ADMINISTRATION OF OXYGEN

SHARON HARVEY

LEARNING OUTCOMES

THE STUDENT SHOULD BE ABLE TO: REVIEW THE PHYSIOLOGICAL

REQUIREMENTS OF THE BODY FOR OXYGEN. IDENTIFY WHEN OXYGEN THERAPY MAY BE NEEDED FOR AN ADULT AND CHILD

DEMONSTRATE HOW OXYGEN THERAPY SHOULD BE PRESCRIBED USING A PRESCRIPTION/MEDICATION CHART

LEARNING OUTCOMES

DISCUSS THE SAFE AND EFFECTIVE DELIVERY OF OXYGEN THERAPY WITH PARTICULAR REFERENCE TO:

USE OF COMMON DELIVERY APPARATUS (FACEMASKS, NASAL CANNULA) FOR ADULT AND CHILD

SAFETY CONSIDERATIONS (THE CORRECT FLOW RATE, AVOIDANCE OF NAKED FLAME)

STORAGE AND DELIVERY OF OXYGEN IN CLINICAL AREAS

LEARNING OUTCOMES

DISCUSS THE PATIENT’S EXPERIENCE WHEN UNDERGOING OXYGEN THERAPY

IDENTIFY EFFECTIVE NURSING INTERVENTIONS TO SUPPORT THE PATIENT, E.G. ORAL HYGIENCE, ADEQUATE FLUID INTAKE, CORRECT POSITIONING TO ACHIEVE MAXIMUM VENTILATION OF LUNGS

DISCUSS THE INDICATIONS AND CONTRAINDICATIONS FOR A CHILD AND ADULT: NASOPHARYNGEAL AND OROPHARYNGEAL SUCTIONING LOWER AIRWAY SUCTIONING SUCTIONING OF THE TRACHEOSTOMY

OXYGENATIONOXYGEN – A PRESCRIBED DRUG

MUST BE WRITTEN LEGIBLY BY THE DOCTOR

PRESCRIPTION SHOULD BE DATED BY THE DOCTOR

DOCTOR MUST INDICATE DURATION OF O2 THERAPY

THE O2 % CONCENTRATION MUST BE PRESCRIBED

THE FLOW RATE MUST BE PRESCRIBED

INDICATION FOR OXYGEN THERAPY

ACUTE RESPIRATORY FAILUREACUTE MYOCARDIAL INFARCTIONCARDIAC FAILURESHOCKHYPERMETABOLIC STATE INDUCED

BY TRAUMA, BURNS OR SEPSISANAEMIACYANIDE POISONINGDURING CPRDURING ANAESTHESIA FOR SURGERY

OXYGEN DELIVERY SYSTEMS

BASIC COMPONENTS OF A OXYGEN DELIVERY SYSTEM

PIPED OR PORTABLE CYLINDER OXYGEN SUPPLY

A REDUCTION GAUGE

FLOW METER (LITRES/MIN)

BASIC COMPONENTS OF A OXYGEN DELIVERY SYSTEM

DISPOSABLE TUBING OF VARYING DIAMETER AND WIDTH

MECHANISM FOR DELIVERY (MASK OR CANNULA)

