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Basic Respiratory Therapy Procedures And Lab > BRTP 05 Oxygen Therapy Equipment > Flashcards

BRTP 05 Oxygen Therapy Equipment Flashcards

1
Q

Nasal cannula

A

(LPM)- 1-6

(Oxygen %) 24-44%

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2
Q

Simple mask

A

(LPM) 5-10

(Oxygen %) 35-50%

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3
Q

Partial rebreathing mask

A

LPM 8 or greater

Oxygen %- up to 60%

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4
Q

Non rebreathing mask

A

LPM 8 or greater

Oxygen %- up to 70%

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5
Q

Air entrainment mask (Venturi mask)

A

LPM varies

% is constant 24, 28, 35, 50%

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6
Q

Oxyhood with heater humidifier

A

7 LPM or greater

21-100%

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7
Q

Briggs or T tube assembly

A

8-12 LPM (can go higher)

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8
Q

SaO2

A

% if hemoglobin saturated with oxygen

Mid 90s

96-99

Found in Blood test- very accurate

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9
Q

SpO2

A

Found with skin test- fairly accurate

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10
Q

Pulse oximetry

A

Composed of a photodetector sensor, a microprocessor, an infrared light emitter

Non invasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood (SpO2)

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11
Q

PaO2

A

80-100 mmHg

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12
Q

3 types of oxygen delivery systems

A

Low flow systems
High flow systems
Reservoir systems

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13
Q

Low flow devices

A

Provide supplemental O2 directly to the airway at a flow of 8 L/ min or less.

O2 provided by a low flow device is always diluted with room air. The result is a low and variable FiO2.

Example: 8 L of flow + 22 L of room air is 30 L of flow

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14
Q

Normal inspiratory flow rate

A

30-40 L

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15
Q

Low flow explanation

A

Low flow is a minor assistance/ the patient will breathe but low flow helps add more flow.

Example: nasal cannula

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16
Q

What factors determine FiO2 delivered by a low flow system?

A

Patients ventilatory pattern
The flow going to the device
The patients tidal volume

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17
Q

Low flow O2 delivery systems include

A

Nasal cannula, nasal catheters, simple mask, tracheostomy collar

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18
Q

What is the determinant if the adequacy of a low flow 02 delivery system?

A

Patient observation and ABG assessment

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19
Q

What is the most commonly used low flow O2 delivery device

A

Nasal cannula

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20
Q

When is a humidifier used with a nasal cannula?

A

When the patient complains of nasal irritation/ drying or if flow rate exceeds 3-4 L/ min

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21
Q

Nasal cannula flow

A 
1 L.  24% O2
2 L.   28% O2
3 L.   32%  O2
4 L.   36% O2
5 L.   40% O2
6 L.   44% O2
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22
Q

Desired FiO2 formula

A

Desired FiO2=(desired PaO2 x current FiO2)/ Current PaO2

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23
Q

Desired PaO2 for normal person

A

80

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24
Q

Diaries PaO2 for COPD

A

60

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25
Q

Simple mask

A

O2 delivered at no less than 5L/ min

5-10 L/ min

O2 35-50%

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26
Q

Simple mask description

A

Fits over the nose and mouth and allows atmospheric air to enter and exit through side ports

Allows for higher level of O2
Used on patients who breath through the mouth

Allows some CO2 to be re-inhaled

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27
Q

Partial rebreather mask description

A

Patient inhales O2 from both the O2 source and O2 contained in the reservoir bag along with atmospheric air. Inhales higher concentration of O2 than a simple mask

Used in emergencies and short term

Sources of O2 are tubing, reservoir and room air

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28
Q

Partial rebreather flow rates

A

Minimum of 8-10 L/ min to prevent reservoir bag from collapsing more than 1/2 way.

If reservoir bag collapses more than 1/2 way, increase flow.

O2 variable at approximately 60%

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29
Q

Non rebreather mask description

A

Look similar to partial rebreather except they have 2 valves attached to device

This mask provides more O2 without the patient breathing their own CO2.

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30
Q

Flow rates for no breather mask

A

Flow 8-10 L/ min to prevent bag from closing more than halfway. If bag collapses more than halfway increase flow.

