Supplemental Oxygen Flashcards
Respiratory Meds: Supplemental Oxygen
Treatment for hypoxemia when PaO2 is unable to deliver adequate O2 to capillaries
Respiratory Meds Delivery:
nasal cannula
mask
tent/hood
endotracheal tube
tracheostomy
FDA states: “medical oxygen is defined as a:
prescription drug which requires a prescription in order to be dispensed except….for emergency use”
Co-morbidities: Why are more patientsneeding supplemental oxygen?
Older patients
Multiple medical diagnoses
Pulmonary diagnoses are increasing in incidence and prevalence
What are the advantages ofSupplemental Oxygen?
Oxygen during Exercise:
1) Decreases SOB
2) Decreases dynamic hyperinflation
3) Prolongs exercise tolerance
4) Improves sleep and mood
5) Increases mental alertness and stamina
6) Prevents/delays heart failure in severe lung disease
Oxygen Equipment =
pulse oximeters
oxygen concentrator
oxygen tanks
nasal cannulas
venti-mask
partial re-breather mask
non re-breather mask
mask + nasal cannula
Oxygen Delivery Device - low flow nasal cannula
1-6 L/min
FiO2 = 25-40
Oxygen Delivery Device - high flow nasal cannula
30-60 L/min
FiO2 = 100
Oxygen Delivery Device - venti-mask
2-15 L/min
FiO2 = 24-60
What is the FiO2 and flow rate for the simple face mask ?
flow = 6-10 L/min
FiO2 = 35-50
What is the FiO2 and flow rate for non rebreather?
flow = 10-15 L/min
FiO2 = 80-90
Respiratory Meds: Supplemental O2 Dose
L/min
> rest, activity, exercise
Hours/day
Supply system
> tank of compressed air, liquid O2 reservoir
Dose/Duration/Frequency = depends on patient and desired SpO2
SpO2 Targets:
Pulmonary Dysfunction: <88%
Normal Value: 94 – 98%
Benefits of supplemental O2 =
Increased exercise tolerance
Decreased morbidity due to improved oxygenation of tissue
Improved quality of life
Risks of O2 =
Fire
Dry nose
Airway irritation
Oxygen toxicity - hyperoxia
FiO2 =
Fraction of inspired Oxygen
Room Air = 20 to 21%
Minute Ventilation @ Rest = 6-8 L air/minute
Supplemental Oxygen: Flow Rate = Low Flow Oxygen
Supplies oxygen at flow rates that are lower than patient’s inspiratory demand
Fraction of Inspired Oxygen (FIO2) varies with respiratory rate (RR) and tidal volume (TV) = LFNC supplements O2 needs
1 – 6 L/min
Supplemental Oxygen: Flow Rate = High Flow Oxygen
More precise O2 delivery
FiO2 does not vary with respiratory rate and tidal volume = exceeds O2 needs
Up to 60 L/min
Effective Oxygen therapy is about =
finding a balance between delivering the lowest FiO2 in order to achieve normal oxygen saturations for the patient
Low Flow Oxygen - nasal cannula
1-6 L/min
Delivers approximately 25-40% FIO2
Simple and safe
Connected to an O2 source and regulated by a flow meter
Easily mobile when connected to portable O2 tanks
Can be humidified = usually when >3 liters/min flow
High Flow Nasal Cannula (HFNC)
Adjustable FiO2: 28% to 100% via an O2 blender
Adjustable Flow Rate: 10 - 60 L/Min; typically used in 30-60 range
Provides humidity
HFNC - goals of Hi-Flow
treat hypoxemia
decrease WOB
provide adequate humidity for a trached patient
Benefits of HFNC compared to a mask =
patient comfort
patient can communicate more easily
can eat and drink without changing O2 devices
allows for easier oral care maintenance
adjustable FiO2
meets their inspiratory demands = decrease work of breathing - by adjusting flow
High Flow: Venturi Face Mask (Venti Mask)
Mask connected to a Venturi entrainment port device that mixes a specific volume of air and O2 (“dial-a-flow”) = Each valve tells you what flow is needed to achieve the desired FiO2
Precise levels of oxygen, humidification not needed
High Flow: Venturi Face Mask (Venti Mask)
Disadvantages =
eating and talking
uncomfortable
air leakage
skin and eye irritation
High Flow: Venturi Face Mask (Venti Mask)
colors and rates =
white:
flow = 4-6L/min
FiO2 = 28%
yellow:
flow = 8-10L/min
FiO2 = 35%
red:
flow = 10-12L/min
FiO2 = 40%
green:
flow = 12-15L/min
FiO2 = 60%
Oxymizer pendant vs mustache =
Mustache (20 L/min)
Pendant (15 L/min)
Oxymizer =
Conserves O2 through the use of a reservoir as it stores O2 during exhalation and delivers an O2 bolus during inhalation = long term use to decrease flow and increased oxygen concentration
Provides more O2 with less flow than other devices
Self-humidifying
Low Flow: Aerosol Mask
Connected to wide bore tubing that receives aerosolized O2 from a nebulizer
Two holes for exhalation
FIO2: 40% - 60%
Flow: 6-15 L/min
Humidification may be needed
Short term use = replaced by nasal cannula
Used for high concentration of oxygen; no breathing assistance needed
Low Flow: Aerosol Mask
Disadvantages =
Eating and talking
Rebreathing exhaled air
Rebreathing Mask 2 types =
Aerosol mask with a reservoir bag = 1 Liter volume to store pure oxygen
Partial Rebreather
Non-Rebreather
Rebreathing Mask
Disadvantages =
Eating and talking
Skin irritation
Air leakage from the mask
Low/High Flow: Non-Rebreather Face Mask
FiO2: 60-90% FIO2
10 - 15 L/min
Works using a one-way valve that prevents exhalation into the reservoir bag and allows inhalation of nearly pure O2
Used for short term, hospital situation
Low/High Flow: Non-Rebreather Face Mask
Disadvantages =
Eating = desaturate when mask is off
Risk of hyperoxygenation
Partial Rebreather =
FiO2: 40%-70%
6 – 10 L/min
No valve in the mask = exhaled air may be inspired again
Used for longer periods of time
1 L/min nasal cannula = ___ FiO2
24%
2 L/min nasal cannula =___ FiO2
28%
3 L/min nasal cannula =__ FiO2
32%
4 L/min nasal cannula =___ FiO2
36%
5 L/min nasal cannula =___ FiO2
40%
6 L/min nasal cannula =___ FiO2
44%
10 L/min nasal cannula = ___ FiO2
60%
> 15 L/min nasal cannula = __ FiO2
80%
