Going back to basics.

1. BASICS OF OXYGEN
THERAPY

2. Oxygen Therapy for Adults in the
Acute Care Facility for Chronic
and Acute conditions
By:
CLAIRE VELASQUEZ – CONSTANTINO
REGISTERED RESPIRATORY
THERAPIST

3. 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

4. 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.

5. 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

6. 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

7. 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.

8. CONTRAINDICATIONS
THERE ARE NO
CONTRAINDICATIONS
WHY?

9. BUT…. KEEP IN MIND
•High levels of oxygen in the
blood and tissue can be
helpful or damaging
depending on
circumstances

10. COMPLICATIONS/PRECAUTIONS
 Oxygen should be handled with precautions :
SIDE EFFECTS
OXYGEN IS A DRUG

11. 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?

12. Absorption atelectasis
A B A B
100% O2
oxygen
nitrogen
PO2 =673
PCO2 = 40
PH2O = 47
A B
After ~15 minutes,
blood N2 is depleted.
Poorly ventilated &
well perfused units (A)
become atelectactic.

13. 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?

14. Oxygen Induced Hypoventilation
•Suppression of ventilation
• Can lead to increased CO2
and carbon dioxide narcosis

15. 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..

16. Signs and symptoms
of oxygen toxicity

17. -Non-productive cough
-Nausea and vomiting
-Substernal chest pain
-Fatigue
-Nasal stuffiness
-Headache
-Sore throat
-Hypoventilation
-Nasal congestion
-Dyspnea
-Inspiration pain

18. GOALS
REVERSE ALL THE INDICATIONS

19. EQUIPMENT

20. LOW FLOW DEVICES ?
HIGH FLOW DEVICES?

21. How do you
DIFFERENTIATE

22. 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?

23. 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?

24. • 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?

25. LOW FLOW
OXYGEN DELIVERY
DEVICES

27. NASAL CANNULA
HOW TO USE?
 disposable.
plastic devise with two protruding
prongs for insertion into the nostrils,
connected to an oxygen source.

28. - 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.

29. Delivers 24 to 44% oxygen at 1 to 6 L/min
• 1 = 24
• 2 = 28
• 3 = 32
• 4 = 36
• 5 = 40
• 6 = 44

30. FACTS
ADVANTAGES
Patients are able
to talk and eat with
oxygen in place
Easily used in
home setting
DISADVANTAGES
may cause irritation
to the nasal and
pharyngeal mucosa
if oxygen flow rates
are above 4
liters/minute
Variable FIO2

31. NURSING INTERVENTION
Check frequently that both prongs
are in clients nasal nares
Never deliver more than 2-3
Lmin to patients with chronic lung
disease if patient doesn’t need it.

34. 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

35. O2 inlet
Exhalation
ports
• Open ports for
exhaled gas
• Air entrained through
ports if O2 flow
through does not
meet peak inspiratory
flow

36. • 5 – 10 liters per minute
• < 5 liters will not flush CO2
from mask
• 40 – 60% FIO2 approximately
depending on the pattern of
breathing.

37. FACTS
ADVANTAGES
• Can provide increased
delivery of oxygen for
short period of time
• The face mask is
indicated in patients
with nasal irritation or
epistaxis.
• It is also useful for
patients who are strictly
mouth breathers.
DISADVANTAGES
-Tight seal required to deliver
higher concentration
- Difficult to keep mask in
position over nose and mouth
-Potential for skin breakdown
due(pressure, moisture)
- Uncomfortable for pt while
eating or talking.
- Obtrusive, uncomfortable
and confining.
- It muffles communication,
obstructs coughing.

38. 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

40. 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.

41. Partial Rebreather mask
Exhalation
ports
O2
Reservoir
• O2 directed into
reservoir
• Insp: draw gas from bag
& ? room air
• Exp: first 1/3 of exhaled
gas goes into bag (dead
space)
• Dead space gas mixes
with ‘new’ O2 going into
bag
• Deliver ~60% O2

42. FACTS
ADVANTAGES
- Can inhale room
air through
openings in mask if
oxygen supply is
briefly interrupted.
- Not as drying to
mucous
membranes
DISADVANTAGES
- Requires tight
seal
- Eating and
talking difficult,
uncomfortable
-

43. 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.

45. 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.

