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Definition

A nasal cannula is a narrow, flexible plastic tubing used to deliver oxygen through the nostrils of

patients using nasal breathing. It connects to an oxygen outlet, a tank source or compressor, on one end

and has a loop at the other end with dual pronged extended openings at the top of the loop. The prongsare slightly curved to fit readily into the front portion of a patient's nostrils. The tubing of the loop is

fitted over the patient's ears and is brought together under the chin by a sliding connector that holds the

cannula in place.

A simple oxygen face mask is a plastic device that is contoured to fit over a patient's nose and mouth. Itis used to deliver oxygen as the patient breathes through either the nose or the mouth. A simple oxygen

mask has open side ports that allow room air to enter the mask and dilute the oxygen, as well as

allowing exhaled carbon dioxide to leave the containment space. It also has narrow plastic tubing fixedto the bottom of the mask that is used to connect the mask to an oxygen source. An adjustable elastic

band is connected to each side of the mask and slides over the head and above the ears to hold the mask

securely in place.

A partial rebreather oxygen mask is similar to a simple face mask, however, the side ports are coveredwith one-way discs to prevent room air from entering the mask. This mask is called a rebreather

because it has a soft plastic reservoir bag connected to the mask that conserves the first third of the

patient's exhaled air while the rest escapes through the side ports. This is designed to make use of the

carbon dioxide as a respiratory stimulant.

A non-rebreather oxygen mask is similar to a simple face mask but has multiple one-way valves in the

side ports. These valves prevent room air from entering the mask but allow exhaled air to leave the

mask. It has a reservoir bag like a partial rebreather mask but the reservoir bag has a one-way valve that

prevents exhaled air from entering the reservoir. This allows larger concentrations of oxygen to collectin the reservoir bag for the patient to inhale.

A Venturi oxygen mask is similar to a simple face mask but the tubing that connects to the oxygensource is larger than that of other masks. The connector has interchangeable adaptors that widen or

narrow the diameter of the flow through the tubing to allow settings of specific concentrations ofoxygen through the mask.

Purpose

The purpose of nasal cannulas and oxygen face masks is to deliver oxygen in as concentrated a form as

required for patients who are hypoxic. There are many conditions that cause hypoxemia and require the

administration of supplemental oxygen, including respiratory disease, cardiac disease, shock, trauma,severe electrolyte imbalance (hypokalemia), low hemoglobin or severe blood loss, and seizures.

Prompt treatment of these conditions with non-invasive oxygen administration can prevent the need formore invasive procedures such as intubation and mechanical ventilation.

A nasal cannula is used to deliver low concentrations of oxygen. It can deliver from 24% to 40%oxygen at a flow rate of 0.26-1.58 gal (1-6 L) per minute. A simple mask is used to deliver moderate to

high concentrations of oxygen. It can deliver from 40% to 60% oxygen at a flow rate of 2.64-3.17 gal

(10-12 L) per minute. A partial rebreather mask is used to deliver high concentrations of oxygen. It can

deliver 70% to 90% oxygen at a flow of1.58-3.96 gal (6-15 L) per minute. A non-rebreather mask isused to deliver high flow oxygen. It can deliver 90% to 100% oxygen at a flow of 3.96 gal (15 L) per

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minute. A variable flow rate mask has interchangeable adaptors that may be set to deliver oxygen at

24%, 28%, 31%, 35%, 40%, or 50%.

Precautions

Oxygen is flammable. "No Smoking" signs should be posed when a patient is receiving oxygen.

Electrical equipment must have special grounding adaptors on plugs to avoid sparks. The patient andfamily should be warned of the dangers involved in using oxygen at home, such as exercising carewhen using oxygen near stoves, portable heating units, and ungrounded electrical equipment. Oxygen

cylinders must be place in a cart or base to avoid dropping or bumping the tank. Oxygen tanks or

compressors should be turned off when not in use and oxygen valves should be checked routinely to besure that they are secure. Oxygen levels in reserve tanks should be monitored to ensure continuous

therapy.

Patients receiving oxygen should be closely monitored. Arterial blood gas analysis or the use of a

pulse oximeter will ensure that the oxygen concentration being delivered is sufficient to meet thepatient's needs. Monitor the patient's condition and vital signs frequently, according to the policy of the

medical setting. The fit of the nasal cannula or mask and all of the oxygen connections should be

evaluated, to ensure that no part of the system has been blocked or diverted and the oxygen is beingdelivered correctly, as ordered.

The use of a face mask can cause a patient to perspire and feel warm, claustrophobic or nauseated.

