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Fire is a significant hazard where oxygen is used. Do not permit flames, sparks, or smoking.
The administration of oxygen to children requires the selection of an oxygen delivery system that suits the child's age, size, needs, clinical condition, and therapeutic goals. Oxygen delivery systems are categorized as low-flow (variable performance) systems or high-flow (fixed performance) systems. With low-flow systems, 100% oxygen mixes with room air during inspiration, and room air is entrained, making the percentage of delivered oxygen variable. High-flow devices provide such a high flow of premixed gas that the child is not required to inhale room air. Supplemental oxygen therapy is often recommended for children when peripheral oxygen saturation is consistently below 94%.1
A nasal cannula, oxygen mask (e.g., simple face mask, partial rebreathing mask with reservoir, a nonrebreathing mask with reservoir, Venturi mask), face tent, and oxygen hood deliver supplemental oxygen to children to treat hypoxia, respiratory distress, and respiratory failure (Table 1) (Table 2) (Table 3). Because oxygen can dry the respiratory system, many oxygen delivery systems allow for humidification.
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Rationale: The correct size device ensures optimal delivery of the prescribed amount of oxygen and reduces the risk of skin breakdown.
Reportable conditions: Tachypnea, bradypnea, apnea, increased work of breathing, nasal flaring, retractions, diminished or abnormal breath sounds, agitation, anxiety, altered mental status, changes in oxygen saturation, changes in blood gas values, arrhythmias (including tachycardia and bradycardia), hypertension, hypotension, changes in skin color such as pallor or cyanosis, changes in peripheral perfusion
Rationale: Changes in oxygen delivery to avoid oxygen-related complications are based on the child's condition.
Rationale: If gas flow is too low, hypercarbia may develop.
Reportable conditions: Increasing agitation, rapid and deep respiration, dyspnea, progressive lethargy
Rationale: Suffocation may occur if the child puts his or her mouth or nose against the plastic walls.
Rationale: The bridge of the nose and the cheeks are prone to skin breakdown.
Reportable condition: Skin breakdown associated with the device
Rationale: Dry and sore mucous membranes can develop with the delivery of oxygen.
Reportable conditions: Dry or cracked mucous membranes
Rationale: Oxygen can dry the respiratory system, resulting in thick secretions that are more difficult to mobilize. Dry air can lead to breakdown of the nasal mucosa, resulting in nosebleeds.
Rationale: Pain in children can decrease the ability to breathe deeply, thereby affecting gas exchange.
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