Oxygen delivery instrument and devices

all type of devices to administer oxygen are describe in easy ways so keep study countinue. thank you

1. JD SIR 1 WELCOME JAGDISH

2. OXYGEN DELIVERY DEVICES BY JAGDISH CHOUDHARY JD SIR 2

3. Indications of O2 therapy Documented hypoxemia In adults, children, and infants older than 28 days, arterial oxygen tension (PaO2) of < 60 mmHg or arterial oxygen saturation (SaO2) of < 90% in subjects breathing room air or with PaO2 and/or SaO2 below desirable range for specific clinical situation In neonates, PaO2 < 50 mmHgand /or SaO2 < 88% or capillary oxygen tension (PcO2) < 40 mmHg JD SIR 3

4. . 2.Severe trauma 3.Acute myocardial infarction 4. Short-term therapy (e.g., post-anesthesia recovery) 5. Increased metabolic demands, i.e. burns, multiple injuries, and severe infections JD SIR 4

5. Three clinical goals of Oxygen therapy Treat hypoxemia 2. Decrease work of breathing (WOB) 3. Decrease myocardial Work JD SIR 5

6. O 2 DELIVERY METHODS Low flow oxygen delivery system (variable performance, Pt dependent ) High flow oxygen delivery system (fixed performance, Pt independent) JD SIR 6

7. LOW FLOW O 2 DELIVERY SYSTEM Stable breathing pattern Minute Venti -<8-10L/min RR- <20 /min VT-<0.8 l Normal insp. Flow – 10-30 l/min Nasal cannula Nasopharyngeal catheter Nasal mask Simple face mask Partial rebreathing mask Non - rebreathing mask •No capacity •Small capacity •High Capacity JD SIR 7

8. NASAL CANNULA Simple plastic tubing + prongs with an over the ear adjustments. Sizing available for adults children and infants( 4-6 French). Fio2 increases app. 1-2% with every increase in o2 flow per liter Flow > 1-6 lt /min is less tolerated due to flow jet in nasal cavity ( COPD pt. 1-2) Concentration of oxygen received by nasal cannula 1 -24% 2 -28% 3 -32% 4 -36% 5 -40% 6 -44% JD SIR 8

9. NASAL CANNULA IMAGE JD SIR 9

10. . Advantages Disadvantages Inexpensive Pressure sores well tolerated, comfortable Crusting of secr . easy to eat, drink Drying of mucosa used in pt with long term therapy(COPD) Epistaxis used with humidity 80% of O2 gets wasted during expiration JD SIR 10

11. NASAL CATHETER Nasal catheter most common method of oxygen administration. Size > 4-6 French. Position > high fowler position/rose position. Measurement > tip of nose to ear lobe. Insert in left nostril. Change catheter every 8 hr. to prevent stenosis . Flow rate > adult 3-4Lt/min, child 1Lt/min Concentrating of oxygen > 22-30 % JD SIR 11

12. Nasal catheter image JD SIR 12

13. Nasal Mask Hybrid of nasal cannula and a face mask . Applied by either an over the ear lariat are a headband strip . Lower end rests on upper lip covering the external nose . Advantage- comfortable , no air jetted in nares . Disadvantage – sores on long term use. JD SIR 13

14. Nasal mask image JD SIR 14

15. Simple face mask Simple or non reservoir, oxygen free mask is a disposable plastic devise that covers both nose and face. The oxygen flow must be run at a sufficient rate, usually 5 liter/min. or more to prevent re-breathing of exhaled gases. Best suited for those who require more o2 than prongs. Oxygen therapy for short period like post operative in recovery R oom, transport of patients. JD SIR 15

16. Simple O2 face mask image JD SIR 16

17. RESERVOIR MASK Two types are commonly used: Partial re-breathing mask 2) Non re-breathing Both are disposable, light wt., transparent plastic under the chin reservoirs. Difference. between two is placement of a valve between mask and bag and over mask. “Partial re-breather” part of a patients expired air refilling the bag. “Non re-breather” same as above except for the position of the valves. Inboard leaking is common, lack of good facial seal system can affect o2 concentration. JD SIR 17

