O2 Administration: Oxygen Therapy and Pulse Oximetry Gail M. Maier, PhD., R.N. Associate Director The Ohio State University Wexner Medical Center.

O2 Administration: Oxygen Therapy and Pulse Oximetry

Gail M. Maier, PhD., R.N.

Associate Director

The Ohio State University Wexner Medical Center

Learning Objectives

•abbreviations and diagnostic tests that are used to monitor the patient’s oxygen levels.Describe

• the indications for oxygen therapy.Identify

• the proper technique for the following:•Setting up a Venturi mask, low flow nasal cannula, and non-rebreather bag•Obtaining the patient’s SpO2 with a pulse oximeter

Demonstrate

•2 low flow and 2 high flow oxygen delivery devices.Identify

• the 4 hazards of oxygen therapyDescribe

• factors that affect the reading of a pulse oximeter.Examine

At the end of this module, you will know how to:

O2 Therapy

Common O2 therapy abbreviations:

PaO2: Partial pressure of O2 in the blood (Normal is 80 – 100 mmHg)

FiO2: Fraction of inspired O2 (Room air is 21% O2)

SaO2: Arterial O2 saturation (Normal is 95-100%)

Indications for Oxygen Therapy

Treat hypoxemia

Mild: PaO2 of 60-80 mm

Hg

Moderate: PaO2 of 40-60 mmHg

Severe: PaO2 below 40 mmHg

Decrease the work of breathing

Decrease myocardial demands

Setting up the delivery device

Oxygen flow meter: indicates

amount of oxygen patient is

receiving

Oxygen measured in

liters per minute (LPM)

Oxygen connections

Tubing connected to the flow meter via the “christmas tree”

Knob on flow meter indicates LPM the patient

is receiving

O2 adjuster knob

Christmas tree

Low Flow Oxygen Cannula

Delivers oxygen from

1-6 LPM

FiO2 from 25-45%

Prongs must face towards

the nares

Use humidification

for rates above 4LPM

Low Flow Oxygen Mask and Catheters

Other Low Flow Delivery Options•Mask can be used for those who are only mouth breathers•Delivers higher amounts of oxygen •Uncomfortable for most patients•Nasal catheters deliver oxygen at the same rates as a cannula. •Uncomfortable for the patient

High Flow Oxygen Cannula

Delivers oxygen up to

15 LPM

FiO2 from 57-81%

Used in severe levels of hypoxemia

High Flow Venturi (Venti) Mask

Sometimes called an “air entrapment”

mask

Provides FiO2s from 24-50%

Size of the entrapment

port determines the FiO2

Hazards of Oxygen Therapy

Oxygen toxicity• Alveolar damage

can occur• Provide only the

level of O2 patient requires

Denitrogenation absorption atelectasis• Absence of nitrogen

reduces alveoli’s ability to expand

Hazards of Oxygen Therapy

O2 induced hypoventilation• Seem primarily in patients

with COPD who have a hypoxic drive to breathe

• Oxygen takes away stimulus to breathe

Fire hazard

Oxygen Tanks

Oxygen is stored at a high pressure in green tanks.

Oxygen tanks are used for transporting patients on oxygen and when a wall hook-up isn’t available.

Before using, check to make sure the PSI is above 300 PSI. If not, get a new tank.

Do not lean tanks against the wall or roll them on the ground. This is a fire hazard. Transport them like this.

Monitoring oxygenation – Pulse Oximetry

Pulse oximeter: non-invasive monitor

Provides estimate of arterial blood oxyhemoglobin saturation levels

SpO2 = oxygen saturation levels

Procedure for Pulse Oximeter Use

Pulse oximeter readings taken with vital signs

Place device snugly on the finger

Earlobes or toe can be used

Record the oxygen saturation shown on the monitor

How does a Pulse Oximeter work?

Two different wavelengths of light are

emitted

Light passes through the finger and

read by the oximeter

Factors affecting the reading

Presence of high levels of

carbon monoxide

High levels of methemoglobin Anemia

Vascular dyes Dark skin pigmentation Ambient light

Poor perfusion Motion artifacts Elevated bilirubin

Checking for Accuracy

Compare the SpO2 on the pulse oximeter with

the patient’s arterial blood levels (if available)

Match the pulse rate on the oximeter with the patient’s actual pulse

rate

SpO2 and PaO2

Below is a chart comparing the SpO2 reading to what the likely PaO2 is.

SpO2 PaO2

90% 60 mmHg

80% 50 mm Hg

70% 40 mm Hg

Oxygen is essential to life so it is important that you understand what to look for that indicates the patient may be experiencing difficulties

Oxygen therapy is a common type of therapy ordered for the patients. You will be responsible for helping set the oxygen devices up

Summary

Thank you for completing this module

If you have any questions, please let me know.

[email protected]

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