Learn more about Clinical Skills today! Standardize education and management competency among nurses, therapists and other health professionals to ensure knowledge and skills are current and reflect best practices and the latest clinical guidelines.
Oxygen is considered a medication and requires a practitioner’s order; administer it cautiously and observe the patient closely for adverse reactions.
Use caution in the presence of oxygen. Oxygen is a fire hazard because it lowers the temperature at which materials catch fire in the presence of an ignition source, such as a spark or heat from a light source.
Respiratory depression can develop in a very small percentage of patients who are chronically hypercapnic when breathing moderate to high oxygen concentrations.undefined#ref1">1
The goal of oxygen therapy is to maintain adequate levels of oxygen to manage suspected or confirmed hypoxemia. Selection of the type of oxygen delivery device is based on the patient’s need, the severity of hypoxemia, and the disease process. Signs and symptoms of mild hypoxemia include restlessness, anxiety, disorientation, confusion, listlessness, and headaches (Box 1).
The two types of oxygen delivery devices are high flow and low flow. High-flow devices limit mixture of room air, which dilutes the fraction of inspired oxygen (FIO2).
The target peripheral oxygen saturation (SpO2) for most patients is 94% to 98%.2 Patients with chronic obstructive pulmonary disease should have a target of 88% to 92%.2
Devices that deliver oxygen therapy include a nasal cannula, various types of face masks, and oxygen tents and hoods (Table 1).
A nasal cannula is a simple, effective, comfortable device for delivering low-flow oxygen (Figure 1).1 It consists of two prongs protruding from the center of a disposable tube and inserted into the nostrils. The nasal cannula allows breathing through the mouth or nose, is available for all age groups, and is adequate for short- or long-term use. Compared with other oxygen delivery systems, a nasal cannula does not produce a feeling of claustrophobia, but it may not be suitable for mouth breathers. Cannulas are inexpensive, disposable, and easily accepted by most patients. When cannulas are used at high flow rates, the patient’s airway mucosa may dry. A humidifier should be used to help prevent drying of the nasal and oral mucous membranes if the flow rate is greater than 4 L/min.1 Approximate FIO2 is estimated by the flow rate. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1
A simple face mask is for short-term, low-flow oxygen therapy (Figure 2).1 A clear plastic mask is placed on the patient’s face and secured with an elastic strap. The body of the mask stores oxygen between the patient’s breaths. Side port openings located on either side of the mask allow room air to mix with delivered oxygen and allow exhaled air to escape. The percentage of delivered oxygen varies, depending on the rate and depth of the patient’s breathing.1 Some patients find a face mask uncomfortable, and it must be removed for eating.
A partial rebreather mask is a face mask with a reservoir bag that delivers moderate-to-high concentrations of oxygen (Figure 3A).1 The oxygen flow rate is high enough to allow for collection of oxygen in the reservoir bag. If the flow is too low or the side ports are blocked, it may collect exhaled carbon dioxide. Side port openings on either side of the mask vent exhaled air on expiration and allow room air to enter the mask on inspiration. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1
A nonrebreather mask is a face mask with a reservoir bag that delivers high concentrations of oxygen (Figure 3B).1 A one-way inspiratory valve sits on top of the reservoir bag, and a one-way expiratory valve covers one of the side ports on the mask. During inhalation the expiratory valve over the side port closes, preventing air from entering the mask while the inspiratory valve on top of the reservoir bag opens, providing oxygen to the patient. During exhalation, the expiratory valve opens allowing exhaled air to vent out of the mask while the inspiratory valve closes preventing exhaled air from entering the reservoir bag. The open exhalation port is a safety feature designed to allow air to enter the mask if the oxygen source fails. However, this feature can result in dilution of the inspired oxygen. The delivered oxygen percentage varies, depending on the rate and depth of the patient’s breathing.1
A Venturi mask is a cone-shaped device with entrainment ports of various sizes at its base (Figure 4).1 The entrainment ports can be adjusted to deliver various oxygen concentrations. This mask is useful because it delivers a more precise concentration of oxygen to the patient.
Verify that the tubing is connected to oxygen, not air or another gas. Connecting the tubing to a gas other than oxygen can have fatal consequences.
Rationale: Humidity prevents drying of nasal and oral mucous membranes and airway secretions. Humidification should be used if the liter flow rate is greater than 4 L/min.1
Rationale: The patient is more likely to keep the device in place if it fits comfortably.
Rationale: Ensuring proper positioning of the cannula tips directs oxygen flow into patient’s upper respiratory tract. Looping the cannula around the patient’s ears reduces pressure on the nares.
Rationale: A tight seal reduces carbon dioxide retention.
Rationale: Verification ensures patency of the delivery device and accuracy of prescribed oxygen flow rate.
Rationale: Changes in oxygen therapy should be based on the patient’s SpO2 levels.
Cookies are used by this site. To decline or learn more, visit our cookies page.