#Nasal canulae

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1. NASAL CANAULAE -- OXYGEN CONCENTRATION -- DR. NISAR AHMED ARAIN Assistant Professor Anesthesia / Critical Care / ER

2. INTR O DUCTI O N -Oxygen is a gas found in the air and has no colour, no smell or taste and is very necessary for the life. -Oxygen has the symbol O and atomic number eight (8). -Oxygen makes up 21% of the atmosphere by volume. -Oxygen is obtained by two (2) methods, that is by distillation of liquid air and by passing a clean dry air through a zeolite that absorbs nitrogen and leaves the oxygen. -Oxygen is used in industries, water treatment and as a therapy .

3. DEFINIT I ON Oxygen administration is the process by which supplemented oxygen is administered in high concentration than that of atmospheric air.

4. 1-- Wall outlets. 2-- Oxygen cylinders. a-- Stationary b-- Portable, mobile or ambulatory. SOURCES OF OXYGEN IN THE HOSPITALS Therapeutic oxygen is available from two sources

5. -- To relieve dyspnea. -- To prevent hypoxemia (low level of oxygen in the blood) and hypoxia (low level of oxygen in cells). -- To increase oxygenation in the tissues. PURPOSE OF OXYGEN ADMINISTRATION

6. INDICATIONS FOR OXYGEN ADMINISTRATION Severe respiratory distress (e.g. acute asthma and pneumonia.) Intra and post operatively Hypoxia and hypoxemia Shock Severe trauma Acute myocardial infraction (heart attack)

7. PRECAUTIONS FOR OXYGEN ADMINISTRATION -Avoid naked flames near oxygen cylinder. - Put a No Smoking sign at the entrance of the ward and near patients bed to warn others. - Do not use oil on the oxygen cylinders. Oil can ignite if exposed to oxygen. - Do not use electrical gadgets or any article which can cause sparks near oxygen cylinder. -Do not give oxygen to a hyperventilated patient.

8. PRECAUTIONS FOR OXYGEN ADMINISTRATION -Keep oxygen cylinders in a dry and cool place - Mark oxygen cylinder to indicate whether full or empty. - Use only carriers with wheel to transport oxygen cylinders, do not roll the cylinders on the ground. -Do not adjust flow meter until instructed. -Encourage or assist patient to move about in bed to prevent hypostatic pneumonia or circulatory difficulties

9. PRECAUTIONS FOR OXYGEN ADMINISTRATION - Oxygen source : wall outlets or oxygen cylinder. -Flow meter . -Humidifier filled with sterile water . -Oxygen tubing . -Nasal catheter or Mask . -Gallipot with cotton swabs. -Water soluble lubricant . -Bowl containing water. -Oxygen precaution sign.

10. Oxygen cylinders. Flow meter Flow adjuster Oxygen output Humidifying bottle Oxygen input pipe Pressure gauge Oxygen input plug Pressure adjuster PART OF OXYGEN CYLINDER

11. Oxygen mask. Nasal cannula. Oxygen stand /transporter PART OF OXYGEN CYLINDER

12. METHODS OF OXYGEN ADMINISTRATION There are many ways of administering oxygen to the patients but the most common methods used are: a--By mask or b--By nasal cannula .

13. OXYGEN ADMINISTRATION BY MASK

14. REQUIREMENTS -Oxygen source. -Oxygen tubing. -Oxygen Mask. -Bowl containing water. -Gallipot with cotton swabs. -Oxygen precaution sign. -Gloves.

15. PROCEDURE -Check doctors orders including the date, time and flow rate - Explain purpose and procedure to patient to gain his/her co-operation and to relieve fear and anxiety - Observe safety precautions in oxygen in progress and let this patient other patients and all visitors knows the dangers involved. - Wash hands and dry. - Assemble the equipment's. - Make patient comfortable in bed.

