oxygendeliverydevices (1)

8/6/2019 Oxygendeliverydevices (1)

http://slidepdf.com/reader/full/oxygendeliverydevices-1 1/7

Oxygen Delivery DevicesRsCr 220

OXYGEN DELIVERY DEVICESIndications for use:

• Correcting hypoxemia• Decreased workload hypoxemia has on the heart• Acute myocardial infarction•

Severe trauma• Post anesthesia recovery

Precautions and or possible complications (Support saturations with least FiO2)• May depress ventilation in some patients with chronic hypercapnia (CO2

retainers)• May cause atelectasis (.60% 02) in partially obstructed patient with use• oxygen toxicity (> 50% 02 < 24-48 hours• In premature infants, can cause Retinopathy of Prematurity (ROP)

LOW FLOW DEVICES Defined as a device that does NOT meet all the inspiratory flow demands of the patient.Do NOT confuse low flow with low oxygen concentrations (FiO2). Some low flowwill supply high oxygen percentage. Some high flow will provide low oxygen percentage.

FiO2 can vary with:• Patient’s respiratory rate and pattern• Flow of gas from the equipment• Equipment reservoir

1. NASAL CANNULA delivers FiO2 of 24 - 44% withflowrates for 1 - 6 liters per minute. A humidifier is usedwith liter flows > 4 LPM or for patient comfort.

Higher flows can cause nosebleeds and headaches.Should use “Cannula Cushions” for sore ears. They areeasy to set up and are well tolerated by patients butgood for only low FiO2.Rule of Thumb: For each liter of flow, add 4% to FiO2

Recently, improved humidifiers has allowed for higher flows and higher FiO2 ’s to be delivered via nasal 02

2. NASAL CATHETERS are seldom used3. TRANSTRACHEAL CATHETERS are seldom seen in the hospital situation Catheter placed through surgically placed opening between 2 and 3 rd trachealring.

Allows for low flows to achieve adequate 02 versus nasal 02Called “SCOOP”Sometimes used for home 02 delivery

4. RESERVOIR and PENDANT RESERVOIR cannulas are seldom seen inhospital. Are designed for oxygen conservation and low flow home use.

5. SIMPLE MASK delivers FiO2 of 40 - 50% with liter flowsof 5 - 12 LPM. Liter flow must be at least 5 LPM to ensurethat CO2 is being flushed out of the mask. Good for patients

1




with blocked nasal passages and mouth breathers. The masks are difficult totolerate with skin irritation and at meal times. Guard against aspiration. Ahumidifier is optional.

6. NON-REBREATHER MASK delivers FiO2 of 50 - 70%. This mask utilizes 3one-way valves and a bag reservoir to supply the highest possible oxygenconcentration of any of the masks. Flow can set to meet the patient’s maximuminspiratory needs and so the bag should not completely deflate on inspiration. Atight fit is necessary to deliver a high FiO2. A PARTIAL REBREATHER MASK (FiO2 40 – 60%) can be achieved by removing valves from the mask. PALSrecommends that you remove the valves on infants and children to prevent possiblesuffocation.

partial rebreather non-rebreather 6. TRACHEOSTOMY MASK Similar to a simple mask designed to fit over neck

area than mouth and nose. Usually is supplied by the large blue tubing from aheated aerosol setup.

TRANSPORT TEE (or trach Tee)is the method used to oxygenate an intubated or a trached patient during transport. Itfits with the ET tube or can beadapted for use with a trach mask. Itsupplies oxygen though oxygen

tubing while attached to a portableoxygen tank (flow 6-10 LPM).

7. FACE TENT Often used with post-operative patients who are claustrophobic witha simple mask. Occasionally used but limited to low oxygen levels and low aerosolhumidity.

2




MORE ON HIGH FLOW SYSTEMSAn oxygen delivery device that meets or exceeds the inspiratory flow demands of the patient. I.E.> 30 lpm total flow delivered

Examples

1. venti – mask or air entrainment mask 2. large volume jet nebulizers (AerosolMist)

characteristics- Provide stable and reliable FIO2. Usually low

concentrations 24 to 50%- only precise if total flow from the unit is > 30lpm (Need to meet pt demand)

advantages- precise and stable- pt’s rr and Vt have no effect on FIO2

disadvantages- may be difficult to achieve higher FIO2’s >50%- uncomfortable, etc.

