-

Oxygen is a drug and should only be

administered following a physicians
prescription.

Oxygen has toxic effects at higher or

prolonged doses.

Dynamic O2 goal, keep SpO2 around

95% with minimum Fio2 range.

Oxygen delivery
is a function of the
following
relationship:

Oxygen

delivery=
Arterial O2
content (Cao2) X
Cardiac output

Pao2 represents the amount of

oxygen dissolved in blood plasma and
contributes the smallest proportion of
oxygen carried to the tissues.
- Hemoglobin (Hgb) levels accounts
for the largest portion of oxygen
delivered to the tissues.
- Arterial oxygen content (Cao2)
- Oxygen saturation (Sao2)

Tissue oxygenation depends

on:
-

adequate ventilation
- efficient gas exchange in lung level
- adequate circulatory distribution
Failure of any of these 3 elements
results in tissue hypoxia.

to administer the lowest fraction of

inspired oxygen (Fio2) for the shortest
period of time to maintain normal oxygen
delivery for the patient.

to correct arterial hypoxemia and

suspected tissue hypoxia

to decrease the symptoms associated

with hypoxemia

to minimize cardiopulmonary
workload associated with
compensatory response to
hypoxemia.

to decrease respiratory rate and

work of breathing

Range
80

100 mmHg
60 79 mmHg
41 59 mmHg
41 below

Level
Normal
Mild Hypoxemia
Moderate
Severe

Acute myocardial infarction (MI).

Hypoxemia (Actual and suspected)

Pao2<60mmHg
Sao2<90%
Severe trauma
Short term therapy
*Post op

Ventilatory depression
*COPD patients
- Fio2 >50%
*O2 toxicity
*Absorption atelectasis
*Fire hazards
*Retinopathy of prematurity
- Bacterial contamination
*Humidification system

OXYGEN DELIVERY
Pressure Regulator
Flowmeter
Low flow Reservoir system
Nasal cannula
Nasal catheter
system

Partial rebreathing mask Air entrainment

Non rebreathing mask

Transtracheal Catheter
Simple mask

High flow

Blending

 Have

classically been described

by two different sets of terms:
Low flow system (variable
performance) and High flow
system (fixed performance).

supply a set flow of oxygen that is a portion

of the patients total inspired gas.

provide lower oxygen concentrations because

of room air entrainment, usually .21 to .40 and
are best suited to patients with a stable
respiratory status.

-cost

effective than other oxygen devices from

supply and personnel perspective.

 -provide

a set flow of oxygen to the patient plus

a volume of gas contained in an appliance
reservoir.

these devices may be considered variable or

fixed performance systems.

provide medium to high concentrations of

oxygen and are best suited for short term
administration of oxygen in emergency
situations.

supply a total flow rate that exceeds the

patients minute ventilation and peak
inspiratory flow demands.
- provide a broad range of oxygen
concentration from .21 to 1 and are
indicated for patients who have changing
spontaneous ventilatory needs.
- structurally more complex, consume
higher gas flows, and require more technical
skill and expertise to function effectively.

nasal cannula is a set

of soft plastic prongs
that fit a short distance
(<1/2 in.) into the nares
and have adjustment
straps that go over the
ears and around the
back of the head
(elastic) or over the
ears and under the chin
(bolero style).

 Elastic

Bolero

style

 The

nasal cannula was invented

byWilfred Jonesand patented in 1949.

is

a device used to deliver

supplementaloxygenorairflowto a
patient or person in need of respiratory
help.

The

nasal cannula is connected to an

oxygen tank, a portable oxygen
generator, or a wall connection in a
hospital via aflowmeter.

- Are variable performance, low flow oxygen

device that are available with straight,
curved, and flared prongs.

- are the most common oxygen delivery device

used today. Available in adult, pediatric, and
infant sizes.

