Oxygen therapy involves administering oxygen at concentrations higher than 21% found in the air. It is used to treat conditions that cause low blood oxygen levels. Common devices for oxygen delivery include nasal cannulas, masks, venturi masks, and endotracheal tubes. Nurses are responsible for safely setting up the appropriate device based on a patient's prescription and monitoring their effectiveness.

1. Oxygen Therapy
B G I S Ariyarathne
RN , BSc nsg Hon 1st class
Tutor Trainee

3. Unit outcome
Safely administer respiratory medication to
the patient with ineffective breathing
according to the medical prescription by
following standardized nursing procedures

4. Specific outcomes
• Identify main sources of oxygen in clinical
practice
• Identify oxygen administration devices
• Discuss potential harm from oxygen
therapy
• List out nurse’s responsibilities when
administrating oxygen

5. Oxygen Therapy Definition
• Oxygen is a colorless, odorless, tasteless
gas that is essential for the body to
function properly and to survive
• Oxygen therapy is the administration of
oxygen at a concentration of pressure
greater than that found in the
environmental atmosphere

6. Oxygen Therapy Definition cont..
• The air that we breathe contain
approximately 21% oxygen
• Oxygen therapy is a key treatment in
respiratory care

7. Purposes
1. The body is constantly taking in oxygen
and releasing carbon dioxide
2. If this process is inadequate, oxygen
levels in the blood decrease, and the
patient may need supplemental oxygen
3. The purpose is to increase oxygen
saturation in tissues where the
saturation levels are too low due to
illness or injury

8. Assess need of oxygen therapy
• Need is determined by measurement of
inadequate oxygen tensions or
saturations, by invasive or noninvasive
methods, or the presence of clinical
indicators as previously described
• Arterial blood gases (ABG)
• Pulse oximetry
• Clinical presentation

9. Pulse oxymetry ABG

10. Indications for Oxygen therapy
1. Acute Respiratory Failure
2. Acute Myocardial Infarction
3. Cardiac Failure
4. Shock
5. Hypermetabolic State Induced by
trauma, burns or sepsis

11. Indications cont:
• Anemia
• Cyanide poisoning
• During CPR
• During anesthesia for surgery

12. Oxygen
• A prescribed drug
• Must be written legibly by the doctor
• Prescription should be dated by the
doctor
• Doctor must indicate duration of oxygen
therapy
• The Oxygen concentration must be
prescribed
• The flow rate must be prescribed

13. Types of Oxygen
(i) Compressed oxygen cylinders
• stored as a gas under pressure in a
cylinder equipped with a flow meter and
regulator to control the flow rate

14. Types of Oxygen cont…
(ii) Liquid oxygen system
Liquid oxygen is made by super cooling
oxygen gas, which changes it to liquid
form. When in liquid form, the oxygen
takes up much less room and can be stored
in special thermos

15. Types of Oxygen cont..
(iii)Oxygen concentrator
electrically operated medical device that
extracts air from the room, separates the
oxygen from other gases present, and
delivers oxygen to the patient

16. Sources of oxygen:
1. Oxygen cylinder 2. Oxygen wall
outlets

17. Oxygen (O2)cylinders Black with
white shoulders
Within the hospital environment oxygen is
usually found in 3 main areas
1. Critical care areas
2. Operating theatres
3. Most wards & treatment therapy areas

18. Oxygen (O2)cylinders Black with
white shoulders
• In most areas the oxygen service is piped
Cylinder oxygen is normally used as an
emergency back up and for patient
transport/transfer
• The approximate consumption rate of a
Oxygen cylinder at 5L per min is 1.5hrs
• Large cylinder contain 6800l at 6l/min
can use for 19 hrs

19. Oxygen cylinder size

20. Using oxygen cylinders:
• The oxygen cylinder is delivered with a
protective cap to prevent accidental
force against the cylinder outlet
• To release oxygen safety and at a
desirable rate, a regulator is used
• A reduction gauge that shows the
amount of oxygen in the tank

21. Using oxygen cylinders cont….
• A flow meter that regulates the control
of oxygen in liters per minutes
• Oxygen is moistened by passing it
through a humidifier to prevent the
mucous membranes of the respiratory
tree from becoming dry.

