Oxygen administration

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1. ADMINISTRATION OF OXYGEN MR. ABHIJIT BHOYAR

2. INTRODUCTION Patients with respiratory dysfunctions are treated with oxygen inhalations to relieve ' anoxaemia ' or ' hypoxaemia ' (deficiency of oxygen in the blood). The normal amount of oxygen in the arterial blood should be in the range of 80 to 100 mm of Hg . If it falls below 60 mm of Hg, irreversible physiologic effects may occur. Thus it is urgent to correct anoxaemia promptly.

3. Remember, that the oxygen administration treats the effects of oxygen deficiency ( anoxaemia ) but it does not correct the underlying causes.

4. INDICATIONS FOR OXYGEN THERAPY Cyanosis Breathlessness An environment low in oxygen content Anaemia Diseases or conditions in the oxygen across the alveolar capillary membranes When to give oxygen ?

5. Patients whose respiratory capacity is diminished by some diseases or conditions e.g ., atelectasis , pneumenectomy , thoracoplasty etc. Poisoning with chemical that alter the tissue's ability to utilize oxygen e.g ., cyanide poisoning. When to give oxygen ?

6. . When to give oxygen ? Shock and circulatory failure. Haemorrhage and air hunger. Patients under anaesthesia When to give oxygen ?

7. Patients who are critically ill. Patients with psychologically induced breathlessness. Asphyxia Asphyxia : It is a condition in which there is lack of oxygen supply in the lungs leading to unconsciousness caused by blocking of the air passage by foreign bodies, drowning. electrical shock, strangulation, inhalation of poisonous gases When to give oxygen ?

8. Methods of Oxygen Administration Oxygen can be delivered to the client by Nasal cannula , Nasal catheter, Face mask or mechanical ventilator. Oxygen tent & oxygen hood

9. NASAL CANNULA A nasal cannula is a simple comfortable device. The two cannula about 1.5 cm (1/2 in) long , protrude from the center of a disposable tube and are inserted into the nares .

10. Conti… Oxygen is delivered via the cannula with a flow rate of up to 4 L/min . Higher flow rates dry the air mucosa and do not further increase inspired oxygen concentrations

11. OXYGEN BY NASAL CATHETER This is the most common method of administering oxygen to the patients in the hospital wards. The nasal catheter is inserted into the nostril reaching up to the uvula and is held in place by adhesive tapes

12. The catheter does not interfere with the patient's freedom to eat, to talk and to move in the bed. Flow of 1 to 4 liters of oxygen will be sufficient to maintain the concentration of 22 to 30% oxygen . The catheter must be changed at least every 8 hours and inserted into the other nostril, to reduce pressure on the nostril.

13. FACE MASK OR MECHANICAL VENTILATOR. An oxygen mask is a device used to administer oxygen, humidity or heated humidity. It is shaped to fit snugly over the mouth and nose and is secured in place with a strap

14. Simple face mask is used for short oxygen therapy Flow of 8 to 12 liters of oxygen will be necessary to maintain the concentration of oxygen 25 to 60%.

15. OXYGEN TENT An oxygen tent consists of canopy over the patient's bed

16. OXYGEN HOOD   oxygen hood  is a plastic dome or box with warmed and humidified oxygen inside. The  oxygen hood  is used for babies who can breathe on.

17. TRANS TRACHEAL OXYGEN This is a method of oxygen delivery for clients, with chronic lung diseases, in which a small intravenous size catheter is inserted directly into the trachea through a surgical tract in the lower neck

18. SUPPLY OF OXYGEN Oxygen is supplied in cylinders or tanks It is stored under a pressure of 2200 pounds (1000 kg) per sq. inch Oxygen cylinders are generally encased in metal carriers equipped with wheels for transport and a broad flat base to stand at the bedside to prevent the danger of falling.

