Oxygen Therapy Administration

and Oxygen Supply Systems

YouTube - RESPIRATORY CARE:
Oxygen E tank - two types
Oxygen Therapy
Administration
Oxygen administration
Treat hypoxemia
Hypoxemia = PaO2 < 80 mmHg
Reduce work of breathing
Reduce work of the heart
Hazards
Hyperoxia
CO2 retainers- (hypoxic drive to breath)
Oxygen Therapy
Administration
Describe the function of reducing valves and
flow meters.
Describe the different oxygen delivery devices
with regard to the delivered fractional
inspired oxygen concentration.
Describe the function of reducing valves and
flow meters.
Pressure Regulating Devices
Gas powered respiratory therapy
equipment in US requires 50 psi.
Central piping systems have pressure
reducing valves within the system
Cylinders pressure (2200 psi) must be
reduced to 50 psi
Ventilators, flowmeters, and blenders
all require 50 psi source.
Regulator
High-pressure
reducing valve
Direct acting or
indirect acting
Single or multiple
stages
Preset or adjustable
Pressure Regulating Devices
Regulator-high pressure reducing valve
for H tank with American Standard
connection
Flow Control Devices
Require that the pressure reduce to 50
psi
Bourdon gauge flow meter:
adjustable inlet pressure with a fixed
outlet orifice
Thorpe tube flow meter: preset inlet
pressure with adjustable outlet orifice
Flow Controlling Device
Bourdon Gauge
Regulator
& Flowmeter
Bourdon Gauge Flowmeter
Fixed outlet orifice
Placed between
pressure source and
fixed orifice

Any change in P
1
P
2

alters output flow
Increased resistance
downstream, create
back- pressure

Summary
Bourdon Gauge Flowmeters provide
accurate measurements when there is
no restrictions
Downstream resistance reduces outlet
flow resulting in an overestimation of
delivered flow
Flow Controlling Device
Thorpe Tube
Flowmeter

Air and Oxygen Flowmeter
& Suction Regulator
Oxygen Administering Devices
Low Flow, variable performance
Nasal cannula
Simple mask
Partial-rebreathing mask
Nonrebreathing mask
High Flow, fixed performance
Air-entrainment masks
Low-flow oxygen devices
Devices can meet normal inspiratory
flow (30 L/min)
F
I
O
2
varies breath by breath
Tidal volume
Respiratory rate
Variable performance
High-flow oxygen devices
Devices can meet full inspiratory flow
demand
Fixed F
I
O
2
independent of
Tidal volume
Respiratory rate
Fixed performance
Low-flow Devices
Nasal Cannula
Nasal prongs straight or curved,
tapered or nontapered
Various sizes
Use pressure-compensated Thorpe tube
flow meter
Adults: 1-6 L/min
Infants: 0-2 L/min, 1/4 or 1/16 L/min
Nasal Cannula
Low flow oxygen
Adults
Flow rate 0-6 L/min
F
I
O
2
= 0.24 at 1 L/min
F
I
O
2
= 0.40 at 5-6 L/min
Infants
Flow rate 0-2 L/min
F
I
O
2
= 0.35 at 0.25
L/min
F
I
O
2
= 0.60 at 1 L/min
Humidification
Simple Mask
Low flow oxygen
Flow rate 5-10 L/min
F
I
O
2
= 0.3 to 0.6
(depends on
respiratory pattern)

Simple Mask
Uses higher F
I
O
2
than NC
Use in ER & Post-op Surgery
Available in various sizes
Acts as a reservoir- increases F
I
O
2

Holes in mask-inhale RA
Flow rate aids in CO
2
removal
Minimum flow rate 5 L/min
Partial-Rebreathing Mask
Reservoir bag : 300-600 ml
Flow rate: keep bag at least partially
inflated throughout inspiration
Flow rate varies depends on RR & V
T

8 to 15 L/min
1/3 exhalation into bag (High F
I
O
2
& low
CO
2
)
Volume Rebreathed
Partial-Rebreathing mask
Low flow oxygen
device
Flow rate 8-15 L/min
F
I
O
2
= 0.4 to 0.7
(depends on respiratory
pattern)
Nonrebreathing Mask
PRM with one-way valves
Bag and mask
Side ports
Exhaled gases cannot enter reservoir
Reservoir 300-500 ml (F
I
O
2
= 1.0)
Flow rate: keep bag at least partially
inflated throughout inspiration

