Oxygen Administration System

7/31/2019 Oxygen Administration System

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Benefits of Oxygen
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PURPOSE To supply oxygen in conditions when there is

interference with normal oxygenation of blood.

To supply the patients with adequate oxygen tomaximize oxygen carrying capacity of blood.

To reduce effects of anoxaemia.

To maintain healthy level of tissue oxygenation.

To reduce work of breathing, maintain pao2and/or reduce the workload on heart, keepingsa02> 90% during rest, sleep and exertion orpao2 > 60%.


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Indications for oxygen

therapy Cynosis

Breathlessness and laboured breathing

Environment low in oxygen content eg. High altitudes.

Anaemia

Diseases in the oxygen across the alveolar- capillarymembranes. Eg. Pulmonary oedema.

Patients whose respiratory capacity is diminished by some

diseases. Eg. Pneumenectomy.


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Poisoning with chemical that alter tissue ability toutilize oxygen. Eg. Cyanide.

shock and circulatory failure

Hemorrhage and air hunger

Patients under anesthesia

patients who are critically ill

Patients with psychologically inducedbreathlessness.

asphyxia


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M h d f


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Methods of oxygenadministration

The method selected depends onfollowing factors:

Fraction of inspired oxygen ( FIO2)require by the patient and delivered bydevice.

Mobility of patient

Humidification required


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O2 delivery system are classified as

Low flow delivery devices

High flow delivery devices

Low flow delivery devices:- Low flow

devices that deliver o2 concentration thatvary with persons respiratory pattern.

Eg. Nasal cannula

Nasal catheter

Oxygen conserving cannula

Transtracheal catheter

Face tent


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Oxygen by mask- Simple face mask- Partial rebreathing mask

- Non-rebreathing mask.

High flow delivery devices:- This device thatdelivers fixed concentration of o2 independent

of patients patients respiratory pattern.

Eg. Venturi maskMechanical ventillators

OTHER METHODS OF O2 ADMINISTRATION ARE O2 cylinder Piped in o2


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NASAL CANNULA
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1. LOW FLOW DELIVERY DEVICES:

o Nasal cannula:- A method by which oxygen

is administered in low concentrationthrough cannula 1.5 cm long which is adisposable plastic device with two

protruding prongs for insertion intonostrils. Itr is the safe, simple, comfortabledevice.

Purpose:o To relieve Dyspnea

o To administer low conc. of oxygen( 4L/m)

o To allow uninterrupted supply of oxygen.


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ARTICLES:

1. Oxygen supply with flowmeter

2. Humidifier with sterile distilled water.

3. Nasal cannula with connecting tubes.

4. Gauze pad

5. Tape


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PROCEDURE:

o Determine need for oxygen

o Perform assessment of vitals, level ofconsciousness, lab values and record.

o Assess risk factors of oxygen therapy inpatients and environment such as patients withhypoxia drive, faulty electrical connections etc.

o

Explain procedure.

o Post no smoking sign on patients door inview osf patient and visitors and explain themhazards of smoking when o2 is on flow.


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o Wash hands

o Set up o2 equipment and humidifier.

o Place tip of cannula to patients nares and adjuststraps around ear. Elastic band may be fixed

behind head or under chin

Pad tubing with gauze pad over ear and inspectskin behind ear periodically forirritation/breakdown.

Inspect patient and equipment frequently forflowrate, clinical condition, level of water inhumidifier


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Ensure safety precautions areperformed.

Wash hands

Document time, flow rate andobservations made on patient

Encourge patient to breath throughhis/her nose with mouse closed.

Remove and clean cannula with soa


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2. Nasal catheter:

The nasal catheter is inserted into

nostril reaching upto uvula and is heldin place by adhesive tapes.

Flow of 1-4 l/m is sufficient to maintainconc. Of 22-30% o2.

