Oxygen

Therapy & Delivery System

Joel PD RN
 Understanding O2

Sometimes, 21% of oxygen may not be

enough to maintain adequate oxygen
saturations. In these situations,
supplemental oxygen can be administered
via various oxygen delivery devices ranging
from nasal prongs to invasive ventilation.
This allows the concentration of oxygen to
be increased, potentially increasing the FiO2
to 100%.
 Understanding O2

PaO2/FiO2 ratio. The ratio of partial pressure

arterial oxygen and fraction of inspired
oxygen, sometimes called the Carrico index,
is a comparison between the oxygen level in
the blood and the oxygen concentration that
is breathed.
 Understanding O2

Oxygen, we all need it! We do not need a lot of

it under normal circumstances, with 21%
being the fraction of inspired oxygen (FiO2)
of room air. FiO2 is defined as the
percentage or concentration of oxygen that
a person inhales. The air that we inhale on a
day to day basis is made up of 21% of
oxygen, 78% of nitrogen and 1% of trace
elements such as argon, carbon dioxide,
neon, helium and methane.
 Understanding O2

oxygen therapy that requires an

understanding of the relationship between
oxygen flow rate and FiO2. In most clinical
areas that require an FiO2 to be
documented, you will be able to find a table
that outlines an approximate correlation
between oxygen flow rate and FiO2, similar
to the table
Understanding O2
 Definition

Oxygen therapy refers to

supplemental oxygen given to
people who, largely due to
breathing disorders, aren’t able to
get enough naturally.
 Nature of oxygen

Oxygen, a gas found in the air we breathe, is

necessary for human life. Some people with
breathing disorders can’t get enough oxygen
naturally. They may need supplemental
oxygen, or oxygen therapy. People who
receive oxygen therapy often see improved
energy levels and sleep, and better quality
of life.
 Indication

Oxygen therapy is prescribed for

people who can’t get enough
oxygen on their own. This is often
because of lung conditions that
prevents the lungs from
absorbing oxygen.
 Indication Table

chronic obstructive pneumonia asthma

pulmonary disease
(COPD)

bronchopulmonary heart failure cystic fibrosis

dysplasia,
underdeveloped lungs
in newborn

sleep apnea lung disease trauma to the

respiratory system
 types of oxygen therapies

oxygen gas
liquid oxygen
oxygen concentrators
hyperbaric oxygen therapy
 Types of oxygen therapies

Oxygen gas can be stored in a portable tank.

These are called compressed gas systems. A
larger stationary concentrator is used within the
home, and a smaller oxygen tank can be taken
to use outside the home. The smaller tanks
might be used along with oxygen-conserving
devices so that the oxygen supply lasts longer.
The oxygen is delivered in pulses, not
continuously.
 Types of oxygen therapies

Liquid oxygen also can be stored in a portable

tank. Liquid oxygen is more highly concentrated,
so more oxygen can fit in a smaller tank. This is
helpful for people who are very active, but it will
evaporate if it isn’t used in a timely manner.
These tanks are refillable. Both liquid oxygen
and oxygen gas are available for home delivery
in many locations.
 Procedures

1. check for doctors order.

2. inform client of the procedure.
3. gather all materials, check for manufacturers
specification.(mask, cannula, O2 tanks)
4. inspect material for any malfunctions or
damages.
5. attachment of materials(eg. Cannula/mask to
O2 tank).
 Procedures

6. install cannula, or mask to client.

7. adjust flow meter as to the prescribe settings
given by the doctor.
 Oxygen Delivery System

A variety of oxygen delivery device are

available for administering oxygen therapy.
Which device to use depends on the degree
of hypoxia the patient is experiencing and
any underlying respiratory diseases. It is
also important to cosider the patient's age,
LOC, presence of artificial airway, and
environment when choosing an oxygen
delivery device.
 Nasal Cannula

It is a thin tube with two small nozzles/

prongs inserted into nostrils.

This device is used to administer

oxygen to a breathing patients with
minor breathing problems

It can only provide oxygen at low flow

rates, 1-6 litres/ min.

It delivers a concentration of 24-40%.

Flow rates greater than 4 liters per

minute should also be used with a
humidifcation system.
 Nasal Cannula

ADVANTAGES DISADVANTAGES
Comfortable for patient Maximum estimated FiO2 .40.
Ideal for claustrophobic Not appropriate for patients
patients. in respiratory distress.

Ideal for oxygen dependent

patients requiring small
amounts of oxygen and home
use.