- standard for stable

respiratory patients
because of the ease
of oxygen
administration.

maximum recommended flowrate is

6 L/min. (0.40 to .44 Fio2) for
adult.

maximum of 2 L/min. (0.25 to .28

Fio2) for newborn and infants.

patients requiring long term oxygen

therapy may prefer the use of a
bubble humidifier to prevent drying
of nasal mucosa at flows greater than
4 L/min.

incorporate small plastic appliance

reservoirs (20 to 40 ml) into the
standard cannula design to facilitate
adequate oxygenation at lower set
flowrates, conserve oxygen supplies,
and reduce costs.
- a reservoir cannula set at .5 L/min can
provide arterial oxygen saturations.

has the appearance of a large

plastic mustache,
whereas the
pendant cannula
hangs the reservoir
under the chin on
the anterior of the
chest like necklace.

incorporates a conventional nasal

cannula with a demand oxygen
delivery system to administer oxygen
in controlled bursts during inspiration
only.
-A sensing valve determines the
beginning of inspiration and activates
a solenoid valve to administer a burst
of oxygen.

 Advantages

easy to use,
comfortable, patient may eat and
talk, low cost device, disposable,

Disadvantages

obtrusive
appearance, not practical for acute
care, *

has been used since the early 1900s.

- it is a soft plastic tube with small gas
flow ports at the tip that is inserted into
one of the nares of the nose and passed
to the back of the nasopharynx into the
oropharynx just behind the uvula.
-should be lubricated with water soluble
gel before insertion to facilitate passage
into the nasopharynx and prevent trauma
and adherence to delicate nasal mucosa.

catheter placement should be

changed to the opposite nare every
8-12 hours to reduce mucosal
crusting and adherence.
- can provide variable low Fio2
delivery (.28 to .45) at flowrates of
1 - 8 L/min.
- nasal catheter are not widely used
today because of patient discomfort.

The newest method of delivering long

term low flow oxygen therapy.
- developed first by Heimlich in 1982 and
enhanced by Spofford and Christopher in
1986
- these system bypasses the nose and
mouth as a route of oxygen administration
by surgically placing a soft, large bore
catheter directly into the trachea between
the second and third tracheal rings

the catheter is secured at the base of

the neck with a bead chain necklace.

Catheters are made of a flexible

plastic, and should be replaced every
90 days (3 months) or if they start to
become brittle, yellowed, or kinked.

a bubble humidifier may be used at

home for supplemental humidification.

-Improved Comfort and Convenience:

-Improved Self Image
-Lower Oxygen Requirements
-Increased Mobility:
-Greater Exercise Capacity:
-True 24 Hour Per Day Oxygen Therapy:
-Improved Sense of Smell, Taste and
Appetite:
-Decreased Work of Breathing:
-Reduced Hospital Days:

routinely clean and replace the

catheter at home, assess the
catheter stoma, and alert healthcare
professionals of signs of
inflammation or other abnormalities
are present.

End

Are soft plastic devices that cover the nose

and mouth.
- they may be classified as low flow
(reservoir) or high flow oxygen system,
depending on the design and principle of
operation
- reservoir masks add an appliance reservoir
to hold a volume of gas that supplements
the set oxygen flow during inspiration.

all masks used for oxygen therapy

should be soft, disposable, and
transparent.
- transparent masks allow health care
provider to identify secretions or vomitus
collected in the masks and prevent
aspiration.
- patients who require continuous oxygen
therapy and who wish to take off their
mask to eat should have a nasal cannula
set up at the bedside.

it is a low flow,
variable
performance
device that
incorporates a
small gas
reservoir, and the
Fio2 varies with
changes in the
patients
respiratory status.

a simple mask is used for the

administration of moderate Fio2.
- estimated Fio2 values range from .
40 to .60 at oxygen flows of 5 to 10
L/min.
- best for short term oxygen therapy
such as anesthesia recovery,
emergency care, therapeutic
bronchoscopy, and patient transport.

design is
similar to the
simple mask
with the addition
of a large
volume plastic
reservoir bag

the bag is attached to a connector

below the patients nose where gas flow
from the flowmeter enters the mask.

as the patients inspire, gas flow is

drawn from the mask, the reservoir bag,
and the set oxygen flow.