22. Oxygen Regulator

23. Oxygen Regulator
• Before using regulator check for no signs
of damage, loose connections or dirt or
grease
• Regulators can be obtained from hospital
medical equipment stores
• It is very expensive

24. Oxygen regulator
• To set flow turn knob by using oxygen key
anti clockwise until ball rises to the flow
rate required, watch for 2-3 seconds to
ensure flow rate maintained, the ball
should sit in the middle of the required
rate

25. Oxygen regulator
• When not in use the flow of gas must be
turned off by turning knob clockwise and
the ball falls to zero.
• Oxygen regulator should be operated by
qualified nursing/medical staff

26. Oxygen key

27. Humidifier bottle
• Fill the humidifier bottle with distilled
water to the maximum fill line
• Do not overfill
• To be changed daily

28. Care of oxygen cylinder
• Always use cylinder of metal case to
prevent danger of falling & breaking
• Oxygen cylinder should be placed at head
end of the bed
• Any source of fire should be kept away
from cylinder for fear of fire
• Oxygen cylinder should be placed at cool
temperature

29. Care of oxygen cylinder
• When cylinder are empty , always marks
i.e. “ empty “ & send for filling
• Inspect the apparatus at frequent
intervals & make sure for its good
working condition
• To test any leakage in the regulator soap
may be used

30. Oxygen cylinders storage
• Storage is divided into two types, a MAIN
store and smaller units, situated in
convenient locations around the hospital
and known as READY TO USE stores
• In addition to this have areas on ward
where two or more cylinders hold, ready
for administration to a patient, this refer
to as a cylinder parking area

31. Oxygen cylinders storage cont….
• Where ever medical gases are stored,
they should be on their own and away
from any other flammable gases or other
materials

32. Storage of Oxygen

33. How to order oxygen gas cylinders
• Always should be keep stand by ready for
use cylinder in ward/unit
• Before over all cylinders, need exchange
empty cylinders
• There is a separated date for get down
oxygen for the ward/unit
• Should be got down relevant day
• It is a responsibility of nurses’

34. How to order oxygen gas cylinders
• Write oxygen book to the chief
pharmacist with the numbers of empty
cylinders and request new cylinders from
indoor dispensary
• Received cylinders must be checked and
take over and to be stored proper way as
ready for use

35. How to request oxygen gas cylinders
for the ward/unit
Wd 34,
2020. 01.30.
CP
Please exchange following empty oxygen gas
cylinders
23091
22031
Thank You
………………….
Wd manager
wd 34

36. How to transport oxygen gas with
patient

37. Wall – outlet oxygen
• The oxygen is supplied from a central
source through a pipeline
• Only a flow meter and a humidifier are
required
• All bed spaces with access to piped
oxygen should have a flow meter in situ
so it can be used if necessary
• When oxygen is not in use flow meters
should be switched off

40. Classification of Oxygen Delivery
Systems
1. Low flow systems
contribute partially to inspired gas client
breathes
Ex: nasal cannula, nasal catheter, simple
mask , non-re breather mask , Partial
rebreather mask

41. Classification of Oxygen Delivery
Systems
2. High flow systems
• deliver specific and constant percent of
oxygen independent of client’s breathing
• Ex: Venturi mask,, tracheostomy collar,
T-piece

42. Oxygen inhalation devices
1. Nasal Cannula
2. Simple Mask
3. Partial Re-Breather Mask
4. Non-Re Breather Mask (NRBM)
5. Venturi Mask
6. Oxygen Hood
7. Oxygen Tent
8. AMBU Bag
9. Tracheostomy Collar
10. T-piece

