Oxygen Therapy

LIMITATIONS FOR PRACTICE:

RN who has been instructed in this procedure.

AIM:

• To supplement a patient with oxygen safely and effectively.

• To reverse hypoxemia.

EXPLANATION:

Patients usually require supplementary oxygen if demand is greater than supply, eg

haemorrhage, myocardial infarct, cardiac failure or if respiratory function is
diminished and gas exchange is inadequate.

DEVICES:

Mapleson Circuit and Silicon Self-inflating Bag With O2 Reservoir Connected

• These deliver 100% O2 with flow rates of 10-15L/min.

• May be used with black, anaesthetic face mask, endotracheal or tracheostomy tube.
• It is important to maintain a seal with the mask.
• A Geudel airway may help with airway maintenance.
• Suitable for short-term use only.
• Uses:
- Cardiac arrest
- Ventilator emergency
- Pre-oxygenation prior to suction, intubation, tracheostomy change, extubation
- Hyperinflation for chest physiotherapy
- Transport of ventilated patient

The St George Hospital Revised August 2003

ICU Nursing Procedure Manual
CIG or Hudson Oxygen Mask (Variable Performance)

• Most commonly used device.

• The O2 percentage delivered to the patient cannot be controlled. O2 percentage is
dependent upon:
- the O2 flow rate
- mask fit (a tight fitting mask delivers a higher percentage of O2 than a loose
mask)
- the patient’s inspiratory effort

Approximate Oxygen percentages:- L/min %

4 35
6 45
8 50
14 65

• Flow rates > 4L/min are recommended to prevent rebreathing of expired CO2.
• Humidification may be used with flow rates >6L/min for a prolonged period or if
the patient’s secretions are tenacious (see procedure “Humidification”).

Venturi Mask (Fixed Performance)

• These are designed to deliver a fixed percentage of O2 (24%, 28%, 35%, 40%,
50%).
• Operate according to the Venturi principle.
• O2 flowing through a narrow orifice entrains room air at up to 150L/min via vents
in the mask connector.
• The gas flow and the Venturi valve determine the O2 concentration.
• Humidification is not necessary due to the large amounts of room air entrained.
• These masks are particularly useful for CAL patients whose stimulus to breathe is
controlled by a degree of hypoxia (hypoxic drive) because the mask delivers a
fixed percentage of O2.

The St George Hospital Revised August 2003

ICU Nursing Procedure Manual
T-Piece Circuit

• Deliver fixed percentage of O2 (according to gas flow rates) via an endotracheal or

tracheostomy tube (see procedure “Humidification”).
• Deliver variable percentage of O2 via CIG, Hudson or tracheostomy mask.

Nasal Prongs (Variable Performance)

• Deliver flow rates of 1-4L/min.

• Flow rates >5L/min are not recommended due to drying out of the nasal mucosa.
• Inspired O2 will be reduced if the patient mouth breathes.
• These are inexpensive and comfortable, allow patient to eat or talk without
disrupting oxygen therapy.
• Ensure correct position of prongs.

Approximate Oxygen percentages:- L/min %

1 24
2 28
3 32
4 35

NURSING MANAGEMENT:

• Ensure equipment is functioning correctly at beginning of each shift.

• Patients requiring oxygen therapy should have their oxygen saturation checked
with a pulse oximeter continuously.
• Arterial blood gases should be taken as ordered or if there is concern about
patient’s condition.

The St George Hospital Revised August 2003

ICU Nursing Procedure Manual