O2 70%

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31
Q

When is partial rebreather used

A

In emergencies, short-term therapy requiring MODERATE TO HIGH FiO2

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32
Q

When non rebreather is used and what affects performance

A

Emergencies, short term therapy requiring high FiO2

Affecting performance: liter flow into mask, size of reservoir bag, the fit of the mask

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33
Q

Nasal cannula flow

A

1-6 LPM

24-44% FiO2

add 4 for every liter

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34
Q

Simple mask flow

A

5-10 LPM

35-50%

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35
Q

Trach mask

A

8-12 LPM

FiO2 varies

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36
Q

Partial rebreather

A

8 or greater LPM

up to 60%

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37
Q

Non rebreather

A

8 or greater

Up to 70%

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38
Q

Dead space (VD)

A

Volume of gas that does not participate in diffusion across the alveolar capillary membrane

Air no blood flow

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39
Q

4 types of dead space

A
  1. Anatomical (normal)
  2. Alveolar
  3. Physiological
  4. Mechanical
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40
Q

Anatomical dead space

A

Dead space in airways that does not participate in gas exchange. (Also known as normal)

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41
Q

Alveolar dead space

A

Volume of gas ventilating unperfused alveoli

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42
Q

Physiological dead space

A

a combination of anatomical and alveolar dead space

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43
Q

Mechanical

A

Volume of expired air that is rebreathed through connecting apparatus or tubing

Rebreathing your own CO2

This will be with machine assistance (anything outside the body)

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44
Q

High flow O2 systems facts

A

Supplies a given O2 concentration at flow rates equaling or exceeding a patients peak Inspiratory flow (meets patients needs)

No room air will be used with high flow systems

This will have fixed and precise settings.

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45
Q

What kind of patient is high flow good for?

A

Good for patients with “marked” variation in minute ventilation

Marked means significant

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46
Q

Types of high flow?

A

Air entrainment masks (AEM) aka Venturi mask / or blending system

Both systems ensure a fixed or precise FiO2

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47
Q

How does a Venturi mask work

A

Mixes O2 and atmospheric air with color coded adapters that are regulated by a dial system allow specific amounts of room air to mix with O2z

EXACT AMOUNT OF O2 prescribed

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48
Q

Flow rates for Venturi mask (AEM)

A

Flow rates set to a varying range for constant O2 %: 24-50% (sometimes higher). (24,28,35,50)

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49
Q

What patient is a Venturi mask best for?

A

COPD Patients

Most appropriate O2 device for chronic CO2 patients in mild to moderate respiratory distress.

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50
Q

Bernoullis principle

A

As O2 from the outlet port is driven through the small jet hole, it’s velocity increases, the pressure around it drops and it entrains(draws in) air through the holes in the body of the device

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51
Q

Calculating total flow for high flow devices

A

Use tic tac toe
100 on top
20 on bottom
Given Fi02 in middle
Take the differences of 100 and 20 from the middle number
Have a fraction
Add numerator and denominator of fraction
Multiple product by initial prescribed flow

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52
Q

What would happen if the entrainment port was cover of occluded?

A

Flow goes down, O2 goes up

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53
Q

Something to remember about high flow

A

Increasing flow will never affect or create an increase in O2 concentration

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54
Q

CPAP (continuous positive airway pressure) devices

A

When a patient has a decreased functional residual capacity (FRC)
-sleep apnea, COPD, cardiogenix pulmonary edema. Immunosuppressed patients with pulmonary infiltrates, and hypoxia or atelectasis.

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55
Q

In order to use CPAP a patient needs to show what

A

That they can ventilate on their own.

CPAP Only helps with oxygenation, not ventilation

56
Q

Advantages of CPAP?

A

Increases FRC (function residual capacity)

Increases lung compliance 
Can open collapsed alveoli
Improve distribution of breath
High total flows and FiO2
Increase removal of secretions
57
Q

Disadvantages of CPAP

A

First 3 most important

  1. Barotrauma (excessive amounts of pressure)
  2. Gastric insufflation (stomach filled with air)
  3. Decreased venous return to the heart

Vomiting on aspiration
Requires adequate ventilation from patient

58
Q

What kind of device does CPAP fall under

A

High flow O2 device

59
Q

Aerosol delivery devices

A 
Face shield
Tracheostomy collar
Aerosol mask 
Briggs or T tube assembly
Oxyhood
60
Q

Face shield (tent) description

A

Open on top, fits around lower face, used to avoid claustrophobia

Used for patients with facial trauma, facial/ nasal surgery or facial burns

If used with humidifier it will be COOL mist

61
Q

Disadvantage of face shield (tent)

A

O2 can actually be inconsistent due to wide opening, may need tandem devices (2 nebulizers) to increase total flow

62
Q

Tracheostomy collar

A

O2 deliver near artificial opening in neck (blow by or flow by O2)

Provides oxygenation and humidification because it bypasses the nose( the bodies nature humidifier)

Warm aerosol used.

