OXYGEN
ADMINISTRATION
INTRODUCTION
Oxygen is a colorless, odorless,
tasteless gas that is essential for the
body to function properly and to survive.
The cardiac and respiratory system
function to supply the body’s oxygen
demands
TERMINOLOGIES
• ANOXEMIA – It is a state of insufficient
oxygen in blood.
• HYPOXEMIA – A decrease in the partial
pressure of oxygen below normal
expected value 80-100 mm Hg.
• HYPOVENTILATION – It is reduced
ventilation resulting in an increased
level of arterial carbon di oxide tension
and decrease in arterial oxygenation.
• HYPOCAPNIA - Reduced concentration
of carbon dioxide in the blood stream.
• HYPERVENTILATION - It is a state of
ventilation in which the rate and
quantity of alveolar ventilation of
carbon dioxide exceeds body’s
production of carbon dioxide.
ANATOMY OF SYSTEM INVOLVED
IN OXYGEN PROCESS
The main organ involved in the
process of oxygenation is heart and
lungs. The purification of blood and the
exchange of gases.
PHYSIOLOGY OF RESPIRATION
The respiration happens by the process
of inspiration and expiration which includes;
•Pulmonary ventilation
•Alveolar gas exchange
•Transport of oxygen
DEFINITION
• Oxygen therapy is the administration of
oxygen at a concentration of pressure
greater than that found in the
environmental atmosphere.
- Craven Ruth
GOALS OF OXYGEN THERAPY
• To improve tissue oxygenation.
• Decrease work of breathing in patients with
dyspnea.
• Decrease work of the heart in patients with
cardiac disease.
METHODS OF DISPENSING
OXYGEN
SOURCES OF OXYGEN
OXYGEN
CYLINDERS
WALL
OUTLETS
USE OF OXYGEN CYLINDERS
The oxygen cylinder is delivered
with a protective cap to
prevent accidental force against
the cylinder outlet.
To release oxygen safely and at
a desirable rate, a regulator is
used. It consists of two parts.
Contd…
A reduction gauge that reduces
the pressure to a working level
and shows the amount of oxygen
in the tank.
A flow meter that regulates the
control of oxygen in liters per
minutes
WALL OUTLETS
• The oxygen is supplied from a central
source through a pipeline.
• Only a flow meter and a humidifier are
required.
OXYGEN DELIVERY
SYSTEM
CLASSIFICATION
LOW FLOW SYSTEM
• The gas flow is insufficient to meet
patient’s peak inspiratory and minute
ventilatory requirement
• O2 provided is always diluted with air
• Deliver low and variable FiO2 - Variable
performance device
HIGH FLOW SYSTEM
• The gas flow is sufficient to meet patient’s
peak inspiratory and minute ventilatory
requirement.
• Deliver low- moderate and fixed FiO2 -
Fixed performance device
RESERVOIR SYSTEM
• Reservoir system stores a reserve volume
of O2, that equals or exceeds the patient’s
tidal volume
• Delivers moderate - high FiO2
• Variable performance device
PARTIAL
SIMPLE FACE
REBREATHER
MASK MASK
NON TRACHEOSTOM
REBREATHER Y MASK
MASK
NASAL CANNULA
NASAL CANNULA
• It is a disposable plastic device consisting
of two tips or prongs of 1cm long
concentrated to oxygen tubing.
• It is used for low to medium concentration
of oxygen
OXYGEN FLOW FROM NASAL CANNULA
OXYGEN IN LITRES PERCENTAGE
1 liter per minute 24%
2 liters per minute 28%
3 liters per minute 31%
4 liters per minute 36%
5 liters per minute 40%
6 liters per minute 44%
ADVANTAGES OF NASAL
CANNULA
Easy to fix
Keeps hands free
Not much interference with further airway
care
Low cost
Compliant
DEMERITS OF NASAL CANNULA
Unstable
Easily dislodged
High flow is uncomfortable
Nasal trauma
Mucosal irritation
FiO2 can be inaccurate and inconsistent
NURSES ROLE
Check frequently that both prongs are
in clients nares
Never deliver more than 2-3 L\min to
client with chronic lung disease
NASAL CATHETER
• It is a catheter made of rubber that is
inserted into the nose.
MERITS OF NASAL CATHETER
• Good stability
• Disposable
• Low cost
DEMERITS OF NASAL CATHETER
Difficult to insert
High flow increases back pressure
Needs regular changing
May provoke gagging, air swallowing,
aspiration
Nasal polyps, deviated septum may block
insertion
TRANSTRACHEAL CATHETER
Contd..
