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
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
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
