BASICS OF OXYGEN

THERAPY
Oxygen Therapy for Adults in the
Acute Care Facility for Chronic
and Acute conditions

By:
CLAIRE VELASQUEZ – CONSTANTINO
REGISTERED RESPIRATORY
THERAPIST
 Learning objectives:
 Define the oxygen therapy and its
indications
 Discuss the type of oxygen therapy
 List the purpose of using the oxygen
therapy
 Explain the procedure
 Demonstrate the procedure
 List Complication of oxygen therapy and
hazards
 DEFINITION
• Oxygen therapy is the administration of
oxygen at concentrations greater than that of
ambient air.

• Intent of treating or preventing the symptoms

and manifestations of hypoxia.

• Is the administration of oxygen as a medical

intervention, which can be for a variety of
purposes in both chronic and acute patient
care.
 INDICATIONS
• Head trauma or acute head injury
• Acute Tachypnea
Respiratory rate increased from normal (RR)

 normal range 12 – 24 breaths per minute

(bpm)
 Significant respiratory rates increasing to
more than 30 bpm
 Visible with a Hemodynamic monitor or an
ordinary monitor
 Acute Tachycardia
• Heart Rate increased from normal (HR)

 Increased Myocardial work

Normal range 60 – 100 beats per minute
(bpm)
 Significant heart rate increasing to more
than 110 bpm
 Visible with a Hemodynamic monitor or an
ordinary monitor
Acute Hypoxemia
Oxygen Saturation level is decreased
(desaturation)
 Normal range for saturation 90-100
SpO2
 Significant decrease of oxygen
saturation level below 85.
 Visible with a Hemodynamic monitor
or an ordinary monitor or can be
internally checked via ABG.
CONTRAINDICATIONS
THERE ARE NO
CONTRAINDICATIONS

WHY?
 BUT…. KEEP IN MIND
•High levels of oxygen in the
blood and tissue can be
helpful or damaging
depending on
circumstances
 COMPLICATIONS/PRECAUTIONS
 Oxygen should be handled with precautions :

SIDE EFFECTS

OXYGEN IS A DRUG
Absorption Atelectasis

 Atelectasis - refers to the partial or complete

collapse of the lungs.

• Absorption Atelectasis Refers to the condition

where the reduction of nitrogen concentration
in the lungs causes a collapse.

WHY?
 Absorption atelectasis
100% O2
nitrogen
oxygen

A B A B

After ~15 minutes,

A B blood N2 is depleted.
Poorly ventilated &
PO2 =673
PCO2 = 40
well perfused units (A)
PH2O = 47 become atelectactic.
The air you breathe contains nearly 78% of
nitrogen.
 nitrogen - helps keep the alveoli open and prevents the
collapse of the alveoli.

Hospital settings:
 surgery and general anesthesia, large amounts of oxygen
are usually administered. This decreases the nitrogen
concentration in the air and leads to absorption
atelectasis.
 Patients who had gone heart or lung surgery and
abdominal surgery?
WHY?
Oxygen Induced Hypoventilation

• Suppression of ventilation

• Can lead to increased CO2

and carbon dioxide narcosis
 Oxygen Toxicity
 Occurs due to inspiration of a high concentration of
oxygen for a prolonged period of time.

Oxygen concentration greater than 50% over 24 to 48

hours can cause pathological changes in the lungs.

 More evident in infants especially prematurely delivered.

(retinopathy of prematurity and in some fibrotic lung –
stiffness develops to pulmonary fibrosis) in adults is mostly
coincides with oxygen induced hypoventilation in copd
patients.

 PRECAUTIONS – FIRE HAZARD..

Signs and symptoms
of oxygen toxicity
-Non-productive cough
-Nausea and vomiting
-Substernal chest pain
-Fatigue
-Nasal stuffiness
-Headache
-Sore throat
-Hypoventilation
-Nasal congestion
-Dyspnea
-Inspiration pain
 GOALS
REVERSE ALL THE INDICATIONS
EQUIPMENT
LOW FLOW DEVICES ?

HIGH FLOW DEVICES?

