Oxygen Therapy

Linda Winn, RN, MSN Ed., BA Ed.

OxygenMedication

Requires MD orderSide Effects

Highly combustible gasClearOdorless

Set-up is part of initial room check

Indications for O2 therapy

GoalPrevent or relieve hypoxia

Keep SaO2 > 90%

Reduce work of breathingRoom Air / FIO2 = 21%

Used with hypoxia due to:Respiratory DisordersCardiovascular disordersCentral nervous system disorders

Safety PrecautionsO2 sign posted

No smoking or flames

Electrical equipment grounded

Check tank level before transport

No oil-based lubricants / lotions

Delivery DevicesNasal CannulaMasks

Simple facePartial rebreathingNon-rebreathingVenturi (Venti Mask)

TracheostomyCollar

VentilatorFlow MeterHumidification

Oxygen Safety

Nasal CannulaAdvantages

Safe, simple, tolerated wellAllows eating and drinkingCan humidify

DisadvantagesEasily dislodged

Check regularlySkin breakdown

Check regularly

O2 Concentrations1L/min = 24%2L/min = 28%3L/min = 32%

Simple Face MaskRA enters via side holes

AdvantagesHumidified

DisadvantagesImprecise FIO2High FIO2 needed to prevent rebreathing CO2

Concentrations5-6L/min = 40%6-7L/min = 50%>7L/min = 60%

Partial Rebreather MaskUsed for short-term high O2 concentrations

Must keep bag partially inflated at all times

AdvantagesLightweightEasy to use

DisadvantagesMust fit snuglyCannot use high humidificationNot for use with COPDUncomfortable

Non-rebreather MaskUse

Valve prevents air from flowing back into bag

Last step, usually, before intubation

AdvantagesHigh O2 concentrationsAccurate

DisadvantagesCan’t use high humidityuncomfortable

Venturi MaskVenti-mask

High flowAdjustable

AdvantagesVery preciseMask of choice for

COPD

Disadvantagesuncomfortable

O2 and COPDHistorically…

Never give O2 >2L/min to COPD pts.

However…

“There has been concern regarding the dangers of administering O2 to COPD pts and reducing their drive

to breath.”

“This has been a pervasive myth but is not a serious threat.”

“In fact, not providing adequate O2 to these patients is much more detrimental.”

Lewis, p. 643 (7th ed.)

Oropharngeal SuctioningOral cavity onlyClean technique, wear glovesInsert catheter into mouth, then apply suctionEncourage coughing to assist removal of secretionsClear catheter with waterStore in clean, dry area for reuseAssess before and after to evaluate effectiveness

Yankauer suction catheter