The Lesson Builder



Oxygen Delivery DevicesFact:Oxygen is a medication ordered by the physicianHumans naturally breath 21% oxygen from the room airNormal oxygen saturation is 95-99% Clinically, if not receiving oxygen therapy, a patient on room air should have pulse ox reading of at least 92% or aboveDefinitions:Pulse oximeter – a non-invasive way to monitor the percentage of oxygen carried in blood.Hypoxia – Impaired level of oxygen in the body Hypoxic - Lack of oxygen in the tissues, tissue starved for oxygenHypoxemia – Not enough oxygen in the patient blood streamOxygen saturation: Indicator of the amount of blood saturated with oxygenSAO2 – Saturation of arterial oxygen oxygen saturation results from a blood gasa calculated result SPO2 - Oxygen saturation from pulse oximetry resultsFIO2 - Fractured of inspired oxygen –FIO2Percentage above 21 percent that is added to in addition to help oxygenate your patientE.g. if giving patient 2 liters of oxygen FIO2 is about 24% based on the patients breathing pattern (remember at room air we at 21% FIO2) E.g. if giving your patient 5 liters of oxygen FIO2 is about 40%Nasal Cannula: Delivers 1/8th of a liter to 6 liters/min of oxygen Drying to nasal mucosa, apply humidification/moistureHumidification adds moisture to the patients nasal mucosa by picking up droplets of water as the air is passed through the tubing to the patientDrying of mucosa is uncomfortable for the patient and can cause nose bleeds3 liters and above should be humidified (TCH standard –other organizations may have other standards)Be sure to check for skin breakdown especially behind the ears6 liters is not enough??? Need to deliver more oxygen to meet the patient’s minimum requirement of 92% O2 sats?Then step up to an oxymizer!!Oxymizer: AKA “the mustache” Larger boar tubingEnables higher flow delivery Can deliver 1/6th liter to 15 liters of oxygen per minute. 8 LPM(flow meter) Pulmonary HTN, Will oxygenate the patient even at the tissue levelCons of using a oxymizerCannot add moisture/humidification – because of larger boar tubing, as the oxygen air flow picks up droplets of water from the humidification, the condensation drains from the tubing inot the patients nose (the amounts can be large enough to drown patient) Not a controlled deviceDoes not give a guaranteed/exact FIO2Exact FIO2 needed????? Not sure what to use????? Don’t panic….the Venturi mask is your new friend!!! Venturi mask: Controls how much air is being delivered Can give an exact FIO2 Venturi port (located at the bottom of the tubing) controls how much air is being delivered. When air and delivered oxygen are mixed, the device can give an exact FIO2 resultLiter flow and FIO2 are printed on the colored tip of the device – devices are color coated so you can easily follow the prescribed order from the physicianCan deliver 2 – 55% FIO2 depending on the devicePatient not responding to the Venturi mask?????? Sats still less than 90 - 92%???? Non-rebreather is the next step to success!!!Non-rebreatherDelivers pure oxygen/gives a “bolus” of oxygen. 10- 15 LPMMost masks have a flutter valves on one side of the face mask and an ambient opening on the other side to allow exhaled air to escapeThis also helps to keep the patient from rebreathing their own CO2 Hence the name non-rebreather!!!!! LOLOLOLOLOLOLSome of the older models have flutter valves on both sides of the maskMake sure the flutter valves do not get stuck to mask – if they do you have just gone from a non-rebreather to a what????????? A CO2 rebreather!!!!Reservoir bag attached to the device must be fully inflated prior to patient useInflate by covering the one way valve at the top of the reservoir bag with your thumb until the bag is full, then place mask on your patientIf face mask has flutter valves on both sides the reservoir bag does not have to be fully inflated to work effectively)Oxygen delivery flow needs to be high enough to keep reservoir bag inflated but not too much to overwhelm the patientPatient must be able to breathe against air flowFun fact….Although an excellent device to help turn your patient around, the non-rebreather is not truly 100% non-rebreatheable – oxygen slightly diluted with room airIt is close…………. but no cigar baby!!!How do I know how much oxygen flow is too little or too much when using a non-rebreather?????If patient is working hard to breathe and the reservoir bag is collapsing between respirations, you need to turn up the oxygen flowPatient should be able to breathe against air flow – if the oxygen flow is overwhelming the patient adequate oxygen therapy is not being delivered Most clinicians turn the oxygen all the way up when using this device; however, that may not always be appropriate for every patientAmount of required oxygen is based on patient demand - amount of delivered air must meet the need of the individual patient Remember, keep the reservoir bag inflated, otherwise you are suffocating the patient The bag should breathe with the patient but not collapseToo high air flow disturbs ability to breathe Simple mask: (oops not this mask !!!) Delivers oxygen @ 4-12 liters safely (some literature may say 6-15)Simple masks can promote CO2 retaining - need at lest 4 liters to flush out patients own CO2Low levels of O2 delivery (less than 4 liters) with a simple mask can lead to patient rebreathing their own CO2, decreased respiratory effort, lethargy, knocking out patients drive to breathe, and decreased level of consciousnessRemember never ever ever put a patient on 1, 2, or 3 liters of oxygen when wearing a simple mask!!!!!! Last but not least……….Make sure to always verify you are connecting your oxygen tubing to the correct gas source.Any questions or concerns please contact Sheri Strodes 5-2502 or Jane Crenshaw 5-2695 ................
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