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Oxygen Therapy Jennifer Oliverio RRT, BSc Clinical Educator Respiratory Services Alberta Children’s Hospital O2 Initiation • O2 is a drug. A Dr.’s order is required to initiate O2 tx except in emergency situations • Order should include specific SpO2 or O2 flow rate/ FiO2 • O2 can be started without an order if hypoxia is suspected. Dr. must be contacted ASAP 2 Humidification • Standard wall set-up for O2 requires humidification (bubble humidifier/ cold neb) • Assess fluid level in humidifier with each RN assessment. Change 3x/week + prn • Portable O2 set-up: DO NOT incorporate humidity (risk of water spilling into delivery device) 3 Bubble Humidifier Use at flowrates < 10 LPM 4 Monitoring • O2 to be treated as a drug so need to ensure the rights: • Patient • Drug (O2) • Route (device) • Dose (flow/FiO2) • Documentation • Reason 5 Monitoring • Any changes to FiO2 or flow rate must be documented, including respiratory assessment • Dr. should be notified if previously stable pt exhibits respiratory instability or O2 needs exceed device 6 Safe Handling of O2 • Cylinders should be placed in secure holder to prevent tipping/ falling when not in use • When transporting pt on O2, cylinder must be secured in a carrier attached to bed, strecher, wheelchair or crib 7 Transporting pts on O2 • Ensure adequate O2 supply in tank for anticipated length of time • Switch to wall O2 if available at destination and TURN TANK OFF! • May need to bring 2 tanks for pt’s requiring high flow • Change cylinders at 500 psi 8 9 Devices • Nasal cannula • Simple O2 Mask • Non- rebreathing mask 10 Nasal Cannula • FiO2 0.22-0.40 • Prongs should not completely occlude the naresmultiple sizes available • **Ensure pt nares are patent** • Use with bubble humidifier 11 12 Nasal Cannula Sizes Size Max Flow Premature (< term) 2 LPM Neonate (>1400 g) 2 LPM Infant (newborn, term) 2 LPM Intermediate Infant (3-12 mo) 2 LPM Pediatric (>1yr) 3 LPM 13 Simple O2 Mask • • • • • • FiO2 0.35-0.50 ****Minimum 5 LPM O2 flow!!!!****** Can’t really titrate O2 Pt can’t eat/ drink Use with bubble humidifier Gently press on metal bar to conform to pt’s face. Do NOT pinch! 14 15 Partial Non- Rebreathing Mask • FiO2 0.60-0.90 (depending on mask fit) • Minimum 5 LPM for infant/child, 10 LPM for teens. Match flow to need • Reservoir bag and one-way valve limit amount of RA inspired and ↓ dilution of FiO2 • Gently press on metal bar to conform to pt’s face. Do NOT pinch! • DO NOT USE WITH HUMIDITY 16 17 Helpful Tips • No child or infant likes strangers • No child or infant likes things on their face • If they are not upset with you putting on a mask or prongs be concerned! • You may need to have parents help you hold the child or you may need to bunny the child for a short time until they get used to the therapy 18 The Parent Hold • Place the child sideways across their lap with the child’s legs held between the parents legs. • Place the child’s arm closest to the parent behind the parent’s back • The parent can use one arm to hold the free arm of the child and the other hand to hold device in place/ or the child’s head still 19 Bunny • snuggly wrap a blanket around the arms and torso of the infant/child 20 21 22 23