HUMIDIFIER (TO WARM AND MOISTEN THE O2

METHODS OF ADMINISTERING OXYGEN SIMPLE SEMI-RIGID MASKS NASAL CANNULA FIXED PERFORMACE MASKS OR HIGH-FLOW

MASKS (VENTURI) T-PIECE CIRCUIT PAEDIATRIC CIRCUITS - HEADBOX OR HOOD

- O2 TENT/COT TRACHEOSTOMY MASK MECHANICAL VENTILATION CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

HUMIDIFICATION OF OXYGEN

NORMAL AIR TRAVELLING THROUGH THE AIRWAYS IS WARMED, MOISTENED AND FILTERED BY EPITHELIAL CELLS OF THE NASOPHARYNX

THE AIR ENTERING THE TRACHEA WILL HAVE A RELATIVE HUMITY OF 90% AND A TEMPERATURE OF BETWEEN 32-36 C

OXYGENATION WILL CAUSE DEHYDRATION OF THE MUCUS MEMBRANES AND PULMONARY SECRETIONS

HUMIDITY IS ESSENTIAL FOR PATIENTS WHO HAVE AN ENDOTRACHEAL OR TRACHEOSTOMY TUBE

HUMIDIFICATION REQUIREMENTS

HUMIDIFICATION AND TEMPERATURE SHOULD NOT BE AFFECTED BY THE FLOW RATE

SAFETY ALARMS SHOULD GUARD AGAINST OVERHEATING, OVER HYDRATION AND ELECTRIC SHOCK

NO INCREASED RESISTENCE TO RESPIRATION

WIDE BORE TUBING (ELEPHANT) SHOULD BE USED TO ALLOW SUFFICIENT FORMATION OF WATER VAPOUR

HEALTH AND SAFETY ISSUES WITH O2

MEDICAL GAS CYLINDERS HAVE TO CONFORM TO COLOUR CODING

CURRENTLY OXYGEN CYLINDERS ARE BLACK WITH WHITE SHOULDERS.

HEALTH AND SAFETY ISSUES WITH OXYGEN OXYGEN IS

COMBUSTIBLE OIL AND GREASE

AROUND CONNECTIONS SHOULD BE AVOIDED

ALCOHOL, ETHER AND INFLAMMATORY LIQUIDS SHOULD BE KEPT SEPARATE FROM O2

NO ELECTRICAL DEVICES NEAR 02 TENT

NO SMOKING FIRE EXTINGUISHER NEEDS

TO BE AVAILABLE CARE WITH USING

DEFIBRILLATOR NEAR HIGH OXYGEN CONCENTRATIONS

POTENTIAL PROBLEMS

CO2 NARCOSIS CO2 LEVELS IN THE BLOOD NORMALLY INFLUENCES

RESPIRATION

PATIENTS WHO ARE HYPERCAPNIC CO2E.G. CHRONIC BRONCHITIS, HAVE THEIR BRAIN CHEMORECEPTORS NO LONGER SENSITIVE TO CO2 LEVELS

- INSTEAD THE HYPOXIC DRIVE BECOMES THE RESPIRATORY DRIVE I.E. O2 IS THE DRIVE FOR RESPIRATION

- HIGH LEVELS OF SUPPLEMENTARY O2 MAY LEAD TO REPIRATORY DEPRESSION/UNCONSCIOUSNESS AND DEATH

POTENTIAL PROBLEMS

OXYGEN TOXICITY THIS FOLLOWS AFTER PROLONGED O2 THERAPY

(>24 HOURS) THERE IS DECREASING LUNG COMPLIANCE FROM

HAEMORRHAGIC INTERSITIAL AND INTRA-ALVEOLAR OEDEMA

THIS ULTIMATELY LEADS TO FIBROSIS OF LUNG TISSUE

>24 HOURS AND > 50 % O2 THERAPY SHOULD BE AVOIDED

PRINCIPLES OF SUCTIONING

SHARON HARVEY

PRINCIPLES OF SUCTIONING

THREE PRIMARY SUCTIONING TECHNIQUES ARE:

OROPHARANGEAL/ NASOPHARANGEAL SUCTIONING

OROTRACHEAL AND NASOTRACHEAL SUCTIONING

SUCTIONING AN ARTIFICAL AIRWAY

SIGNS OF A NEED FOR SUCTIONING RESPIRATORY RATE CHANGE IN

RESPIRATORY PATTERN

NOISY BREATHING DIFFICULTY

SUCTIONING REDUCED OR UNEVEN

AIR ENTRY INCREASED AIRWAY

PRESSURE

SURGICAL EMPHYSEMA OR OTHER NECK SWELLING

DISTRESSED PATIENT

HYPOXIA THE ABILITY TO

HEAR THE PATIENT SPEAK WHEN CUFF IS INFLATED

PRINCIPLES OF SUCTIONING

OROPHARYNGEAL SUCTIONING REMOVES SECRETIONS FROM THE PHARYNX VIA A CATHETER PLACED THROUGH THE MOUTH OR NOSTRILS

THIS TYPE OF SUCTIONING IS USED WHEN THE PATIENT S ABLE TO COUGH EFFECTIVELY BUT UNABLE TO CLEAR SECRETIONS BY EXPECTORATING OR SWALLOWING

