Oxygen administration procedure, indication, complications

oxygen administration, indication, contraindication

1. Oxygen administration

2. Oxygen therapy is widely available and used in a variety of settings to relieve or prevent tissue hypoxia. The goal of oxygen therapy (AARC, 2007) is to prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air(21%).

3. Purposes It reduces mortality related to hypoxia Improves self-reported sleep quality and general comfort Increases exercise tolerance Reduces polycythemia and pulmonary function

4. Safety Precautions Oxygen is a highly combustible gas. Although it does not burn spontaneously or cause an explosion, it can easily cause a fire in a patient’s room if it contacts a spark from an open flame or electrical equipment

5. continued.. Promote oxygen safety by the following measures Oxygen is a therapeutic gas and must be prescribed and adjusted only with a health care provider’s order. Distribution must Place an “Oxygen in Use” sign on the patient’s door and in the patient’s room. No smoking should be allowed on the premises. Keep oxygen-delivery systems 10 feet from any open flames. Determine that all electrical equipment in the room is functioning correctly and properly grounded

6. Supply of Oxygen Oxygen is supplied to a patient’s bedside either by oxygen tanks or through a permanent wall-piped system. Oxygen tanks are transported on wide-based carriers that allow the tank to be placed upright at the bedside. Regulators control the amount of oxygen delivered. One common type is an upright flow meter with a flow adjustment valve at the top. A second type is a cylinder indicator with a flow adjustment handle.

7. Methods of Oxygen Delivery Nasal Cannula : A nasal cannula is a simple, comfortable device used for precise oxygen delivery. The two nasal prongs are slightly curved and inserted in a patient’s nostrils. To keep the nasal prongs in place, fit the attached tubing over the patient’s ears and secure it under the chin using the sliding connector. Attach the nasal cannula to a humidified oxygen source with a flow rate up 1 to 6 L/min (24% to 44% oxygen). Flow rates equal to or greater than 4 L/ min have a drying effect on the mucosa and thus need to be humidified.

8. Oxygen Masks. An oxygen mask is a plastic device that fits snugly over the mouth and nose and is secured in place with a strap. It delivers oxygen as the patient breathes through either the mouth or nose by way of a plastic tubing at the base of the mask that is attached to an oxygen source. An adjustable elastic band is attached to either side of the mask that slides over the head to above the ears to hold the mask in place.

9. high flow There are two primary types of oxygen masks: those delivering Low concentrations of oxygen and those delivering high concentrations.

10. Continued.. Simple face mask fits loosely and delivers oxygen concentrations from 6 to12 L/min (35% to 50% oxygen). The mask is contraindicated for patients with carbon dioxide retention because retention can be worsened. Flow rates should be 5 L or more to avoid rebreathing exhaled carbon dioxide retained in the mask. Be alert to skin breakdown under the mask with long-term use

11. A plastic face mask with a reservoir bag is capable of delivering higher concentrations of oxygen. A partial rebreather or non rebreather mask is a simple mask with a reservoir bag that should be at least one third to one half full on inspiration. It delivers a flow rate of 10 to 15 L/ min (60% to 90% oxygen). Frequently inspect the reservoir bag to make sure that it is inflated. If it is deflated, the patient is breathing large amounts of exhaled carbon dioxide. High-flow oxygen systems should be humidified.

12. The Venturi mask delivers higher oxygen concentrations of 24% to 60% and usually requires oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected

13. Face tent : Apply tent under patient’s chin and over mouth and nose. It will be loose, and a mist is always present used primarily for humidification and for oxygen only when the patient cannot or will not tolerate a tight-fitting mask .

14. Articles Oxygen Tubing (Consider Extension Tubing), Humidifier If Indicated, Sterile Water For Humidifier Oxygen Source Oxygen Flow meter Stethoscope Pulse Oximeter Appropriate Room Signs

15. Procedure Identify patient using two identifiers (e.g., name and birth date or name and medical record number Assess patient’s respiratory status, including symmetry of chest wall expansion, chest wall abnormalities (e.g., kyphosis), temporary conditions (e.g., pregnancy, trauma) affecting ventilation, respiratory rate and depth, sputum production, and lung sounds. Observe for patent airway and remove secretions by having patient cough and expectorate mucus or by suctioning

16. Continued.. Position tips of nasal cannula properly in patient’s nares and adjust elastic headband or plastic slide on cannula so it is snug and comfortable If using an oxygen face mask, adjust elastic band over ears until mask fits comfortably over patient’s face and mouth.

17. Continued.. Verify setting on flow meter and oxygen source for proper setup and prescribed flow rate. Check cannula/mask every 8 hours. Keep humidification container filled at all times. Monitor patient’s response to changes in oxygen flow rate with pulse oximetry Monitor ABGs when ordered; however, obtaining ABG measurement is an invasive procedure, and ABGs are not measured frequently

18. Observe patient’s external ears, bridge of nose, nares, and nasal mucous membranes for evidence of skin breakdown.

19. Type Flow rate Advantage Disadvantage Low-Flow Delivery Devices Nasal cannula 1-6 L/min: 24%-44% Safe and simple Easily tolerated Effective for low concentrations Does not impede eating or talking Inexpensive, disposable Unable to use with nasal obstruction Drying to mucous membranes Can dislodge easily May cause skin irritation or breakdown around ears or nares Patient’s breathing pattern (mouth or nasal) affects exact FiO2 Simple face mask 6-12 L/min: 35%-50% Useful for short periods such as patient transportation Contraindicated for patients who retain CO2 May induce feelings of claustrophobia Therapy interrupted with eating and drinking Increased risk of aspiration

20. Partial and Non rebreather masks 10-15 L/min: 60%-90% Useful for short periods Delivers increased FiO2 Easily humidifies O2 Does not dry mucous membranes Hot and confining; may irritate skin; tight seal necessary Interferes with eating and talking Bag may twist or kink; should not totally deflate High Flow Venturi mask 24%-50% Provides specific amount of oxygen with humidity added Administers low, constant O2 Mask and added humidity may irritate skin Therapy interrupted with eating and drinking Specific flow rate must be followed

21. Humidifier Humidification of inspired air Fill distilled water

22. Complications of oxygen therapy Oxygen-induced hypoventilation/ hypoxic drive Absorption actelectasis Oxygen toxicity

23. Oxygen toxicity Breathing oxygen at higher than normal partial pressure leads to hyperoxia and can cause oxygen toxicity or oxygen poisoning  patient is exposed to very high concentrations of oxygen for a short duration, patient is exposed to lower concentrations of oxygen but for a longer duration.

24. Central Nervous System manifestations Headache Irritability and anxiety Dizziness Disorientation Hyperventilation Hiccups Cold shivering Fatigue Tingling in the limbs Visual changes such as blurring vision Tinnitus and Hearing disturbances Nausea Twitching Seizure

25. Pulmonary toxicity Mild tickle sensation on inhalation Mild burning on inhalation Uncontrollable coughing Hemoptysis Dyspnea Fever Hyperemia of the nasal mucosa CXR shows inflammation and pulmonary edema

26. Eye related manifestations In premature babies, retinopathy of prematurity retinal edema Cataract formation (long-term exposure)