- Oxygen is a drug and should only be administered following a physician’s prescription.

- Oxygen has toxic effects at higher or prolonged doses.

- Dynamic O2 goal, keep SpO2 around 95% with minimum Fio2 range.

- Oxygen delivery is a function of the following relationship:

Oxygen delivery= Arterial O2 content (Cao2) X Cardiac output

- Pao2 represents the amount of oxygen dissolved in blood plasma and contributes the smallest proportion of oxygen carried to the tissues.

- Hemoglobin (Hgb) levels accounts for the largest portion of oxygen delivered to the tissues.

- Arterial oxygen content (Cao2) - Oxygen saturation (Sao2)

Tissue oxygenation depends on:

- adequate ventilation - efficient gas exchange in lung level - adequate circulatory distribution

Failure of any of these 3 elements results in tissue hypoxia.

- to administer the lowest fraction of inspired oxygen (Fio2) for the shortest period of time to maintain normal oxygen delivery for the patient.

- to correct arterial hypoxemia and suspected tissue hypoxia

- to decrease the symptoms associated with hypoxemia

- to minimize cardiopulmonary workload associated with compensatory response to hypoxemia.

- to decrease respiratory rate and work of breathing

Range Level

80 – 100 mmHgNormal60 – 79 mmHg Mild Hypoxemia41 – 59 mmHg Moderate41 below Severe

- Acute myocardial infarction (MI).

- Hypoxemia (Actual and suspected)Pao2<60mmHgSao2<90%Severe traumaShort term therapy

*Post op

- Ventilatory depression*COPD patients

- Fio2 >50%*O2 toxicity*Absorption atelectasis*Fire hazards*Retinopathy of prematurity

- Bacterial contamination*Humidification system

OXYGEN DELIVERY

Pressure Regulator

Flowmeter

Low flow Reservoir system High flow

Nasal cannula Partial rebreathing mask Air entrainment

Nasal catheter Non rebreathing mask Blending system

Transtracheal Catheter

Simple mask

Have classically been described by two different sets of terms: Low flow system (variable performance) and High flow system (fixed performance).

- supply a set flow of oxygen that is a portion of the patient’s total inspired gas.

- provide lower oxygen concentrations because of room air entrainment, usually .21 to .40 and are best suited to patients with a stable respiratory status.

-cost effective than other oxygen devices from supply and personnel perspective.

-provide a set flow of oxygen to the patient plus a volume of gas contained in an appliance reservoir.

- these devices may be considered variable or fixed performance systems.

- provide medium to high concentrations of oxygen and are best suited for short term administration of oxygen in emergency situations.

- supply a total flow rate that exceeds the patient’s minute ventilation and peak inspiratory flow demands.

- provide a broad range of oxygen concentration from .21 to 1 and are indicated for patients who have changing spontaneous ventilatory needs.

- structurally more complex, consume higher gas flows, and require more technical skill and expertise to function effectively.

A nasal cannula is a set of soft plastic prongs that fit a short distance (<1/2 in.) into the nares and have adjustment straps that go over the ears and around the back of the head (elastic) or over the ears and under the chin (bolero style).

Elastic Bolero style

The nasal cannula was invented by Wilfred Jones and patented in 1949.

is a device used to deliver supplemental oxygen or airflow to a patient or person in need of respiratory help. 

The nasal cannula is connected to an oxygen tank, a portable oxygen generator, or a wall connection in a hospital via a flowmeter.

- Are variable performance, low flow oxygen device that are available with straight, curved, and flared prongs.

- are the most common oxygen delivery device used today. Available in adult, pediatric, and infant sizes.

- standard for stable respiratory patients because of the ease of oxygen administration.

- maximum recommended flowrate is 6 L/min. (0.40 to .44 Fio2) for adult.

- maximum of 2 L/min. (0.25 to .28 Fio2) for newborn and infants.

- patients requiring long term oxygen therapy may prefer the use of a bubble humidifier to prevent drying of nasal mucosa at flows greater than 4 L/min.

- incorporate small plastic appliance reservoirs (20 to 40 ml) into the standard cannula design to facilitate adequate oxygenation at lower set flowrates, conserve oxygen supplies, and reduce costs.

- a reservoir cannula set at .5 L/min can provide arterial oxygen saturations.

- has the appearance of a large plastic mustache, whereas the pendant cannula hangs the reservoir under the chin on the anterior of the chest like necklace.

- incorporates a conventional nasal cannula with a demand oxygen delivery system to administer oxygen in controlled bursts during inspiration only.

-A sensing valve determines the beginning of inspiration and activates a solenoid valve to administer a burst of oxygen.

Advantages – easy to use, comfortable, patient may eat and talk, low cost device, disposable,

Disadvantages – obtrusive appearance, not practical for acute care, *

- has been used since the early 1900s. - it is a soft plastic tube with small gas flow ports at the tip that is inserted into one of the nares of the nose and passed to the back of the nasopharynx into the oropharynx just behind the uvula.

-should be lubricated with water soluble gel before insertion to facilitate passage into the nasopharynx and prevent trauma and adherence to delicate nasal mucosa.

