When is oxygen indicated

Check and document oxygen equipment set up at the commencement of each shift and with any change in patient condition. Hourly checks should be made for the following: oxygen flow rate patency of tubing humidifier settings if being used Hourly checks should be made and recorded on the patient observation chart for the following unless otherwise directed by the treating medical team : heart rate respiratory rate respiratory distress descriptive assessment - i.

Ensure the individual MET criteria are observed regardless of oxygen requirements See below nursing guidelines for additional guidance in assessment and monitoring: Observation and Monitoring Nursing Clinical Guideline re: pulse oximetry monitoring Nursing Assessment Nursing Clinical Guideline Weaning Oxygen Unless clinically contraindicated, an attempt to wean oxygen therapy should be attempted at least once per shift.

Rationale: Cold, dry air increases heat and fluid loss Medical gases, including air and oxygen, have a drying effect on mucous membranes resulting in airway damage. Follow the instructions in the disinfection kit manual : For routine cleaning instructions please refer to the following link: RCH Equipment Cleaning Table Prepared by Infection Prevention and Control Team Delivery Mode Click to view the delivery mode quick reference table Simple Nasal Prongs Nasal prongs without humidification This system is simple and convenient to use.

Ensure straps and tubing are away from the patient's neck to prevent risk of airway obstruction. Check nasal prong and tubing for patency, kinks or twists at any point in the tubing and clear or change prongs if necessary.

Check nares for patency - clear with suction as required. Change the adhesive tape weekly or more frequently as required Nasal prongs with humidification system If the required flow rate exceeds those as recommended above this may result in nasal discomfort and irritation of the mucous membranes. Below is an image of the RT pressure relief valve. Consider PICU transfer if after one hour no clinical improvement has occurred Optiflow Nasal Prong junior and standard humidification and flow rate guide for Airvo.

Non-rebreathing face mask A non-rebreathing face mask has an oxygen reservoir bag and one-way valve system which prevents exhaled gases mixing with fresh gas flow. Ensure the flow rate from the wall to the mask is adequate to maintain a fully inflated reservoir bag during the whole respiratory cycle i.

Non-rebreathing face mask are not designed to allow added humidification. Note: HME are used without a heated humidifier circuit. Trach-Vent's are changed daily or as required if contaminated or blocked by secretions. NOTE : While a specific FiO 2 is delivered to the patient the FiO 2 that is actually inspired by the patient ie what the patient actually receives varies depending on: flow rate delivered to the patient mask size and fit the patient's respiratory rate Incubator At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly neonatal intensive care unit.

Considerations Supplemental oxygen relieves hypoxaemia but does not improve ventilation or treat the underlying cause of the hypoxaemia. Monitoring of SpO 2 indicates oxygenation not ventilation. Therefore, beware the use of high FiO 2 in the presence of reduced minute ventilation. Normal SpO 2 values may be found despite rising blood carbon dioxide levels hypercapnea. High oxygen concentrations have the potential to mask signs and symptoms of hypercapnea.

Potential complications of oxygen use CO 2 Narcosis - This occurs in patients who have chronic respiratory obstruction or respiratory insufficiency which results in hypercapnea i. In these patients the respiratory centre relies on hypoxaemia to maintain adequate ventilation. If these patients are given oxygen this can reduce their respiratory drive, causing respiratory depression and a further rise in PaCO 2.

Monitoring of SpO 2 or SaO 2 informs of oxygenation only. Therefore, beware of the use of high FiO 2 in the presence of reduced minute ventilation. Substernal pain-due: characterised by difficulty in breathing and pain within the chest, occurring when breathing elevated pressures of oxygen for extended periods. Oxygen safety Oxygen is not a flammable gas but it does support combustion rapid burning. Due to this the following rules should be followed: Do not smoke in the vicinity of oxygen equipment.

Do not use aerosol sprays in the same room as the oxygen equipment. Turn off oxygen immediately when not in use. Oxygen is heavier than air and will pool in fabric making the material more flammable. Therefore, never leave the nasal prongs or mask under or on bed coverings or cushions whilst the oxygen is being supplied. Oxygen cylinders should be secured safely to avoid injury.

Do not store oxygen cylinders in hot places. Keep the oxygen equipment out of reach of children. Do not use any petroleum products or petroleum byproducts e. References Bersten, A. Oh's Intensive care manual. Sydney, Australia: Butterworth-Heinemann. Brink, F; T Duke, T. Oxygen administration in infants. Martin, S. However, in a normoxemic patient, increasing the inspired fraction of oxygen has a marginal effect on oxygen-carrying capacity, since hemoglobin saturation and concentration rather than arterial oxygen tension PaO 2 predominantly determine oxygen-carrying capacity.

