Oxygen Therapy: Administration and Managment
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| What is the goal of oxygen therapy? | To maintain adequate tissue oxygenation while minimizing cardiopulmonary work.
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| What are the objectives of oxygen therapy? | To treat hypoxemia.
To decrease symptoms of hypoxemia
To decrease cardiopulmonary workload.
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| How do you assess need of oxygen therapy? | Assess ABG
Assess underlying problem or condition. (history)
Physical Assessment
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| It is important to beware of conflicting information. You must always... | Treat the patient and not the numbers
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| What are the hazards of oxygen therapy? | oxygen toxicity
Depression of ventilatory drive
absorption atelectasis
Bronchopulmonary dysplasia
retrolental fibroplasia
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| What is oxygen toxicity? | High exposure to oxygen that results in an increased concentration of oxygen and causes and over production of free radicals that damage the epithelial tissues.
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| What are two factors that contribute to oxygen toxicity? | Fi02 and exposure time
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| What does oxygen toxicity primarily affect? | The lungs and CNS
CNS- tremors, twitching, convulsions
PNS- Pneumonia, Pulmonary fibrosis
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| What is absorption atelectasis? | Nitrogen washout, damage to type II pneumocytes
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| What is Bronchopulmonary dysplasia? | (BPD) is found in premature babies
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| What is retrolental fibroplasia? | scar tissue in the eyes
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| What is considered a high oxygen concentration? | A concentration greater than 60%.
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| What are the two oxygen delivery systems? | Low Flow Systems
High Flow Systems
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| Low flow systems | have variable FI02
Does not meet the patients flow rate demand
FI02 is just an estimate
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| What are some examples of a low flow system? | Nasal Cannula
Reservoir Cannulas
Nasal Catheter
Transtracheal oxygen
simple mask
Partial rebreathing mask
non-rebreating mask
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| High flow systems | Fixed FI02
Meets patient's flow rate demand
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| High Flow system examples | Air entrainment mas
i.e. Venturi Mask
Air Entrainment Nebulizer
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| What's special about the nasal cannula? | It's the most commonly used oxygen therapy device
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| The nasal cannula handles flow rates | up to 6 Liters/Minute (adult)
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| Estimating Fi02 with nasal cannula | 1 L/minute=24% Fi02
Each additional liter increases Fi02 4%
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| In nasal cannulas can you use a bubble humidifier? | Yes, at flow rates set at 4 L/min and greater
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| Are pediatric and infant sizes available in the nasal cannula? | yes
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| What's a special nasal cannula? | Reservoir cannulas (conserving devices)
They suppliment the fi02 and are rarely seen
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| Is there a high flow nasal cannula? | Yes it is rarely seen and it comes with a special bubble humidifier that can handle high flow.
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| Nasal cannulas replaced what device? | Nasal catheters
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| Nasal catheters can handle flow rates up to? | 6L/Minute
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| Estimating percentage of nasal cannulas | 1 L/minute=24% fio2
Each additional liter increases Fi02 4%
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| The bubble humidifiers are used for flow rates | Set at 4L/min and greater
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| Are there pediatric and infant sizes available for nasal catheters? | Yes
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| Transtracheal oxygen is | inconspicuous/ Rare
Is designed for long term oxygen therapy.
Commonly used with a bubble humidifier.
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| Why is the transtracheal oxygen more efficient than a nasal cannula? | Oxygen delivery directly to the trachea.
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| What happens to flow rates? | They can be reduced by 50%
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| What are disadvantages to transtracheal oxygen? | Requires a minor surgery
Infection
Bleeding
Subcutaneous emphysema
Must be cleaned frequently
damage to catheter requires replacement over time.
Not covered by all insurance agencies
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| The simple mask is | More commonly used by EMT's
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| What are the flow rate requirements? | 6-10 liters per minute
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| What fi02 values can the simple mask achieve | 35%-50%
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| Can a bubble humidifier be used with a simple mask? | Yes but the flow rate requirement for the simple mask is 6 L/minute and you do not want the bubble humidifer to go past 6 or 7 or it will alarm
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| Are there pediatric sizes available for the simple mask? | Yes
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| What is the difference between an aerosol mask/simple mask? | The aerosol mask has larger holes on the side.
The simple mask have small holes on the side.