Nonrebreathing Mask
Low flow oxygen
Flow rate 10-15
L/min
F
I
O
2
= 0.6 to 0.8
Partial vs. Nonrebreather
High-flow Devices
Air entrainment masks
High flow oxygen device
Consist of mask, jet
nozzle, and air-
entrainment ports
Flow rate depend on
F
I
O
2

In order to achieve
fixed F
I
O
2
flow must
exceed pts insp. flow
Air Entrainment Masks
High velocity gas entrains air into mask
Precise mixing of air and oxygen
F
I
O
2
depends on nozzle size and size of
entrainment ports
Obstruction of entrainment
ports/changes in flow rate affects F
I
O
2

Air Entrainment Masks
Problems with Pts wearing
masks
Pt may complain of
Claustrophobia
Being hot
Pain at site
Muffled speech
Eating and drinking
Vomiting into the mask

Aerosol masks
Face mask
Face tents
T-pieces
Tracheostomy
collars
Head hoods
Blenders
Mixture of Air and Oxygen
2 flow meters (air and oxygen)
Use with Humidifier
50 psi source (air and oxygen)
Control knob
Oxygen Enclosures
Hoods (over head)
Oxygen : air-
entrainment device
Min F
I
O
2
(may need
hood)
Monitor oxygen-
Layering effect
Minimizes: heat loss,
cold stress, and high
noise levels
Oxygen Enclosures
Incubators (enclose infant)
Control oxygen, temp.,
and humidity (servo-
controlled)
Oxygen : blender or
nebulizer
Min CO
2
6-8 L/min (CO
2
removal)
Monitor oxygen-
Layering effect
Avoid heat loss, cold
stress, and high noise
levels
Oxygen Enclosures
Tents
Primarily pediatric pts.
F
I
O
2
less than 0.5, flows 8 - 12 L/min
Temp & circulation
Oxygen Supply Systems
Identify the contents of a medical gas
cylinder using the U.S. and
International color code system.
Air
78 % Nitrogen
21% oxygen (F
I
O
2
= 0.2095)
Partial pressure
1% inert and trace gases
Compressed Gas Association (CGA)
medical grade (J)
19.5%-23.5% oxygen
No water vapor
Minimum impurities
Tank color = yellow
Color Codes
Gas US Color Code
Oxygen Green
Air Yellow
Nitrogen Black
Carbon Dioxide Gray
Helium Brown
Helium/Oxygen Brown and Green
Medical Gases
Cylinder press > 2000psi
Cylinder size
E
Transport with a pull cart
Medical Gas
Transporting an H cylinder
Rolling/ cart
Push cart
Transporting an E cylinder
Pull cart
Cylinder Valve
Safety-Indexed Connection
Systems
American Standard Compresses Gas
Cylinder Outlet
Inlet Connections (American Standard
Safety System (ASSS)
Pin-Indexed Safety System (PISS)
DiameterIndex Safety System (DISS)
Safety Systems
High Pressure (>200psi)
ASSS
Threaded outlets (larger than E tanks)
PISS
Two holes (E or smaller)
Low Pressure (<200psi)
DISS
Two holes (E or smaller)
Male/female connections
Pin-Index System
Hole Positions 1-6
Oxygen 2 & 5
Yokes and Pins
Examples of Safety Systems
Medical Gas
Cracking the cylinder
Remove any dust particles
Prevent contamination
Announce what you are doing
Rotate handle quickly 1/4 of a turn
counterclockwise then clockwise
loud noise
Oxygen Supply Systems
Bulk systems
Gas or liquid
Gas Piping Systems
Zone valves
Manifold
National Fire Protection
Association Standards
Liquid Oxygen
Economical
Portable systems
Hold as much as an H tank
At low flow rate last approx. 11 hours
Liquefied at 297.3 F
Calculate duration of flow for liquid oxygen
One liter of liquid oxygen weighs 2.5 lb (1.1 kg)
One liter of liquid oxygen produces 860 L of gaseous oxygen
Gas Remaining = (weight (lb) X 860)/ 2.5 lb/L
Duration = Gas remaining (L) / Flow (L/min)
Liquid Oxygen System
Station outlets (DISS)
female nut and
nipple tightened
onto outlet
Quick Connect
Brand specific
Gas specific
male adapter
inserted into outlet
Locked into place
Zone Shut-Off Valves
Primary shut-off
valve
Emergency- fire,
maintenance, or
construction
Valves grouped
together