• A thin polytetrafluoroethylene (Teflon) catheter
• Inserted surgically with a guidewire between
2nd and 3rd tracheal rings
• FiO2 – 22-35%
• Flow – ¼ - 4L/min
MERITS OF TRANSTRACHEAL
CATHETER
• Lower O2 use and cost
• Eliminates nasal and skin irritation
• Better compliance
• Increased exercise tolerance
• Increased mobility
DEMERITS OF
TRANSTRACHEAL CATHETER
• High cost
• Surgical complications
• Infection
• Mucus plugging
SIMPLE FACE 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.
It delivers 35% to 60% oxygen .
A flow rate of 6 to 10 liters per
minute.
It has vents on its sides which
allow room air to leak in at many
places, thereby diluting the
source oxygen.
MERITS OF FACE MASK
• Can provide increased delivery of
oxygen for short period of time
• Good for patients with blocked nasal
passages and mouth breathers
• Easy to apply
DEMERITS OF FACEMASK
Tight seal required to deliver higher
concentration
Difficult to keep mask in position over
nose and mouth
Potential for skin breakdown
PARTIAL REBREATHER MASK
The mask is provided with a reservoir
bag which must remain inflated during
both inspiration & expiration
It is the collection of the first part of the
patients' exhaled air.
It is used to deliver oxygen
concentration up to 80%.
Mechanics
Exp: O2 + first 1/3 of exhaled
gas enters the bag and last 2/3
of exhalation escapes out
through ports
Insp: the first exhaled gas
and O2 are inhaled
FiO2 - 60-80%
Oxygen 8L/min
MERITS
• Client can inhale room air through
openings in mask if oxygen supply is
briefly interrupted
DEMERITS
• Requires tight seal
• Uncomfortable
NURSES ROLE
Set flow rate so mask remains two-
thirds full during inspiration
Keep reservoir bag free of twists or
kinks
NON REBREATHER MASK
Has 3 unidirectional valves
Expiratory valves prevents air entrainment
Inspiratory valve prevents exhaled gas
flow into reservoir bag
FiO2 – 10 – 15L/min
To deliver ~100% O2, bag should remain
inflated
NON-REBREATHING MASK
• It is similar to the partial re
One-way valves breather mask
• except two one-way valves
prevent conservation of
exhaled air.
• The bag is an oxygen
O2 reservoir
Reservoir
Contd…
• When the patient exhales air.
• the one-way valve closes and all of the
expired air is deposited into the
atmosphere, not the reservoir bag.
• In this way, the patient is not rebreathing
any of the expired gas
MERITS OF NRBM
• Client can inhale room air through
openings in mask if oxygen supply is
briefly interrupted
DEMERITS OF NRBM
• Requires tight seal
• It dries the mucus membrane
VENTURI MASK
It is high flow concentration of oxygen.
Oxygen from 40 - 50%
At liters flow of 2 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
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).
It is used primarily for patients with
chronic obstructive pulmonary
disease
MERITS OF VENTURI MASK
Delivers most precise oxygen
concentration
Doesn’t dry mucous membranes
(humidity
DEMERITS OF VENTURI
MASK
Uncomfortable
Risk for skin irritation
Produce respiratory depression in
COPD patient with high oxygen
concentration 50%
NURSES ROLE
Requires careful monitoring to verify
FiO2 at flow rate ordered
Check that air intake valves are not
blocked
OXYGEN TENT
Consists of a canopy placed over the head
and shoulders or over the entire body of
a patient
FiO2 – 40-50% @12-15L/minO2
Variable performance device
Disadvantage
Expensive
Difficult to clean
Constant leakage
Limits patient mobility
OXYGEN HOOD
• An oxygen hood covers only the head of
the infant
• O2 is delivered to hood through either a
heated entrainment nebulizer or a
blending system
• Fixed performance device
• Fio2 – 21-100%
COMPLICATIONS
[Link] toxicity
2. Depression of ventilation
3. Retinopathy of Prematurity
4. Absorption atelectasis
5. Fire hazard
EVALUATION
Breathing pattern regular and at normal
rate.
Pink color in nail beds, lips,
conjunctiva of eyes.
No confusion, disorientation, difficulty
with cognition.
Oxygen saturation within normal
limits.
DOCUMENTATION
Date and time oxygen started.
Method of delivery.
Oxygen concentration and flow rate.
Patient observation.
Add oronasal care to the nursing care
plan
SUMMARY
REFERENCES
• Craven Ruth, Fundamentals of Nursing,
2012, 8th edition, Pearsons publications
United States.
• Barbara Kozier, Fundamentals of Nursing,
2008, 8th edition, ISBN publications.