18. 1. PARTIAL RE-BREATHING MASK Simple mask with reservoir bag. Small quantity of CO2 again inhale by patient after exhale. Oxygen flow to maintain the reservoir bag should be at least 1/3 to ½ full on inspiration. Reservoir bag capacity of O2 >1.5 lt Oxygen concentration Of exhaled gas combined with supply of fresh oxygen, permits the lower flow than non re-breathing masks. Flow rate 8-10L/min provides 40-80% of concentrate oxygen JD SIR 18

19. Partial RE-BREATHER MASK image JD SIR 19

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21. 2.NON RE-BREATHING MASK Also known as higher concentration mask •Sufficient flow of o2 is used so the reservoir bag is at least partially full during inspiration •Minimum flow-10-15 l/min •O2 concentration– >90 to 100% at 15 lt /min. •Either style of mask indicated for pts suspected for significant hypoxemia , with relatively normal spont . Respiration. JD SIR 21

22. HIGH FLOW O 2 DELIVERY SYSTEM Patient with variable ventilator level and breathing pattern Profoundly Dyspnia and hypoxemia patient. For those who require consistent high fio2 and with late inspiratory flow of gas(>40 lt /min) Venturi mask Face tent Aerosol mask Tracheotomy collar T-piece JD SIR 22

23. VENTURI MASK Also called “Air entrainment venture masks” OR “High Air Flow with Oxygen-Entrainment” (HAFOE). Goal is to create an open system with high flow about the nose and mouth, with a fixed FIo2. O2 is directed by a small bore tubing to a mixing jet. Final conc. depends on the ratio of air drawn in through environment ports. Due to high flow , excess gas flushes out the expired co2 through the holes on the sides of mask. Good for those with hypoxemia cannot be controlled with low fio2. JD SIR 23

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26. Venturi valves JD SIR 26

27. COLOR CONCENTRATION OF O 2 % O 2 FLOW BLUE 24% 2 LT/MIN WHITE 28% 4LT/MIN ORANGE 31% 6LT/MIN YELLO 35% 8LT/MIN RED 40% 10LT/MIN GREEN 60% 15LT/MIN MASK USED ACCORDING TO COLOURS JD SIR 27

28. Aerosol Mask HIGHER HUMIDIFY MASK Use for patient who has thick secretion of mucus in airway. Delivers 21-100% FiO2 depending on nebulizer setting Flow rates of 8 to 15 L/min. JD SIR 28

29. OXYGEN TANT Transparent enclosures in larger sizes for adult pts. Co2 is removed by soda lime and water vapour by calcium chloride. Temperature is regulated by flowing oxygen and air over ice. 60-70% O2 conc. Achieved by flow rates of 6-12Lt/min. The air changes 20 times/hour. Limitations : Confining and isolating . concentration can vary from 0.21 to 1.0 . Fungal infection risk. JD SIR 29

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31. HOOD METHOD Covers only head allowing access to the lower body. Use for short term use for neonates and infants. O 2 and air premixed passed through heated humidifiers. Nebulizers should be avoided. Mini. Flow >7 lt /min. average flow 10-15 lt /min results in 80-90% oxygen concentration. JD SIR 31

32. Bag Valve Mask systems Self inflating bags are AMBU bags, with an oxygen inlet reservoir Anesthesia bag is a non self inflating reservoirs with gas inlet and valve. Mask are designed to provide comfortable leak free seal for manual ventilation. Flow to the reservoirs should be kept high so bags do not deflate substantially. These devices have a potential for a constant FiO2 of >90%. Limitation: In spont . Breathing person flow has to be adjusted with the valve, chances of aspiration, constant adequate flow of gases has to be maintained. JD SIR 32

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34. COMPLICATIONS Induced apnea (temporary cessation or stopping of respiration)normal>10-15sec. Atelectosis collops of alveoli of lung Retronatal fibroplasia JD SIR 34

35. About O 2 21 % oxygen concentration in environment. Oxygen haviour gas than air. Supportive inflammable gas. Pressure of oxygen in cylinder> 2200 pound/inch/2seq. Open in anticlock direction . Humidifying bottle also known as wolf bottle. JD SIR 35

36. O 2 CYLINDER JD SIR 36

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38. O 2 CYLINDER REGULATOR JD SIR 38

39. CO 2 CYLINDER Use nephrotic surgery nephroscopy JD SIR 39

40. N 2 O GAS CYLINDER Also known as laughing gas and use in general anesthesia and administer by inhalation JD SIR 40

41. THANK YOU JAGDISH CHOUDHARY JD SIR 41