43. How to select method
Selected method depends on
1. Required concentration of oxygen
2. Desired variability in delivered oxygen
concentration (None, minimal,
moderate)
3. Required ventilator assistance(
mechanical ventilator, spontaneous
breathing)

44. Nasal cannula (prongs):
• It is a disposable, plastic devise with two
protruding prongs for insertion into the
nostrils, connected to an oxygen source.
• Used for low-medium concentrations of
Oxygen (24-44%).
• Need nose breathing

45. Nasal cannula

48. Nasal cannula (prongs): cont..
• Amount delivered Fio2 (Fraction Inspired
Oxygen) Low flow- 24-44 %
• 1 L/min=24%
• 2 L/min=28%
• 3 L/min=32%
• 4 L/min=36%
• 5 L/min=40%
• 6 L/min=44%

49. Nasal cannula (prongs): cont..
Advantages Disadvantages
Client able to talk
and eat with oxygen
in place
• Easily used in home
setting
• Safe and simple
• Easily tolerated
• Delivers low
concentrations
Unable to use with nasal
obstruction
• Drying to mucous membranes, so
flow greater than 4 L/min needs to
be humidified
• Can dislodge from nares easily
• Causes skin irritation or breakdown
over ears or at nares
• Not good for mouth breathers
• Patient’s breathing pattern affects
exact FIO2

50. Nasal cannula (prongs): cont..
NURSING interventions:
• Be alert for skin breakdown over the ears
and in the nostrils from too tight an
application
• Observe for mucosal dryness
• Check frequently that both prongs are in
clients nares

51. Nasal Catheter
• Flexible, lubricated oxygen catheter with
multiple holes in distal 2 cm
• Advanced posteriorly into the pharynx
through nostril
• No advantage over nasal cannula
• Hemorrhage and gastric distention can
occur

52. nasal catheter

55. Face mask
• The Simple Oxygen Mask
• BLB mask
(Boothby Levelace Bulbulian)
• The Partial Re-Breather Mask
• The Non Re- Breather Mask
• The Venturi Mask

56. The simple Oxygen mask (Hudson’s
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.
• It delivers 35% to 60% oxygen
• A flow rate of 6 to 10 liters per minute

58. The simple Oxygen mask
• It has vents on its sides which allow room
air to leak in at many places, thereby
diluting the source oxygen.
• Often it is used when an increased
delivery of oxygen is needed for short
periods (i.e., less than 12 hours)

59. Simple Oxygen Mask Cont..
Advantages Disadvantages:
Can provide
increased
delivery of
oxygen for
short period
of time
• Tight seal required to deliver higher
concentration
• Difficult to keep mask in position over
nose and mouth
• Potential for skin breakdown (pressure,
moisture)
• Uncomfortable for patient while eating or
talking
• Expensive with nasal tube

60. Simple Oxygen Mask Cont..
Nursing interventions:
• Monitor client frequently to check
placement of the mask
• Secure physician's order to replace mask
with nasal cannula during meal time

61. BLB mask
(Boothby Levelace Bulbulian)
• A mask used for administering oxygen to
patients during anesthesia

62. The Partial Re Breather Mask:
• The mask is with a reservoir bag that
must remain inflated during both
inspiration & expiration
• It collects of part of the patients' exhaled
air
• It is used to deliver oxygen
concentrations up to 80%

63. • The oxygen flow rate must be maintained
at a minimum of 6 L/min to ensure that
the patient does not re-breathe large
amounts of exhaled air
• The remaining exhaled air exits through
vents

65. Partial Re Breather Mask: cont..
Advantages Disadvantages
Client can inhale room air
through openings in mask
if oxygen supply is briefly
interrupted
Requires tight seal (eating
and talking difficult,
uncomfortable)

