Group Discussion on

oxygen therapy
PRESENTED BY: Namita Jadhao M.Sc Nursing Final yr.

Definition
The System of oxygen administration is therapeutic modality. It is the process of Providing oxygen It is prescribed by the physician, who specifies the concentration, method of delivery, and litre flow per minute.

Benefits of Oxygen

PURPOSE
To supply oxygen in conditions when there is interference with normal oxygenation of blood. To supply the patients with adequate oxygen to maximize oxygen carrying capacity of blood.

To reduce effects of anoxaemia.

To maintain healthy level of tissue oxygenation.

To reduce work of breathing, maintain pao2 and/or reduce the workload on heart, keeping sa02> 90% during rest, sleep and exertion or pao2 > 60%.

Indications for oxygen therapy Cynosis

Breathlessness and laboured breathing

Environment low in oxygen content eg. High altitudes. Anaemia Diseases in the oxygen across the alveolar- capillary membranes. Eg. Pulmonary oedema. Patients whose respiratory capacity is diminished by some diseases. Eg. Pneumenectomy.

 Poisoning with chemical that alter tissue ability to utilize oxygen. Eg. Cyanide. shock and circulatory failure Hemorrhage and air hunger Patients under anesthesia patients who are critically ill

Patients with psychologically induced breathlessness. asphyxia

Types of oxygen therapy

Long term oxygen therapy:- ( > 15 hrs / day) to treat patient with severe hypoxaemia.

Short term oxygen therapy: ( 1 to 30 days) . It is used after discharge of the patient from the hospital in whom persists.

 The method selected depends on following factors:

Methods of oxygen administration

Fraction of inspired oxygen ( FIO2) require by the patient and delivered by device.

Mobility of patient
Humidification required

 O2 delivery system are classified as Low flow delivery devices High flow delivery devices Low flow delivery devices:- Low flow devices that deliver o2 concentration that vary with persons respiratory pattern. Eg. Nasal cannula Nasal catheter Oxygen conserving cannula Transtracheal catheter Face tent

Oxygen by mask Simple face mask Partial rebreathing mask Non-rebreathing mask.

High flow delivery devices:- This device that delivers fixed concentration of o2 independent of patients patients respiratory pattern. Eg. Venturi mask Mechanical ventillators

OTHER METHODS OF O2 ADMINISTRATION ARE O2 cylinder Piped in o2

NASAL CANNULA

1. LOW FLOW DELIVERY DEVICES: o Nasal cannula:- A method by which oxygen is administered in low concentration through cannula 1.5 cm long which is a disposable plastic device with two protruding prongs for insertion into nostrils. Itr is the safe, simple, comfortable device. Purpose: o To relieve Dyspnea o To administer low conc. of oxygen( 4L/m) o To allow uninterrupted supply of oxygen.

 ARTICLES: 1. Oxygen supply with flowmeter 2. Humidifier with sterile distilled water. 3. Nasal cannula with connecting tubes.

4. Gauze pad
5. Tape

PROCEDURE: o Determine need for oxygen o Perform assessment of vitals, level of consciousness, lab values and record. o Assess risk factors of oxygen therapy in patients and environment such as patients with hypoxia drive, faulty electrical connections etc. o Explain procedure. o Post no smoking sign on patients door in view osf patient and visitors and explain them hazards of smoking when o2 is on flow.

o Wash hands
o Set up o2 equipment and humidifier. o Place tip of cannula to patients nares and adjust straps around ear. Elastic band may be fixed behind head or under chin Pad tubing with gauze pad over ear and inspect skin behind ear periodically for irritation/breakdown. Inspect patient and equipment frequently for flowrate, clinical condition, level of water in humidifier

 Ensure safety precautions are performed.

Wash hands
Document time, flow rate and observations made on patient Encourge patient to breath through his/her nose with mouse closed.

Remove and clean cannula with soap

2. Nasal catheter:

The nasal catheter is inserted into nostril reaching upto uvula and is held in place by adhesive tapes. Flow of 1-4 l/m is sufficient to maintain conc. Of 22-30% o2.

