ADMINISTRATION OF

OXYGEN
PRESENTED BY
R.SIVABARATHY
M.SC (N) 2 ND YEAR
CON, JIPMER
 INTRODUCTION
• The medical administration of supplemented oxygen is considered to be a process
similar to that of administering medications and requires similar nursing actions.
• Oxygen is of the most important element without which life on earth would not
able to exist
• The word oxygen comes from the Greek word Meaning ACID FORMER because
most mineral acid contain oxygen.
• The term oxygen was first coined by ANTOINE LAVOISEIR
• Oxygen therapy is prescribed by the primary care providers, who specifies the
concentration, method of delivery and litre of flow of oxygen per minute .
 OXYGEN ADMINISTRATION

• Oxygen therapy is a process of giving oxygen to a child whose

oxygen concentration is low in the blood.
• Children with respiratory dysfunction are usually given oxygen
inhalation
• Normal amount of oxygen in blood should be 80 to 100 mm of Hg.
 BENEFITS

Increase oxygenation at tissue level maintain aerobic metabolism

Decreases the work of breathing by improving the ventilation

Decreases workload on myocardium by improving the cardiac output

OXYGEN DELIVERY SYSTEMS
 USING OXYGEN CYLINDER
• The oxygen cylinder is delivered with a protective cap to prevent accidental
force against the cylinder outlet
• To release oxygen safety and at a desirable rate, a regulator is used
• A reduction gauge that shows the amount of oxygen in the tank
• A flow meter that regulates the control of oxygen in litres per min
• Oxygen is moistened by passing it through a humidifier to prevent the
mucous membranes of the respiratory tree from becoming dry
 WALL OUTLET OXYGEN

• The oxygen is supplied from a central source through a pipeline

• Only a flow meter and a humidifier are required
 LOW FLOW OXYGEN SYSTEMS:

• NASAL CANNULA
• FACE MASK
• SIMPLE FACE MASK
• PARTIAL REBREATHER MASK
• NON REBREATHER MASK
• VENTURI MASK
• OXYGEN HOOD/TENT
• TRANS TRACHEAL CATHETERS
 NASAL CANNULA
• The nasal cannula ( nasal Prongs) is the most common inexpensive device to administer
oxygen. It delivers a relatively low concentration of o2 (24% to 45%) at flow rates of 2-6
liter per minute.
• It is a disposable, plastic device with two protruding prongs for insertion into the nostrils,
connected to an oxygen source.
• It is also relatively comfortable, permits same freedom of movement and is well tolerated
by the client.
• To deliver relatively low concentration of O2 when only minimal O2 support is required
• To allow uninterrupted delivery of O2 while the client ingests food or fluid.
ADVANTAGE DISADVANTAGE

• EASILY USED IN HOME • UNABLE TO USE NASAL

SETTING OBSTRUCTION
• SAFE AND SIMPLE • DRYING THE MUCOUS
• EASILY TOLERATED MEMBRANES

• DELIVERS THE LOW • CAN DISLODGE FROM

CONCENTRATION NARES EASILY
• SKIN IRRITATION
 FACE MASK
• It covers the clients nose and mouth may be used for O2 inhalation.
Exhalation parts on the sides of the mask allow exhaled carbon di
oxide to escape.
• Purpose are to provide moderate O2 support and a higher
concentration of O2 and or humidity that provided by cannula.
• A variety of O2 masks are available:
 SIMPLE FACE MASK:
• It delivers O2 concentration from 40% to 60% at liter flows of oxygen 5 to 8
L per minute, respectively.
• Simple mask is made of clear, flexible, plastic or rubber that can be molded to
fit the face
• It is held to the head with elastic bands
• Some have a metal clip that can be bent over the bridge of the nose for a
comfortable fit
• It has vents on its sides which allow room air to leak in at many places,
thereby diluting the source oxygen
• Often it is used when an increased delivery of oxygen is needed for short
periods
 PARTIAL REBREATHER MASK:

• The mask is with a reservoir bag that must remain inflated during both
inspiration and expiration
• It delivers O2 concentration of 60% to 90% at liter flow of 6 to 10L/min and
the remaining exhaled air exits through vents.
• The O2 reservoir bag that is attached allows the client to rebreathe about the
first third of the exhale air in conjunction with O2,
• Thus it increases the Fio2 by recycling expired O2
• The partial rebreather bag must bot totally deflate during inspiration to avoid
carbon dioxide build ups.
 NON REBREATHER MASK
• It delivers the highest O2 concentration possible 95% to 100% by means other
than intubation or mechanical ventilation, at flow rate of 10 to 15 L/min.
• It is similar to the partial re breather mask except two one way valves prevent
conservation of exhaled air. The bag has an oxygen reservoir.
• When the patient exhales air the one way valve closes and all of the expired
air is deposited into the atmosphere, not the reservoir bag
• In this way, the patient is not re breathing any of the expired gas.
 VENTURE MASK
• It delivers oxygen concentration varying from 24% to 40% or 50% at liter
flows of 4 to 10 L/min
• The venture mask has wide bore tubing and colour coded jet adapters that
correspond to a precise O2 concentration and liter flow.
• The mask is constructed so there is a constant flow of room air blended with a
fixed concentration of oxygen.
• A blue adapter delivers a 24% concentration of O2 at 4L/min and a green
adapter delivers a 35% concentration of O2 at 8L/min.
 OXYGEN HOOD
• Face tents can replace oxygen mask when masks are poorly tolerated by the
clients. Face tents provide varying concentrations of oxygen.
• An oxygen hood is used for babies who can breathe on their own but still need
extra oxygen.
• A hood is a plastic dome or box with warm, moist oxygen inside.
• The hood is placed over the baby’s head.
• To provide high humidity
• To provide oxygen when a mask is poorly tolerated
• To provide a high flow of O2 when attached to a venture mask.
 OXYGEN TENT
• An oxygen tent consists of a canopy placed over the head and shoulders, or
over the entire body of a patient to provide oxygen at a higher level than
normal
• Typically the tent is made of see through plastic material it can envelop the
patients bed with the end sections held in place by a mattress to ensure that the
end is alright.
• The enclosure often has a side opening with a zipper.
 TRANS TRACHEAL CATHETERS

• A trans tracheal catheter is placed through surgically created tract in

the lower neck directly into the trachea. Once the tract has matured
the client removes and cleans the catheter two to four times a day.
• 15 to 20 L/min high flow rates can be administered through the trans
tracheal catheters.
 SAFETY PRECAUTIONS DURING
ADMINISTRATION OF OXYGEN
Oxygen act as a drug it must be prescribed and administered in specific dose.
Humidifier and regulator must be used.
O2 should be warmed to room temperature.
It should be given at lowest concentration and for shortest period of time to achieve
satisfactory level of spo2 or paco2 that should not exceed 100mm of Hg as there is no
clinical signs which indicate hypoxia that result in oxygen toxicity.
Oxygen therapy to be discontinued gradually
Precautions to be taken to prevent fire hazards.
General principles of O2 administration to be followed
The child should be observed frequently
• Oxygen is a therapeutic gas and must be prescribed and adjusted only with a health
care provider orders
• Place an oxygen in use sign on the patients door and in the patients room
• If using oxygen at home, place a sign on the door of the house.
• No smoking should be allowed on the premises.
• Oxygen is a highly combustible gas
• Although it does not burn spontaneously or cause an explosion, it can easily cause a
fire in a patients room if it contacts a spark from an open flame or electrical
equipment.
• Keep oxygen delivery systems 10 feet from any open flames
• Determine that All electrical equipment in the room is functioning correctly.
 ARTIFICIAL VENTILATION

• Artificial ventilation is means of assisting or stimulating respiration, a

metabolic process referring to the overall exchange of gases in the body
• Artificial airways are inserted to maintain a patent air passage for clients
whose airways are become or may become obstructed

OROPHARYGEA NASOPHARYGE ENDOTRACHEA TRACHEOSTOM

L AL L TUBE Y
 MANUAL METHODS

• Pulmonary ventilation is achieved through manual insufflation of the

lungs either by the rescuer blowing into the patients lungs.
 MECHANICAL VENTILATION
• It is a method to mechanically assist or replace spontaneous
breathing.
• If it involve any instrument penetrating
Through the mouth endotracheal tube
Through the skin tracheostomy
• Tracheal intubation is often used for short term mechanical
ventilation.
Through the nose nasotracheal intubation
 MODES OF MECHANICAL VENTILATION

• POSITIVE PRESSURE
• NEGATIVE PRESSURE
 ORO AND NASOPHARYNGEAL AIRWAYS:

• Used to keep the upper air passage open when they may become
obstructed by secretions or the tongue.
• They are inserted through the nares, terminating in the oropharyngeal
airway, provide frequent oral care and nares care, repositioning the
airway every8 hour or as ordered to prevent necrosis of the mucosa.
 ENDOTRACHEAL TUBES:

• Endotracheal intubation are most commonly done in clients who have had
general anesthesia or those in emergency situations where mechanical
ventilations is required an endotracheal tube is inserted through the mouth or
nose and into the trachea with the guide of a laryngoscope.
• Although it is more difficult naso tracheal intubation is preferred over the oro
tracheal intubation, because it facilitates oral hygiene and provides more
stable fixation, which reduces the complication.
• The endotracheal tube (ETT) size formula, (age/4) + 3.5, with a
cuffed tube makes more sense anatomically. Classic teaching is that
we should use the formula (16+age)/4 or (age/4) + 4 to calculate the
uncuffed pediatric ETT size.
• Endotracheal tube (ETT) internal diameter in millimetres can
be calculated as gestational age in weeks divided by 10. Typically, a
2.5 tube is appropriate for infants <1kg weight, a 3.0 tube for infants
weighing 1-2 kg, a 3.5 tube for infants 2-3 kg, and a 3.5 or
4.0 tube for infants over 3 kg
ET TUBE SIZE INTERNAL DEPTH
DIAMETER
(mm)
1-2 YR 4.0 10-11
3-4 YR 4.5 12-13
5-6 YR 5.0 14-15
10 YR 6.0 16-17
 NURSING INTERVENTION FOR
ENDOTRACHEAL INTUBATION:
• Perform hand hygiene and wear glove
• Assess the clients respiratory status
• Frequently assess the nasal and oral mucosa for redness and irritation.
• Secure the endotracheal tube with tape or a commercially prepared tracheostomy holder to prevent the
movement of the tube into or out and assess the position of the tube frequently.
• Unless contraindicated, elevate the head of the bed 30 – 45 degrees
• Using sterile techniques during suction
• Maintain vacuum pressure
• Provide oral hygiene and nasal care
• Provide the humidified oxygen
• If the child is an mechanical ventilation, ensure that all alarms are enabled at all times.
 TRACHEOSTOMY:
• Child who need an airway support due to temporary or permanent condition
may have a tracheostomy.
• A tracheostomy is an opening into the trachea through the neck. A vertical
midline incision is made from the inferior aspects of the thyroid cartilage to the
suprasternal notch and continued down between the infra hyoid muscles.
• Incision on the second, third and fourth tracheal ring should be made
immediately
• A tube is usually inserted through the opening and an artificial airway is
created.
 COMPLICATION OF TRACHEOSTOMY

• HEMORRHAGE
• EDEMA
• ASPIRATION
• ACCIDENTAL DE CANNULATION
• TUBE OBSTRUCTION
• ENTRANCE OF FREE AIR INTO THE PLEURAL CAVITY
 ASSESSMENT AND PREPARATION
• Perform hand hygiene
• Assess the child developmental level and ability to interact
• Assess the child signs and symptoms of inadequate oxygenation and
ventilation
• Determine if a conditions in the medical history predisposes the
child to baseline lower than normal oxygen saturation levels
• Assess the child and family understanding of the reasons for and the
risks and benefits of the procedure.
 MONITORING AND CARE
• Monitor cardiopulmonary status, including vital signs, oxygen saturation and indicators of
oxygenation and ventilation
• Monitor the child’s respiratory status and need for increased oxygen therapy
• Monitor the child for sign of hypercarbia
• Monitor a child in an oxygen hood carefully
• Assess skin frequently for breakdown
• Monitor the child for signs of dry mucous membranes
• Provide humidification when the supplemental oxygen delivery device permits. If
humidified oxygen is used, check the linens frequently and change them as needed
• Assess, treat and reassess pain
 DOCUMENTATION

• Delivery device and amount of oxygen delivered

• Respiratory status, including work of breathing and breath sounds
• Vital signs
• Pulse oximeter reading as indicated
• Child’s response to supplemental oxygen
• Pain assessment and related interventions
• Unexpected outcomes and related nursing interventions
• Child and family education
 OXYGEN TOXICITY

• It is a condition which occurs due to inspiration of a high

concentration of oxygen for prolonged period of time
• Oxygen concentration greater than 50% over 24 to 48 hours can
cause pathological changes in the lungs.
 ABSORPTION ATELECTASIS
• During 100% oxygen delivery, nitrogen in alveoli is washed out and
replaced by oxygen
• In contrast to nitrogen, Oxygen is extremely soluble in blood and
diffuses very quickly into the pulmonary Vasculature, so that not
enough gas is left in the alveoli to maintain patency, and the alveolus
collapses.
 THEORY APPLICATION

• ROY ADAPTATION MODEL

 JOURNAL REFERENCE
Title: Non invasive pressure support ventilation versus conventional oxygen
therapy in acute cardiogenic pulmonary edema. A randomized trial
Author: MOSIP J, BETEBESE AJ, PAEZ J, VECILLA ET AL,.
Background:
• Non invasive pressure support ventilation is an effective treatment for acute
respiratory failure in patients with chronic obstructive pulmonary disease we
assessed the efficacy of this therapy in acute cardiogenic pulmonary edema
in a randomized comparison with conventional O2 therapy.
Methods:
• 40 patients were randomly assigned conventional O2 therapy or NIPSV
supplied by a standard ventilator through a face mask, with adjustment of
tidal volume and pressure support in addition to a positive end expiratory
pressure of 5 cm water. Physiological measurements wee obtained in the first
2 hours and at 3 hours, 4 hours and 10 hours. The main end pints were
intubation rate and resolution time
Interpretation:
• In this study of acute cardiogenic pulmonary edema, NIPSV was superior to
conventional oxygen therapy. Further studio should compare NIPSV with
continuous positive airway pressure.
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• https://apps.who.int/iris/bitstream/handle/10665/204584/9789241549554