Part 4: oxygen therapy and potential complications

Oxygen Delivery Devices

Introduction

  • Supplemental oxygen is essential for clients with cardiopulmonary issues to achieve a fraction of inspired oxygen greater than 21% (the oxygen level in room air).

  • Used primarily to treat hypoxemia.

  • Oxygen is a medication and requires prescription by a healthcare provider.

  • Can decrease the work of breathing and increase oxygen availability to alveoli.

Oxygen Saturations

  • Healthy individuals: maintain saturation between 95-100%.

  • Clients with illnesses: maintain saturation between 88-92%.

  • Pediatric considerations: WHO recommends SpO2 of 90% for children with respiratory distress. AHA guidelines suggest SpO2 between 94-99% for pediatric patients.

Delivery Methods

  • Nasal Cannula

    • Preferred method for most clients; less intrusive.

    • Delivers 1-6 L/min (24%-44% oxygen).

    • Can lead to skin breakdown due to drying of mucous membranes; humidified oxygen can alleviate this.

    • Pediatric: High-flow nasal cannula effective for infants with moderate to severe bronchiolitis.

  • Simple Face Mask

    • Inexpensive, works for mouth breathers.

    • Can cause claustrophobia; contraindicated for CO2 retention.

    • Delivers 5-10 L/min (35%-60% oxygen).

  • Partial Rebreather Mask

    • Higher flow rate (10-15 L/min) delivering 60%-90% oxygen.

    • Requires an inflated reservoir bag to prevent CO2 retention.

  • Non-Rebreather Mask

    • Similar to the partial rebreather but prevents exhaled gases from returning.

    • Delivers 80%-95% oxygen at 10-15 L/min.

    • Not suitable for long-term use with COPD clients.

  • Venturi Mask

    • Delivers precise oxygen concentrations (24%-60%) using flow rates of 4-15 L/min.

    • Features interchangeable Venturi barrels for varying oxygen delivery.

  • Aerosol Mask

    • Administers nebulized solutions for inhalation, suitable for breathing treatments.

    • Recommended face mask for children under 5; older children can use mouthpieces.

  • Positive Airway Pressure Treatments

    • CPAP: Delivers constant airflow to keep airways open, used for obstructive sleep apnea (OSA).

    • BiPAP: Provides different pressures during inhalation and exhalation; beneficial for clients with airway collapse, COPD, or heart failure.

Complications of Oxygen Therapy

  • Oxygen toxicity can occur from high concentrations leading to cellular damage.

  • Acute toxicity affects the CNS, causing symptoms such as muscle twitching and convulsions. Chronic toxicity may lead to pulmonary issues like atelectasis.

  • Managing oxygen toxicity includes reducing exposure and using the lowest effective concentrations.

Safety Considerations for Home Oxygen Use

  • Oxygen is combustible; safety guidelines are crucial:

    • Keep away from flames, avoid smoking, and keep flammable products away.

    • Use cotton bedding; secure oxygen cylinders to prevent falling.

    • Maintain safe distances for oxygen concentrators.

    • Have a fire extinguisher and smoke alarms.

Preparing and Using Oxygen Cylinders

  • Ensure flow regulator is set to zero.

  • Tighten the T-handle and use a wrench to open the cylinder counterclockwise.

  • Check the pressure gauge (around 2,000 PSI when full).

  • Attach tubing to the regulator's nipple adapter; adjust flow as prescribed.