Oxygen therapy involves the administration of oxygen to maintain adequate tissue oxygenation levels and minimize workload on the cardiopulmonary system. Oxygen is indicated when a patient has documented hypoxemia with oxygen saturation below 90% or a partial pressure of oxygen below 60 mmHg. Various oxygen delivery systems can be used including nasal cannulas, face masks, Venturi masks, and non-rebreather masks to provide different concentrations of oxygen from 24-100% at flow rates of 2-10 LPM. Potential complications of oxygen therapy include oxygen toxicity, depression of ventilation, retinopathy of prematurity, absorption atelectasis, and fire hazards.

1. Oxygen Therapy

2. Oxygen is a drug.
When appropriately used, it is extremely beneficial
When misused or abused, it is potentially harmful

3. OVERVIEW
• Introduction
• Indications
• Oxygen delivery systems
• Complications of oxygen therapy

4. Goal of oxygen therapy
To maintain adequate tissue oxygenation while
minimizing cardiopulmonary work

5. O2 Therapy : CLINICAL OBJECTIVES
1. Correct documented or suspected hypoxemia
2. Decrease the symptoms associated with chronic hypoxemia
3. Decrease the workload hypoxemia imposes on the
cardiopulmonary system

6. O2 Therapy : Indications
• Documented hypoxemia as evidenced by
• PaO2 < 60 mmHg or SaO2 < 90% on room air
• PaO2 or SaO2 below desirable range for a specific clinical situation
• Acute care situations in which hypoxemia is suspected
• Severe trauma
• Acute myocardial infarction
• Short term therapy (Post anaesthesia recovery)

7. ASSESSMENT
• The need for oxygen therapy should be
assessed by
1. monitoring of ABG - PaO2, SpO2
2. clinical assessment findings.

8. Oxygen therapy
• is the administration of oxygen as a medical intervention, which can be for
a variety of purposes in both chronic and acute patient care
• Oxygen is often prescribed for people to prevent hypoxia because of the
following conditions:
1. Difficulty ventilating all areas of their lungs
2. Impaired gas exchange
3. Heart failure
• Prescribed by the physician who specifies the following:
1. Concentration
2. Liter per minute
3. Method of delivery

9. Oxygen supply
1. Piped in wall outlets – at the client’s bedside
2. Portable (Tanks or cylinders) – for transporting oxygen
dependent clients, in home use;
Humidifier – add water vapor to inspired air because Oxygen
is a dry gas that dehydrates respiratory mucous membrane
• Prevents mucous membrane from drying and becoming
irritated
• Loosens secretions for easier expectoration

10. Safety Precautions for Oxygen Administration
• Teach family members to smoke only outside away from the client
and oxygen equipment.
• Set up “No Smoking: and “oxygen in Use” signs at the site of
administration and at the door, according to agency policy.
• Instruct the client and visitors about the hazard of smoking with
oxygen in use
• Provide cotton gown and blankets . Synthetics and wool may
generate sparks of static electricity

11. Safety Precautions for Oxygen Administration
• Avoid the use of volatile, flammable materials such as oils, greases,
alcohol, ether and acetone near clients receiving oxygen
• Remove matches, lighters, ashtrays, and any friction-type or battery
operated toys or devices from bedside
• Be sure that electric monitoring equipment , suction machines, and
portable diagnostic machines are electrically grounded.
• Locate fire extinguishers and oxygen meter turn-off lever.

12. Various devices used for administration of oxygen.
• Pressure regulator - used to control
the high pressure of oxygen delivered
from a cylinder (or other source) to a
lower pressure. This lower pressure is
then controlled by a flowmeter.
• Flowmeter – controls the lower
pressure which may be preset or
selectable, and this controls the flow in
a measure such as litres per minute
(lpm).

13. PaO2 as an indicator for Oxygen therapy
• PaO2 : 80 – 100 mm Hg : Normal
60 – 80 mm Hg : cold, clammy
extremities
< 60 mm Hg : cyanosis
< 40 mm Hg : mental deficiency
memory loss
< 30 mm Hg : bradycardia
cardiac arrest
PaO2 < 60 mm Hg is a strong indicator for
oxygen therapy

14. Clinical assessment of hypoxia
mild to moderate severe
CNS : Restlessness,
somnolence, confusion
disorientation
impaired judgement
lassitude
loss of co-ordination
headache,
obtunded mental
status
Cardiac : tachycardia, arrhythmia mild hypertension
hypotension
bradycardia, peripheral
vasoconst.
Respiratory: dyspnea, possible
shallow &tachypnea
Increasing dyspnoea
bradypnoea,
laboured breathing
Skin : paleness, cold, clammy
cyanosis