46. Non-Rebreathing Mask
• Valve prevents exhaled
gas flow into reservoir
bag
• Valve over exhalation
ports prevents air
entrainment
• Delivers ~100% O2, if
bag does not
completely collapse
during inhalation
O2
Reservoir
One-way valves

47. FACTS
ADVANTAGES
Delivers the highest
possible oxygen
concentration
Suitable for pt breathing
spontaneous with sever
hypoxemia
DISADVANTAGES
- Impractical for long term
Therapy
- Malfunction can cause
CO2 buildup
-- suffocation
 Expensive
 Feeling of suffocation
 Uncomfortable

48. 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

49. Non-rebreathing system
Reservoir
Gas source
Room air
Expiratory
gas
To patient
One way valves

50. 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

51. HIGH FLOW
DELIVERY DEVICES
Or
FIXED
DELIVERY SYSTEMS

52. 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

53. 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

54. How does it work?
exhaled gas
oxygen
room air

55. VENTURI MASK

56. 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.

57. FACTS
ADVANTAGES
Delivers most
precise oxygen
concentration
Doesn’t dry
mucous membranes
(humidity)
DISADVANTAGES
uncomfortable
Risk for skin irritation
produce respiratory
depression in COPD
patient with high
oxygen concentration
50%

58. 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%

60. 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

62. FACTS
ADVANTAGES
• Delivers high
concentrations of oxygen
directly to the lungs.
• Stable and not moved
when the patient is moved
or cleaned.
• Maintains saturation
levels.
DISADVANTAGES
• Viscosity of secretions
• Ability to cough and
expectorate
• Clinical status
• Systemic hydration
• Patient compliance
• Method of humidification in use
• if any of the above list remain a
problem the current method of
humidification may be
inadequate

63. 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

64. 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

65. ASSEMBLY

66. Technique of oxygen
administration

67. RationalSteps
provide a baseline data for
future assessment
Oxygen may depress the
hypoxia drive ( decrease
respiratory rate , alliterate
mental states
 Check the physician order.
 Assesses physical condition
 Assess vital signs ,
 Assess level of consciousness
 Assess the laboratory results,
especially the ABG analyses,
 Assess risk of CO2 retention
with oxygen administration
 Wash hands.
 Prepare equipment
 plastic nasal cannula
 connection tube
Administering oxygen by nasal cannula

68. RationalSteps
Humidification maybe
not be ordered if the flow
rate is <4 /l/min
To be sure you are
performing the procedure
for the correct patient.
To gain his cooperation.
This position permits
easier chest expansion and
hence easier breathing.
To prevent dehydration
of mucous membrane.
Humidifier filled with distilled
water .
Flow meter
No smoking signs
Identify the patient.
Explain procedure to the
patient.
Assist the patient to a semi-
fowler's position if possible.
Attach the oxygen supply tube
with humidification to the
cannula , face mask.

69. RationalSteps
Low flow
1 Lmin=24%
2 Lmin=28%
3 Lmin=32%
4 Lmin=36%
5 Lmin=40%
6 Lmin=44%
To facilitate oxygen
administration and comfort
the patient.
To reduce irritation and
pressure and protect the skin.
Allow 3-5 L oxygen to flow
through the tubing.
Place the prongs in the
patient's nostrils and adjust it
comfortably.
Use gauze pads both behind
the head or the ears and under
the chin and tighten to comfort.

70. RationalSteps
To provide optimal
delivery of oxygen to
patient..
Oxygen dries the mucous
membrane and cause
irritation
Adjust the flow rate to the
ordered level.
Encourage patient to breath
through his nose with his mouth
closed.
Assess the patient nose and
mouth and provide oronasal care
at least every 8 hours.

71. Administering oxygen by Face Mask
RationalSteps
Ensure pt receive
flow sufficient to meet
respiratory demand &
maintain accurate
concentration oxygen
Produce the flow rate ( 5 -10/min)
Attach the oxygen supply tube to
the mask .
Regulate the oxygen flow.
Position the mask over the
patient's nose and mouth.
And fit it securely, shaping the
metal band on the mask to the
bridge of the nose.

72. RationalSteps
There is danger of
inhaling powder if it is
placed on the mask.
Remove the mask
and dry the skin every
2-3 hours if the oxygen
is running
continuously.
 Don't powder
around the mask.
Wash your hands.

73. Administering oxygen by:
• The partial re-breather mask
• The non-rebreather mask
• The venturi mask

74. RationalSteps
to ensure
correct air /
oxygen mix
Attach tubing to flow meter
 Show the mask to pt & explain
procedure
 Turn on oxygen flowmeter &
prescribed rate ( usually indicated on
mask )
 Place mask over pt nose & mouth
under chin

75. 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.

76. 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)

77. Documentation:
Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow rate.
Patient observation.
Add oronasal care to the nursing care
plan

78. THANK YOU FOR
LEARNING WITH ME
HAVE A
PLEASANT DAY