 How do you

DIFFERENTIATE
 WHAT IS: LOW FLOW
The delivery of oxygen to the patient with variability of
concentration
OR
The oxygen concentration is not determined only
estimated
OR

The FI,O2 is influenced by breath rate, tidal volume and

pathology.

WHY?
 Depending on:

- Breathing pattern

• If the breathing is fast or labored what

happens to the concentration of oxygen?
• How do we know that the patient is having
labored breathing just by looking?
• And what do we do first as medical
practitioners?
–A. call the doctor?
–B. Increase the oxygen?
• Breathing pattern is slow

• What happens to the concentrations of oxygen

being delivered?

• Is it going to be higher even were giving a small

amount?

• Will the concentration of oxygen were giving be the

same?

WHY?
 LOW FLOW
OXYGEN DELIVERY
DEVICES
 NASAL CANNULA
HOW TO USE?
 disposable.

plastic devise with two protruding

prongs for insertion into the nostrils,
connected to an oxygen source.
- The standard nasal cannula delivers an
inspiratory oxygen fraction (FIO2) of 24-44% at
supply flows ranging from 1-6 L·min-1.

- The formula is FIO2 = 20% + (4 × oxygen litre

flow). The FIO2 is influenced by breath rate,
tidal volume and pathophysiology.

- The slower the inspiratory flow the higher the

FIO2.
Delivers 24 to 44% oxygen at 1 to 6 L/min
• 1 = 24
• 2 = 28
• 3 = 32
• 4 = 36
• 5 = 40
• 6 = 44
 FACTS
ADVANTAGES DISADVANTAGES
Patients are able may cause irritation
to talk and eat with to the nasal and
oxygen in place pharyngeal mucosa

if oxygen flow rates

Easily used in are above 4
home setting liters/minute
Variable FIO2
 NURSING INTERVENTION
Check frequently that both prongs
are in clients nasal nares

Never deliver more than 2-3

L\min to patients with chronic lung
disease if patient doesn’t need it.
 SIMPLE OXYGEN MASK
Simple mask is made of clear, flexible , plastic
or rubber that can be molded to fit the face.

 It is held to the head with elastic bands.

Some have a metal clip that can be bent over

the bridge of the nose for a comfortable fit
Exhalation • Open ports for
ports exhaled gas

• Air entrained through

ports if O2 flow
through does not
meet peak inspiratory
flow
O2 inlet
• 5 – 10 liters per minute
• < 5 liters will not flush CO2
from mask
• 40 – 60% FIO2 approximately
depending on the pattern of
breathing.
 FACTS
ADVANTAGES DISADVANTAGES
-Tight seal required to deliver
• Can provide increased higher concentration
delivery of oxygen for
- Difficult to keep mask in
short period of time position over nose and mouth
• The face mask is -Potential for skin breakdown
indicated in patients due(pressure, moisture)
with nasal irritation or - Uncomfortable for pt while
epistaxis. eating or talking.
• It is also useful for - Obtrusive, uncomfortable
patients who are strictly and confining.
mouth breathers. - It muffles communication,
obstructs coughing.
 NURSING INTERVENTION

Monitor client frequently to check

placement of the mask.

Support client if claustrophobia is concern

Secure physician's order to replace mask

with nasal cannula during meal time
 PARTIAL REBREATHING MASK
• Mask is a simple mask with a reservoir bag.
• Same as the Non re-breathing bag
but..without a one way valve.
• Low flow, medium concentration
• 50 – 70%
• 8 – 12 liters per minute
• Bag should remain at least 1/3 full during
inspiration
• Allow the mixture or oxygen and carbon
dioxide in the mask.
 Partial Rebreather mask

• O2 directed into
Exhalation
ports
reservoir
• Insp: draw gas from bag
& ? room air
• Exp: first 1/3 of exhaled
gas goes into bag (dead
O2 space)
• Dead space gas mixes
with ‘new’ O2 going into
bag
• Deliver ~60% O2
Reservoir
 FACTS
ADVANTAGES DISADVANTAGES
- Can inhale room - Requires tight
air through seal
openings in mask if
oxygen supply is
briefly interrupted. - Eating and
talking difficult,
- Not as drying to uncomfortable
mucous -
membranes
NURSING INTERVENTION
Set flow rate so mask remains two-
thirds full during inspiration
Keep reservoir bag free of twists or
kinks
Prevents the reservoir bag to collapse
or be empty
Prevents anyone to squeeze the
bag while on the patient.
 NON REBREATHING MASK
the one-way valve closes and all of the expired air is
deposited into the atmosphere, not the reservoir
bag.
This mask provides the highest concentration of oxygen
(95-100%) at a flow rate 8-15 L/min.