- catheter placement should be changed to the opposite nare every 8-12 hours to reduce mucosal crusting and adherence.

- can provide variable low Fio2 delivery (.28 to .45) at flowrates of 1 - 8 L/min.

- nasal catheter are not widely used today because of patient discomfort.

- The newest method of delivering long term low flow oxygen therapy.

- developed first by Heimlich in 1982 and enhanced by Spofford and Christopher in 1986

- these system bypasses the nose and mouth as a route of oxygen administration by surgically placing a soft, large bore catheter directly into the trachea between the second and third tracheal rings

- the catheter is secured at the base of the neck with a bead chain necklace.

- Catheters are made of a flexible plastic, and should be replaced every 90 days (3 months) or if they start to become brittle, yellowed, or kinked. 

- a bubble humidifier may be used at home for supplemental humidification.

-Improved Comfort and Convenience:-Improved Self Image-Lower Oxygen Requirements-Increased Mobility: -Greater Exercise Capacity:-True 24 Hour Per Day Oxygen Therapy: -Improved Sense of Smell, Taste and Appetite:

-Decreased Work of Breathing:-Reduced Hospital Days:

- routinely clean and replace the catheter at home, assess the catheter stoma, and alert healthcare professionals of signs of inflammation or other abnormalities are present.

End……

- Are soft plastic devices that cover the nose and mouth.

- they may be classified as low flow (reservoir) or high flow oxygen system, depending on the design and principle of operation

- reservoir masks add an appliance reservoir to hold a volume of gas that supplements the set oxygen flow during inspiration.

- all masks used for oxygen therapy should be soft, disposable, and transparent.

- transparent masks allow health care provider to identify secretions or vomitus collected in the masks and prevent aspiration.

- patients who require continuous oxygen therapy and who wish to take off their mask to eat should have a nasal cannula set up at the bedside.

- it is a low flow, variable performance device that incorporates a small gas reservoir, and the Fio2 varies with changes in the patients respiratory status.

- a simple mask is used for the administration of moderate Fio2.

- estimated Fio2 values range from .40 to .60 at oxygen flows of 5 to 10 L/min.

- best for short term oxygen therapy such as anesthesia recovery, emergency care, therapeutic bronchoscopy, and patient transport.

- design is similar to the simple mask with the addition of a large volume plastic reservoir bag

- the bag is attached to a connector below the patients nose where gas flow from the flowmeter enters the mask.

- as the patients inspire, gas flow is drawn from the mask, the reservoir bag, and the set oxygen flow.

- exhalation port remain open in this mask during inspiration and provide a potential source of entrained room air.

- recommended minimum flow is 10 L/min. to prevent carbon dioxide buildup. predicted Fio2 is .60 to .80 at 10 to 15 L/min.

- adds one way valves to the design of the partial rebreather to prevent rebreathing of gas and decrease room air entrainment

- leaflets valve are placed between the reservoir bag and the mask and at one of the exhalation ports.

- during inspiration, the valve between the bag and the mask opens to entrain gas from the reservoir bag in addition to the set gas flow and exhalation port closes to decrease room air entrainment and dillution of the delivered Fio2.

- it delivers an Fio2 of greater than .80 at flow rates in excess of 15 L/min.

- should be used for the short term emergency administration of high concentrations of oxygen.

- they are also recommended for the administration of other medical gas mixture such as heliox and carbogen.

- deliver moderate to high Fio2 - Convenient and easy to patient transport

- Easy to assemble and maintain - Can provide high inspiratory flow rate - Nebulizers provide high relative humidity

- Analysis of delivered Fio2 is possible - Disposable

- Increased risk of aspiration - Masks are hot; patient cannot eat, wear

glasses - Flow rate adjustment is vital to Fio2

delivery - Decrease patient compliance - Airway obstruction may be a problem in

children - Bubble humidifiers are not practical

◦Air entrainment ◦Blending system

Include: ◦ Air-Entarinment Mask (AEM) ◦ Air-Entrainment Nebulizer

- employs an air entrainment system to provide accurate, reliable Fio2 delivery at high total flow rates.

- a variable size restriction is created in the source gas stream.

- are very cost effective because they deliver high gas flows to the patient at low to average source gas setting.

- Also known as an air-entrainment mask, is a medical device to deliver a known oxygen concentration to patients on controlled oxygen therapy.

- Venturi masks are considered high-flow oxygen therapy devices. This is because venturi masks are able to provide total inspiratory flow at a specified FiO2 to patients therapy.

Flow ◦Varies, should provide output flow > 60 L/min

FiO2 range ◦24 - 50%

FiO2 stability ◦Fixed

FiO2 Lpm

Blue 24% 2Yellow 28% 4White 31% 6Green 35% 8Pink 40% 8 Orange 50% 12

- Aerosol face masks, Tracheostomy masks, Tee pieces(Brigg’s adapters), Face tents may be used with these nebulizers.

- Is a soft, transparent mask similar to the simple, except for the large bore tubing connection near the patient’s nose and the large exhalation ports on each side of the mask.

- “Tusks”, or short lengths of aerosol tubing may be inserted into the exhalation ports to act as gas reservoirs to reduce room air entrainment and preserve the delivered Fio2.

