Oxygen Deliver Methods

Oxygen Delivery Systems

• Low Flow – delivers oxygen through small bore tubing • Examples are: Nasal Cannula (NC), Face mask, oxygen tents, trans tracheal catheters • FiO2 varies depending on the patient’s repiratory rate, tidal volume, and liter flow. • High Flow – delivers oxygen in precise amounts regardless of the patient’s respirations. • Example: Venturi Mask

Oxygen Delivery System

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Depends on :

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Client’s O2 needs

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Comfort

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Developmental considerations

Nasal Cannula (NC)

• A length of tubing with two small prongs for insertion into the nares • FiO2 – 24% to 44% at flow rates of 1 to 6 L/min • Advantages • It is safe, easy to apply, comfortable, and well tolerated.

• The client is able to eat, talk, and ambulate. • Disadvantages • The FiO2 varies with the flow rate and the client’s rate and depth of breathing.

• Extended use can lead to skin breakdown and dry the mucous membranes.

• The tubing is easily dislodged.

Simple Face Mask

• FiO2 40% to 60% at flow rates of 1 to 6 L/min (the minimum flow rate is 5 L/min to ensure flushing of CO2 from the mask).

• Advantages • A face mask is easy to apply and may be more comfortable than a nasal cannula • Disadvantages • Flow rates of 5L/min or lower can result in rebreathing of CO2 • This device is poorly tolerated by clients who have anxiety or claustrophobia • • Eating, drinking and talking are impaired Use caution with clients who have a high risk of aspiration or airway obstruction

Partial Re-breather Mask

• FiO2 – 60% to 75% at flow rates of 6-11 L/min • Advantages • The mask has a reservoir bag attached with no value, which allows the client to breathe up to 1/3 of exhaled air together with room air • Disadvantages • Complete deflation of the reservoir bag during inspiration casues CO2 buildup • The FiO2 varies with the client’s breathing pattern • This device is poorly tolerated by clients who have anxiety or claustrophobia • • Eating, drinking and talking are impaired Use with caution for clients who have a high risk of aspiration or airway obstruction

Non Re-breather Mask

• FIO2 – 80% to 95% at flow rates of 10 to 15 L/min to keep the reservoir bag 2/3 full during inspiration and expiration • Advantages • Delivers the highest O2 concentration possible (except for intubation).

• A one-way valve situated between the mask and reservoir allows the client to inhale maximum O2 from the reservoir bag. • The two exhalation ports have flaps covering them that prevent room air from entering the mask.

• Disadvantages • The valve and flap on the mask must be intact and functional during each breath.

• Poorly tolerated by clients who have anxiety or claustrophobia.

• Eating, drinking, and talking are impaired .

Venturi Mask

• FIO2 – 24% to 55% at flow rates of 2 to 10 L/min via different sized adaptors • Advantages • • • Delivers the most precise oxygen concentration.

Humidification is not required.

Best suited for clients who have chronic lung disease.

• Disadvantages • The use of a Venturi mask is expensive.

Aerosol Mask, Face Tents, and Tracheostomy Collars

• Aerosol mask, face tent - fit loosely around the face and neck • Tracheostomy collar - a small mask that covers a surgically created opening in the trachea • FiO2 – 24% to 100% at flow rates of at least 10 L/min (they provide high humidification with oxygen delivery) • Advantages • Good for clients who do not tolerate masks well.

• Useful for clients who have facial trauma, burns, and/or thick secretions.

• Disadvantages • High humidification requires frequent monitoring

Lifespan Considerations Oxygen Delivery Equipment

• Infants • Oxygen Hood - a rigid plastic dome that encloses an infant’s head.

• It provides precise oxygen levels and high humidity.

• The gas should not be allowed to blow directly into the infant’s face, and the hood should not rub against the infant’s neck, chin, or shoulder • Children • Oxygen Tent - a rectangular, clear, plastic canopy with outlets that connect to an oxygen or compressed air source and to a humidifier that moisturizes the air or oxygen.

• Because the enclosed tent becomes very warm, some type of cooling mechanism such as an ice chamber or a refrigeration unit is provided to maintain the temperature at 20°C to 21°C (68°F to 70°F).

• Cover the child with a gown or a cotton blanket. • The child needs protection from chilling and from the dampness and condensation in the tent.

• Flood the tent with oxygen by setting the flow meter at 15 L/min for about 5 minutes. Then, adjust the flow meter according to orders (e.g., 10 to 15 L/min). Flooding the tent quickly increases the oxygen to the desired level.