63
Q

Aerosol mask

A

Looks similar to simple mask but has larger holes in mask.

Heated or cooled, usually heated.

Used after surgery to help with swelling of throat or to administer drugs

Needs enough flow to flush out CO2

64
Q

Briggs or T-Tube

A

Flow rates of 8-15 L/ min

“50 ml reservoir tubing to maintain FiO2”

“Adequate flow is demonstrated by visible mist”

65
Q

Disadvantages of Briggs or t-tube assembly

A

Moisture accumulates, could go down patients lung

Weight of t tube could yank on trach and cause irritation and coughing

Maybe need double the devices to keep up flow

If reservoir detaches, the amount of inspired O2 will decrease

66
Q

When you don’t know someone’s inspiratory flow rate what do you set it at?

A

60 will meet or exceed needs

67
Q

Oxyhood

A

Usually set up with a heated humidifier for perspire infants, not a nebulizer

“Delivers precise amount of oxygen that is heated and humidified”

7 lpm or greater -21-100%

68
Q

Oxygen (croup) tent

A

Large tent like device used to deliver high levels of oxygen to a bedridden patient requiring a cool environment.

Tent will cover entire head.

Recommended flow rate of 12-15 L/min to flush exhaled CO2 from the enclosure.

VARIABLE oxygen from 21-40%, up to 50%.

69
Q

Incubator

A

Keeps babies heated, stable, and can add oxygen but it will be separate from incubator.

For infants in stable condition

premature infants/ infants use these.

NICU can add O2 if needed but will be from separate device.

70
Q

Humidified High Flow Nasal Cannula (HFNC)

A

An oxygen delivery system which blends oxygen/ air from 21-100%.

Can be administered via wide bore nasal cannula or trach adapter from 1 Lpm to 60 Lpm.

Provides humidity enriched oxygen therapy for patients in mild to moderate respiratory distress.

Doesn’t augment tidal volume nor does it facilitate CO2 removal.

71
Q

5 Key benefits to Humidified high flow nasal cannula (HFNC)

A
  1. Delivers a high FiO2 accurately
  2. Meets the patients ventilatory demands (inspiratory flow rate)
  3. Provides patient comfort and decreases work of breathing.
  4. May provide positive airway pressure.
  5. Optimizes mucociliary clearance.
72
Q

Humidified HFNC benefits

A

Flow rate that exceeds patients inspiratory flow rate at various minute ventilation.

Can be used as a bridge from a more invasive O2 device to a noninvasive O2 device

73
Q

Types of HFNC systems

A

Optiflow
Airvo 2
Vapotherm
Comfort flow

74
Q

Optiflow and Airvo System

A

Flow rate ranges from 1 L/min to 60 L/min
Oxygen deliverey 21-100%
Delivered via nasal cannula or trach adaptor
4 cannula sizes

75
Q

Vapotherm

A

Flow rates 1 L/min to 40 L/min
O2 delivery 21-100%
Delivery only by nasal cannula
7 different sizes

CAN BE USED FOR IN HOSPITAL TRANSIT

REMEMBER THIS SYSTEM HAS LESS FLOW CAPPING AT 40 L/MIN

76
Q

Comfort flow

A 
Flow rates 1 L/min to 60 L/min
O2 delivery 21-100%
Heated/humidified using conchatherm or conchasmart tech
Delivered via nasal cannula
4 different sizes
77
Q

How should you wean from HFNC?

A

It is recommended that oxygen be weaned to 30% as tolerated, THEN begin to decrease the flow.

Adult- 10 L/min then change to conventional cannula
Pediatric- 6 L/min then change to conventional cannula
Neonate- 2 L/min then change to conventional cannula

78
Q

Oxygen toxicity

A

Lung damage that develops when O2 concentrations of more than 50% are administered for longer than 48-72 hours.

TWO PRIMARY FACTORS DETERMINE THE HARMFUL EFFECTS OF O2 TOXICITY

  1. FiO2
  2. EXPOSURE TIME
79
Q

COPD AND HYPOXIC DRIVE

A

Normal PaO2 for COPD patient is 60 mmHg

Raising PaO2 above 70 mmHg with supplemental O2 may “knock out” the COPD patients hypoxic drive and cause hypoventilation. (PATIENT WILL BECOME DROWSY OR SOMNOLENT)

80
Q

What devices and FiO2 do you want to stick to for COPD patients?