Humidification (bubble bottle)

not required up to 4 lpm.
 Nursing Considerations

Must be ordered in litres per minute (lpm), not

FiO2
Flow rates greater than 6 lpm can be
uncomfortable for patient. (Headaches, nose
bleeds)
Possible water in the catheter from the bubble
bottle will be sprayed up the patient’s nose.
(Turn flow on before applying to patient.)
Simple Face Mask
 Simple Face Mask

It is a basic mask used for non-life-threatening

conditions but which may progress in time,
such as chest pain (possible heart attacks),
dizziness, and minor hemorrhage.
It is often set to deliver oxygen between 5-10 L/
min.
The final oxygen concentration delivered by this
device is dependent upon the amount of room
air that mixes with the oxygen the patient
breathes. The general oxygen concentration is
between 35% and 50%
 Simple Face Mask

ADVANTAGES DISADVANTAGES

Quick and easy to setup and Nonspecific FiO2 (Dependant

apply. on patients inspiratory flows)

Often found at the head of the Maximum FiO2 estimated at .

bed in emergency areas. (eg. 50
Emergency, Dialysis, PACU)

Not intended for long term

use.
 NURSING CONSIDERATIONS

Flow rates set less than 5 lpm may cause

CO2 rebreathing.
Non- rebreather Mask
 Non - rebreather Mask

It is an effective method for delivering high

concentrations of oxygen to a breathing
patient.
It is similar to the partial rebreathing mask except
it has a series of one-way valves.
Non-rebreather masks consist of a face mask
with an attached oxygen reservoir bag and a
one-way valve, which prevents the patient’s
exhaled air from mixing with the oxygen in the
reservoir bag.
 Non - rebreather Mask

Flutter valves on the side of the mask allow

exhaled air to escape freely. As the patient
breathes, he or she inhales oxygen from the
bag.
One valve is placed between the bag and the
mask to prevent exhaled air from returning
to the bag.
There should be a minimum flow of 10-
15L/min.
The delivered FIO2 of this system is 60-80%.
 Non – rebreather mask

ADVANTAGES DISADVANTAGES

Fast and easy to set up. Delivers only one FiO2: 1.00

Can deliver high concentration FiO2 is extremely variable.

oxygen in breathing patients. While theoretically capable of
delivering an FiO2 of 1.00,
realistically it is more likely
between .60 and .80 due to air
entrainment around the mask.
 Nursing Considerations

Reservoir bag must always remain inflated. If

deflation occurs the oxygen flow may be too
low.
This is not a long term usage mask. The
patient should be switched to a 100%
aerosol mask at the earliest convenience.
Venturi Mask
Venturi Mask
 Flow rate and O2 conc delivered
using venture mask

Nozzle Color code Flow rate (l/m) Conc of o2 %

blue 3 24
yellow 6 28
white 8 31
green 12 35
pink 15 40
orange 15 50
 Venturi Mask

Administer oxygen via a Venturi provides high

gas flow with a fixed oxygen concentration
It provides much controlled oxygen delivery
between 20 – 55%.
Most reliable and accurate method for
delivering a precise O2 concentration.
Consists of a mask with a jet
 Venturi Mask

Excess gas leaves by exhalation ports.

O2 flow rate- 4 to 15L/min.
Can cause skin breakdown; must remove to
eat.
This type of oxygen delivery is advocated for
patients with chronic hypercarbia(for the in
management of moderate to severe
hypoxemia.
 Venturi Mask

Advantages Disadvantages
Administers a specific
FiO2. (Determined FiO2 only available
by air entrainment according to mask
adaptor on end of adapters. .24, .28, .
mask.) 31, .35, .40 and .50
Quiet
Face Tents
 Face tents

It is compose of a soft mask that fits under

then patient's chin and loosely covers the
mouth and nose, with an adjustable strap to
keep it in place.
 Face Tents

advantage disadvantage
It is convenient for Oxygen concentration
people who are cannot be
claustrophobic. controlled.
It convenient for
humidification &
oxygenation.
Oxygen Hood
 Oxygen Hoods

a clear plastic hood that fits over an infant’s

head, to deliver a constant concentration of
oxygen.
as support in cases of mild respiratory event.
 Oxygen Hoods

Advantages
Oxygen can be warmed and humidified
without pressure
Hoods can be used for infants of various sizes
in different types of beds
Good for short term use (a few days
maximum)
 Oxygen Hoods
Disadvantages
oxygen content of inspired gas may vary with
hood position, amount of leakage and
movement of the infant out from under the
hood
Noise levels may be high when liter flow is
high
Caregiver ability to visualize the infant’s face
maybe be obscured due to fogging or
condensation
 Oxygen Hoods

Carbon dioxide buildup if flow is low and the

hood is well sealed and risk of positive
pressure creation if the hood is well sealed
and the gas flow is high
High levels of humidity and condensation
increase the risk of infection when hoods
are used for extended periods.
 Nursing Responsibilities

1. assess signs & symptoms of hypoxemia.

2. check doctors orders
3. positioning of patients.
4. open source of oxygen before insertion of
oxygen device. This is to check malfunctioning
of the device.
5. regulate flow of oxygen accurately.
6.place a no smoking sign at the bedside.
 Nursing Responsibilities

7. avoid use of oil, grease, near the client

receiving oxygen.
8. check electrical appliances before use.
9. sterile water on the humidifier.
10. provide good oronasal hygiene.
11. lubricate nares.
12. assess effectiveness of oxygen therapy
13. make relevant documentation.
 Estimating FiO2

system O2 flow rate FiO2 (%)

cannula 24-28 1-2

30-35 3-4

36-40 5-6

Simple face mask 44-68 5-10

NRM 60-80 10-15

venturi 24 2-4

28 4-6

35 6-8

50 10-15
Thank You