O2 Delivery Devices Flashcards
How do we assess patient response to O2 therapy
ABG
Nasal Cannula
Low Flow System, flow .25-6LPM, FiO2 24-45%, uses humidifier > 4LPM, special rules- decrease in FiO2 increase minute volume, add humidity
Simple mask
Low flow, flow range- 5-10 LOL, FiO2- 35-50%, needs humidity, special rules- needs minimum 5LPM to flush CO2 from mask (has no bag, has small bore tubing)
Air-entrainment (venturi-mask)
High flow, 10LPM, FiO2- 24-50%, no humidity, speaks in terms of FiO2 (has variable air to O2 ratio. Gives exact FiO2)
Partial rebreather (emergency mask)
Low flow, 10LPM, FiO2-40-70%, no humidity, rule- keep reservoir inflated, some CO2 goes back in bag some out of mask
Non-rebreather (emergency mask)
Low flow, 10LPM, FiO2- 60-80%, no humidity, one way valve between mask and bag expiratory gas goes outside of mask
Two long pieces of large bore tubing
8-10 links for cutting
Drain Bag
Catches condensation
Trach collar (TC)
Smiley face sits up. Used on trachs
Face tent
Used on patients with facial trauma or claustrophobia.
Aerosol Mask
Has no tubing. FiO2 28%
Briggs T adapter
Green T. Way to provide humidity and O2 to someone intubated (test to see if they can come off ventilator)
Oxygen Analyzer
Validates FiO2
Total flow
Magic box
hypoxemia
low ambient 02, hypoventilation, ventilation-perfusion mismatch, shunt, or diffusion defect
Hypoxemia numbers
decreased PaO2 less than 60mmhg or SpO2 bellow 90%
Hypoxemia occur from
severe trauma, acute myocardial infarction, short-term therapy or surgical intervention
Pulse Oximetry measures
SpO2
Arterial blood gas measures
PaO2
CO- oximetry measures
SaO2
Uses Spectrophotometry
SpO2 (pulse oximeter %), SaO2 (arterial blood draw)
SaO2
arterial blood draw= analysis through co-oximeter= distinction between 4 absorption wavelenths
SaO2 4 wavelengths
- oxy-hemoglobin, 2.Carboxyhemoglobin, 3. Methemoglobin, 4. Reduced Hemoglobin
Limitations to Pulse Oximeter
Poor perfusion to sample site, motion artifact, abnormal hbg, intravascular dyes, dark nail polish, light
CO poisoning
can run a venous sample through the co-oximeter to get carbon monoxide % value- wrong value
Complications and hazards of O2 therapy
Supplemental O2 shouldnt be used as a subsitute for ventilation, Supplement O2 is relatively benign drug, Oxygen toxicity, Nitrogen washout atelectasis, Oxygen-induced hypoventilation, ROP
Goal of RT during O2 therapy
use the minimum concentration required to achieve adequate tissue oxygenation
Oxygen toxicity defined as
cellular injury of lung parenchyma and airway epithelium
O2 Toxicity occurs when
24 to 48 hours at an FiO2 of 1.0. They include hypoxemia caused by right to left shunting from atelectasis, decreased lung compliance, and infiltrates on chest radiograph that reflect the cellular pathology
exposure of FiO2 of 1.0 longer than 72 to 96 hours
Inflammatory changes, edema, and fibrosis
Absorption atelectasis/ Nitrogen washout atelectasis
Absorption atelectasis can occur with high concentration oxygen breathing, secondary to washout of nitrogen from lungs
Oxygen-induced hypoventilation involves
the neurologic control of ventilation
Retinopathy of prematurity (ROP)
oxygen radicals attack the incompletely developed retinal tissue, resulting in vasoconstriction
complications and hazards of O2 Therapy to babies
Neonates with Congenital heart lesions depend on patency of the ductus arteriosus for either pulmonary or systemic blood flow, Many newbors will have profound hypoxia or circulatory collapse as the ductus closes spontaneously
Fire Hazard
is a concern when dealing with normobaric oxygen and a major haxard in hyperbaric applications
Variable-Performance devices (low-flow devices) provide
variable and approximate FiO2
Fixed-performance devices (high-flow devices) are designed to provide
a fixed and known FiO2
Major difference between high and low flow devices
high flow device provides such a high flow of premixed gas that the patient is not required to inhale any room air
Nasal Cannula
most widely used device for administering low-flow oxygen.
