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Oxygen Therapy

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

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Oxygen Therapy

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  1. Oxygen Therapy Jennifer Oliverio RRT, BSc Clinical Educator Respiratory Services Alberta Children’s Hospital

  2. 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

  3. 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)

  4. Bubble Humidifier Use at flowrates < 10 LPM

  5. Monitoring • O2 to be treated as a drug so need to ensure the rights: • Patient • Drug (O2) • Route (device) • Dose (flow/FiO2) • Documentation • Reason

  6. 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

  7. 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

  8. 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

  9. Devices • Nasal cannula • Simple O2 Mask • Non- rebreathing mask

  10. Nasal Cannula • FiO2 0.22-0.40 • Prongs should not completely occlude the nares- multiple sizes available • **Ensure pt nares are patent** • Use with bubble humidifier

  11. Nasal Cannula Sizes

  12. 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!

  13. 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

  14. 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

  15. 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

  16. Bunny • snuggly wrap a blanket around the arms and torso of the infant/child

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