What is the goal of oxygen therapy?To maintain adequate tissue oxygenation while minimizing cardiopulmonary work.
What are the objectives of oxygen therapy?To treat hypoxemia. To decrease symptoms of hypoxemia To decrease cardiopulmonary workload.
How do you assess need of oxygen therapy?Assess ABG Assess underlying problem or condition. (history) Physical Assessment
It is important to beware of conflicting information. You must always…Treat the patient and not the numbers
What are the hazards of oxygen therapy?oxygen toxicity Depression of ventilatory drive absorption atelectasis Bronchopulmonary dysplasia retrolental fibroplasia
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.
What are two factors that contribute to oxygen toxicity?Fi02 and exposure time
What does oxygen toxicity primarily affect?The lungs and CNS CNS- tremors, twitching, convulsions PNS- Pneumonia, Pulmonary fibrosis
What is absorption atelectasis?Nitrogen washout, damage to type II pneumocytes
What is Bronchopulmonary dysplasia?(BPD) is found in premature babies
What is retrolental fibroplasia?scar tissue in the eyes
What is considered a high oxygen concentration?A concentration greater than 60%.
What are the two oxygen delivery systems?Low Flow Systems High Flow Systems
Low flow systemshave variable FI02 Does not meet the patients flow rate demand FI02 is just an estimate
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
High flow systemsFixed FI02 Meets patient’s flow rate demand
High Flow system examplesAir entrainment mas i.e. Venturi Mask Air Entrainment Nebulizer
What’s special about the nasal cannula?It’s the most commonly used oxygen therapy device
The nasal cannula handles flow ratesup to 6 Liters/Minute (adult)
Estimating Fi02 with nasal cannula1 L/minute=24% Fi02 Each additional liter increases Fi02 4%
In nasal cannulas can you use a bubble humidifier?Yes, at flow rates set at 4 L/min and greater
Are pediatric and infant sizes available in the nasal cannula?yes
What’s a special nasal cannula?Reservoir cannulas (conserving devices) They suppliment the fi02 and are rarely seen
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.
Nasal cannulas replaced what device?Nasal catheters
Nasal catheters can handle flow rates up to?6L/Minute
Estimating percentage of nasal cannulas1 L/minute=24% fio2 Each additional liter increases Fi02 4%
The bubble humidifiers are used for flow ratesSet at 4L/min and greater
Are there pediatric and infant sizes available for nasal catheters?Yes
Transtracheal oxygen isinconspicuous/ Rare Is designed for long term oxygen therapy. Commonly used with a bubble humidifier.
Why is the transtracheal oxygen more efficient than a nasal cannula?Oxygen delivery directly to the trachea.
What happens to flow rates?They can be reduced by 50%
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
The simple mask isMore commonly used by EMT’s
What are the flow rate requirements?6-10 liters per minute
What fi02 values can the simple mask achieve35%-50%
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
Are there pediatric sizes available for the simple mask?Yes
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.
What are the two types of rebreathing masks?Non-Rebreathing/Partial rebreathing mask
What does the non-rebreathing mask have?2 check valves
What are the flow rate requirements for the non-rebreathing mask?Enough to keep the bag inflated
What fi02 values can be achieved with the non-rebreathing mask?60-80%
Can a bubble humidifier be used with both rebreathing masks??yes
Are pediatric sizes available?yes
What is the flow rate requirement for partial-rebreathing masks?enough to keep the bag inflated
What fi02 values can the partial rebreather mask achieve?40-60%
Are pediatric sized available in the partial-rebreathing mask?yes
Does the partial rebreathing mask have check valves?no
What are factors that alter the performance of low flow systems and increase the Fi02Higher oxygen input Mouth-closed breathing Low inspiratory flow low tidal volume slow respiratory rate
What are factors that affect performance of low flow systems and decrease fi02Lower oxygen input mouth-open breathing high inspiratory flows High tidal volume fast respiratory rate
The air entrainment is a high flow device. It is also known asVenti mask, Venturi mask
The Fi02 depends on?The size of entrainment port Velocity of the gas
A blocked entrainment port on the venti mask willincrease the Fi02
What are the Fi02 ranges for the venti mask?24%-60%
It might be difficult to provide fixed fi02 at highFi02 setting
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
Are pediatric venti masks available?yes
The jet orifice on the venti mask changes what 2 things?Fi02 and Flow
If bed sheets cover the Venti Mask what happens?The fi02 increases and the flow decreases
The air entrainment nebulizer is…The large volume jet nebulizer
Fi02 and flow rate requirements on the air entrainment nebulizer depend on what?The size of the air entrainment port
If the entrainment port becomes blocked or water condenses in the tubing what will happen with the air entrainment nebulizer?The fi02 will increase
What are the fi02 ranges for the air entrainment nebulizer?28%-98%
The air entrainment nebulizer can provide 21% by attaching what to the flow meter?air
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
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.
What are some disadvantages of oxygen masks?Claustrophobia Muffled Speech Difficulty eating and drinking Blocks vomitus in unconscious patient Potential suffocation hazard
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.
How do you troubleshoot patient constantly removing mas?Try to find a comfortable option if possible.