It is similar to the partial rebreather mask except

two one-way valves prevent conservation of
exhaled air.
 Non-Rebreathing Mask
One-way valves
• Valve prevents exhaled
gas flow into reservoir
bag
• Valve over exhalation
ports prevents air
O2
entrainment
• Delivers ~100% O2, if
bag does not
completely collapse
during inhalation
Reservoir
 FACTS
ADVANTAGES DISADVANTAGES
Delivers the highest - Impractical for long term
possible oxygen Therapy
concentration - Malfunction can cause
CO2 buildup
Suitable for pt breathing -- suffocation
spontaneous with sever  Expensive
hypoxemia  Feeling of suffocation
 Uncomfortable
NURSING INTERVENTION
Maintain flow rate so reservoir bag collapses
only slightly during inspiration

Check that valves and rubber flaps are

function properly (open during expiration )

Monitor SaO2 with pulse oximeter

Never allow anybody to squeeze the bag

empty
 Non-rebreathing system
Room air
Gas source

Expiratory
gas

Reservoir

To patient
One way valves
 Estimating FiO2

O2 Flow rate FiO2 O2 Flow rate FiO2 O2 Flow rate FiO2

Nasal cannula Oxygen mask Mask with reservoir
1 0.24 5-6 0.4 6 0.6
2 0.28 6-7 0.5 7 0.7
3 0.32 7-8 0.6 8 0.8
4 0.36 9 0.80+
5 0.4 10 0.80+
6 0.44
 HIGH FLOW
DELIVERY DEVICES
Or
FIXED
DELIVERY SYSTEMS
AIR ENTRAINMENT DEVICES
• High flow device (o2 concentration)
• Entrains air through side ports to achieve
high flows
• Variable entrainment ports and/or jets
adjust FIO2
• Air Entrainment or Venti Masks
• Manufacturer recommends liter flows for
each FIO2
 The Venturi System
Room air dilutes the oxygen entering
the tubing to a certain concentration

The amount of air drawn in is

determined by the size of the orifice
(jet adapter).

 Applying the Bernoulli principle

 How does it work?

