Nitrous Oxide / Oxygen Administration

Flow safe:

Unit should be unable to deliver more than 70%N2O/30% O2.

Test by turning the nitrous up beyond the 70% level

(until will sound or some other way let you know it will not work).

Fail safe:

Unit should be unable to deliver N2O if O2 has depleted or there was a malfunction with the O2.

Test this by disconnecting the O2 or closing the O2 valve.

Color coding: Blue tanks

N20

Blue = sky

high in the sky = high on nitrous oxide lol

Color coding: Green Tanks (fluted)

O2

Green = Good

Oxygen = good

Pin index:

N2O compressed gas cylinder pins will not

connect to the O2 adapter and visa-versa

Pins are different shapes and color coded cords

Diameter index:

Diameter of the N2O couplings is

larger than O2 preventing them from being connected

improperly.

You should turn the unit on and begin the flow of _________________% of

oxygen. You may now seat the nasal hood and adjust it until it is comfortable to

the patient.

100

Adequate flow will result in the reservoir bag filling

_______________________.

1//2 way full

Too little gas flow will result in the reservoir bag

__________________________.

collapsing

Too much gas flow will result in the reservoir bag

_________________________.

overinflated

Average flow rate for adults =

5-6 Liters/minute

Average flow rate for children =

4-5 liters /min

Once flow rate is determined, begin titrating the N2O/O2.

o Initial concentration should be _____%N2O and ____%O2 for ________

minutes.

20% N2O

80% O2

3 minutes

Following initial time period, patient should be asked how they are feeling

o Avoid ______________________ types of questions

leading

ex: are u feeling lightheaded

just ask them how they're feeling don't ask if they're feeling a certain way

If the provider determines they should receive more N2O/O2, incriments of _______% every _______ minutes should be added until adequate sedation is

achieved.

10%

3 minutes

A concentration of N2O/O2 may not exceed _____%N2O and ____%O2.

70 % N2O

30 % O2

At the completion of the procedure, provider should administer _____%O2 for a duration of ____ minutes prior to removing the nasal hood.

100 % O2

5 minutes

Confirm the presence of the ______ inside the scavenger

nasal hood

"wafer"

As you are setting up the unit, be sure to inspect your _____ for holes, tears, or cracks.

tubing

You should set up your unit prior or during to bringing your pt back.

prior

anxiolytic

decrease anxiety

analgesic

decreases perception of pain

is nitrous oxide safe for pregnant patients?

NO during FIRST trimester

it is debatable during under trimesters

is used in labor and delivery

crosses placenta without apparent effect to baby

is nitrous oxide safe for pts with COPD, emphysema, or cystic fibrosis?

No

pulmonary diseases require extreme caution and Nitrous should be avoided

demand flow units

does not deliver gas continuously

no longer recommended due to inconsistent flows

continuous flow units

gas continues to flow even when pt is EXHALING

we use a portable system continuous

manifold (central systems)

connects multiple cylinders which can allow for cylinders to be automatically switched when empty

yokes (portable system)

connects cylinder with unit

regulator

valves for controlling gas flow

decrease from high pressure to safe pressure for pt and flowmeter

flowmeters

measure gas being delivered

reservoir bag

used to supply additional gas when pt takes an excessively deep breath and to evaluate respiration

conducting tubing

connects unit to breathing apparatus

T/F

the scavenging nasal hood is the standard of care

True

acute complications in patients - oversedation

mouth closing, breathing

dysphoria

sluggish response

incoherence

laughing, crying

spastic movements

how to observe for sedation for nitrous

visibly sedated into chair

hands relaxed

legs uncrossed

eyes not following all movement in room

listen to words and also how they respond

how to observe for over sedation

closed eyes

slow verbal responses

can't keep mouth open

hard to engage in conversation

acute complications in patients - nausea and vomiting

very rare

increased by higher concentration of N2O

chair movement during sedation

frequent changes in concentration of N2O

very full stomach

pt predisposition to nausea

external suggestion

chronic exposure to N2O symptoms

bone marrow depression secondary to abusive exposure

sensory depression from peripheral neuropathy

possible increase in spontaneous abortion rate

N2O abuse complications

hypoxia

asphyxiation

unconsciousness, vomiting, aspiration

death

peripheral neuropathy

bone marrow suppression