The size of the entrainment port determines the delivered FIO2.- the larger the port the lower the FIO2- the smaller the port the greater the FIO2

The size of the jet determines the FIO2 delivered- the smaller the jet the lower the FIO2.

NOTE: A heater must be added to the aerosol mist when the patient’s normal breathing system is bypassed (ET Tube or trach mask)

A double nebulizer setup is one way to increaseflow with high FIO2s.

CALCULATING TOTAL FLOW DELIVERED USING A HIGH FLOW SYSTEM.is it at least 30 l/m air entrained vs. air delivered?

STEP 1: DETERMINE AIR-OXYGEN MIXING RATIO (Entrainmnet)FORMULA: 100 – FIO2 = air/02 entrainment ratio

FIO2 – 21 (use 20 if FI02 > 40%)

EXAMPLE: at 40% 100 – 40 = 60 = 3.2: 140 – 21 19 (use 20 if FI02 > 40%)

for every 1l delivered, 3.2 liters room air gets entrained.

STEP 2: CALCULATE TOTAL FLOW BASED UPON THE MIXINGRATIO IN STEP 1.

(source gas flow = the setting on the thorpe tube meter)

4




FORMULA: TOTAL FLOW = entrainment (source gas flow (almost always 02) +(source gas flow x mixing ratio)

EXAMPLE: 7 L/M X 3) + 7 L/M = 29.4 L/M

EXAMPLE: 100 – 28 = 72 = 10 : 1 3 + (3 X 10) = 3328-21 7 (if source gas flow = 3)

STEP 3: ask yourself is the total flow greater than 30lpm?if it is not then increase the source flowif it is -: then the system is ok (a high flow) unless patient is very

tachypneic where you should insure 40 LPM of total flow

LIMITATIONS OF A HIGH FLOW SYSTEM:1. The size of the jet may inhibit the ability to increase source gas flow. Many

systems can not deliver more than 12 liters of source flow.2. Downstream back pressure may inhibit the amount of room air entrainment.

Water in the tubing causes backpressure resistance. This can cause the FIO2to be inaccurate. (increased)

• Low end : 24, 26 air entrainment masks have specificFIO2’s• 28, 30, 35, 40, 45, 50 high end

Entrainment ratios

100% 0:1

60% 1:1

40% 3:1

35% 5:1

30% 8:1

28% 10:1

24% 25:1

5




OTHER LESS COMMONLY USED O2 DELIVERY DEVICES

A. Infant head hood and incubators1. used with a nebulizer (large jet)2. used with heated humidifier

B. Pendant or reservoir nasal cannula1. used primarily in home care2. conserves oxygen so that less is needed

to achieve prescribed FIO2C. Nasal Biflow

1. a small resevoir cup instead of prongsD. Patient demand systems and transtracheal

cathetersE. Croup tents

1. used to deliver O2 and cool mistF. IncubatorsG. Blenders (O2 blenders)

allows for mixing of air & O2 for a desired %

Newer devices:

Vapotherm: http://vapotherm.inquisiq.com/default.asp

http://www.oxyarm.com/ourProducts_oxyarm.shtml

http://www.oxyarm.com/ourProducts_oxymask.shtml

HYPERBARIC OXYGEN THERAPY

Monoplace chambers- Clear plexiglass tube that pt is placed in

Multiplace chambers- RT and nurses accompany pt in chamber

Indications1. Carbon monoxide gas poisoning2. Decompression sickness (the bends)3. Air embolism4. Cyanide poisoning5. Gas gangene

6. Improve wound healing (decubitus ulcers)7. Refractory osteomyelitis8. Thermal burns9. Improves skin grafting success10. Severe anaerobic infections

OTHER GASES OF NOTE:

6

http://vapotherm.inquisiq.com/default.asp




http://vapotherm.inquisiq.com/default.asp






Carbogen:o Usually 95% oxygen and 5% carbon dioxide

o Treats singultus (hiccups)

o Provides a challenge to stimulate breathing in some patients

HelioxoUseful with ventilators and in ER

oUpper airway narrowing

o Croup

o Asthma

o Stridor

o Tracheal tumors

Nitric Oxide

oTreatment of neonates with hypoxic respiratory failure associated with pulmonary

hypertension

7

oxygendeliverydevices (1)

Documents