66. Partial Re Breather Mask: cont..
Priority Nursing Interventions
• Set flow rate so mask remains two- thirds
full during inspiration
• Keep reservoir bag free of twists or kinks

67. Non Re- Breather Mask
• This mask provides the highest
concentration of oxygen (95-100%) at a
flow rate6-15 L/min.
• It is similar to the partial re-breather
mask except two one-way valves prevent
conservation of exhaled air.
• The bag has an oxygen reservoir

68. Non Re- Breather Mask
• When the patient exhales air the one-
way valve closes and all of the expired air
is deposited into the atmosphere, not
the reservoir bag.
• In this way, the patient is not re-
breathing any of the expired gas.

70. Non Re- Breather Mask

71. Non Re- Breather Mask

72. Non Re- Breather Mask
Advantages Disadvantages
• Delivers the highest
possible oxygen
concentration .
• Suitable for patient
breathing
spontaneous with
sever hypoxemia
• Impractical for long
term Therapy
• Malfunction can
cause CO2 buildup
suffocation
• Expensive
• Uncomfortable

73. Non Re- Breather Mask
Priority Nursing Interventions
• 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

74. Venturi Mask
• It is high flow oxygen delivery device.
• Oxygen from 40 - 50% At liters flow
of 4 to 15 L/min.
• The mask is constructed so that
there is a constant flow of room air
blended with a fixed concentration
of oxygen

75. Venturi Mask cont..
• Designed with wide- bore tubing and
various color - coded jet adapters.
• Each color code corresponds to a precise
oxygen concentration and a specific liter
flow.
• It is used primarily for patients with
chronic obstructive pulmonary disease

76. Venturi valve

79. Venturi Mask cont..
Advantages Disadvantages
• Delivers most
precise
oxygen
Concentration
• Doesn’t dry
mucous
membranes
• uncomfortable
• Risk for skin irritation
• Produce respiratory
depression in COPD patient
with high oxygen
concentration 50%

80. Venturi Mask cont…
Priority Nursing Interventions
• Requires careful monitoring to verify
FiO2 at flow rate ordered
• Check that air intake valves are not
blocked

81. Oxygen Hood
• An oxygen hood is used for babies who
can breathe on their own but still need
extra oxygen.
• A hood is a plastic dome or box with
warm, moist oxygen inside.
• The hood is placed over the baby's head

83. Oxygen Tent
• An oxygen tent consists of a canopy placed
over the head and shoulders, or over the
entire body of a patient to provide oxygen at a
higher level than normal.
• Typically the tent is made of see-through
plastic material.

84. Oxygen Tent cont..
• It can envelop the patient’s bed with the
end sections held in place by a mattress
to ensure that the tent is airtight.
• The enclosure often has a side opening
with a zipper.

86. Ambu bag
Artificial Manual Breathing Unit (or)
Bag Valve Mask Ventilation is a hand-
held device commonly used to provide
positive pressure ventilation to
patients who are not breathing or not
breathing adequately

87. Ambu Bag

90. Tracheostomy Collar/ Mask
• Inserted 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

91. Tracheostomy Collar/ Mask

93. T-PIECE
• Used on end of ET tube when
weaning from ventilator
• Provides accurate FIO2
• Provides good humidity

94. T- Piece

95. T- Piece

99. Oropharyngeal Airway

100. Oropharyngeal Airway
• Size: corner of mouth to angle of jaw

102. Nasopharyngeal Airway

103. Tracheostomy
Vocal foldsThyroid
cartilage
cricoid
cartilage
Tracheal
rings
Balloon cuff

105. Endotracheal Airway
Most effective and reliable method of
assisted ventilation because:–
• The airway is isolated, ensuring
adequate ventilation and O2 delivery
• Reduces aspiration chance

106. Endotracheal Airway cont….
• Interposition of ventilations with
chest compressions can be
accomplished efficiently
• Inspiratory time and Peak Inspiratory
Pressure(PIP) can be controlled
• Positive End Expiratory
Pressure(PEEP) can be delivered.