19. A cap on the top protects the valves and the outlets. The oxygen cylinders, as per the international norms are coloured black and white with a white top. Black body White neck

20. Always use the cylinders with a metal case to prevent the danger of falling and breaking. Care of Oxygen Cylinders 1

21. Care of Oxygen Cylinders Oxygen cylinders should be placed at the head end of the bed, away from the traffic areas where these are likely to be knocked down 2

22. Any source of fire should be kept away from the cylinder for fear of fire. Oxygen is not explosive, but it supports combustion , which means that a spark of flame can cause a major fire in a very short time when the oxygen is on. Care of Oxygen Cylinders 3

23. Oxygen cylinders should be stored in a cool temperature away from the heaters. High temperatures cause expansion of the gas with consequent loss of gas through the safety valve. Care of Oxygen Cylinders 4

24. The supply of oxygen must always be equipped with a regulator to control the flow of gas and prevent wastage Care of Oxygen Cylinders 5

25. Avoid grease on the regulator. In the presence of high oxygen concentration, oils are likely to catch fire and the cylinder may explode. Care of Oxygen Cylinders 6

26. Warning signs ( e.g ., 'No smoking' sign) should be placed at the unit where the oxygen is on Teach the patient and the family about the danger of smoking, when oxygen is administered. Care of Oxygen Cylinders No smoking' Avoid smoking here 7

27. When the cylinders are empty, always mark it 'empty' and send for filling. Inspect the apparatus at frequent intervals and make sure for its good working condition. Care of Oxygen Cylinders 8 9

28. The nurse should learn the working of oxygen cylinders. To test any leakage in the regulator, soap lather may be used. If there is leakage, bubbles are seen. Care of Oxygen Cylinders 10 11

29. HAZARDS OF OXYGEN INHALATION The use of contaminated equipment can spread infection in the patient. The causative organisms may be present in such places as catheters, tracheostomy or endotracheal tubes, humidifying water and masks. 1. Infection

30. HAZARDS OF OXYGEN INHALATION The use of contaminated equipment can spread infection in the patient. The causative organisms may be present in such places as catheters, tracheostomy or endotracheal tubes, humidifying water and masks. 2. Combusion

31. HAZARDS OF OXYGEN INHALATION If oxygen is administered without sufficient humidity, it causes drying and irritation of the mucus membranes. 3. Drying of the mucus membranes of the respiratory tract

32. HAZARDS OF OXYGEN INHALATION Starting as a tracheal irritation and cough Symptoms of oxygen toxicity are dryness and irritation of the mucus membrane, substernal pain, nausea and vomiting and formulation of a membrane similar to hyaline membrane on the alveolar valves, which causes dyspnoea 4. Oxygen toxicity Prolonged exposure to a high concentration causes damage to the lung tissues and ATELECTASIS . Progressively, the exchange of oxygen carbondioxide becomes diminished

33. HAZARDS OF OXYGEN INHALATION Collapse of the alveoli develops as a result of increased oxygen concentrations in the inspired air. 5. Atelectasis Atelectasis  is a complete or partial collapse of the entire lung or area (lobe) of the lung

34. HAZARDS OF OXYGEN INHALATION Since the carbondioxide is washed off completely from the blood by a high concentration of oxygen, the respiratory centre is not stimulated sufficiently. 6. Oxygen Induced Apnoea

35. HAZARDS OF OXYGEN INHALATION The hazards of oxygen therapy may affect the eyes The eyes of the adults may also be damaged by the oxygen administration. Ulceration, oedema and visual impairment etc 7 . Retrolental Fibroplasia

36. HAZARDS OF OXYGEN INHALATION Patients receiving oxygen inhalation by means of masks and closed tents must be protected from the danger of asphyxia resulting from unexpected and unobserved depletion of oxygen in the oxygen cylinders. 8. Asphyxia

