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Basics of Oxygen Therapy


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Going back to basics.

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Basics of Oxygen Therapy

  2. 2. Oxygen Therapy for Adults in the Acute Care Facility for Chronic and Acute conditions By: CLAIRE VELASQUEZ – CONSTANTINO REGISTERED RESPIRATORY THERAPIST
  3. 3. 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
  4. 4. 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.
  5. 5. INDICATIONS • Head trauma or acute head injury • Acute Tachypnea Respiratory 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
  6. 6. 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
  7. 7. 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.
  9. 9. BUT…. KEEP IN MIND •High levels of oxygen in the blood and tissue can be helpful or damaging depending on circumstances
  10. 10. COMPLICATIONS/PRECAUTIONS  Oxygen should be handled with precautions : SIDE EFFECTS OXYGEN IS A DRUG
  11. 11. 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?
  12. 12. Absorption atelectasis A B A B 100% O2 oxygen nitrogen PO2 =673 PCO2 = 40 PH2O = 47 A B After ~15 minutes, blood N2 is depleted. Poorly ventilated & well perfused units (A) become atelectactic.
  13. 13. 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?
  14. 14. Oxygen Induced Hypoventilation •Suppression of ventilation • Can lead to increased CO2 and carbon dioxide narcosis
  15. 15. 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 copd patients.  PRECAUTIONS – FIRE HAZARD..
  16. 16. Signs and symptoms of oxygen toxicity
  17. 17. -Non-productive cough -Nausea and vomiting -Substernal chest pain -Fatigue -Nasal stuffiness -Headache -Sore throat -Hypoventilation -Nasal congestion -Dyspnea -Inspiration pain
  19. 19. EQUIPMENT
  21. 21. How do you DIFFERENTIATE
  22. 22. WHAT IS: LOW FLOW The delivery of oxygen to the patient with variability of concentration OR The oxygen concentration is not determined only estimated OR The FI,O2 is influenced by breath rate, tidal volume and pathology. WHY?
  23. 23. 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?
  24. 24. • 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?
  26. 26. NASAL CANNULA HOW TO USE?  disposable. plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source.
  27. 27. - 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 litre flow). The FIO2 is influenced by breath rate, tidal volume and pathophysiology. - The slower the inspiratory flow the higher the FIO2.
  28. 28. Delivers 24 to 44% oxygen at 1 to 6 L/min • 1 = 24 • 2 = 28 • 3 = 32 • 4 = 36 • 5 = 40 • 6 = 44
  29. 29. FACTS ADVANTAGES Patients are able to talk and eat with oxygen in place Easily used in home setting DISADVANTAGES may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 4 liters/minute Variable FIO2
  30. 30. NURSING INTERVENTION Check frequently that both prongs are in clients nasal nares Never deliver more than 2-3 Lmin to patients with chronic lung disease if patient doesn’t need it.
  31. 31. 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
  32. 32. O2 inlet Exhalation ports • Open ports for exhaled gas • Air entrained through ports if O2 flow through does not meet peak inspiratory flow
  33. 33. • 5 – 10 liters per minute • < 5 liters will not flush CO2 from mask • 40 – 60% FIO2 approximately depending on the pattern of breathing.
  34. 34. FACTS ADVANTAGES • 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.
  35. 35. 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
  36. 36. 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.
  37. 37. 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
  38. 38. FACTS ADVANTAGES - 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 -
  39. 39. 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.
  40. 40. NON REBREATHING MASK the 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.
  41. 41. Non-Rebreathing Mask • Valve prevents exhaled gas flow into reservoir bag • Valve over exhalation ports prevents air entrainment • Delivers ~100% O2, if bag does not completely collapse during inhalation O2 Reservoir One-way valves
  42. 42. FACTS ADVANTAGES Delivers 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
  43. 43. NURSING INTERVENTION Maintain 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
  44. 44. Non-rebreathing system Reservoir Gas source Room air Expiratory gas To patient One way valves
  45. 45. 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
  47. 47. 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
  48. 48. The Venturi System Room 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
  49. 49. How does it work? exhaled gas oxygen room air
  50. 50. VENTURI MASK
  51. 51. 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.
  52. 52. FACTS ADVANTAGES Delivers most precise oxygen concentration Doesn’t dry mucous membranes (humidity) DISADVANTAGES uncomfortable Risk for skin irritation produce respiratory depression in COPD patient with high oxygen concentration 50%
  53. 53. 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%
  54. 54. 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
  55. 55. FACTS ADVANTAGES • 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
  56. 56. 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
  57. 57. 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
  58. 58. ASSEMBLY
  59. 59. Technique of oxygen administration
  60. 60. 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
  61. 61. 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.
  62. 62. RationalSteps Low flow 1 Lmin=24% 2 Lmin=28% 3 Lmin=32% 4 Lmin=36% 5 Lmin=40% 6 Lmin=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.
  63. 63. RationalSteps To 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.
  64. 64. 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.
  65. 65. 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.
  66. 66. Administering oxygen by: • The partial re-breather mask • The non-rebreather mask • The venturi mask
  67. 67. 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
  68. 68. 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.
  69. 69. 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)
  70. 70. Documentation: Date and time oxygen started. Method of delivery. Oxygen concentration and flow rate. Patient observation. Add oronasal care to the nursing care plan