ADMINISTRATION OF OXYGEN SHARON HARVEY
Dec 14, 2015
LEARNING OUTCOMES
THE STUDENT SHOULD BE ABLE TO: REVIEW THE PHYSIOLOGICAL
REQUIREMENTS OF THE BODY FOR OXYGEN. IDENTIFY WHEN OXYGEN THERAPY MAY BE NEEDED FOR AN ADULT AND CHILD
DEMONSTRATE HOW OXYGEN THERAPY SHOULD BE PRESCRIBED USING A PRESCRIPTION/MEDICATION CHART
LEARNING OUTCOMES
DISCUSS THE SAFE AND EFFECTIVE DELIVERY OF OXYGEN THERAPY WITH PARTICULAR REFERENCE TO:
USE OF COMMON DELIVERY APPARATUS (FACEMASKS, NASAL CANNULA) FOR ADULT AND CHILD
SAFETY CONSIDERATIONS (THE CORRECT FLOW RATE, AVOIDANCE OF NAKED FLAME)
STORAGE AND DELIVERY OF OXYGEN IN CLINICAL AREAS
LEARNING OUTCOMES
DISCUSS THE PATIENT’S EXPERIENCE WHEN UNDERGOING OXYGEN THERAPY
IDENTIFY EFFECTIVE NURSING INTERVENTIONS TO SUPPORT THE PATIENT, E.G. ORAL HYGIENCE, ADEQUATE FLUID INTAKE, CORRECT POSITIONING TO ACHIEVE MAXIMUM VENTILATION OF LUNGS
DISCUSS THE INDICATIONS AND CONTRAINDICATIONS FOR A CHILD AND ADULT: NASOPHARYNGEAL AND OROPHARYNGEAL SUCTIONING LOWER AIRWAY SUCTIONING SUCTIONING OF THE TRACHEOSTOMY
OXYGENATIONOXYGEN – A PRESCRIBED DRUG
MUST BE WRITTEN LEGIBLY BY THE DOCTOR
PRESCRIPTION SHOULD BE DATED BY THE DOCTOR
DOCTOR MUST INDICATE DURATION OF O2 THERAPY
THE O2 % CONCENTRATION MUST BE PRESCRIBED
THE FLOW RATE MUST BE PRESCRIBED
INDICATION FOR OXYGEN THERAPY
ACUTE RESPIRATORY FAILUREACUTE MYOCARDIAL INFARCTIONCARDIAC FAILURESHOCKHYPERMETABOLIC STATE INDUCED
BY TRAUMA, BURNS OR SEPSISANAEMIACYANIDE POISONINGDURING CPRDURING ANAESTHESIA FOR SURGERY
BASIC COMPONENTS OF A OXYGEN DELIVERY SYSTEM
PIPED OR PORTABLE CYLINDER OXYGEN SUPPLY
A REDUCTION GAUGE
FLOW METER (LITRES/MIN)
BASIC COMPONENTS OF A OXYGEN DELIVERY SYSTEM
DISPOSABLE TUBING OF VARYING DIAMETER AND WIDTH
MECHANISM FOR DELIVERY (MASK OR CANNULA)
HUMIDIFIER (TO WARM AND MOISTEN THE O2
METHODS OF ADMINISTERING OXYGEN SIMPLE SEMI-RIGID MASKS NASAL CANNULA FIXED PERFORMACE MASKS OR HIGH-FLOW
MASKS (VENTURI) T-PIECE CIRCUIT PAEDIATRIC CIRCUITS - HEADBOX OR HOOD
- O2 TENT/COT TRACHEOSTOMY MASK MECHANICAL VENTILATION CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)
HUMIDIFICATION OF OXYGEN
NORMAL AIR TRAVELLING THROUGH THE AIRWAYS IS WARMED, MOISTENED AND FILTERED BY EPITHELIAL CELLS OF THE NASOPHARYNX
THE AIR ENTERING THE TRACHEA WILL HAVE A RELATIVE HUMITY OF 90% AND A TEMPERATURE OF BETWEEN 32-36 C
OXYGENATION WILL CAUSE DEHYDRATION OF THE MUCUS MEMBRANES AND PULMONARY SECRETIONS
HUMIDITY IS ESSENTIAL FOR PATIENTS WHO HAVE AN ENDOTRACHEAL OR TRACHEOSTOMY TUBE
HUMIDIFICATION REQUIREMENTS
HUMIDIFICATION AND TEMPERATURE SHOULD NOT BE AFFECTED BY THE FLOW RATE
SAFETY ALARMS SHOULD GUARD AGAINST OVERHEATING, OVER HYDRATION AND ELECTRIC SHOCK
NO INCREASED RESISTENCE TO RESPIRATION
WIDE BORE TUBING (ELEPHANT) SHOULD BE USED TO ALLOW SUFFICIENT FORMATION OF WATER VAPOUR
HEALTH AND SAFETY ISSUES WITH O2
MEDICAL GAS CYLINDERS HAVE TO CONFORM TO COLOUR CODING
CURRENTLY OXYGEN CYLINDERS ARE BLACK WITH WHITE SHOULDERS.