The catheter must be changed at least

3. Oxygen conserving cannula:Cannula has a built in reservoir that increases o2 conc delivered and allows patient to use lower flow.(usually 30-50%)

 It increases comfort, lower cost and can be increased with activities. It can deliver upto 8 l/min. of o2 Disadvantages: o Cannula can not be cleaned, manufacturer recommends changing cannula every week. o It requires evaluation with ABGS and pulseoximetry to determine correct flow for patient.

TRANSTRACHEAL CATHETER

4. Transtracheal catheter:o It is method of oxygen delivery in which a small intravenous size catheter is inserted directly into trachea through surgical tract in lower neck. Oxygen is delivered directly into trachea. o It is used for clients with chronic lung diseases. Advantages:o Continuous oxygen administration o Less expensive because no loss of o2 to atmosphere. o Less nasal irritation o Since oxygen reaches trachea directly, client achieve adequate oxygenation at lower flow rate.

Steps of using transtracheal oxygenation: o Assess client and family to determine whether they can effectively and safely use transtracheal oxygenation.

o Surgical insertion of stent (stoma type access route) directly into trachea.
o Initiation of oxygen stoma. o On healing of stoma, teach client to remove and irrigate catheter at least three times a day with normal saline, to maintain patency of catheter. o Final oxygen flow rate usually less than 4 l/min is delivered through an 8 fr. Catheter.

FACE

TENT

5. Face tent: o Tent is ideal for providing moderate to high density aerosol. o Open plastic mask fits under chin. o O2 conc administered varies with o2 flow rate. o Temp of aerosol must be checked to maintain at or near body. 6. Oxygen tent:o Oxygen tent consist of canopy over patients bed that may cover patient partially or fully and connected to oxygen supply.

Articles : Oxygen tent with tubing Flow regulator Oxygen analyzer Oxygen source Humidifier Sterile distilled water Bath blankets -2 Ice Procedure: Explain procedure Assemble all equipments Wash your hands Use bath blankets to cover plastic mattress. Place second bath blanket over bottom sheet

 Prepare tent and position over bed. Attach to oxygen source. Fill ice trough or start refrigeration component. Fill nebulizer or humidifier upto recommended level. Use oxygen analyzer at least every 4 hrs.

Secure tent between folded top sheet and under matress. Wash hands
Assess client and monitor equipment at frequent intervals.

 While performing hygienic care or other procedures, loosened edge of tent and secure tent with bath blankets under client chin.
Record type of therapy and clients response Advantages: o It provides environment for the patient with controlled oxygen conc, temp regulation and humidity control.

o It allows freedom for free movt in bed.

Disadvantages: o Creates feeling of isolation o o Requires high vol of oxygen( 10 to12 l/min) Loss of desired conc of o2 occurs each time due to opening of tent frequently.

 Requires much time and efforts to clean and maintain tent. 7. Tracheostomy collar: o Collar can deliver high humidity and o2 via tracheostomy o Collar attaches to neck with elastic strap and should be removed and cleaned at least q4 hr to prevent aspiration of fluid and infection. Disadvantages: o Condensed fluid in tubing may drain into tracheostomy

o Water traps are usually puts in.

o Secretions collect inside collar and around tracheostomy. o Due to ill fitting of collar o2 conc may loss into atmosphere.

8.Oxygen by mask: o Simple face mask o Partial rebreathing mask o Nonrebreathing mask 1. Simple face mask o Used for short oxygen therapy and Fits loosely. o Delivers o2 conc from 30-60% with flow rate of 6-12 l/min

2. Partial rebreathing mask: o Light weight and easy to use

o Advantageous for client who are unable to breath through nose eg. those needs higher conc of o2(70%) o Useful for short term therapy.