How do you troubleshoot the resivoir bag collapsing during inhalation?Increase the flow of oxygen
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
How do you handle a patient that develops sores or irritation over face and ears?Use rubber cushions
How do you troubleshoot the humidifier pop-off sounding?Look for obstruction, kinking, flow may be too high
How do you troubleshoot no humidity/aerosol coming from the system?Check the water level Look for faulty equipment.
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)
Oxygen blendersReplace manual titration of fi02 using an oxygen and airflow meter.
How are oxygen blenders powered?Pneumatically
Oxygen blenders canachieve any fi02
What does the oxygen blender contain?A proportioning module for blending oxygen and air.
The oxygen blender has one alarm. What does it do?Notify in case of loss of gas supply
Other things for oxygen blendersIt’s accurate and precises Requires 50 PSI source Flow meter attachments are available
What are the two most common analyzers used in respiratory care?Electrochemical Galvonic fuel cell
ElectrochemicalPolarographic (Clark)electrode Commonly used in ABG machines and transcutaneous monitors Requires a battery for power
The electrochemical, polarographic clark electrodehas a 10-30 second response time,
The galvonic fuel cellIs commonly used in ventilators and hand held analyzers
The galvonic fuel cell gets a result in60 seconds and needs no external power
The galvonic fuel cell will require calibration.It uses 21% or 100% calibration gases
The galvonic fuel cell may be one point or two point calibration.One point- Room Air Two Point- Room air and 100% Oxygen
Hyperbaric theraypInreases the pa02 wound healing around since the 1600’s Based on boyles law
Indications of hyperbaric therapyAir embolism C02 poisoning Wound Healing
Hazards of hyperbaric therapyTempanic Membrane rupture.
In O2 Therapy when do you apply ABG values?when a patient PaO2 is below 80mmHg (Adult) – unless COPD
In O2 Therapy when do you apply Visual/ Bedside signs1. Cyanosis 2. Tachycardia 3. Confusion 4. Anxiety 5. Low O2 Saturation (Pulse Oximetry needed) 6. Lethargic/ Sleepy
what is the appropriate Levels to administer O2 Therapy ?1.Adult= 30-60%(40-55% is better)-if pt. not COPD never start on <30% (40% is better). 2.Emergency-100% 3.COPD pts.=24-30%. 4.if a choice is given start with lower FIO2. O2 is a drug&should be kept @ lowest possible dose (if PaO2 =110mmHg, LOWER FIO2/PEEP
What is a Titration UP in O2 Thearpy?1.Increases FIO2 (if Hypoxic)-10% until @ 60% 2.Once @ 60% need to add PEEP(If on vent.)/CPAP/BIPAP. 3. Keep adding PEEP in 5cm H20 until a desire PaO2 is obtained/until you witness -ve cardiac response. 4.If PEEP @ its limit then increase FIO2 above 60%
What is Titration DOWN in O2 Therapy?1. If pt. on High FIO2(100%) & PEEP: Lower FIO2 first -below 60%. 2. Once below 60% : then begin lowering the PEEP.
What is the special consideration for COPD pts. With O2 Therapy?1. High PaO2 – causes Hypoventilation. 2. Decrease RR & Vt. 3. Lower O2 to treat. 4. Permit hypoxemia (PaO2-50-65 mmHg is ok) 5. It is described as stuporous (indicates excessive CO2).
what are the goals of O2 Therapy?1. Decrease WOB. 2. Resolve of decrease hypoxemia. 3. Decrease Cardiac work requirements.
What are the hazards of O2 Therapy?1. O2 toxicity. 2. Absorption atelectasis.
O2 hazards- O2 toxicity-1. when pts. FIO2 is >60% or more for more than 12hrs.
O2 hazards- what are the O2 toxicity signs?1. Tachypnea. 2. Refractory hypoxemia – a fix hypoxemia w/PEEP/CPAP not FIO2. 3. Decreases compliance – decreased surfactant in the lungs. 4. Pulmonary lungs and 5. Nausea.
O2 hazards- what is Absorption atelectasis?1. Caused by rapid changes in FIO2. 2. Alveoli collapse as a result of changing FIO2 too quickly. 3. Prevent by making small changes in FIO2(10%/less @ a time.)
What are the saftey consideration for O2 Hazards?1. No smoking. 2. Post O2 in use sign. 3. Instruct pt. and family members of the rules and dangers. 4. No electrical devices.
What are the O2 mixtures & therapies in O2 Therapy – HeliOx1. Used for Lower airway resistance. 2. He molecules are apart & easier to breath when comparing w/Nitrogen(N). 3. He replaces N but must be combined w/O2. 4.Decreases WOB. 5. Good for pts. w/upper airway obstruction & inflammation. 6.Given w/ a NBR mask
What are the O2 mixtures & therapies in O2 Therapy – Most common 3 mixtures?1. 80/20 – 80% He, 20% O2. 2. 70/30 3. 60/40.
What are the O2 mixtures & therapies in O2 Therapy – What are the correction factor?1.8 for 80/20, 1.6 for 70/30 mixture.
In O2 Therapy-Hyperbaric O2 therapy?1. Method of Increasing O2 tension through increasing barometric pressure (in a closed space) 2.Helpful in diseases that require more than 100% O2 @ normal atmospheric pressure can offer.
In What situations does Hyperbaric O2 therapy is used ?1. CO poisioning. 2. Decompression sickness. 3. Help wounds to heal more quickly. 4. Assist tissue grafts.