37. GENERAL INSTRUCTIONS

38. GENERAL INSTRUCTIONS

39. GENERAL INSTRUCTIONS

40. GENERAL INSTRUCTIONS

41. GENERAL INSTRUCTIONS

42. GENERAL INSTRUCTIONS

43. GENERAL INSTRUCTIONS

44. GENERAL INSTRUCTIONS

45. NURSE'S RESPONSIBILITY IN THE ADMINISTRATION OF OXYGEN BY THE CATHETER METHOD Preliminary Assessment Check the name, bed number and other identifications of the patient. Check the diagnosis and the need for oxygen therapy. Check the doctor's orders for the initiation of the therapy, the dosage ( litre /minute) etc. Check the doctor's orders for specific precautions regarding the movement and positioning of the patient.

46. Preliminary Assessment Assess the patient for any signs of clinical anoxia, e.g ., cyanosis. Assess the patient's vital signs and the breathing patterns carefully before starting the therapy. This will help to determine the patient's response to therapy. Check the results of arterial blood gas analysis. Note any signs of pulmonary dysfunction. Inspect the anterior nare’s for encrustation and irritation.

47. Preliminary Assessment 10. Inspect the skin on the nose and the surrounding areas for any skin lesions. The adhesive tapes may have to be used to fix the catheter in position. 11. Check the patient's mental state and the ability to follow instructions. 12. Check the articles available in the unit. Check the oxygen cylinder and its accessories for their functions. ( e.g ., check for any leakage of oxygen).

48. Article’s used In OXYGENATION SR. NO. ARTICLE RATIONAL (A) Oxygen cylinder with its stand and accessories (the regulator, flow meter, humidifier, connecting tube etc). (B) A tray containing 1. Nasal catheter of appropriate size, clean, and sterile or disposable type in a covered container. To administer oxygen without introducing infection into the respiratory passage

49. Articles . SR. NO. ARTICLE RATIONAL 2 Water soluble lubricating jelly To lubricate the catheter before its insertion into the nares 3 Adhesive tapes. To secure the catheter in place. 4 Bowl of water. To test the oxygen flow

50. Articles . SR. NO. ARTICLE RATIONAL 5 Flash light and tongue depressor To help to assess the correct placement of the catheter 6 Cotton applicators and normal saline in a container. To clean the nostrils. 7 Kidney tray and paper bag. To receive the wastes and the used tongue depressor

51. Articles . SR. NO. ARTICLE RATIONAL 8 Mackintosh and towel To protect the garment and the end clothes 9 Rag pieces or gauze pieces in a container To wipe off the secretions from the nose and mouth during the procedure

52. How to prepare Patient & the Environment for oxygenation Explain the procedure to the patient to win his confidence and co-operation. - Answer his questions and allay the anxiety. Explain the sequence of the procedure and tell him how he can co-operate in the procedure. Explain the purpose of the procedure to the relatives also.

53. How to prepare Patient & the Environment for oxygenation 2 . Instruct the patient, the family members and the visitors, if any' about the safety precautions required during the oxygen therapy 3. Put up the instruction regarding fire precautions in the unit. 4. Remove the cigars, matches, electric appliances and other inflammable articles from the patient's unit.

54. How to prepare Patient & the Environment for oxygenation 5. Assemble the equipments and arrange them conveniently in the unit. 6. Place the patient in a comfortable position (Fowler's position) to help in the expansion of the lungs. 7. Clean the nostrils, if there is crust formation. 8. Protect the bed and the garments by spreading the mackintosh and towel.

55. Procedure (oxygenation) SR. NO. STEPS RATIONAL 1. Wash hands To prevent cross infection 2. Measure the length of the nasal catheter to be introduced into the nostrils. Measure the length of the catheter from the tip of the nose to ear lobe. Mark the length with ink To know the proper length

56. Measure the length of the catheter from the tip of the nose to ear lobe. The catheter should extend from the anterior nares to the level of the uvula. The tip should be visible only when the uvula is elevated. The distance from the tip of the nose to the ear lobe roughly equals the distance from the anterior nares to the uvula . How to measure the length of tube ?