exhaled gas

oxygen

room air
VENTURI MASK
Oxygen from 24 - 50%
At liters flow of 4 to 15 L/min.
The mask is so constructed that there is a
constant flow of room air blended with a fixed
concentration of oxygen
Is designed with wide- bore tubing and
various color - coded jet adapters.
Each color code corresponds to a precise
It is high flow concentration of oxygen.
Oxygen concentration and a specific liter flow.
 FACTS
ADVANTAGES DISADVANTAGES
Delivers most uncomfortable
precise oxygen Risk for skin irritation
concentration produce respiratory
depression in COPD
Doesn’t dry patient with high
mucous membranes oxygen concentration
(humidity) 50%
 NURSING INTERVENTION
Maintains on the patient’s face
all the time.
Makes sure that the flow from
the flow meter is appropriately on
the level prescribed.
Produce respiratory depression in
COPD patient with high oxygen
concentration 50%
 TRACHEOSTOMY COLLAR
Directed into trachea
Is indicated for chronic o2 therapy need
O2 flow rate 8 to 10L
Provides accurate FIO2
Provides good humidity.
Comfortable ,more efficient
Less expensive
 FACTS
ADVANTAGES DISADVANTAGES
• Delivers high • Viscosity of secretions
concentrations of oxygen • Ability to cough and
directly to the lungs. expectorate
• Clinical status
• Systemic hydration
• Stable and not moved
• Patient compliance
when the patient is moved
• Method of humidification in use
or cleaned.
• if any of the above list remain a
problem the current method of
• Maintains saturation humidification may be
levels. inadequate
 NURSING INTERVENTIONS
• Suctioning
• Maintains patent bronchial airway
• Make sure the tracheostomy site is clean and
uninfected
• Check the cuff pressure if needed to be
inflated or the trach tube is properly secured.
• Make sure adequate humidification is present
to prevent further complications
Additional devices for high flow
• T-PIECE ADOPTOR
Used on end of ET tube
Prove when weaning from
ventilator
is accurate FIO2
Provides good humidity
ASSEMBLY
Technique of oxygen
administration
 Administering oxygen by nasal cannula
Steps Rational
 Check the physician order.
 Assesses physical condition provide a baseline data for
 Assess vital signs , future assessment
 Assess level of consciousness Oxygen may depress the
 Assess the laboratory results, hypoxia drive ( decrease
especially the ABG analyses, respiratory rate , alliterate
 Assess risk of CO2 retention mental states
with oxygen administration
 Wash hands.
 Prepare equipment
 plastic nasal cannula
 connection tube
Steps Rational
Humidifier filled with distilled Humidification maybe
water . not be ordered if the flow
Flow meter rate is <4 /l/min
No smoking signs To be sure you are
Identify the patient. performing the procedure
Explain procedure to the for the correct patient.
patient. To gain his cooperation.
Assist the patient to a semi- This position permits
fowler's position if possible. easier chest expansion and
Attach the oxygen supply tube hence easier breathing.
with humidification to the To prevent dehydration
cannula , face mask. of mucous membrane.
Steps Rational
Allow 3-5 L oxygen to flow Low flow
through the tubing. 1 L\min=24%
2 L\min=28%
3 L\min=32%
4 L\min=36%
5 L\min=40%
6 L\min=44%

Place the prongs in the To facilitate oxygen

patient's nostrils and adjust it administration and comfort
comfortably. the patient.

To reduce irritation and

Use gauze pads both behind pressure and protect the skin.
the head or the ears and under
the chin and tighten to comfort.
Steps Rational
Adjust the flow rate to the To provide optimal
ordered level. delivery of oxygen to
patient..
Encourage patient to breath
through his nose with his mouth
closed.

Assess the patient nose and Oxygen dries the mucous

mouth and provide oronasal care membrane and cause
at least every 8 hours. irritation
 Administering oxygen by Face Mask
Steps Rational

Produce the flow rate ( 5 -10/min)

Attach the oxygen supply tube to Ensure pt receive
the mask . flow sufficient to meet
Regulate the oxygen flow. respiratory demand &
Position the mask over the maintain accurate
patient's nose and mouth. concentration oxygen
And fit it securely, shaping the
metal band on the mask to the
bridge of the nose.
Steps Rational

Remove the mask There is danger of

and dry the skin every inhaling powder if it is
2-3 hours if the oxygen placed on the mask.
is running
continuously.
 Don't powder
around the mask.

Wash your hands.

Administering oxygen by:

• The partial re-breather mask

• The non-rebreather mask

• The venturi mask

Steps Rational
Attach tubing to flow meter to ensure
 Show the mask to pt & explain correct air /
procedure oxygen mix
 Turn on oxygen flowmeter &
prescribed rate ( usually indicated on
mask )
 Place mask over pt nose & mouth
under chin
 Evaluation:
Breathing pattern - regular and at normal rate.
 Color - nail beds, lips, conjunctiva of eyes -
pink
 No confusion, disorientation, difficulty with
cognition.
Arterial oxygen concentration or hemoglobin
within normal
 Oxygen saturation within normal limits.
 Assessment
. Identify the type of oxygen equipment and
oxygen source in your facility

Hospitals – O2 inlet or O2 cylinders (E type)

 in clinics – O2 inlet or O2 cylinders (E type)

 Documentation:
Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow rate.
Patient observation.
Add oronasal care to the nursing care
plan
 THANK YOU FOR
LEARNING WITH ME

HAVE A
PLEASANT DAY