The catheter must be chan ed at least


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3. Oxygen conserving cannula:-Cannula has a built in reservoir that increaseso2 conc delivered and allows patient to use

lower flow.(usually 30-50%)


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It increases comfort, lower cost and canbe increased with activities.

It can deliver upto 8 l/min. of o2

Disadvantages:o Cannula can not be cleaned,

manufacturer recommends changing

cannula every week.o It requires evaluation with ABGS and

pulseoximetry to determine correct flow

for patient.


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TRANSTRACHEAL CATHETER


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4. Transtracheal catheter:-o It is method of oxygen delivery in which a small

intravenous size catheter is inserted directly intotrachea through surgical tract in lower neck.

Oxygen is delivered directly into trachea.

o It is used for clients with chronic lung diseases.

Advantages:-o Continuous oxygen administration

o Less expensive because no loss of o2 toatmosphere.

o Less nasal irritation

o Since oxygen reaches trachea directly, client

achieve adequate oxygenation at lower flow rate.
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Steps of using transtracheal oxygenation:o Assess client and family to determine whether

they can effectively and safely usetranstracheal oxygenation.

o Surgical insertion of stent (stoma type accessroute) directly into trachea.

o Initiation of oxygen stoma.

o On healing of stoma, teach client to remove andirrigate catheter at least three times a day with

normal saline, to maintain patency of catheter.

o Final oxygen flow rate usually less than 4 l/minis delivered through an 8 fr. Catheter.


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FACE TENT

5 F t t
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5. Face tent:

o Tent is ideal for providing moderate to highdensity aerosol.

o Open plastic mask fits under chin.

o O2 conc administered varies with o2 flow

rate.o Temp of aerosol must be checked to

maintain at or near body.

6. Oxygen tent:-o Oxygen tent consist of canopy over patients

bed that may cover patient partially or fully

and connected to oxygen supply.


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Articles :

Oxygen tent with tubing Flow regulator

Oxygen analyzer Oxygen source

Humidifier Sterile distilled water

Bath blankets -2 IceProcedure:

Explain procedure

Assemble all equipmentsWash your handsUse bath blankets to cover plastic mattress.

Place second bath blanket over bottom sheet


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Prepare tent and position over bed. Attach tooxygen source.

Fill ice trough or start refrigeration component.

Fill nebulizer or humidifier upto recommendedlevel. Use oxygen analyzer at least every 4 hrs.

Secure tent between folded top sheet andunder matress.

Wash hands

Assess client and monitor equipment at

frequent intervals.


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While performing hygienic care or other procedures, loosenededge of tent and secure tent with bath blankets under clientchin.

Record type of therapy and clients response

Advantages:o It provides environment for the patient with controlled

oxygen conc, temp regulation and humidity control.

o It allows freedom for free movt in bed.

Disadvantages:o Creates feeling of isolation

o Requires high vol of oxygen( 10 to12 l/min)

o Loss of desired conc of o2 occurs each time due to openingof tent frequently.


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Requires much time and efforts to clean and maintain tent.

7. Tracheostomy collar:o Collar can deliver high humidity and o2 via tracheostomy

o Collar attaches to neck with elastic strap and should beremoved and cleaned at least q4 hr to prevent aspiration offluid and infection.

Disadvantages:o Condensed fluid in tubing may drain into tracheostomy

o Water traps are usually puts in.

o Secretions collect inside collar and around tracheostomy.

o Due to ill fitting of collar o2 conc may loss into atmosphere.

8 O b k


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8.Oxygen by mask:o Simple face masko Partial rebreathing masko Nonrebreathing mask1. Simple face masko Used for short oxygen therapy and Fits loosely.o Delivers o2 conc from 30-60% with flow rate of 6-12

l/min

2. Partial rebreathing mask:o Light weight and easy to use

o Advantageous for client who are unable to breaththrough nose eg. those needs higher conc of o2(70%)

o Useful for short term therapy.


