COMPS:UNIT 2: O2 DELIVERY SYSTEMS + EQUIPMENT Flashcards
What should you ALWAYS REMEMBER w/ mobilizing a pt w/ vent?
ALWAYS MOBILIZE TO SIDE OF VENT!!!
FiO2 ===
fraction of inspired O2
FiO2
Inspired O2 conc. depends on 3 things:
- Flow of 02 in the unit
- VT of the pt
- Pts breathing pattern
Normal FIO2 in Room Air===
20.98% or ~21%
PulseOX Normal lvl should read====
95-100
PulseOX
Purpose
- measures of Arterial O2 saturation and Pulse Rate
- O2 saturation (SaO2)== % of hgb saturated w/ O2
-
Spectophotometry det’s amt of Hgb
- sensor measures absorption of selected wavelengths beamed thru tissue
PulseOX
Indications
- Used to detect hypoxemia in pts w/ unstable O2 status
-
Medicare/Medicaid
- Sat. of =88% qualifies some for O2 tx
- NORMA==95-100%
PulseOX
Documentation MUST include: 3
- BEFORE: Ambulation/stairs/exercise on room air
- DURING: Exertion on room air and on satisfactory O2 lvl
- AFTER: Exertion
PulseOX
Applying…
- Body probes:
- Digit
- Earlobe
- Bridge of nose
- Forehead
PulseOX
Limitations:
REASONS FOR FALSE READINGS
- Error in initial calibrations
- Motion artifacts
- **Diminished pulse
- **Peripheral vasoconstriction from drugs or hypOthermia
- Dysfunctional Hgb
- Injected dyes
- **Dark nail polish
- Optical shunting (light wont reach vascular bed)
- Outside light sources
O2 Delivery systems often involve 2 pieces:
- Flowmeter
2. Humidification system
O2 Delivery Systems
1. Nasal Cannula
PURPOSE
- Delivers FiO2 of 24-44% w/ flow rates up to 6L of O2/minute
- __6L is MAX for regular Nasal Cannula*****
O2 delivery
- Nasal Cannula
DEVICE DESIGN (MOST IMPORTANT STUFF)
- Prongs attach tubing that is connected to O2 tank, portable O2 generator, or wall connection via Flowmeter
- **For every 1L/min INC in O2 delivered—> APPROXIMATE 4% INC in FiO2
- ADD HUMIDIFICATION if >3L O2
O2 Delivery
1. Nasal Cannula
INDICATIONS :
- LOW lvls O2 w/in any pt setting
O2 Delivery
1. Nasal Cannula
BENEFITS
- Convenient in delivering O2 conc’s ranging 24-44%
- EZ pt mobility
- Permits pt to eat, drink, talk, oral/facial ADLs, take oral meds and/or nebulizer while receiving O2
O2 Delivery
1. Nasal Cannula
LIMITATIONS:
- UNABLE to deliver O2 conc’s >6L OR 44%****
- MUST nasally breath==> encourage “Pursed-Lip breathings”
- May NOT be used if pt unable to tolerate, or no cognition or cooperation to consistently wear
O2 Delivery
2. High Flow Nasal Cannula
*THICKER TUBING
*LOUDER SOUND
PURPOSE:
- Allows flow of 6-15L/min of O2
- FiO2 is 54-75%
O2 Delivery
2. High Flow Nasal Cannula
DEVICE DESIGN:
LARGE prongs/tubing for HIGHER O2 flows
High Flow Nasal Cannulas mostly seen where?
Hospitals
High Flow Nasal Cannulas
BENEFITS
- ALL SAME AS Reg. Nasal Cannula
- allows for 6-15L/min O2
- FiO2 delivery is 54-75% (better for higher O2 demand)
High Flow Nasal Cannula
LIMITATIONS:
- SAME as reg. nasal cannula
- Min. research on bennies long term
- MUST be humidified for long durations
O2 Delivery
3. Aquinox/Optiflow/High Flow Humidification System
PURPOSE
- humidification system delivers warm, humid O2 @ HIGH FLOWS
- up to 45L/min, 100% FiO2—Lg. nasal cannula
O2 Delivery
3. Aquinox/Optiflow/High Flow Humidification System
DEVICE DESIGN:
- Humidifier chamber
- O2 tubing
- Delivery tube
- High flow nasal cannula
O2 Delivery
3. Aquinox/Optiflow/High Flow Humidification System
INDICATIONS:
- ONLY in hospital or LTACH
- *cannot go home w/ this
O2 Delivery
3. Aquinox/Optiflow/High Flow Humidification System
BENEFITS
- SAME as nasal cannula’s
- Pot. provide some Positive Pressure (not measurable)
O2 Delivery
3. Aquinox/Optiflow/High Flow Humidification System
LIMITATIONS:
- CANNOT UNPLUG
- cannot mobilize in hallway
- Need continuous nasal breathing to receive FiO2 (100% FiO2 received)
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
PURPOSE:
- High lvl of O2 to pts in varying lvls of resp. distress
- High amts of O2 to pts during emergency situations @ 100% FiO2 @ 15L/min
- hypoxia
- seizures
- conscious w/ VTACH
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
DEVICE DESIGN
- 3 one-way valves and bag reservoir to supply highest O2 conc. possible
- Flap valves–> prevent EXHALED air from entering bag and ensure EXHALED air exit side of mask—> INSP air therefore 100% from reservoir bag
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
INDICATIONS
- SHORT TERM for emergency situation when pts have adequate, spontaneous respirations
- hypoxia
- seizures
- VTACH w/ conscious pts
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
SETUP:
Reservoir bag must be COMPLETELY INFLATED BEFORE applying to pt
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
BENEFITS:
- Delivers O2 conc 100%
- easy setup in an emergency situation
O2 Delivery
4. NON-Rebreather Mask
*Bag ALWAYS inflated
LIMITATIONS:
- NO POSITIVE PRESSURE
-
Cannot complete ADL while donned–> switch to alternative nutrition source/medication route
- MORE SHORT TERM ANYWAY!
