Oxygen Delivery Systems
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| Low flow systems | Do not meet the patients inspiratory flow demands.,Normal inspiratory flow rate is 25 to 30 L/min,Additional flow comes from RA
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| Low flow systems include | Nasal Cannula,Nasal,Catheters,Transtracheal Catheters, Simple masks, Partial Rebreathing Masks, Non-rebreathing Mask
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| High Flow Oxygen Systems Include | Venturi Mask or air-entrainment masks,Aerosol Mask, Face Tent, T-Piece, Trach Mask, Oxygen Tent
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| Nasal Cannula and Nasal Catheters | Delivers 24 to 44% oxygen at 1 to 6 L/min 1 = 24, 2 = 28, 3 = 32, 4 = 36, 5 = 40, 6 = 44
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| Nasal Catheters position | measured from nose to ear, lubricated, inserted to just above the uvula
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| Nasal Catheters cons | deep insertion can cause air swallowing and gastric distension , must be repositioned every 8 hours to prevent breakdown
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| Transtracheal Catheters | Delivers low flow rates (1 to 3 L/min) directly to the trachea through a small incision, Requires less oxygen (lower flows) because the upper airway deadspace is bypassed
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| Transtracheal Catheters risk | Can develop infection and irritation at site and there is a risk of accidental removal, If pt becomes SOB or has increased, Flush with saline, Cleaning Rod, reposition
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| Cannulas | better tolerated, may be humidified but often not if run @ less than 5 L/min, there are two types of O2-conserving cannulas
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| Nasal reservoir | reservoir just below the nose stores ~ 20 mL of O2 ,allows for lower flows because of increase O2 delivery
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| Pendent reservoir | pendent stores O2 ,must exhale through nose
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| Pendent reservoir limits | HFNC - 6-15lpm
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| Simple masks | Delivers 35 to 55 % O2 at flows of 5 to 12 L/min
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| Partial Rebreathing Masks | Delivers 35 to 60 % O2 at flow rates of 8 to 15 L/min
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| Partial Rebreathing Masks Cons | Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times
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| Non-rebreathing Mask | Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times ,Is equipped with a one-way valve that does not allow exhaled gas into the reservoir, One way valves are located on both expiratory ports of the mask to prevent RA entrainment
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| Methods for setting up high flow oxygen | air entrainment mask, mechanical aerosol systems, Gas Injection Nebulizer- need high flow flowmeters, High FiO2 Misty Ox- for FiO2 of .60+ , Blender and titration system
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| High flow O2 systems provide | all of the inspiratory flow required by the patient at consistent FiO2s, These devices are normally attached to nebulizers (Venti-mask may or may not be)
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| Venturi Mask or air-entrainment masks | provide FiO2's from 24 to 50%
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| what happens with Venturi Mask or air-entrainment masks | Increasing flow will not alter FiO2 (precise) The size of the entrainment port determines FiO2 The larger the port, the more RA entrained, the lower the FiO2
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| Aerosol Mask | Delivers 21-100% FiO2 depending on nebulizer setting, Flow rates of 8 to 15 L/min
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| Aerosol Mask limits | On 100% the device will probably not meet flow demands.(>60%) (No air entrained so flow = flowmeter setting)
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| Face Tent | 21% to 40% depending on nebulizer setting Flow rates of 8 to 15 L/min
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| Face Tent limits | Used mainly for patients who can not tolerate a mask
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| T-Piece | 21-100% depending on nebulizer setting Flow rates of 8 to 15 L/min
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| T-Piece limits | Used on intubated or trached patients
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| Trach Mask | 35-60% O2 depending on nebulizer setting Flow rates of 10 to 15 L/min
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| Trach Mask limits | Adequate flow shown by mist flowing out the exhalation port at all times
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| Oxygen Tent | 21 -50% at flow rates of 10 to 15 L/min Used mainly on children with croup or pneumonia
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| Oxygen Tent Risks | Problem with leakage ,Fire hazard
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| High FiO2's Important Points | High FiO2's (>.60) may not meet the patient's inspiratory flow demands To insure adequate flow with stable FiO2's, a special made high flow device should be used or two flowmeters set up to provide at least 40 L/min total flow
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| High FiO2's Risk | A restriction, such as a kink, or water in the tubing, causes back-pressure into the nebulizer. This decreases the amount of RA entrained and INCREASES the delivered FiO2. increasing flow on a high flow device will not increase FiO2, only total flow
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| Head box- | small, clear plastic enclosures over infant's head or head and upper torso
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| Head boxes allows | for a higher oxygen concentration and more accessibility to patient without disturbing oxygen delivery. Best not to entrain room air into head box because of noise and microorganism introduction (Blender)
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| air: oxygen entrainment ratios: | .60 1:1, .50 1.7:1, .40 3:1, .35 5:1,.30 8:1
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