NONREBREATHING MASK

 Nonrebreathing mask:

o Maintain high conc. Of o2 supply in reservoir (80-90%) with flow rate of 10 l/min

o O2 flows into bag and mask during inhalation. Valve prevents expired air from flowing back into bag.

o Frequent inspection of bag is needed to make sure that bag is inflated. If it is deflated, this can cause breathing in of exhaled co2.

VENTURI MASK

High flow delivery devices: 1.Venturi mask:

Lightweight plastic, cone shaped device fitted to face.

O2 is delivered to small jet in center of wide based cone Air is pulled through in cone as o2 flows through small jet. Mask has large vent through which exhaled air can escape.

 Deliver oxygen conc of 24%,28%, 30%,35%,40%,55% with o2 flow rate of 2,3 4, 6, 8,14 l/min 2.Mechanical ventillators

Other methds1. o2 cylinder

Fitments of oxygen cylinder: Rubber tubing connections to patients Flowmeter Fine adjustment valve Pressure gauge On and off metallic key

Care of oxygen cylinder

o Always use the cylinder with metal case o Oxygen cylinder should be placed at the head end of the bed , away from the traffic areas o Any source of fire should be kept away from the cylinder o It should be stored in cool temp. away from the heaters

o The supply of the oxygen must always be equipped with regulator to control the flow of gas and prevent the wastage

o Warning signs ( no smoking sign ) should be placed at unit where oxygen is on. o When the cylinders are empty , always mark it empty and send for filling o Inspect apparatus at frequent interval for the good working condition o The nurse should learn working of cylinder, its regulator before handling the equipment. The cylinder is open by turning the large valve with anti-clockwise direction . o To test any leakage in regulator, soap lather may be used.

2.Piped in oxygen

o It is supplied from wall outlets at bedside ( wall system). o It is usually stored under low pressure about 50 to 60 lbs/ sq. inch.

Hazards of oxygen therapy

1. Infection 2. Combustion(fire)

3. Drying of mucus membrane of respiratory tract

4. Oxygen toxicity 5. Atelectasis 6. Oxygen induced apnea 7. Retrolental fibroplasia

8. Asphyxia
9. Co2 narcosis

Nurse responsibility
o Check the name , bed no and other identification of patient .

o Check diagnosis and need for oxygen therapy.

o Check doctors order for specific precaution regarding movements and positioning of patient. o Explain procedure and its purpose.

o Assess patient for any signs of clinical anoxia eg. Cynosis.

o Assess patients vitals, breathing patterns carefully before starting therapy and thereafter frequently.

o Check results of arterial blood gas analysis.

o Check patients mental state and ability to follow instructions.

o Check articles available in unit.

Home oxygen therapy

It is made available to clients who require continuous oxygen therapy at home. It is usually delivered by nasal cannula.

Home o2 systems are usually rented from a company that sends respiratory therapist to patients home.

classification
a. Liquid oxygen- supply o2 7-10days at 2 l/min continuously. b. Compressed o2 cylinders. c. Concentrator or extractor:- as o2 supply is made from room air, they never need to be filled. d. O2 conserving or pulse devices: o o o o It delivers pulse of o2 only during inhalation to conserve o2. It supply o2, upto 20 hr Usually best for low activity levels. System may clip on, or be contained in backpack or shoulder bag.

Patient Education
1. The therapist and home nurse should teach patient and family how to use o2 system, how to care for it, how to recognize when supply is runing slow and needs to be recorded. 2. Explain procedure step by step to patient 3. Educate client to ensure that straps of mask/canuula should not be too tight. 4. Educate to remove 2-3 times/day to wash and dry skin where straps touch skin, massage skin. 5. Educate client about to pad any pressure points.

6. Educate the client to assess oral and nasal membrane 2-3 times/day. 7. Educate the client to use water based gel to lips and nasal mucosa. 8. Educate client about frequent oral hygiene.

9. Educate to change disposable equipment frequently.

10. Educate client to remove secretions that are cough out. 11.Educate client about risk of fire injuries, smoking. advice client not to use open flames, portable radios.

THANK YOU