-
Only provide ONE setting reliably: 15L/min @ 100% FiO2
-
Can be placed on 6-14L/min w/ LESS FiO2
- prevents O2 induced barotrauma to parenchyma
-
Can be placed on 6-14L/min w/ LESS FiO2
Partial Rebreather Mask
What’s the deal w/ this?
- SIMILAR to NRM BUT:
- __Resp. bag W/OUT flaps–> this makes both valves, 2-way valves allowing for passage of gases during INHALE AND EXHALE.
- about 1/3 of EXHALED VT re-enters bag to be re-inhaled
-
specific design allows for pt to inhale MIXTURE of atm. air, O2, and EXHALED air
- Use of CO2==Resp. stimulant***
O2 Delivery
6. Face Tent
*OPEN-CIRCUIT
PURPOSE:
- Delivers HIGH FLOW to pt thru soft plastic “bucket”
O2 Delivery
6. Face Tent
*OPEN-CIRCUIT
DESIGN:
- FLOW RATE:
-
8-10L/min w/ estimated FiO2 30-100%
- bc OPEN CIRCUIT
-
8-10L/min w/ estimated FiO2 30-100%
O2 Delivery
6. Face Tent
*OPEN-CIRCUIT
BENEFITS:
- Post-op pts, claustrophobic, facial trauma, burn pts
- comfortable
O2 Delivery
6. Face Tent
*OPEN-CIRCUIT
LIMITATIONS
- Amt. of O2 pt actually receives varies
- bc OPEN CIRCUIT
- remove to eat/ADL
- NO POSITIVE PRESSURE
O2 Delivery
7. Ambu Bag/Resuscitator Bag
The CPR one*
PURPOSE:
- Used when POSITIVE PRESSURE is indicated
- provides POSITIVE pressure vent–> directs O2 (or CO2) inside via 1-way valve
O2 Delivery
Ambu Bag/Resuscitator Bag
DESIGN:
- Reservoir bag connected by tubing and a non-rebreathing valve to a face mask and/or ET tube
- self-inflating w/ room air OR from O2 source
Ambu Bag/Resuscitator Bag
SET UP
- Squeeze bag once every 6s for adequate RR
- 10 respirations/min for Adult
Ambu Bag/Resuscitator Bag
INDICATIONS
- IMMEDIATE ventilation/POSITIVE PRESSURE short term
- 1-1.5L capacity in bag
- CAN provide FiO2 100% if flowmeter available OR provides 21% FiO2 if set to Room Air
Ambu Bag/Resuscitator Bag
BENEFITS:
- Used in emergency when pt loses consciousness but vent. is not present OR ET not placed
- used if vent malfunctions or stops working
- used for pt who req’s POSITIVE PRESSURE during mobilization
Ambu Bag/Resuscitator Bag
LIMITATIONS:
- Need person to squeeze bag
- 1x every 5s appears slow and untrained indiv’s can struggle to maintain this rate
O2 Delivery
Tracheostomy weaning: Trach Mask vs. T-piece
TRACH MASK
- BLUE TUBING BC HUMIDIFICATION
- OPEN CIRCUIT
- Similar to face tent—-humidified HIGH FLOW O2 via soft plastic mask
- used after weaning from vent for weeks prior to physician decannulation
- unreliable FiO2 due to lost O2 around collar
- Flow rate changed via air entrainment port on wall
Tracheostomy weaning: Trach Mask Vs. T-Piece
T-Piece
*CLOSED CIRCUIT
- CLOSED CIRCUIT means you can directly measure amt O2 delivered
- adaptor attached to trachostomy and tubing to provide closed circuit O2 delivery
- Flow rate changed via air entrainment port on wall
- BENEFIT: aware of specific FiO2
Tracheostomy weaning: Trach Mask vs. T-Piece
*BOTH PORTABLE!!
- Either can be attached to a O2 tank via air entrainment port and tubing
- trach collar or t-piece portable entrainment port O2 tubing
Monitoring SpO2 sats
Maintain >/= 90%
FLOWCHART
SEE PICS