107. Indications for Intubation
• Inadequate CNS control of
ventilation
• Functional or anatomic airway
obstruction
• Loss of protective airway reflexes
• Excessive work of breathing

108. Indications for Intubation cont….
• Need of high PIP or PEEP
• Need of MV support
• Potential occurrence of any of the
above if patient is transported

109. Endotracheal Tube
• A cuffed ET tube is generally
indicated for children aged 8-10 yrs.
or older
• In younger children normal anatomic
narrowing at the level of cricroid
cartilage provides a functional cuff
• ET tube size= age/4 + 4

110. Endotracheal Tube
• length= age/2 +12 or
• depth of insertion= tube size*3
• ET tube 0.5 mm smaller and larger
should be readily available.

111. Non cuffed ET tube

112. Cuffed ETT

115. Aerosol treatments
• Administering medications into the
airways
• The method can be nebulizers or
oropharengeal inhalers
• These devices deliver topical
medications to the respiratory tract

116. Aerosol treatments cont
• Producing local and systemic effects
• The mucosal lining of the respiratory
tract absorbs the inhalant almost
immediately

117. Medications used to improve
respiratory functioning
• Epinephrine injection
• Bronchodilators
1. Salbutamol
2. Theophylline
3. Terbutaline
4. Metaproterenol (alupent )
5. Aminophyllin inj
6. Corticosteroids
7. Antihistamins

118. Metered dose inhalers

119. Spacers
• Provide greater
benefits for
children and
patients with poor
coordination
• Provides more
dead air space for
mixing medication

121. Dry Powder Inhaler

122. Nebulization
• Nebulizer is a type of inhaler that
sprays a fine, liquid mist of
medication.
• The medication is instilled into the
nebulizer chamber

123. Nebulization cont..
• two types of nebulizers- jet aerosol,
ultrasonic
• jet – gas under pressure, ultrasonic-
vibrations
• Nebulization improves clearance of
pulmonary secretions and
bronchodilation

124. Nebulizer

125. Tracheostomy tubes
• Disposable or reusable
• cuffed or non cuffed tube for airway
maintenance
• Inner cannula disposable or reusable
• Fenestrated tube

126. Mechanical ventilation
• Mechanical ventilation is a method to
mechanically assist or replace spontaneous
breathing
• A ventilator is a device used to provide
assisted respiration and positive-pressure
breathing
• Mechanical ventilation is the use of
mechanical device (machine) to inflate and
deflate the lungs

128. CPAP
• Administering oxygen by
CPAP(continuous positive airway
pressure):
1. Non invasive CPAP
2.Nasal CPAP
2-Endotracheal CPAP

129. Non invasive CPAP

130. Nasal CPAP
• It consists of a single nasopharyngeal
tube that deliveries 2-8 cm of
positive pressure with or without o2.
• Nursing care : - Frequent suction . -
Tube care. - Change the nasal tube

131. Endotracheal CPAP
Continues Positive Airway pressure
delivering via an ETT.
Nursing care : Use sterile suctioning
techniques - Mouth care
- Change the ETT every seven days

132. Side Effects & Complication Of
Oxygen Therapy
• Oxygen toxicity
• Retro lental fibroplasia
• Absorption atelectasis
• Infections

133. Oxygen Toxicity
• It is a condition which 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

134. Signs and symptoms of oxygen
toxicity
1. Non-productive cough
2. Nausea and vomiting
3. Substernal chest pain
4. Fatigue
5. Nasal stuffiness
6. Headache
7. Sore throat
8. Hypoventilation
9. Nasal congestion
10. Dyspnea
11. Inspiration pain

135. Retro lental fibroplasia
• Blindness due to vasoconstriction &
Ischemia ( premature infants ) owing
to the excessive administration of
oxygen Normal Disease