57. If the tip of the catheter is not reaching the oro -pharynx there is a chance for the oxygen loss through the open mouth. If the tip of the catheter goes beyond the level of the uvula into the oesophagus , there is a chance for the gas to be introduced into the stomach and cause distension of the abdomen. DISTENSION OF THE ABDOMEN.

58. SR. NO. STEPS RATIONAL 3. - Check the apparatus for the working condition. Open the main valve in an anti-clockwise direction. Look for the pressure reading on the gauge. Open the wheel valve on the regulator and see the reading on the flow meter and adjust the flow of oxygen 2 to 4 litres for adults or as desired. When the wheel valve is opened, the oxygen will start bubbling through the water in the Wolf's bottle. Attach the catheter to the connecting tube and check the flow of oxygen through the catheter by submerging it under the water in the bowl. Checking the apparatus before inserting the catheter will help to find out the amount of oxygen in the cylinder, the flow rate ( litres per minute) and whether the whole apparatus is in good working order or not. bubbling through the water in the Wolf's bottle will help to humidify the gas, to assess the patency of the tube and to assess flow rate.

59. SR. NO. STEPS RATIONAL 4. Lubricate the tip of the catheter sparingly with water soluble jelly and then check the flow by immersing it in the water Lubricating the tube prevents irritation of the nasal mucosa. Checking the flow of oxygen again under the water helps to know whether the terminal holes are plugged with the lubricant. 5. Introduce catheter slowly into one of the nostrils to the previously marked distance. If any obstruction is encountered, withdraw the catheter a little, rotate it and introduce it again. Never use force. Forcing the catheter can cause injury to the mucus membranes. It can also cause kinking of the tube in the nasal cavity.

60. SR. NO. STEPS RATIONAL 6. Check the position of the catheter in the oropharynx at the level of the uvula. It can be checked by asking the patient to open his mouth widely, depressing the tongue witha tongue depressor directing the flash light into the throat. Checking is done to make sure that the catheter is positioned in a correct place and not kinked. 5. Fix the catheter either over the forehead or at the cheek with adhesive straps. Secure the connecting tube to the bed clothes or the patient's gown using an elastic band and a safety pin Prevents displacement of the catheter when the patient moves in bed.

61. After Care of the Patient and the Articles Stay with the patient till he is at ease. Keep the patient warm and comfortable. Evaluate the patient's progress by observing the vital signs and color. Assess the vital signs very frequently. Record the procedure with date and time on the nurse's record. Record the time at which the oxygen therapy was started and the patient's response to the therapy.

62. After Care of the Patient and the Articles 5. Check the apparatus for its good working order - the flow rate, level of the distilled water in the humidifier, the safety measures. 6. Arrange for blood gas analysis at specified intervals to make sure that state of anoxaemia is treated. 7 . Change the nasal catheters at every 8 hours or more frequently, because the mucus may plug the opening of the catheter and block the oxygen supply. Replace it with a fresh one. Change the nostrils also.

63. After Care of the Patient and the Articles 8. When the oxygen is to be stopped, do it gradually. Reduce the volume of oxygen first, then give it intermittently. 9. To discontinue the oxygen inhalation, loosen the adhesive tapes and take out the catheter from the nostrils. Close the main valve first by turning it clockwise, then the wheel valves. Disconnect the catheter and put it in the kidney tray.

64. After Care of the Patient and the Articles 10 . Take all articles to the utility room. Clean the catheter first with cold water and then with warm soapy water and finally with clean water. Boil it, dry it and store it in its place or send it for sterilization. All other articles used should be cleaned, dried and replaced in their proper places. Record the time of the oxygen inhalation discontinued, in the nurse's record. 11. Watch the patient for any deteriorating symptoms after the removal of oxygen inhalation.

65. Thank you for oxygen