15. MONITORING
• Physical examination for clinical signs of hypoxemia
• Pulse oximetry ---- SpO2
• ABG analysis
• pH
• PaO2
• PaCO2
• Mixed venous blood oxygenation

16. O2 Delivery systems

17. O2 Delivery devices
o Low flow (Variable performance devices )
Nasal cannula
Nasal catheter
Transtracheal catheter
o Reservoir system (Variable performance device)
Simple face mask
Partial rebreathing mask
Non rebreathing mask
Tracheostomy mask
o High flow (Fixed performance devices)
Ventimask (HAFOE)
Aerosol mask and T-piece with nebulisers

18. Complications of Oxygen therapy

19. Complications of Oxygen therapy
1. Oxygen toxicity
2. Depression of ventilation
3. Retinopathy of Prematurity
4. Absorption atelectasis
5. Fire hazard

20. 1. O2 Toxicity
• Primarily affects lung and CNS.
• 2 factors: PaO2 & exposure time
• CNS O2 toxicity (Paul Bert effect)
• occurs on breathing O2 at pressure > 1 atm
• tremors, twitching, convulsions

21. How much O2 is safe?
100% - not more than 12hrs
80% - not more than 24hrs
60% - not more than 36hrs
Goal should be to use lowest possible FiO2
compatible with adequate tissue oxygenation

22. Indications for 70% - 100% oxygen
therapy
1. Resuscitation
2. Periods of acute cardiopulmonary instability
3. Patient transport

23. Oxygen Delivery System
1. Nasal cannula (NC)
• is a thin tube with two small nozzles that protrude
into the patient's nostrils.
• Most common and inexpensive device
• provides oxygen at low flow rates, 2–6 litres per
minute (LPM), delivering a concentration of 24–45%.

24. Cont: Oxygen Delivery System, (NASAL Cannula)
• allows the patient to continue to talk, eat and drink while still
receiving the therapy.
• associated with greater comfort, and improved oxygenation
and respiratory rates than with face mask oxygen.
Limitation of nasal cannula:
• Unable to deliver higher concentration of oxygen
• Can be drying and irritating to mucous membrane

25. 2. Simple face mask
• Covers the patient’s nose and mouth.
• Exhalation ports at the sides of the mask allow
exhaled CO2 to escape
• Often used at between 5 and 8 LPM, with a
concentration of oxygen to the patient of
between 40 – 60%.
Oxygen Delivery System

26. 3. Air-entrainment masks, also known as Venturi
masks,
• Has a wide bore tubing and color coded jet
adapters ( blue adapter – 24% at 4-10 lpm;
green adapter – 35% at 8lpm)
• can accurately deliver a predetermined oxygen
concentration to the trachea up to 24 - 50% at
4- 10 lpm .
Oxygen Delivery System

27. • Venturi masks
Oxygen Delivery System

28. • 4. Partial rebreathing mask – has
a reservoir bag, which increases
the provided oxygen rate to 60–
90% oxygen at 6 to 10 LPM.
Oxygen Delivery System

29. 5. Non-rebreather masks ( reservoir mask), -
draw oxygen from an attached reservoir bags,
with one-way valves that direct exhaled air out
of the mask.
• Delivers the highest oxygen concentration
when properly fitted and used at flow rates of
8-10 LPM or higher, they deliver close to 100%
oxygen. This type of mask is indicated for
acute medical emergencies.
Oxygen Delivery System

30. 6. Face Tent
• Can replace oxygen mask when masks are
poorly tolerated by clients
• Provides oxygen concentration at 30 – 50%
with flow rates of 4- 8 LPM
Oxygen Delivery System

31. 7. Bag-valve-mask (BVM) - a malleable bag attached to a face mask (or
invasive airway such as an endotracheal tube or laryngeal mask
airway), usually with a reservoir bag attached, which is manually
manipulated by the healthcare professional to push oxygen (or air) into
the lungs.
• Used in many emergency medical service and first aid personnel
Oxygen Delivery System

32. Characteristic Concentration LPM
1. Nasal Cannula provides oxygen at low
flow rates
24–45%. , 2–6 litres per minute
(LPM),
2. Simple face mask 40 – 60%. 5 - 8 LPM
3. Air-entrainment masks
also known as Venturi
masks,
blue adapter – 24%
green adapter – 35%
At trachea : 24 - 50%
4-10 lpm;
8 lpm
4- 10 lpm .
4. Partial rebreathing
mask –
has a reservoir bag 60–90% 6 to 10 LPM.
5. Non-rebreather masks (
reservoir mask),
Delivers the highest
oxygen concentration
Close to 100% of 8-10 LPM or higher,
they deliver close to
6. Face Tent 30 – 50% 4- 8 LPM or higher
Oxygen Delivery System