o2 administration: oxygen therapy and pulse oximetry gail m. maier, phd., r.n. associate director...
TRANSCRIPT
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.
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