HEALTH AND SAFETY ISSUES WITH OXYGEN OXYGEN IS
COMBUSTIBLE OIL AND GREASE
AROUND CONNECTIONS SHOULD BE AVOIDED
ALCOHOL, ETHER AND INFLAMMATORY LIQUIDS SHOULD BE KEPT SEPARATE FROM O2
NO ELECTRICAL DEVICES NEAR 02 TENT
NO SMOKING FIRE EXTINGUISHER NEEDS
TO BE AVAILABLE CARE WITH USING
DEFIBRILLATOR NEAR HIGH OXYGEN CONCENTRATIONS
POTENTIAL PROBLEMS
CO2 NARCOSIS CO2 LEVELS IN THE BLOOD NORMALLY INFLUENCES
RESPIRATION
PATIENTS WHO ARE HYPERCAPNIC CO2E.G. CHRONIC BRONCHITIS, HAVE THEIR BRAIN CHEMORECEPTORS NO LONGER SENSITIVE TO CO2 LEVELS
- INSTEAD THE HYPOXIC DRIVE BECOMES THE RESPIRATORY DRIVE I.E. O2 IS THE DRIVE FOR RESPIRATION
- HIGH LEVELS OF SUPPLEMENTARY O2 MAY LEAD TO REPIRATORY DEPRESSION/UNCONSCIOUSNESS AND DEATH
POTENTIAL PROBLEMS
OXYGEN TOXICITY THIS FOLLOWS AFTER PROLONGED O2 THERAPY
(>24 HOURS) THERE IS DECREASING LUNG COMPLIANCE FROM
HAEMORRHAGIC INTERSITIAL AND INTRA-ALVEOLAR OEDEMA
THIS ULTIMATELY LEADS TO FIBROSIS OF LUNG TISSUE
>24 HOURS AND > 50 % O2 THERAPY SHOULD BE AVOIDED
PRINCIPLES OF SUCTIONING
THREE PRIMARY SUCTIONING TECHNIQUES ARE:
OROPHARANGEAL/ NASOPHARANGEAL SUCTIONING
OROTRACHEAL AND NASOTRACHEAL SUCTIONING
SUCTIONING AN ARTIFICAL AIRWAY
SIGNS OF A NEED FOR SUCTIONING RESPIRATORY RATE CHANGE IN
RESPIRATORY PATTERN
NOISY BREATHING DIFFICULTY
SUCTIONING REDUCED OR UNEVEN
AIR ENTRY INCREASED AIRWAY
PRESSURE
SURGICAL EMPHYSEMA OR OTHER NECK SWELLING
DISTRESSED PATIENT
HYPOXIA THE ABILITY TO
HEAR THE PATIENT SPEAK WHEN CUFF IS INFLATED
PRINCIPLES OF SUCTIONING
OROPHARYNGEAL SUCTIONING REMOVES SECRETIONS FROM THE PHARYNX VIA A CATHETER PLACED THROUGH THE MOUTH OR NOSTRILS
THIS TYPE OF SUCTIONING IS USED WHEN THE PATIENT S ABLE TO COUGH EFFECTIVELY BUT UNABLE TO CLEAR SECRETIONS BY EXPECTORATING OR SWALLOWING
PROCEDURE IS CARRIED OUT AFTER THE PATIENT HAS COUGHED
ASSESSMENT PRIOR TO SUCTIONINGABNORMAL BREATHING SOUNDSIRREGULAR RESPIRATORY PATTERNCHANGES IN SECRETIONSINCREASE IN COUGHING INCIDENTSCHANGE IN PATIENT’S APPEARANCE
OROPHARYNGEAL SUCTIONING
MEASUREMENTS? ALWAYS USE THE SMALLEST DIAMETER SUCTION
CATHETER POSSIBLE TO REMOVE THE SECRETIONS
FOR ADULTS USE CATHETERS SIZE 12-16 FRENCH GAUGE
FOR CHILDREN USE 8-12 CATHETER GAUGE INSERTION DEPTH
FOR NASOPHARYNGEAL SUCTIONING: ADULTS INSERT ABOUT 16CM INFANTS AND YOUNG CHILDREN 4-8 CM
OROPHARYNGEAL SUCTIONING
CAUTION ON PATIENTS WITH: NASOPHARYNGEAL BLEED OR CSF LEAK ANTI COAGULANT THERAPY
OROPHARYNGEAL SUCTIONINGPROCEDURE REVIEW OXYGEN SATURATIONS AND BREATHING
PATTERN EVALUATE ABILITY TO COUGH CHECK HISTORY FOR DEVIATED SEPTUM, NASAL
POLYPS, NASAL OBSTRUCTION, TRAUMATIC INJURY, EPISTAXIS OR MUCOSAL SWELLING
EXPLAIN PROCEDURE INFORM THAT SUCTIONING MAY CAUSE
TRANSIENT COUGHING AND GAGGING MINIMISE ANXIETY POSITION PATIENT IN AN UPRIGHT POSITION TO
PROMOTE LUNG EXPANSION
OROPHARYNGEAL SUCTIONING
TURN ON SUCTION (80-120 MMHG)EXCESSIVE PRESSRE MAY CAUSE
TRAUMAOCCLUDE THE END OF CONNECTING
TUBE TO CHECK SUCTION PRESSUREASEPTIC TECHNIQUEUSE LUBRICANT IF THE CATHETER IS
PASSED THROUGH NASAL PASSAGE
OROPHARYNGEAL SUCTION
USE YOUR DOMINANT HAND TO CONTROL THE CATHETER
USE YOUR OTHER HAND TO CONTROL SUCTION VALVE
PATIENT TO COUGH AND BREATH DEEPLY BEFORE SUCTIONING
COUGHING HELPS TO LOOSEN SECRETIONS
DEEP BREATHING HELPS TO MINIMISE HYPOXIA AND LUNG COLLAPSE
OROPHARYNGEAL SUCTIONING
SPECIAL CONSIDERATIONS ALTERNATE BETWEEN NASAL PASSAGES
TO MINIMISE TRAUMATIC IJURY WHERE REPEATED SUCTIONING IS
REQUIRED, A PHARYNGEAL AIRWAY WILL HELP WITH CATHETER INSERTION, REDUCE TRAUMA AND PROMOTE PATENT AIRWAY
RESPT PATIENT AFTER SUCTIONING AND OBSERVE