Explain the importance of the oxygen to the patient and encourage him to relax and breathe slowly. A

cold cloth on the forehead and moral support can help the patient overcome these anxious feelings. If apatient with an oxygen mask begins to vomit, quickly remove the mask. There is a danger of aspirating

vomit into the lungs if it collects in the mask over the nose and mouth. Support the patient, assist them

in cleaning the mouth after vomiting by rinsing with water or mouthwash, clean off the mask and the

attached tubing, and replace it. The physician should be notified and antiemetics may be ordered.

A nasal cannula is more comfortable for a patient than a mask but can only deliver low concentrations

of oxygen. Nasal cannulas should only be used in patients who breathe adequately through their noses.Use of cannulae is not indicated in patients who have severe hypoxia, poor respiratory effort, blocked

nasal passages, apnea, or are mouth breathers.

Be cautious about giving oxygen to patients with chronic obstructive pulmonary disease because they

may retain carbon dioxide. Oxygen may depress the hypoxic drive in these patients. They should be

observed for decreased respirations, an altered mental state or further elevations of their carbon dioxide

levels.

Description

Before applying a nasal cannula, the oxygen-flow meter should be turned to the setting in liters perminute that is ordered by the physician. The nurse should use his or her finger tips to ensure that

oxygen is flowing through the prongs of the cannula. The nurse should apply a nasal cannula by

placing the nasal prongs gently into the patient's nostrils, draping the tubing over the patient's ears, andsliding the fit connector up under the chin to hold the tubing securely in place. Two small pieces of

clear plastic tape can be used to hold the cannula against the patient's cheeks to secure the cannula in

place if necessary. This is only necessary if the patient is restless, confused, or is a young child who

may bat the cannula out of place.

Before applying an oxygen face mask, the nurse should turn on the oxygen flow-meter to the setting in

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liters per minute that is ordered by the physician. If using a Venturi mask, the adaptor device should be

selected and applied to deliver the oxygen concentration that is ordered. Use the finger tips to ensure

that oxygen is flowing through the face mask. An oxygen face mask is applied by placing the molded

plastic mask onto the patient's face, over the nose and mouth. The nurse should pull the elastic strapover the patient's head to the back of the head and adjust the strap on both sides of the mask to secure

the mask in a position that seals it against the face. Some masks have a nose-clip that can be gently

squeezed to mold the mask over the bridge of the nose. The mask should fit snugly against the face butmust not press so tightly as to leave impressions in the skin. If the mask has a reservoir bag and its

purpose is to serve as an oxygen reservoir, the nurse should check that oxygen is filling the bag before

applying the mask.

Preparation

The nurse should place the patient in a comfortable position, preferably semi-Fowler's or full Fowler'sposition (to assist breathing). She or he should take baseline vital signs and note the patient's level of

consciousness. A pulse-oximetry reading or draw blood gases should be done as ordered for baseline

lab values. Oxygen delivery to the patient should be explained, including what equipment is to be used

(such as a mask or nasal cannula) and the importance of keeping the apparatus in place. The patientshould know of the flammability of oxygen and a "No Smoking" sign should be posted. The nurse

should instruct the patient to notify him or her of increasing distress, air hunger, nausea, anxiety, dry

nasal passages, or "sore throat" (due to drying). The equipment needed should be assembled, includingthe oxygen-flow meter, humidity bottle if ordered, nasal cannula, or appropriate face mask. The mask

or cannula should be connected securely to the oxygen flow-meter. Extension tubing should be used

between the mask tubing and the oxygen flow-meter if necessary so that the patient may move aboutwithout pulling the mask off or pulling the tubing out of the oxygen source. The nurse should place a

pulseoximeter machine at hand if ordered, to monitor the patient's response to oxygen therapy.

Aftercare

After initiating oxygen therapy, the nurse should stay with the patient for a while to reassure the patient

and observe his or her reactions to the therapy. The patient's vital signs should be monitored, along with

the level of consciousness, comfort with the oxygen apparatus, and oximetry levels, as ordered by thephysician or as directed by policy of the medical setting. Oxygen connections and settings should be

checked. The nurse should observe the patient, either for improvements in color, respiratory rate and

rhythm, and comfort levels, or for increased or decreased respiratory effort, diaphoresis, alteration inmental status, anxiety and restlessness. Facemasks will interfere with communication and eating.

Oxygen will dry out the mucous membranes of the nose and mouth. The nurse should briefly remove

the mask periodically to allow the patient to drink or eat, for mouth care, or to communicate clearly.

When the mask or cannula is off, the skin on the face and above the ears should be checked for signs of

skin irritation. If the skin is irritated