136. Absorption Atelectasis
• During 100% oxygen delivery,
nitrogen in alveoli is washed out and
replaced by oxygen.
• In contrast to nitrogen, oxygen is
extremely soluble in blood and
diffuses very quickly into the
pulmonary vasculature

137. Absorption Atelectasis cont..
• So that not enough gas is left in the
alveoli to maintain patency
• Alveolus collapses; this is known as
absorption atelectasis

138. Absorption Atelectasis

139. Safety Precautions During Oxygen
Therapy
• Oxygen is a highly combustible gas
• It can easily cause a fire in a patient’s
room if it contacts a spark from an open
flame or electrical equipment
• Oxygen is a therapeutic gas and must be
prescribed and adjusted only with a
health care provider’s order

140. Safety Precautions During Oxygen
Therapy cont…
• Place an “Oxygen in Use” sign on the
patient’s door and in the patient’s room.
• If using oxygen at home, place a sign on
the door of the house
• No smoking should be allowed on the
premises
• Keep oxygen-delivery systems 10 feet
from any open flames

141. Safety Precautions During Oxygen
Therapy
• Determine that all electrical equipment
in the room is functioning correctly
• Accidental opening outlet could cause
the tank to take off like a dangerous jet
• When using oxygen cylinders, secure
them so they do not fall over
• Store them upright and either chained
or secured in appropriate holders

142. Safety Precautions During Oxygen
Therapy
• Check the oxygen level of portable
tanks before transporting a patient
to ensure that there is enough
oxygen in the tank
• Do not use oil on oxygen
equipment.( Rationale: Oil can ignite
if exposed to oxygen)

143. Safety Precautions During Oxygen
Therapy cont..
• With all oxygen delivery systems, the
oxygen is turned on before the mask
is applied to the client
• Make sure the tubing is patent at all
times and that the equipment is
working properly

144. Nursing responsibilities for
administration of oxygen
• Check the name & bed no. & other
identification of patient
• Check the diagnosis & need for
oxygen therapy
• Check the doctors order for the
initiation of the therapy dosage etc

145. Nursing responsibilities for
administration of oxygen cont..
• Check the doctors order for specific
precaution regarding the movement
of the positioning of the patient
• Assess the patient for any sign of
clinical analysis ex: cyanosis
• Check the patients vital sign

146. Nursing responsibilities for
administration of oxygen cont..
• Check the result of arterial blood gas
analysis
• Note any signs of pulmonary
dysfunction
• Check the patients mental state &
the ability to follow instructions
• Check the articles available in the
unit

147. Nursing responsibilities for
administration of oxygen cont..
• Check the oxygen cylinder for its
accessories & their working
condition
• Maintain a constant oxygen
concentration for the client to
breathe

148. Nursing responsibilities for
administration of oxygen cont..
• Give pain medications as needed,
prevent chilling and try to ensure that
the client gets needed rest
• Be alert to cues about hunger and
elimination.( Rationale: The client’s
physical comfort is important.)
• Provide good oral hygiene
• Lubricate nares
• Make relevant documents

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

150. Summary
• Main sources of oxygen in clinical
practice
• Oxygen administration devices
• Potential harm from oxygen therapy
• Nurse’s responsibilities when
administrating oxygen

151. Assignment
1. Write nursing care of patient
with Oxygen therapy via simple
face mask

152. References
• Potter.P.A., Perry. A.G. (2006). Fundamentals of nursing
(6th ed). Elsevier publishers. New delhi. Pp1121-1131.
• Taylor. C., Lillis.C., Lemone.P. (1993). Fundamentals of
nursing (2nd ed). Lippincot company. Philadelphia.
Pp942-993.
• Wong.M., Elliot. M. (2009). The use of medical orders
in acute care oxygen therapy. British journal of nursing.
18(8). Pp462-464.
• http://www.slideshare.net/mobile/aparnaA1/nursing
management of patients with oxygen insufficiency