NC flow should be titrated using
vital signs, pulse oximetry, and arterial blood gas measurements
Simple mask
used when a higher FiO2 is needed than can be attained with a NC ( has small bore tubing)
Parial Rebreathing mask
Simple mask with the addition of 300 to 600 mL reservoir bag
Nonrebreathing Mask
uses the same basic system as the partial rebreathing mask but incorporates valves between the bag and mask and on at least one of the exhalation ports
Partial and non rebreathing mask deliver
precise delivery of FiO2 is required to supply therapeutic levels of O2 and avoid complications
Nasal Cannulas
standard, high flow cannula, reservoir cannula, heated high flow cannula
High flow nasal cannula devices
are designed to administer higher O2 flows than the standard NC
Large bore tubing attatches to
aerosal
Oxyhood
supply flow to flush out CO2, analyze as close as possible to baby. water vapor
Dual flow meters
the simplest and most economical method of delivery a specific FiO2 and total flow
Air Oxygen blenders
provide a convenient, compact device for dialing in specific FiO2
O2 Enclosures include
O2 tents and hoods
Hyperbaric Oxygen Therapy is indicated for treatment of
Carbon monoxide poisoning, wounds, air embolism, and decompression sickness
Symptoms of hypoxia are
Cognitive impairment, cardiac rhythm and conduction (EKG) dysfunction, and renal dysfunction
Monitoring arterial blood gas analysis is standard for
documenting oxygenation, ventilation, and acid-base balance
Most common form of continuoulsy monitioring oxygen saturation
pulse oximetry
Oxygen analyzers are used to measure
the concentration of oxygen administered to patients
RT are frequently asked to integrate patient info and recommend a medica gas therapy by
patient assessment, laboratory data, initial concentration of O2, appropriate O2 therapy device
Helium-Oxygen Therapy
Use of heliox for some patients with partial upper airway obstruction or asthma, a mask with a reservoir is used. replaces nitrogen with helium
Accordign to Grahams law, heliox
diffuses at a rate 1.8 times greater than oxygen (80%helum/ 20% oxygen)
Carbon Dioxide Therapy
Several dangerous side effecs, administration devices for CO2/O2 gas therapy include the disposable nonreabreathing mask with reservoir and the well fitted mask with reservoir
Patients on Carbongen therapy must be carefully monitored by
pulse, RR, blood pressure, and mental state
Carbogen is
5% carbon dioxide in O2
Nitric Oxide Therapy
NO is a selective pulmonary vasodilator. Low toxicity
Selective pulmonary vasodilators
reduce pulmonary vascular resistance without affectign systemic vascular resistance and affects vascular resistance only near ventilated alveoli
Only FDA approved indication for inhaled NO is
Hypoxic respiratory failure of the newborn
Treat Hypoxemia
Supplement O2
O2 therapy is used for periperative conditions, and
COPD, ARDS, CPR, MI, Pulmonary edema, CO poisoning, and traumatic brain injury
Complications of O2 therapy include…
O2 toxicity, nitrogen washout atelectasis, oxygen induced hypoventilation, retinopathy of prematurity, and failure of ductus closure in infants with Congenital heart disease
O2 may be limited use for
anemia, low cardiac output, or high shunt
Low flow Oygen Devices
Nasal catheters, NC, Simple mask, partial rebreather masks, nonrebreather mask
FiO2 from a low flow device is determined by
flow, reservoir volume and patient inspiratory volume
High flow O2 delivery systems meet
the inspiratory needs of the patient
Oxygen enclosed devices
hood incubators, tents
Hyperbaric O2 therapy is indicated for treatment of
Carbon monoxide poisoning, wounds, air emolism, and decompression sickness
Oxygen analyzers are
polarography or galvanic cells to measure oxygen concentration
Heliox
is used clinically because of its low density… at 70/30, 8/20 (Helium/ O2)
Therapeutic applications of CO2 therapy are
limited or controversal
Inhaled NO is
Selective pulmonary vasodilator
Thorpe tube display true flow
Yes
How much oxygen is in room air
21%
For every one liter of O2
you increase the FiO2 by 4%
Tank Pressure measured in
PSI
Why is duration of flow important
how long tank will last
Regulator
Reduces pressure and provides flow
What types of flow meter would you want to use if you needed to place a cylinder on its side
bourdon
Standard working pressure of all bulk oxygen gas supply systems
50 psi
Safety relief valve for E tank
fussible flug, frangible disk
What type of safety relief valve does an H tank have
spring loaded
How long would an E cylinder with 800 PSI last at a liter flow of 31pm Nasal Cannula
800x.28/ 3 = 74.6 = 1 hour and 15 min
E cylinder
.28
H Cylinder
3.14
SpO2 arrows
Pulse oximeter limited spectrophotometry, 92%-100%
PaO2 arrows
Blood gas analyzer (electrode pressure of O2), ABG, 80-100mmHg, Reflects O2 available to Hgb
SaO2 Arrows
ABG, Blood gas analyzer with co-oximeter multiple wavelength spectrophotometry, 92%-100%, Reflects oxygen attatched to Hgb (CO levels - smokers/ poor air quality)