exhalation port remain open in this

mask during inspiration and provide a
potential source of entrained room air.

recommended minimum flow is 10

L/min. to prevent carbon dioxide
buildup. predicted Fio2 is .60 to .80
at 10 to 15 L/min.

adds one way

valves to the
design of the
partial rebreather
to prevent
rebreathing of gas
and decrease room
air entrainment

leaflets valve are placed between

the reservoir bag and the mask and
at one of the exhalation ports.
- during inspiration, the valve
between the bag and the mask
opens to entrain gas from the
reservoir bag in addition to the set
gas flow and exhalation port closes
to decrease room air entrainment
and dillution of the delivered Fio2.

it delivers an Fio2 of greater than .

80 at flow rates in excess of 15
L/min.
- should be used for the short term
emergency administration of high
concentrations of oxygen.
- they are also recommended for the
administration of other medical gas
mixture such as heliox and
carbogen.

deliver moderate to high Fio2

- Convenient and easy to patient
transport
- Easy to assemble and maintain
- Can provide high inspiratory flow rate
- Nebulizers provide high relative
humidity
- Analysis of delivered Fio2 is possible
- Disposable

- Increased risk of aspiration

- Masks are hot; patient cannot eat, wear
glasses
- Flow rate adjustment is vital to Fio2
delivery
- Decrease patient compliance
- Airway obstruction may be a problem in
children
- Bubble humidifiers are not practical

 Air entrainment
Blending system

Include:
Air-Entarinment Mask (AEM)
Air-Entrainment Nebulizer

employs an air entrainment system

to provide accurate, reliable Fio2
delivery at high total flow rates.
- a variable size restriction is created
in the source gas stream.
- are very cost effective because they
deliver high gas flows to the patient at
low to average source gas setting.

Also known as an air-entrainment

mask, is amedical deviceto deliver
a knownoxygenconcentration to
patients on controlledoxygen
therapy.
- Venturi masks are considered highflow oxygen therapy devices. This is
because venturi masks are able to
provide total inspiratory flow at a
specifiedFiO2to patients therapy.

 Flow

Varies, should provide output flow > 60

L/min
FiO2

range
24 - 50%

FiO2

stability
Fixed

FiO2
Blue
Yellow
White
Green
Pink
Orange

24%
28%
31%
35%
40%
50%

Lpm
2
4
6
8
8
12

Aerosol face
masks,
Tracheostomy
masks, Tee
pieces(Briggs
adapters),
Face tents may
be used with
these
nebulizers.

Is a soft, transparent mask similar to the

simple, except for the large bore tubing
connection near the patients nose and the
large exhalation ports on each side of the
mask.
Tusks, or short lengths of aerosol tubing
may be inserted into the exhalation ports
to act as gas reservoirs to reduce room air
entrainment and preserve the delivered
Fio2.

are large clear plastic masks that

cup the chin and stand out from the
face to directs gas flow upward
toward the nose and mouth without
actually touching the face
- these devices are very helpful with
patients who have facial injuries or
burns and cannot tolerate an oxygen
device touching their face or skin.

Trach mask are designed to hold

large bore tubing via a swivel
adapter over the opening of a
patients tracheostomy tube with the
support of an elastic strap around
the patients neck.

tracheostomy is a small opening

through the skin in your neck into
the windpipe (trachea). A small
plastic tube, called a tracheostomy
tube or trach tube, is placed through
this opening into the trachea to help
keep the airway open. A person
breathes directly through this tube,
instead of through the mouth and
nose.

Is a 15mm connection that fits

directly onto the 15mm connection
of an endotracheal or tracheostomy
tube. Reservoir tubing may be added
to the tee to create an appliance
reservoir and decrease room air
entrainment from the open end of
the tee-piece.

