Administration of oxygen to some patients may result in hypoventilation, further hypercapnia, hypoxia, and apnea.
Patients with sudden changes in their vital signs, level of consciousness (LOC), or behavior may be experiencing profound hypoxia or hypercapnia.undefined#ref3">3
Verify that the tubing is connected to the oxygen and not to air or another gas. Connecting the tubing to a gas other than oxygen can have fatal consequences.
Supplemental oxygen is defined as delivery of oxygen in a concentration greater than room air, which has an oxygen concentration of 21% or a fraction of inspired oxygen (FIO2) of 0.21.4
Supplemental oxygen is provided mainly to patients with adequate spontaneous respirations (ventilation) but inadequate oxygenation. Supplemental oxygen can also be used with emergency devices such as manual resuscitation and positive pressure devices. The need for supplemental oxygen may be determined by clinical assessment of the patient, pulse oximetry, and arterial blood gas (ABG) or venous blood gas analysis, when indicated. In ill or injured patients who do not have chronic lung disease, oxygen is never contraindicated. Insufficient oxygen administration may lead to hypoxia, which is a significant risk to the patient.
The provision of supplemental oxygen should be treated with the same respect and caution that is used when administering any medication. Oxygen delivery has safe dosing ranges, but it may produce adverse effects; toxic effects are possible, especially with delivery of high concentrations or with prolonged use. Supplemental oxygen administration is subject to federal, state, and local laws and regulations.1
Rationale: Fire is a significant physical hazard of oxygen therapy.
Do not allow smoking and remove spark-producing items and flammable and volatile substances.
Connecting the tubing to a gas other than oxygen can have fatal consequences.
Aggressively monitor patients who have underlying chronic obstructive pulmonary disease (COPD), cystic fibrosis, sedation from medications, neuromuscular disease, morbid obesity, or extensive previous chest disease.
Rationale: Oxygen concentration delivery is highly variable, and factors such as oxygen flow rate, ventilatory rate and depth, mask seal, and anatomic dead space all contribute to this variability.
Rationale: Masks interfere with the patient's speech. Aspiration is a potential hazard when an oxygen delivery mask is in use. Elevating the head of the bed may reduce this risk.
Rationale: Compressed air is dry, and standard humidification equipment delivers only a fraction of the needed humidity to the patient. The mucosa must be kept moist to prevent excessive dryness and nosebleeds.
Albert, R.K. and others. (2016). A randomized trial of long-term oxygen for COPD with moderate desaturation. The New England Journal of Medicine, 375(17), 1617-1627. doi:10.1056/NEJMoa1604344
Haynes, J.M., Ruppel, G.L. (2016). Pulse oximetry in acute respiratory failure: What should be expected? Respiratory Care, 61(8), 1135-1136. doi:10.4187/respcare.04965
Iliaz, S. and others. (2015). Does the 6-minute walk test predict nocturnal oxygen desaturation in patients with moderate to severe COPD? Chronic Respiratory Disease, 12(1), 61-68. doi:10.1177/1479972314562406
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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