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NONREBREATHING MASK


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Nonrebreathing mask:

o Maintain high conc. Of o2 supply in reservoir(80-90%) with flow rate of 10 l/min

o O2 flows into bag and mask during inhalation.Valve prevents expired air from flowing backinto bag.

o Frequent inspection of bag is needed to makesure that bag is inflated. If it is deflated, this cancause breathing in of exhaled co2.


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VENTURI MASK


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High flow delivery devices:

1.Venturi mask:

Lightweight plastic, cone shaped devicefitted to face.

O2 is delivered to small jet in center of widebased cone

Air is pulled through in cone as o2 flows

through small jet.

Mask has large vent through which exhaledair can escape.

Deliver oxygen conc of 24% 28% 30% 35% 40% 55%


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Deliver oxygen conc of 24%,28%, 30%,35%,40%,55%with o2 flow rate of 2,3 4, 6, 8,14 l/min

2.Mechanical ventillators

Other methds-

1. o2 cylinder

Fitments of oxygen cylinder:

Rubber tubing connections to patients

Flowmeter

Fine adjustment

valve

Pressure gauge

On and off metallic key

Care of oxygen cylinder


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Care of oxygen cylinder

o Always use the cylinder with metal case

o Oxygen cylinder should be placed at the head endof the bed , away from the traffic areas

o Any source of fire should be kept away from the

cylinder

o It should be stored in cool temp. away from theheaters

o The supply of the oxygen must always be equippedwith regulator to control the flow of gas andprevent the wastage


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o Warning signs ( nosmoking sign ) should

be placed at unit where oxygen is on.

o When the cylinders are empty , always markit empty and send for filling

o Inspect apparatus at frequent interval for the

good working conditiono The nurse should learn working of cylinder,

its regulator before handling the equipment.

The cylinder is open by turning the largevalve with anti-clockwise direction .

o To test any leakage in regulator, soap lather

may be used.


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2.Piped in oxygen

o It is supplied from wall outlets at bedside( wall system).

o It is usually stored under low pressureabout 50 to 60 lbs/ sq. inch.


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Hazards of oxygen therapy

1. Infection

2. Combustion(fire)

3. Drying of mucus membrane of respiratory tract

4. Oxygen toxicity

5. Atelectasis

6. Oxygen induced apnea

7. Retrolental fibroplasia8. Asphyxia

9. Co2 narcosis


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Nurse responsibilityo Check the name , bed no and other identification of

patient .

o Check diagnosis and need for oxygen therapy.

o Check doctors order for specific precautionregarding movements and positioning of patient.

o Explain procedure and its purpose.

o Assess patient for any signs of clinical anoxia eg.Cynosis.

o Assess patients vitals, breathing patterns carefully

before starting therapy and thereafter frequently.


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o Check results of arterial blood gasanalysis.

o Check patients mental state and abilityto follow

instructions.

o Check articles available in unit.


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Home oxygen therapy

It is made available to clients whorequire continuous oxygen therapy athome.

It is usually delivered by nasal cannula.

Home o2 systems are usually rentedfrom a company that sends respiratory

therapist to patients home.


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P ti t Ed ti


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Patient Education

1. The therapist and home nurse should teachpatient and family how to use o2 system,how to care for it, how to recognize whensupply is runing slow and needs to be

recorded.2. Explain procedure step by step to patient

3. Educate client to ensure that straps ofmask/canuula should not be too tight.

4. Educate to remove 2-3 times/day to washand dry skin where straps touch skin,massage skin.

5. Educate client about to pad any pressurepoints.

6 Educate the client to assess oral and nasal


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6. Educate the client to assess oral and nasalmembrane 2-3 times/day.

7. Educate the client to use water based gel to lipsand nasal mucosa.

8. Educate client about frequent oral hygiene.

9. Educate to change disposable equipmentfrequently.

10. Educate client to remove secretions that arecough out.

11.Educate client about risk of fire injuries, smoking.advice client not to use open flames, portable

radios.


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Documents

Oxygen Administration System