The weight and size of a tee-piece

connection with large bore tubing
and a reservoir attached may cause
tracheal damage or dislocate a
tracheostomy tube, so this is not
practical for long term use.*

Flow
Should provide output flow of at least 60 L/minute

FiO2 range
21 - 100%

FiO2 stability
Fixed

Advantages
Full range of FiO2s

Disadvantages
Requires 50 psi air and O2, Blender failure or
inaccuracy common

Best use
Patients with high minute volumes needing high F iO2s

- are high flow reservoir devices that

encircle a patient with a prepared

atmosphere of medical gas, moisture,
and temperature. Mist tents,
Isolettes (incubators), oxygen
hoods are common examples of
environmental oxygen devices and
are used primarily in neonatal and
pediatric respiratory care.

these devices is limited to pediatrics

because manipulation of a complete
medical gas environment is more
practical, controllable, and tolerable
for infants and small children than for
adults.
- sicker children tolerate
environmental devices better than
oxygen masks, which produce feelings
of claustrophobia and suffocation.

Mist tents have an electrically

powered fan that circulates cool air and
nebulized water particles inside a
canopy which covers the entire child or
infant.
- Used for children
- provides cool aerosol and low to
moderate oxygen concentrations (.21
to .50) for older babies and toddlers

the fio2 should be analyzed

continuously, as close to the child
face as possible
- Tents are air conditioned or cooled
by ice to provide a comfortable
temperature within a plastic sheet
canopy.

 Flow

12 - 15 L/minute
FiO2 range
40 - 50%
FiO2 stability
Variable

Equipment:
1. A complete pediatric mist tent
with nebulizer unit, a fan, and drain
bottle.
2. Mist tent canopy.
3. High-pressure oxygen hose, about
6 feet in length.
4. Oxygen or air flowmeter.
5. Two liters of sterile water.
6. Oxygen analyzer for monitoring
oxygen concentrations.

Purpose:
1.

Provide continuous cool mist with

oxygen if needed.
2. Relieve laryngeal, tracheal, or
bronchial edema.
3. Help promote and improve cough
mechanism.
4. Hydrate dried secretions.

 Indications:
1.

Mist Tents are used for infant and

pediatric patients with dried secretions.
2. Used especially for pediatric patients
who have laryngotracheobronchitis
(croup),
bronchitis, bronchiolitis, inhalation burns,
and other edematous airway processes.
3. Can give oxygen concentrations
predictably up to 50%.

Contraindications/hazards/Complications:

1. Must have a working circulation unit. Malfunctions in this

unit can cause excessive heat and C02 build-up inside the
tent canopy.
2.
Precautions for oxygen usage must be observed.
3: Water reservoir must be monitored.
4. Consistent oxygen concentrations cannot be maintained if
the canopy is opened frequently.
5. Bed linen can become damp(moist) and need to be
changed.
6. Large volume nebulizers are susceptible to contamination.
7. Potential for electric shock or fire exists from the electrical
fan or static electricity
from the plastic.

are clear plexiglas chambers that deliver

controlled oxygen concentrations to the
head and face of neonates and small
infants.
- An oxygen hood is the best method for
providing controlled oxygen therapy to
infants.
- Covers only the head.
- Oxygen is delivered to the hood via either
a heated air entrainment nebulizer or a
blending system with a heated humidifier.

Flow
> 7 L/minute

FiO2 range
21 - 100%

FiO2 stability
Fixed

 Are

most effective at providing a

humidified neutral thermal environment
for a newborn but are very poor as
oxygen delivery devices.
Are plexiglass enclosures that combine
servo-controlled convection heating with
supplemental oxygen
Supplemental oxygen can be provided by
directly connecting the incubator to a
flowmeter with heated humidifier.

 Flow

8 - 15 L/minute
FiO2 range
40 - 50%
FiO2 stability
Variable

O2 DEVICE

Fio2

Flow(L/min.)

Nasal catheter
.28-.45
1-8
Nasal cannula
.40-.44
1-6
Simple mask
.40-.60
5-10
Partial Rebreathing .60-.80
>10
Nonrebreathing
.90- 1
>15
Venturi mask
.24, .28
Variable Fio2
Mist tent
.21-.50
>10-15
Incubator/Isolette low,variable
<8, titrate Fio2

 END..