On the other hand, supraphysiologic levels of dissolved oxygen may lead to toxicity. For over a century, we have known the potential harms of hyperoxia.

Original studies in animal models showed that hyperoxia led to lung injury, altered hemodynamics, endothelial cell dysfunction, and inflammatory activation. Chronic obstructive pulmonary disease COPD is the clinical setting in which risks of supplemental oxygen are most well-recognized historically.

These unintended consequences may also occur in patients with other forms of acute and chronic lung disease. The British Medical Journal published the first randomized controlled trial of oxygen use in suspected MI in Two recent trials investigated the effects of hyperoxia in critically ill patients.

Compared with conventional oxygen targets, conservative oxygen use was associated with an absolute risk reduction in mortality of 8. The trial was stopped early for safety concerns. Trials of liberal oxygen use in other settings of acute illness, 13 including ischemic stroke, 14 traumatic brain injury, 15 and postcardiac arrest, 16 have also linked liberal oxygen use with increased risk of mortality and other adverse events. Significant secondary outcomes included fewer hospital-free and ventilator-free days in patients with liberal oxygen use.

In addition to the data above, there are practical reasons to avoid unnecessary use of supplemental oxygen. Also, some alveoli drop out of use during sleep. If your waking oxygen saturation is greater than about 94 percent on room air, it is unlikely that your saturation during sleep will fall below 88 percent. However, your doctor can order an overnight oximetry test if there is a question about your oxygen saturation levels while you are sleeping.

How do I know that I'm using the right amount of supplemental oxygen? To determine if you're getting the right amount of supplemental oxygen, your oxygen saturation must be measured while you are using your oxygen.

Your provider or a respiratory therapist from the oxygen supplier should test your oxygen saturation on oxygen while you are at rest, while walking and, if indicated, while you are asleep. As long as your saturation is in the 90s, you are getting the right amount of supplemental oxygen. Should I buy my own finger oximeter to test my oxygen saturations? It is probably a good idea to buy a finger oximeter, so that you are sure you are getting the right amount of supplemental oxygen.

Finger oximeters are available on the internet, through medical supply companies and even in sporting goods stores. When a person isn't getting enough oxygen, all organs of the body can be affected, especially the brain, heart and kidneys. Wearing supplemental oxygen keeps these organs, and many others, healthy.

There is evidence that, for people who are hypoxemic, supplemental oxygen improves quality of life, exercise tolerance and even survival. Supplemental oxygen can also help relieve your symptoms.

You may feel relief from shortness of breath, fatigue, dizziness and depression. You may be more alert, sleep better and be in a better mood. You may be able to do more activities such as traveling, including traveling to high altitudes.

Symptoms such as shortness of breath may be caused by something other than lack of oxygen. In these cases, supplemental oxygen may not relieve the symptom. But if tests show you are not getting enough oxygen, it is still important to wear your oxygen. Does my need for supplemental oxygen mean that I don't have long to live?

That depends on the reason oxygen was prescribed. Your oxygen level should not go above mmHg. Some people need oxygen therapy all the time, while others need it only occasionally or in certain situations. Oxygen gas can be stored in a portable tank. These are called compressed gas systems. A larger stationary concentrator is used within the home, and a smaller oxygen tank can be taken to use outside the home.

The smaller tanks might be used along with oxygen-conserving devices so that the oxygen supply lasts longer. The oxygen is delivered in pulses, not continuously. Liquid oxygen also can be stored in a portable tank. Liquid oxygen is more highly concentrated, so more oxygen can fit in a smaller tank. These tanks are refillable. Oxygen concentrators are less portable than the other options. An oxygen concentrator is a device that takes oxygen from the room, concentrates it for therapeutic use, and removes other naturally occurring gases.

Portable versions are available. However, most models are too large to be truly portable. Oxygen is distributed from the tank through a tube.

Hyperbaric oxygen therapy is unlike the other methods of oxygen therapy. People will breathe in pure oxygen in a pressurized room or chamber. In the hyperbaric chambers, the air pressure is increased to three or four times the normal air pressure levels. This type of oxygen delivery is often used to treat wounds, serious infections, or bubbles of air in your blood vessels. The most common delivery method is the nasal cannula , which consists of a tube that runs through both nostrils.

Other delivery methods include:. Oxygen therapy can be extremely beneficial for those who frequently experience low oxygen levels, regardless of the reason. If needed, regularly utilizing oxygen therapy can allow people to be more active and mobile by decreasing shortness of breath.