should be
corrected for proper oxygen transport to the tissue.

54. A small increment in arterial oxygen tension results
in a significant rise in the saturation of hemoglobin.
Under normal situations, no additional benefit is
secured by raising PaO2 level to greater than 60 to 80
mmHg. An increase of 1% oxygen concentration
elevates oxygen tension by 7 mmHg. It is necessary to
maintain normal hemoglobin level in the presence of
respiratory disease as proper oxygen transport to the
tissues is to be maintained. Measurement of arterial
blood gases repeatedly is difficult so a simple and non-
invasive technique like pulse oximeter may be used to
assess oxygen therapy.

55. When to stop oxygen therapy
Weaning should be considered when the patient
becomes comfortable, his underlying disease is
stabilized, BP, pulse rate, respiratory rate, skin
color, and oxymetry are within normal range.
Weaning can be gradually attempted by
discontinuing oxygen or lowering its concentration
for a fixed period for e.g., 30 min. and reevaluating
the clinical parameters and SpO2 periodically.
Patients with chronic respiratory disease may
require oxygen at lower concentrations for
prolonged periods.

56. Impact on the patient
 Fear death is likely to occur sooner
 Become less active
 Experience a sense of loss of freedom
 May become more socially isolated

57. oxygen toxicity
It is a condition in which ventilator failure
 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.

58. 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.

59. Hazards & complications of oxygen
therapy
 Oxygen-induced hypoventilation
 Oxygen toxicity/O2 narcosis
 Absorption atelectasis
 Retinopathy
 Drying of mucous membranes
 Infection
 Fire hazards

60. Evaluation:
 Breathing pattern regular and at normal
rate.
 pink color in nail beds, lips, conjunctiva
of eyes.
 No confusion, disorientation, difficulty
with cognition.
 Arterial oxygen concentration or
hemoglobin
 Oxygen saturation within normal limits.

61. Documentation:
Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow
rate.
Patient observation.
Add oronasal care to the nursing
care plan

62. O2 DELIVERY DEVICES
EQUIPMENT FLOW FIO2 SPECIAL NOTES
NASAL CANNULA 1/2 - 6 L/M .24 – 44 6 L/M MAX.
SIMPLE O2 MASK 6 - 10 L/M .35 – 55 USE 5 L/M
(WITHOUT BAG) MINIMUM
RESERVOIR MASK 10-15 L/M .60 -80 PAGE RT IF USED
(MASK WITH BAG) (BAG TO NOT
COLLAPSE)
VENTI MASK 3 L/M .24, 26, 31, READ ENCLOSED
6 L/M .35, .40, .50 INSTRUCTIONS
NEBULIZER 8 L/M OR > .28, .30, .35 MIST MUST BE
.40, .50, 70 VISIBLE
*** SHOWS THAT FIO2 VARIES WITH DIFFERENT
F, VT, INSPIRATORY FLOW RATES.

64. Oxygen is one of the most important drugs you
will ever use, but it is poorly prescribed by medical
staff. In 2000, a Nicola Cooper and colleague did
survey of treatment with oxygen. The first looked at
prescriptions of oxygen in postoperative patients in a
large district hospital. They found that there were
many ways used to prescribe oxygen and that the
prescriptions were rarely followed.

65. Oxygen dissociation curve
Shift to the left in O2 curve
O2 affinity }
{
1. Causes: pH, CO2, 2-3 DPG, Temp.
O2 sat. for any pao2 but resulting
in less gradient to move O2 to tissue. (Carries more
O2 but more difficult to release it at tissue level)
3. Examples: stored blood loses 2-3 dpg a shift to
the left results from this. Hyperventilation,
Hypothermia.
2. Results:

66. Shift to the right in O2 curve
O2 affinity }
{
1. Causes: pH , CO2 , 2-3 DPG, Temp.
2. Results: O2 sat for any PaO2 but resulting
in more gradient to move o2 into the tissues.
3. Examples: hypoventilation, fever, metabolic
acidosis.