PROCEDURE IS CARRIED OUT AFTER THE PATIENT HAS COUGHED

ASSESSMENT PRIOR TO SUCTIONINGABNORMAL BREATHING SOUNDSIRREGULAR RESPIRATORY PATTERNCHANGES IN SECRETIONSINCREASE IN COUGHING INCIDENTSCHANGE IN PATIENT’S APPEARANCE

COMPLICATIONS OF SUCTIONING

TRAUMAHYPOXIAINFECTION

OROPHARYNGEAL SUCTIONING

MEASUREMENTS? ALWAYS USE THE SMALLEST DIAMETER SUCTION

CATHETER POSSIBLE TO REMOVE THE SECRETIONS

FOR ADULTS USE CATHETERS SIZE 12-16 FRENCH GAUGE

FOR CHILDREN USE 8-12 CATHETER GAUGE INSERTION DEPTH

FOR NASOPHARYNGEAL SUCTIONING: ADULTS INSERT ABOUT 16CM INFANTS AND YOUNG CHILDREN 4-8 CM

OROPHARYNGEAL SUCTIONING

CAUTION ON PATIENTS WITH: NASOPHARYNGEAL BLEED OR CSF LEAK ANTI COAGULANT THERAPY

OROPHARYNGEAL SUCTIONINGPROCEDURE REVIEW OXYGEN SATURATIONS AND BREATHING

PATTERN EVALUATE ABILITY TO COUGH CHECK HISTORY FOR DEVIATED SEPTUM, NASAL

POLYPS, NASAL OBSTRUCTION, TRAUMATIC INJURY, EPISTAXIS OR MUCOSAL SWELLING

EXPLAIN PROCEDURE INFORM THAT SUCTIONING MAY CAUSE

TRANSIENT COUGHING AND GAGGING MINIMISE ANXIETY POSITION PATIENT IN AN UPRIGHT POSITION TO

PROMOTE LUNG EXPANSION

OROPHARYNGEAL SUCTIONING

TURN ON SUCTION (80-120 MMHG)EXCESSIVE PRESSRE MAY CAUSE

TRAUMAOCCLUDE THE END OF CONNECTING

TUBE TO CHECK SUCTION PRESSUREASEPTIC TECHNIQUEUSE LUBRICANT IF THE CATHETER IS

PASSED THROUGH NASAL PASSAGE

OROPHARYNGEAL SUCTION

USE YOUR DOMINANT HAND TO CONTROL THE CATHETER

USE YOUR OTHER HAND TO CONTROL SUCTION VALVE

PATIENT TO COUGH AND BREATH DEEPLY BEFORE SUCTIONING

COUGHING HELPS TO LOOSEN SECRETIONS

DEEP BREATHING HELPS TO MINIMISE HYPOXIA AND LUNG COLLAPSE

OROPHARYNGEAL SUCTIONING

SPECIAL CONSIDERATIONS ALTERNATE BETWEEN NASAL PASSAGES

TO MINIMISE TRAUMATIC IJURY WHERE REPEATED SUCTIONING IS

REQUIRED, A PHARYNGEAL AIRWAY WILL HELP WITH CATHETER INSERTION, REDUCE TRAUMA AND PROMOTE PATENT AIRWAY

RESPT PATIENT AFTER SUCTIONING AND OBSERVE

OROPHARYNGEAL SUCTIONING

COMPLICATIONS DYSNOEA BLOODY ASPIRATE

DOCUMENTATION

RECORD THE DATETIME

PROCEDURETECHNIQUE

REASON FOR SUCTIONING