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As a Respiratory Therapist, it’s important to know how to evaluate, recommend, and administer the appropriate oxygen therapy for your patients.

So let’s discuss how we can do just that in this article. Here’s a tidbit of knowledge that we all seem to forget far too often:

Oxygen is a drug, so we must treat it as such.

Oxygen is a prescribed drug that Respiratory Therapists commonly administered to patients requiring emergency life support, pulmonary disability, and post-operative states that have or may develop cardiopulmonary complications. The administration of oxygen and other medical gases is one of the main job duties of a Respiratory Therapist.

This is why it’s so important to understand the goals, indications, contraindications, and hazards of oxygen therapy. The Respiratory Therapist must be able to evaluate, recommend, and administer all medical gas modalities appropriately, as well as recognize adverse reactions of the therapy. 

Here are some of the necessary skills that are required in order to aminister oxygen therapy:

  • Be able to follow the direct orders written by the physician. 
  • Be able to use an oxygen analyzer.
  • Be able to use a pulse oximeter.
  • Be able to use an oxygen cylinder with a regulator.
  • Be able to recommend the appropriate oxygen therapy after assessing the patient.
  • Be able to implement an oxygen therapy regimen in the patient’s treatment plan.

Oxygen Therapy Procedure:

1. Verify the physician’s orders. First and foremost, you always want to review and evaluate the orders that were written by the doctor, so that you can fulfill them appropriately in order to give the right care to the right patient.

2. Examine the patient’s chart. You want to do this so that you can review any relevant notes or data. For example, you may review the following in the patient’s chart: their diagnosis, medications, therapies, radiographs, laboratory results, hemodynamic, electrocardiograms, sleep lab reports.

3. Gather and prepare all needed equipment. In this step, you may need to wash your hands and disinfect any equipment if needed. Assemble any equipment appropriately to verify that it is functioning properly. This includes troubleshooting the equipment if necessary. 

4. Explain the procedure to the patient. Use two patient identifiers to confirm the identity of the patient and introduce yourself and be sure to state that you are with the respiratory therapy department. Explain the purpose and objective of the procedure and be sure that the patient understands you. 

5. Assess the patient and implement the therapy. Make sure to position the patient properly. Fully assess the patient which includes obtaining their vital signs, breath sounds, oxygen saturation, and ventilatory status. 

Attach the oxygen device to the patient and use the appropriate humidification if needed. Adjust the flow meter to the order or necessary liter flow to deliver the appropriate amount of oxygen to the patient. Make sure to position the interface so that it is comfortably placed on the patient’s face. Verify that it is comfortable for the patient. 

6. Assess the effectiveness of the therapy and make any needed adjustments. This may require you to re-check the patient’s vital signs. Say, for instance, you place the patient on 2 liters binasal cannula, but their oxygen saturation is still hovering around 87%. In this case, you would need to increase the liter flow in order to elevate the patient’s oxygen saturation back into the normal range.

7. Follow-up. This is where you ensure the patient’s comfort and safety, as well as noting that the oxygen therapy is working effectively. You will need to perform proper hand-washing and dispose of any infectious wastes or materials. Proceed to document all of the important and pertinent information in the patient’s chart. 

Also, if the treatment type is not a continuous modality, now is the time for you to remove or disconnect any equipment. However, if it is a continuous modality (like a nasal cannula) then you can leave it as-is and monitor the stability of the oxygenation parameters. 

Other Skills that a Respiratory Therapist must know for Oxygen Therapy:

  • You must know how to identify the contents of medical gas cylinders and identify the markings on the cylinders as defined by the department of transportation. Know how to store and transport the cylinders safely. 
  • Know the difference between the American Standard Safety System (ASSS), the Diameter Index Safety System (DISS), and the Pin Index Safety System (PISS). 
  • Be able to describe the two main types of valves found on “E” and “H” cylinders and their functions.

  • Know the components of a bulk liquid system and a reserve system. Understand the characteristics of a small and large liquid oxygen reservoir and the advantages and disadvantages of each.
  • Know how to operate and troubleshoot an air compressor. 
  • Know and understand the components of regulators, bourdon gages, and Thorpe tubes. This includes knowing the difference between a pressure-compensated and non-pressure compensated flowmeter.
  • Know how to set up and operate an oxygen blender.
  • Know how to locate and identify zone valves in your healthcare facility in case of an emergency. Also just know and understand the purpose of zone valves.
  • Know how to use the wall outlet quick-connect system.  

Oxygen Therapy Administration:

In order to know how to administer oxygen therapy properly, the Respiratory Therapist must know how to do the following:

  • Know how to identify and assemble various oxygen delivery devices. This includes nasal cannulas, high-flow nasal cannulas, simple masks, partial re-breathing masks, non-re-breathing masks, high-flow non-re-breathing masks, and Venturi masks.

  • Know the difference between and be able to classify each oxygen delivery device as either low-flow or high-flow. 
  • Be able to estimate the FIO2 for an oxygen delivery device, given the operating flow rate.
  • Be able to select the appropriate oxygen device different patient scenarios.
  • You may be required to calculate inspiratory flow demands and total flows delivered for a given FIO, using air-to-oxygen ratios.

  • Perform a post-assessment on the patient in order to determine how well the responded to the therapy.

  • Be able to identify and troubleshoot any problems with the oxygen devices. 

Final Thoughts

So there you have it. Now, as a Respiratory Therapist (or student), you now know how to properly select and administer the appropriate oxygen therapy for any given patient. You can use the information and steps listed out here in the article the next time you get ready to assess and start your patient on some oxygen therapy.