techniques of oxygen delivery.pptx........

Oxygen

1. Techniques of Oxygen Delivery

2. Contents Requirement of supplemental oxygen Different types of flow systems Devices used for oxygen delivery Technique to delivery oxygen Adjuncts to Oxygen Delivery Summary References

3. Patient conditions that warrant administration of Supplemental oxygen: Difficulty breathing Respiratory compromise due to any cause Circulatory compromise Shock Decreased level of consciousness SpO 2 of less then 96%

4. Oxygen delivery system can be divided into Low flow systems High flow systems

5. Low Flow System In this the room air is entrained because the gas flow is insufficient to meet all inspiratory flow requirements. Provide an oxygen concentration of 23% to 90 % Not so reliable

6. High Flow Systems The flow rate and reservoir capacity provide adequate gas flow to meet the total inspired flow requirements of the patient. Entrainedment of the room air does not occur. Provide low or high inspired oxygen concentration. Reliable

7. Low Flow Systems

8. Oxygen mask Simple oxygen mask- low flow device Deliver 35% to 60% oxygen with flow rate of 6 to 10 L/ min Minimum oxygen flow of 6L/min should be used Indications: Medium flow O 2 desired- mild to mod. Resp distress Contra indication: Poor resp. effort, Severe hypoxia, Apnea Advantage: less expensive Disadvantage : does not deliver high conc. O 2 , Interferes with eating and talking.

9. Partial rebreathing mask Simple face mask + reservoir bag Reliable to provide oxygen concentration of 50% to 60 % Oxygen flow of 10 to 12 L/min is generally required Indications: relatively high O 2 requirement . Contra indication: Poor resp. effort, Severe hypoxia, Apnea Advantage: inspired gas not mixed with room air Disadvantage : more O 2 flow does not increase O 2 conc , Interferes with eating and talking.

10. Non breathing mask Face mask + reservoir bag+ A valve incorporated into the exhalation port A valve placed between reservoir bag and mask Oxygen flow into the mask is adjusted to prevent collapse of bag Inspired concentration of oxygen of 95% can be achieved by 10 to 12L/min of oxygen Well sealed face mask is used Indications: delivery of high conc. Of O 2 Contra indication: Poor resp. effort, Apnea Advantage: high conc. O 2 without intubation Disadvantage : expensive, more O 2 required. Interferes with eating and talking. Requires a tight seal.

11. Venturi - type mask Reliable Provide controlled low to moderate (25% to 60%) of inspired oxygen concentration Indications: desire to deliver exact amount of O 2 Contra indication: Poor resp. effort, Severe hypoxia, Apnea Advantage: fine control of FIO 2 at a constant flow Disadvantage : expensive, can not deliver high O 2 conc. Interferes with eating and talking

12. Face tent Also known as face shield High flow soft plastic bucket Well tolerated by children then face mask Up to 40% of oxygen can be delivered with 10 to 15 L/min of oxygen flow Access for suctioning is achieved without interrupting the oxygen flow.

13. Oxygen tent Clear plastic shell that encloses the child’s upper body Provide more then 50% of O 2 Not reliable Limits access to patient Cannot be used in emergency situation.

14. Nasal Cannula Low flow oxygen device Consist of 2 short soft plastic prongs which are inserted in to the ant. Nares and O 2 is delivered into the nasopharynx Upto 4 L/min of O 2 can be used Does not provide humidified oxygen Indications: low to mod O 2 required, mild or no distress, long term O 2 therapy requirement. Contra indication: Poor resp. effort, Apnea, severe hypoxia, mouth breathing. Advantage: comfortable, well tolerated. Disadvantage : does not deliver high O 2 conc.

15. Nasal catheter Flexible, lubricated oxygen catheter with multiple holes in distal 2 cm Advanced posteriorly into the pharynx through nostril No advantage over nasal cannula Hemorrhage and gastric distension can occur

16. High Flow Systems

17. Oxygen hood Clear plastic shell with covers the patient’s head Well tolerated by infants Allows access to chest, trunk and extremities Permits control of inspired oxygen concentration, temp. and humidity Flow of oxygen- 10-15 L/min 80 to 90 % of oxygen conc. can be achieved Can be used in neonates and infants only.

18. Bag Valve Mask Ventilation Two hands must be used One hand- head tilt- chin lift maneuver Other hand- compress ventilation bag In infants and toddlers, the jaw is supported with base of middle and ring finger. Pressure in submental area should be avoided In older children finger tips of 3 rd , 4 th , 5 th fingers are placed on the ramus of mandible to hold the jaw forward and extend head.