- are large clear plastic masks that cup the chin and stand out from the face to directs gas flow upward toward the nose and mouth without actually touching the face

- these devices are very helpful with patients who have facial injuries or burns and cannot tolerate an oxygen device touching their face or skin.

- “Trach mask” are designed to hold large bore tubing via a swivel adapter over the opening of a patients tracheostomy tube with the support of an elastic strap around the patient’s neck.

A tracheostomy is a small opening through the skin in your neck into the windpipe (trachea). A small plastic tube, called a tracheostomy tube or trach tube, is placed through this opening into the trachea to help keep the airway open. A person breathes directly through this tube, instead of through the mouth and nose.

Is a 15mm connection that fits directly onto the 15mm connection of an endotracheal or tracheostomy tube. Reservoir tubing may be added to the tee to create an appliance reservoir and decrease room air entrainment from the open end of the tee-piece.

- The weight and size of a tee-piece connection with large bore tubing and a reservoir attached may cause tracheal damage or dislocate a tracheostomy tube, so this is not practical for long term use.*

Flow ◦ Should provide output flow of at least 60 L/minute

FiO2 range ◦ 21 - 100%

FiO2 stability ◦ Fixed

Advantages ◦ Full range of FiO2’s

Disadvantages ◦ Requires 50 psi air and O2, Blender failure or inaccuracy

common Best use

◦ Patients with high minute volumes needing high FiO2’s

- are high flow reservoir devices that encircle a patient with a prepared atmosphere of medical gas, moisture, and temperature. Mist tents, Isolettes (incubators), oxygen hoods are common examples of environmental oxygen devices and are used primarily in neonatal and pediatric respiratory care.

- these devices is limited to pediatrics because manipulation of a complete medical gas environment is more practical, controllable, and tolerable for infants and small children than for adults.

- sicker children tolerate environmental devices better than oxygen masks, which produce feelings of claustrophobia and suffocation.

- Mist tents have an electrically powered fan that circulates cool air and nebulized water particles inside a canopy which covers the entire child or infant.

- Used for children - provides cool aerosol and low to moderate oxygen concentrations (.21 to .50) for older babies and toddlers

- the fio2 should be analyzed continuously, as close to the child face as possible

- Tents are air conditioned or cooled by ice to provide a comfortable temperature within a plastic sheet canopy.

Flow ◦12 - 15 L/minute

FiO2 range ◦40 - 50%

FiO2 stability ◦Variable

Equipment: 1. A complete pediatric mist tent with nebulizer unit, a fan, and drain bottle.

2. Mist tent canopy. 3. High-pressure oxygen hose, about 6 feet in length.

4. Oxygen or air flowmeter. 5. Two liters of sterile water. 6. Oxygen analyzer for monitoring oxygen concentrations.

Purpose:

1. Provide continuous cool mist with oxygen if needed.

2. Relieve laryngeal, tracheal, or bronchial edema.

3. Help promote and improve cough mechanism.

4. Hydrate dried secretions.

Indications: 1. Mist Tents are used for infant and pediatric patients with dried secretions.

2. Used especially for pediatric patients who have laryngotracheobronchitis (croup),

bronchitis, bronchiolitis, inhalation burns, and other edematous airway processes.

3. Can give oxygen concentrations predictably up to 50%.

Contraindications/hazards/Complications:

1. Must have a working circulation unit. Malfunctions in this unit can cause excessive heat and C02 build-up inside the tent canopy.

2. Precautions for oxygen usage must be observed. 3: Water reservoir must be monitored. 4. Consistent oxygen concentrations cannot be maintained if

the canopy is opened frequently. 5. Bed linen can become damp(moist) and need to be

changed. 6. Large volume nebulizers are susceptible to

contamination. 7. Potential for electric shock or fire exists from the

electrical fan or static electricity from the plastic.

- are clear plexiglas chambers that deliver controlled oxygen concentrations to the head and face of neonates and small infants.

- An oxygen hood is the best method for providing controlled oxygen therapy to infants.

- Covers only the head. - Oxygen is delivered to the hood via either a heated air entrainment nebulizer or a blending system with a heated humidifier.

Flow ◦ > 7 L/minute

FiO2 range ◦ 21 - 100%

FiO2 stability

◦ Fixed

Are most effective at providing a humidified neutral thermal environment for a newborn but are very poor as oxygen delivery devices.

Are plexiglass enclosures that combine servo-controlled convection heating with supplemental oxygen

Supplemental oxygen can be provided by directly connecting the incubator to a flowmeter with heated humidifier.

Flow ◦8 - 15 L/minute

FiO2 range ◦40 - 50%

FiO2 stability ◦Variable

O2 DEVICE Fio2 Flow(L/min.)

Nasal catheter .28-.45 1-8Nasal cannula .40-.44 1-6Simple mask .40-.60 5-10Partial Rebreathing .60-.80 >10Nonrebreathing .90- 1 >15Venturi mask .24, .28… Variable Fio2Mist tent .21-.50 >10-15Incubator/Isolette low,variable <8, titrate Fio2

END…..