A

We want O2 devices that are low in FiO2 less than 30% FiO2

We want low flow nasal cannulas and venturi masks

1-2 lpm nasal cannulas

24-28% AEM (venturi mask)

81
Q

With what exception would you give a COPD patient high FiO2?

A

One exception is during resuscitation (CPR)

Use 100% FiO2

82
Q

With what exception would you give a COPD patient high FiO2?

A

One exception is during resuscitation (CPR)

Use 100% FiO2

83
Q

With what exception would you give a COPD patient high FiO2

A

One exception is during resuscitation (CPR)

Use 100% FiO2

84
Q

Pulse Oximetry

A

Oximetry utilizes a probe that transmits two wavelengths of light, red and infrared, from a light emitting diode to a photo detector through a capillary bed.

Capillary beds commonly utilized are those found in the finger, toe, or earlobe

Red light associated with deoxygenated

Infrared is associated with oxygenated

85
Q

What oxygen saturations are pulse oximeters accurate for?

A

Accurate for oxygen saturations higher than 80%.

lower than 80% indicates its not accurate

86
Q

What is the minimum value acceptable for O2 saturation?

A

90%

87
Q

What does an oxygen saturation less than 90% warrant?

A

Warrants an increase in delivered oxygen percent to the patient and a physician should be contacted.

88
Q

What is SaO2?

A

The amount of oxygen bound to hemoglobin

Found with an ABG

89
Q

What is SpO2?

A

Oxygen saturation measured by a pulse

The % of Hb that is fully saturated

90
Q

PaO2

A

Amount of oxygen dissolved in the blood plasma

Found with ABG

91
Q

With normal pH and temp, This O2 correlates to PaO2 via ABG analysis

A

90% O2 saturation to a PaO2 of 60 mmHg

92
Q

Normal SpO2

A

Normal is 98-99%

93
Q

Other ranges in SpO2

A

Acceptable for normal people: anything greater than 95%
Acceptable for a COPD patient: 88%
Acceptable in a sick patient: anything less than less than 90%

(A really sick patient may have a SpO2 in the 80’s)

94
Q

What are some indications for Pulse oximetery

A

When receiving supplemental O2

When weaning patients patients from mechanical ventilation

During sleep apnea studies

During cardiopulmonary stress studies

To determine if an arterial blood gas sample is arterial or mixed venous blood by comparison of saturations
(IF ABG IS DRAWN IT VERIFIES IF NEEDLE POKE ACTUALLY HIT ARTERY)

95
Q

Factors that affect accuracy of pulse oximeter?

A 
External bright
Patients with weak or absent peripheral pulses, low perfusion states
Motion artifact (moving around too much)
Artificial or painted nails
Skin pigmentation
Injection of radiographic dyes
96
Q

What is Methemoglobin?

A

Oxidized hemoglobin
Saturations read around 85%
(falsely low at high SpO2, falsely high at low SpO2)

97
Q

What Carboxyhemoglobin?

A

Carbon monoxide poisoning

CO bind to O2 with 250 times the affinity of O2

Readings are artificially high

98
Q

percentages related to Carboxyhemoglobin

A

Normally less than 5%
Smokers will be 9% or less
Symptoms of CO poisoning start at 15-25% (headache, nausea, fatigue)

Above 30%: dizziness, mental confusion, sever headache, fainting

50% unconscious or death
Treatment for CO poisoning is 100% O2

99
Q

How to ensure accuracy of pulse oximeter?

A

Compare actual counted heart or ECG rate to the displayed heart rate on the oximeter.

Also look at pleth ( mountain like outline that goes up and down for heart beat)

Irregular pleth or straight line (you can’t trust the reading)

100
Q

Probe placement for pulse oximeter?

A

Adults: fingers, toes, earlobe
(preferred: non dominate hand)

Children: hand, wrist, foot

101
Q

What does pnuematically powered mean?

A

Powered by a compressed gas

102
Q

How do you know if you patient needs humidity?

A 
Dry cough aka a nonproductive cough
nose bleeds
increased work of breath
increased incidence of infections
thick secretions

Atelectasis

103
Q

What are the four factors that effect the efficiency of humidifiers?

A
  1. Temperature
  2. Time expose
  3. surface area
  4. Depth of water in reservior
104
Q

What does inpissated mean

A

Thickened, dried, or made less fluid by evaporation.

105
Q

Humidity deficit results in?

A 
impairs ciliary activity
atelectasis
pneumonia
inflammation
retention of tenacious secretions
106
Q

What is a servo controlled humidifier?