19. A neutral sniffing position is maintained. Hyperextension of head is avoided to maintain the optimum position for airway patency. This can be achieved by placing folded towel under the neck and head. Distention of stomach frequently occurs. It should be avoided or treated promptly to prevent aspiration. It can be minimized in unconscious patient by applying cricoid pressure (Sellick maneuver)

20. Self inflating Bag-Valve Ventilation Devices At oxygen inflow of 10L/min, pediatric self inflating bag provides 30-80% of oxygen without oxygen reservoir and 60-95% with reservoir. 10-15L/min of oxygen is required to keep the adequate amount of oxygen in reservoir. Before initiating ventilation oxygen flowing into the bag should be confirmed. Many bags have a pop off valve set as 35 to 45 cm of H 2 O to prevent barotrauma. During CPR a high pressure is required so pop off valve should be closed.

21. Administered tidal volume should be approx. 10-15 ml/kg. About 450ml of bag should be used for ventilating full term neonate or infant. When larger bags are used , only the force and tidal volume necessary to produce effective chest expansion should be used. Bag with fish mouth or leaf flap operated valve should not be used to provide supplemental oxygen during spontaneous respiration.

22. Anesthesia Ventilation System Consist of reservoir bag, an overflow port, fresh gas port and standard connector for mask or ET tube For infant- 500ml; for children- 1000 to 2000ml; for adult- 3000-5000ml is reqd. More experience is reqd. to use Fresh gas flow should be <10 kg= 2l/min 10-50 kg= 4L/min >50 kg= 6L/min Risk of barotrauma and hypercarbia is more Effective ventilation is determined by adequate chest movement. PEEP or CPAP can be provided by adjusting pop off valve.

23. Endotracheal Airway Most effective and reliable method of assisted ventilation because: The airway is isolated, ensuring adequate ventilation and O 2 delivery Reduces aspiration chance Interposition of ventilations with chest compressions can be accomplished efficiently. Insp. Time and PIP can be controlled PEEP can be delivered.

24. Indications for Intubation Inadequate CNS control of ventilation Functional or anatomic airway obstruction Loss of protective airway reflexes Excessive work of breathing Need of high PIP or PEEP Need of MV support Potential occurrence of any of the above if patient is transported

25. Endotracheal Tube A cuffed ET tube is generally indicated for children aged 8-10 yrs or older. In younger children normal anatomic narrowing at the level of cricroid cartilage provides a functional cuff. ET tube size= age/4 + 4; length= age/2 +12 or depth of insertion= tube size*3 ET tube 0.5 mm smaller and larger should be readily available.

26. Adjuncts to Oxygen Delivery

27. Oropharyngeal Airway Flange + Bite block Segment+ curved body Curved body is designed to fit over the back of tongue to hold it and soft hypophalengeal structures away from post. Pharyngeal wall. Indicated in in unconscious pt. if procedure to open airway fail to provide and maintain a clear, unobstructed airway. Size: corner of mouth to angle of jaw

28. Oropharyngeal airway should be inserted by using the tongue depressor or The airway can be inverted for insertion into the mouth , using the curved portion as depressor. As the airway approaches the back of oropharynx , it is rotated 180° into proper position.

29. Nasopharyengeal Airway Soft rubber or plastic tube that provide airflow between nares and posterior pharyngeal wall Shortened ET tube can also be used Responsive pt. can tolerate well. Length= tip of the nose to tragus of the ear The airway is lubricated and inserted through the nostril in a posterior direction perpendicular to the plane of the face and passed gently along the floor of nasopharynx . Patency must be frequently evaluated Too long size may irritate vagus nerve, epiglottis or vocal cords and stimulate cough, vomit or laryangospasm .

30. Summary Low flow systems are: Face mask- Simple Face Mask Partial rebreathing Mask Venturi Mask Face tent Oxygen tent Nasal Cannula

31. High Flow Systems Non Rebreathing Mask Oxygen Hood Bag Valve Mask Ventilation Endotracheal Airway Proper device should be selected according to the patient’s need. Proper size of device should be used for effective oxygen delivery.

32. References Pediatric Advance Life Support Paramedic: Airway Management   2011 Pediatric Critical Care Medicine: Basic Science And Clinical Evidence edited by Derek S. Wheeler, Hector R. Wong, Thomas P. Shanley

33. Thank You