Artificial Airways

• Oropharyngeal • Nasopharyngeal • Endotracheal Tube • Tracheostomy

Oro and Nasopharyngeal Airways

• • • • • • used to keep the upper air passages open when they may become obstructed by secretions or the tongue. easy to insert and have a low risk of complications. Sizes vary and should be appropriate to the size and age of the client. The airway should be well lubricated with water-soluble gel prior to inserting.

Oropharyngeal airways stimulate the gag reflex and are only used for clients with altered levels of consciousness (e.g., because of general anesthesia, overdose, or head injury) Nasopharyngeal airways are tolerated better by alert clients. They are inserted through the nares, terminating in the oropharynx

Endotracheal Tubes

• • • • • • most commonly inserted in clients who have had general anesthetics or for those in emergency situations where mechanical ventilation is required. inserted by an anesthesiologist, primary care provider, certified nurse anesthetist (CRNA), or respiratory therapist with specialized education. inserted through the mouth or the nose and into the trachea with the guide of a laryngoscope The tube terminates just superior to the bifurcation of the trachea into the bronchi. The tube may have an air-filled cuff to prevent air leakage around it.

Because an endotracheal tube passes through the epiglottis and glottis, the client is unable to speak while it is in place.

Tracheostomy

• • • • • • Clients who need airway support due to a temporary or permanent condition an opening into the trachea through the neck. A tube is usually inserted through this opening and an artificial airway is created. Tracheostomy is done using one of two techniques: • • the traditional open surgical method or a percutaneous insertion. The percutaneous method can be done at the bedside in a critical care unit.

• The open technique is done in the operating room, and a surgical incision is made in the trachea just below the larynx. A curved tracheostomy tube is inserted to extend through the stoma into the trachea.

Tracheostomy tubes are available in different sizes and may be plastic, silicone, or metal, and cuffed, uncuffed, or fenestrated. • A fenestrated tracheostomy has an opening in the tube that allows air to pass through to the vocal cords, thus allowing the client to communicate.

Tracheostomy Continued

• When the client breathes through a tracheostomy, air is no longer heated, humidified, and filtered as it is when passing through the upper airways; therefore, special precautions are necessary. • Humidity may be provided with a mist collar • Clients with long-term tracheostomies may use a “heat moisture exchange device known as a ‘Swedish nose’” • They may also wear a stoma protector such as a 4 × 4 gauze held in place with a cotton tie over the stoma or a light scarf to filter air as it enters the tracheostomy.

Suctioning

• • • • To remove secretions that obstruct the airway To facilitate ventilation To obtain secretions for diagnostic purposes To prevent infection that may result from accumulated secretions • Oropharyngeal and Nasopharyngeal Suctioning may use clean technique • Nasotracheal Suctioning must use sterile technique

Suction Catheters

• open tipped catheter (Figure A) • may be more effective for removing thick mucous plugs • whistle-tipped catheter (Figure B) • is less irritating to respiratory tissues • C Yankauer device (Figure C) is used to suction the oral cavity. • Most suction catheters have a thumb port on the side to control the suction. The catheter is connected to suction tubing, which in turn is connected to a collection chamber and suction control gauge

Complication of Suctioning

• • • • • Hypoxemia Trauma to the airway Nosocomial or health care–associated infection Cardiac dysrhythmia (which is related to the hypoxemia) • The following techniques are used to minimize or decrease these complications:

Hyperinflation.

This involves giving the client breaths that are greater than the tidal volume set on the ventilator through the ventilator circuit or via a manual resuscitation bag. Three to five breaths are delivered before and after each pass of the suction catheter.

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Hyperoxygenation.

This can be done with a manual resuscitation bag or through the ventilator and is performed by increasing the oxygen flow (usually to 100%) before suctioning and between suction attempts. This is the best technique to avoid suction-related hypoxemia.

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Hyperventilation.

receiving. This can be done through the ventilator or using a manual resuscitation bag.

This involves increasing the number of breaths the client is

Tracheostomy Care

• • • To maintain airway patency To maintain cleanliness and prevent infection at the tracheostomy site To facilitate healing and prevent skin excoriation around the tracheostomy incision • To promote comfort

Tracheostomy Care Continued

• • • • • • Suction patient if needed Prepare supplies Remove inner cannula and old dressing Clean inner cannula and replace Clean site and tube flange Sterile dressing • Procedure is sterile procedure once you have removed inner cannula and dressing!