A

Heated humidifier that regulates the delivery temperature

shuts down heater if theres no water in it

Like a heater in a house it comes on/off when needed

107
Q

What does inpissated mean?

A

Thickened, dried, made less fluid by evaporation

108
Q

What are four factors that effect humidification?

A

contact time, temperature, surface area, depth of water reservoir

109
Q

Humidity is water in what form?

A

Molecular form

Less chance of carrying germs

will be invisible

110
Q

What is bland aerosol?

A
  1. sterile water
  2. hypertonic saline (has extra salt)
  3. isotonic saline (this is normal saline in body)
  4. hypotonic saline (thick secretion)
111
Q

Why would we want to heat the nebulizer?

A

Increasing the temperature will carry moisture

112
Q

What is the purpose of a baffle?

A

Makes particles smaller

113
Q

What should you do if your nebulizer is not producing mist?

A

Make sure jet is inside

114
Q

What does pneumonic mean

A

Powered by compressed gas

115
Q

What type of matter do aerosols produce?

A

Particulates

115
Q

What type of matter do aerosols produce?

A

Particulates

116
Q

How do you add humidity to an AEM( venti) mask?

A

Large volume nebulizer

117
Q

How do you estimate inspiratory flow?

A

Inspiratory flow aka minute ventilation

VE= Tidal volume x Respiratory rate

118
Q

When do you need an analyzer?

A

When FiO2 needs to be known:

COPD patient
oxyhood
briggs adaptor
mist tent
trach collar
119
Q

What does a whistling bubble humidifier mean?

A

Bubble humidifiers have a safety pressure relief or pop off valve

It will whistle and pop up to RELEASE EXCESSIVE PRESSURE

(can be caused by high flow or kinked tube)

120
Q

what is an aerosol?

A

Aerosol is the suspension of solid or liquid particles in a gas

Medical aerosols generated by nebulizers, inhalers, and atomizers

REMEMBER AEROSOLS AND NEBULIZERS DELIVER PARTICULATE MOISTURE

121
Q

FACTORS AFFECTING PARTICLE DEPOSITION?

A

intertial impaction (tend to follow same path)
sedimentation (larger particles are deposited)
size (larger particles deposit faster)
diffusion (movement from an area of higher concentration to an area of lower concentration)

122
Q

inertial impaction

A

Inspiratory flow rates greater than 30 L/min associated with increased inertial impaction

Larger the particle the more likely to move alone in a set path.

123
Q

turbulent flow

A

Larger particles are deposited

124
Q

Sedimentation

A

Particles are deposited due to gravity

Sedimentation is main reason for deposition of particles

125
Q

diffusion

A

most aerosol particles reach the lungs by diffusion

126
Q

Increased deposition factors

A

Patient factors: larger Vt, Longer inhalation, breath hold

Other:

Flow- higher the flow the smaller the particle size
Jet orifice: larger the orifice, larger the particle size

Humidity increases particle size

127
Q

Bernoulli’s principle

A

A fall in pressure in a flowing fluid must always be accompanied by an increase in the speed

128
Q

How to avoid contaminating reservoir

A

Change water, wash hands, avoid touching inside of reservoir

129
Q

How do jets work?

A

compressed air expands, and increases velocity

expanding air causes an under pressure and liquid is sucked up to the air orifice

liquid meets rapidly expanding air, forming droplets

the droplets are carried on the air to the baffle system

130
Q

How are large volume nebulizers powered and what about their flow rates?

A

Pneumatically powered ( powered by compressed gas)

Flow rates meet or exceed patients inspiratory demand

131
Q

How do do you determine total flow?

A

Use magic box

(tic tac toe)

100 on top

20 on bottom

current Fio2 in middle

132
Q

Heated large volume nebulizers

A

Used to humidify( add water content) to gas delivered to patients

( this was large container of liquid that screwed into flowmeter)

133
Q

Flow rates for small volume nebulizer

A

Most effective flow rate is 7-8 L
5 L for infants only

The higher the flow the smaller the particle size

134
Q

Flow for Large volume nebulizers

A

Typical flows 10-15 L

Need to see mist on inspiration

May need to “t” another flowmeter to provide adequate flow

135
Q

Electrochemical analzyers

A

calibrate at both 100% O2 and 21% room air before using.

Galvanic analyzers have fuel cells

Polarographic analyzers use batterys

136
Q

PRN
SB
DC

A

PRN (as needed)
SB (standby)
DC (discontinued)

Basic Respiratory Therapy Procedures And Lab (11 decks)

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