16. PROCEDURE - Attach the flow meter with humidifier filled with 1/3 of water and pressure gauge to the threaded outlet of the oxygen cylinder. -Connect the tubing from the mask to the outlet on the humidifier. -Turn on the key on the oxygen cylinder and put the end of tubing in the bowl of water to test for the flow of oxygen. -Apply the mask over patients nose and mouth and adjust the elastic strap over clients head to keep the mask in position. -Use gauze or cotton swab to reduce irritation caused by the elastic strap especially on patients scalp and ears. -Regulate flow meter as prescribed e.g. 2-3 liters/minute in adults and half-2 liters in children.

17. PROCEDURE - Stand by to observe the flow of oxygen for some time before leaving the patients bed side. -Document the procedure and wash hands. -Regularly check on patient for any abnormalities. -Regularly check the flow meter and gauge for the amount of oxygen in the cylinder and the water level in the humidifier. - Remove mask from the patient when he/she is better. - Turn off oxygen and make the patient comfortable in the bed. -Record and report any abnormalities.

18. OXYGEN ADMINISTRATION BY NASAL CANNULA

19. REQUIREMENTS -Oxygen source -Oxygen tubing. - Nasal cannula Mask. -Bowl containing water - Gallipot with cotton - Oxygen precaution sign -Gloves.

20. PROCEDURE - Check doctors order including the date, time, flow rate and method. - Explain purpose and procedure to patients to gain his/her cooperation and to finish fear and anxiety. - Observe safety precautions in giving oxygen and let this patient & other patients and their visitors know the dangers involved. - Wash hands and dry. - Assemble the equipment's. - Make patient comfortable in bed.

21. PROCEDURE - Attach the flow meter with humidifier filled with 1/3 of water and pressure gauge to the threaded outlet of the oxygen cylinder. - Connect the tubing from the nasal cannula to the outlet on the humidifier. - Turn on the key on the oxygen cylinder and put the end of tubing in the bowl of water to test for the flow of oxygen. - Clean patient nostrils and place cannula in patients nostrils, send the tubing over patients head and adjust it behind patients head/ears. -Encourage patient to breath through the nose and exhale through the mouth to trap more oxygen into the trachea which is less likely to be exhaled through the mouth.

22. PROCEDURE - Regulate flow meter as prescribed e.g. 2-3 liters/minute in adults and half-2 liters in children. - Stand by to observe the flow of oxygen for some time before leaving patients bed side. - Document the procedure and wash hands. - Regularly check on patient for any abnormalities especially the nares for irritations in an interval of four (4) hours. - Regularly check the flow meter and gauge for the amount - of oxygen in the cylinder and the water level in the humidifier.

23. PROCEDURE - Remove nasal cannula from patient when he/she is better. - Turn off oxygen and make patient comfortable in bed. - Record and report any abnormalities.

24. CLEANING THE CANNULA AND MASK -After each use, the oxygen cannula and mask must be cleaned by a-soaking the cannula or mask in a soap water or savlon for an hour b-Dry it properly -Clean the tip of the cannula with a spirit swab -With the mask, clean the interior before re-applying it to a patient

25. NASAL CANNULA ADVANTAGES DISADVANTAGES -Patients are able to talk, eat and drink with oxygen in place. -Patients can vomit and let oral secretion go out easily without any interruption in oxygen delivery. -It delivers low concentration of oxygen. - It can easily dislodge from patient nostrils. -It causes irritation in the nostrils. -It causes dryness in the nostrils.

26. MASKS DISADVANTAGES ADVANTAGES - It delivers high concentration of oxygen. -Its quick and easy to apply -It must be removed while talking, eating, vomiting and drinking. -It obstruct coughing. -It blocks vomitus in unconscious patients. -Carbon dioxide may build up in the mask. -It causes skin irritation. -Aspiration of vomitus is likely when mask is in place.

27. SIDE EFFECTS OF OXYGEN ADMINISTRATION - Oxygen toxicity. - Drying of the mucus membrane. - Infection.

28. THANK YOU