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| What are the two types of rebreathing masks? | Non-Rebreathing/Partial rebreathing mask
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| What does the non-rebreathing mask have? | 2 check valves
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| What are the flow rate requirements for the non-rebreathing mask? | Enough to keep the bag inflated
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| What fi02 values can be achieved with the non-rebreathing mask? | 60-80%
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| Can a bubble humidifier be used with both rebreathing masks?? | yes
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| Are pediatric sizes available? | yes
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| What is the flow rate requirement for partial-rebreathing masks? | enough to keep the bag inflated
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| What fi02 values can the partial rebreather mask achieve? | 40-60%
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| Are pediatric sized available in the partial-rebreathing mask? | yes
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| Does the partial rebreathing mask have check valves? | no
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| What are factors that alter the performance of low flow systems and increase the Fi02 | Higher oxygen input
Mouth-closed breathing
Low inspiratory flow
low tidal volume
slow respiratory rate
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| What are factors that affect performance of low flow systems and decrease fi02 | Lower oxygen input
mouth-open breathing
high inspiratory flows
High tidal volume
fast respiratory rate
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| The air entrainment is a high flow device. It is also known as | Venti mask, Venturi mask
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| The Fi02 depends on? | The size of entrainment port
Velocity of the gas
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| A blocked entrainment port on the venti mask will | increase the Fi02
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| What are the Fi02 ranges for the venti mask? | 24%-60%
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| It might be difficult to provide fixed fi02 at high | Fi02 setting
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| Can the air entrainment mask be used with a bubble humidifier? | No, humidity must be proveided with bland aerosol set up attached to mask for humidity therapy
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| Are pediatric venti masks available? | yes
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| The jet orifice on the venti mask changes what 2 things? | Fi02 and Flow
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| If bed sheets cover the Venti Mask what happens? | The fi02 increases and the flow decreases
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| The air entrainment nebulizer is... | The large volume jet nebulizer
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| Fi02 and flow rate requirements on the air entrainment nebulizer depend on what? | The size of the air entrainment port
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| If the entrainment port becomes blocked or water condenses in the tubing what will happen with the air entrainment nebulizer? | The fi02 will increase
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| What are the fi02 ranges for the air entrainment nebulizer? | 28%-98%
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| The air entrainment nebulizer can provide 21% by attaching what to the flow meter? | air
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| What attachments can be used with the air entrainment nebulizer? | aerosol mask, trach collar, face tent, t-tube, tents, and oxyhoods
Pediatric sizes are available
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| What is one thing about high fi02 settings on the air entrainment nebulizer? | It can be difficult to provide a fixed fi02 at high fi02 settings.
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| What are some disadvantages of oxygen masks? | Claustrophobia
Muffled Speech
Difficulty eating and drinking
Blocks vomitus in unconscious patient
Potential suffocation hazard
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| How do you troubleshoot if no gas flow can be detected? | See if gas is turned on.
Look for kinking in tubing
look for a leak.
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| How do you troubleshoot patient constantly removing mas? | Try to find a comfortable option if possible.
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| How do you troubleshoot the resivoir bag collapsing during inhalation? | Increase the flow of oxygen
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| How do you troubleshoot the reservoir bag remaining inflated during inhalation? | Mask may not have a tight fit.
Inspiratory valve jammed/reversed.
Flow may be too high
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| How do you handle a patient that develops sores or irritation over face and ears? | Use rubber cushions
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| How do you troubleshoot the humidifier pop-off sounding? | Look for obstruction, kinking, flow may be too high
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| How do you troubleshoot no humidity/aerosol coming from the system? | Check the water level
Look for faulty equipment.
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| What are factors used to select appropriate oxygen device? | Objectives of therapy (short term/long term)
Performance characteristics of set up (high flow/low flow)
Individual needs of the patient and patient characteristics. (Age, LOC, Breathing Pattern, Presence or absense of a tracheal airway)
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| Oxygen blenders | Replace manual titration of fi02 using an oxygen and airflow meter.
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| How are oxygen blenders powered? | Pneumatically
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| Oxygen blenders can | achieve any fi02
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| What does the oxygen blender contain? | A proportioning module for blending oxygen and air.
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| The oxygen blender has one alarm. What does it do? | Notify in case of loss of gas supply
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| Other things for oxygen blenders | It's accurate and precises
Requires 50 PSI source
Flow meter attachments are available
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| What are the two most common analyzers used in respiratory care? | Electrochemical
Galvonic fuel cell
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| Electrochemical | Polarographic (Clark)electrode
Commonly used in ABG machines and transcutaneous monitors
Requires a battery for power
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| The electrochemical, polarographic clark electrode | has a 10-30 second response time,
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| The galvonic fuel cell | Is commonly used in ventilators and hand held analyzers
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| The galvonic fuel cell gets a result in | 60 seconds and needs no external power
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| The galvonic fuel cell will require calibration. | It uses 21% or 100% calibration gases
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| The galvonic fuel cell may be one point or two point calibration. | One point- Room Air
Two Point- Room air and 100% Oxygen
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| Hyperbaric therayp | Inreases the pa02
wound healing
around since the 1600's
Based on boyles law
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| Indications of hyperbaric therapy | Air embolism
C02 poisoning
Wound Healing
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| Hazards of hyperbaric therapy | Tempanic Membrane rupture.
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