Oxygen Administration

Vutha ket, MD
• A patient will need oxygen therapy when hypoxemia results from
a respiratory or cardiac emergency or an increase in metabolic
function.
• In a respiratory emergency, oxygen administration enables the
patient to reduce his ventilatory effort. When conditions such as
atelectasis or acute respiratory distress syndrome impair
diffusion, or when lung volumes are decreased from alveolar
hypoventilation, this procedure boosts alveolar oxygen levels.
• In a cardiac emergency, oxygen therapy helps meet the increased
myocardial workload as the heart tries to compensate for
hypoxemia. Oxygen administration is particularly important for a
patient whose myocardium is already compromised—for
instance, from a myocardial infarction or cardiac arrhythmia.
• When metabolic demand is high (in cases of massive trauma,
burns, or high fever, for instance) oxygen administration
supplies the body with enough oxygen to meet its cellular
needs.
• This procedure also increases oxygenation in the patient with
a reduced blood oxygen-carrying capacity, perhaps from
carbon monoxide poisoning or sickle cell crisis.
• The adequacy of oxygen therapy is determined by arterial
blood gas (ABG) analysis, oximetry monitoring, and clinical
examinations.
• The patient’s disease, physical condition, and age help
determine the most appropriate method of administration.
Equipment
The equipment needed depends on the type of delivery
system ordered.
Equipment includes selections from the following list:
• Oxygen source (wall unit, cylinder, liquid tank, or
concentrator)
• flowmeter
• adapter, if using a wall unit, or a pressure-reduction gauge, if
using a cylinder
• sterile humidity bottle and adapters
• sterile distilled water
• oxygen precaution sign
• appropriate oxygen delivery system (a nasal cannula, simple mask,
or nonrebreather mask for low-flow and variable oxygen
concentrations; a Venturi mask, aerosol mask, T tube, tracheostomy
collar, tent, or oxygen hood for high-flow and specific oxygen
concentrations)
• small-diameter or large-diameter connection tubing
• gauze pads and tape
• jet adapter for Venturi mask (if adding humidity)
• gloves
• stethoscope
• sphygmomanometer
• Optional: oxygen analyzer.
Preparation of Equipment
• Although a respiratory therapist typically is
responsible for setting up, maintaining, and
managing the equipment, you’ll need a working
knowledge of the oxygen system being used.
Guide to Oxygen Delivery
Systems
• Patients may receive oxygen through one of several
administration systems. Each has its own benefits,
drawbacks, and indications for use. The advantages
and disadvantages of each system are compared
below.
Nasal Cannula
• Oxygen is delivered through plastic cannulas in the
patient’s nostrils.
Nasal Cannula
• Advantages: Safe and simple; comfortable and easily tolerated; nasal
prongs can be shaped to fit any face; effective for low oxygen
concentrations; allows movement, eating, and talking; inexpensive and
disposable.
• Disadvantages: Can’t deliver concentrations higher than 40%; can’t be
used in complete nasal obstruction; may cause headaches or dry mucous
membranes if flow rate exceeds 6 L/minute; can dislodge easily.
• Administration guidelines: Hook the cannula tubing behind the patient’s
ears and under the chin. Slide the adjuster upward under the chin to
secure the tubing. If using an elastic strap to secure the cannula, position
it over the ears and around the back of the head. Avoid applying it too
tightly, which can result in excess pressure on facial structures and
cannula occlusion as well. With a nasal cannula, oral breathers achieve
the same oxygen delivery as nasal breathers.
Simple Mask
• Oxygen flows through an entry port at the bottom
of the mask and exits through large holes on the
sides of the mask.
Simple Mask
• Advantages: Can deliver concentrations of 35% to 50%.
• Disadvantages: Hot and confining; may irritate patient’s skin; tight seal,
which may cause discomfort, is required for higher oxygen concentration;
interferes with talking and eating; impractical for long-term therapy
because of imprecision.
• Administration guidelines: Select the mask size that offers the best fit.
Place the mask over the patient’s nose, mouth, and chin, and mold the
flexible metal edge to the bridge of the nose. Adjust the elastic band
around the head to hold the mask firmly but comfortably over the cheeks,
chin, and bridge of the nose. For elderly or cachectic patients with sunken
cheeks, tape gauze pads to the mask over the cheek area to try to create
an airtight seal. Without this seal, room air dilutes the oxygen, preventing
delivery of the prescribed concentration. A minimum of 5 L/minute is
required in all masks to flush expired carbon dioxide from the mask so that
the patient doesn’t rebreathe it.
Non-rebreather Mask
• On inhalation, the one-way valve opens, directing
oxygen from a reservoir bag into the mask. On
exhalation, gas exits the mask through the one-way
expiratory valve and enters the atmosphere. The
patient only breathes gas from the bag.
Non-rebreather Mask
• Advantages: Delivers the highest possible oxygen concentration (60% to 90%)
short of intubation and mechanical ventilation; effective for short-term
therapy; can be converted to a partial rebreather mask, if necessary, by
removing the one-way valve.
• Disadvantages: Requires a tight seal, which may be difficult to maintain and
may cause discomfort; may irritate the patient’s skin; interferes with talking
and eating; impractical for long-term therapy.
• Administration guidelines: Follow procedures listed for the simple mask. Make
sure that the mask fits very snugly and that the one-way valves are secure and
functioning. Because the mask excludes room air, valve malfunction can cause
carbon dioxide buildup and suffocate an unconscious patient. If the reservoir
bag collapses more than slightly during inspiration, raise the flow rate until you
see only a slight deflation. Marked or complete deflation indicates an
insufficient flow rate. Keep the reservoir bag from twisting or kinking. Ensure
free expansion by making sure the bag lies outside the patient’s gown and
bedcovers.
Non-rebreathing mask
with an oxygen reservoir
bag attached. The mask
has one unidirectional
inspiration valve and two
unidirectional expiration
valves. The carbon dioxide
exhaled by the patient is
constantly diluted by a
high flow of oxygen
delivered to the mask (10–
15 L/min.) 
CPAP Mask
• This system allows the spontaneously breathing
patient to receive continuous positive airway
pressure (CPAP) with or without an artificial airway.
• Advantages: Noninvasively improves arterial oxygenation
by increasing functional residual capacity; allows the patient
to avoid intubation; allows the patient to talk and cough
without interrupting positive pressure.