Hypoxemia is lack of oxygen in the
blood
Hypoxia is lack of oxygen in the
tissue
Mild Hypoxemia
PaO2 60-80 mmhg
Moderate Hypoxemia
PaO2 45-59 mmhg
Severe Hypoxemia
PaO2 below 45 mmhg
Regular PaO2
80-100mmhg
Start on what with NC
21% RA (ambient air)
PSi
Medical gas
mmHg
BP
FiO2
Percent of O2
Daltons law
760= .21(O2) and .79 (N2)…
6LPM NC
6x4 = 24 + 21 = 45%
E-Cylinder PSI, Wall PSI
2500 PSI, 50 PSI
Compressed air is color coded
yellow
Helium
Rare gas naturally occuring in the atmosphere, it is colorless, transparent, odorless, tasteless, and nonflammable. Doesnt support combustion or lfie
NO
Colorless, tasteless gas with slight metallic odor. Nonflammable/ non-life supporting gas. Supports combustion and is toxic
Nitrogen
major component of the atmosphere 78% by volume. responsible for blue color in sky
Cylinders filled between
2200-2500
O2 Color
Green
Air color
Yellow
Heliox Color
brown-green
Helium
brown
ASSS
Larger Cylinders
PISSS
Smaller cylinders
DISSS
any pressure that is passed the reducing falve is a diameter index safety system
Grab n GO
DISS, cant remove, not true flow, 50 psi source
Flow restricter
what we used on race… similar to bourdon- not gravity dependent and not true flow. Calibrated liter flow- based on diameter of outlet, 50 PSI with pin
Reducing valve
On regulator
Relief valve
is on tank opposite side of hole
Quick connect is a
DISS, at wall 50 PSI
Zone Valves
Adjusts for maintanence or a fire
Liquid Bulk Oxygen
Stores O2 in liquid in large tanks for hospital at 50PSI with back up tank
Increase O2 will do what to arterial pressure
Increase
Normal inspiratory flow demand
30LPM
How do we asscess a patient response to O2 Therapy
ABG, Arterial blood (80-100mmHg), analyze- Electrodes (80-100) and co-oximeter normal SaO2 below 92% and below 95%
CO poisoning best treated
NRB
active pt.. SpO2 86% (normal should be higher)
Tape NC to their face
PvCo2 values
35-45mmHg
Norm PaCO2 in COPD, and SpO2
45-65 mmHg (high), they depend on a hypoxic drive, SpOx 88-92%
COPDers
Maintain a low O2, to keep them ventilating; they depend on a hypoxic drive
What catches condensation
Drainbag, cant be 1/3 full
Briggs T adaptor
way to provide Humidity and O2 to someone intubated
Aerosol humidity can be connected to
(limits at 12 flow) Aerosal mask, TC, Face tent, Briggs T, Oxyhood (water not aerosal)
Donut heater
attatches to aerosal humidity tank
Meeting patients inspiratory demand?
if you see aerosol coming out of resevore tubing
Retinopathy of prematurity
Premature infants retinal vasoconstriction in the presence of PaO2 less than 80mmhg ( keep between 50-80 mmHg
absorption atelectasis
nitrogen washout increase FiO2, nitrogen gets pushed out PaO2 close to 700. alveolar space shrinks. obstruction= atelectasis
best mask to least
NRB, Partial, Simple, Venturi, NC
MAP
Sys+ dias x 2/ 3
MI
heart attack, blockage of coronary arteries.. little bit of O2 to improve heart muscle itself
EKG
1 time reflection of the electricity in heart, views from different angles (12)
Small bore tubing vs large bore tubing
NC tubing, Aerosal tubing
Oxygen/ air blender why
air flow and FiO2 are independent from each other.. flush out CO2
O2 and air blender where, when, who
Ventilators,oxyhood/ tent, in ER, Patients with trachs, endotracheal tube, heated high flow NC
How to use O2 blender
Connect O2 and air.. have to have 2 psi sources— O2 and air,L flow and FiO2 must be stated
Oxygen analyzer
Why.. to validate FiO2, where.. Neonate ICU, Who.. babies; anyone, how.. as close to pt as possible
Clinical teaching of O2 analyzer
directions on back, needs to be calibrated to 100% and 21% FiO2
Clinical teachings of Pulse ox
measure SpO2 using infared and red light, look for consistant wave from plethysmograph, has high and low alarms
Trouble shoot o2 devices (rebreather)
have to re inflate the bag on a rebreather, not a high enough flow
name 3 different types of oxygen regulators
bourdon gauge, thorpe tube, flow restrictor
Bourdon gauge
fixed outlet supply, pressure regulator is adjustable= flow adjustment
thorpe tube
displays actual outlet flow, adjustable flow
Flow restrictor
fixed flow, not adjustable.
What two factors influence total flow
FiO2 and liter flow (LPM)
List in detail the equipment used in a standard continuous aerosal set up
thorpe tube- air entrainment large volume nebulizer- large bore tubing- drain bag - large bore tubing - o2 delivery defice
how is liter flow limited with a large colume air entrainment nebulizer
driving gas inlet or iface diameter that limits. flow continuous aerosal limits at 12 lpm
blip
bar moves up and down during pulse heart beat
Pleth
Graph that moves up and down during pulse heart rate
1 Liter=
25%
6 liters=
6x4 = 24+ 21 = 45%
duration of flow=
PSI x tank factor/ LPM (how long tank will last)
Produce O2
Photosynthesis, fractional distillation of air, electrolysis of H20, Molecular filtration
Liquid O2 creates how much more O2
4%
boiling point
Changes liquid to gas at 760mmHg
Temp from C to F
number x 1.8 + 32
