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Oxygen Therapy Rhonda Contant, BScH, RRT. Let’s Start with the Basics!  How much O2 is in room air?  How much O2 comes out of a flowmeter?

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Presentation on theme: "Oxygen Therapy Rhonda Contant, BScH, RRT. Let’s Start with the Basics!  How much O2 is in room air?  How much O2 comes out of a flowmeter?"— Presentation transcript:

1 Oxygen Therapy Rhonda Contant, BScH, RRT

2 Let’s Start with the Basics!  How much O2 is in room air?  How much O2 comes out of a flowmeter?

3 Oxygen Therapy O 2 delivery systems: design and performance Three basic designs exist 1. Low-flow systems 2. Reservoir systems 3. High-flow systems 3

4 We need to answer 2 key questions… 1. How much O2 can the system deliver?  What is the FiO2 or FiO2 range of the device? 2. Does the FiO2 vary or remain fixed with changing pt demands?

5 Fixed or Variable FiO2?  Depends on how much of the pt’s inspired gas the device delivers

6 Fixed or Variable FiO2?  Fixed FiO2  The device is designed to deliver ALL the pt’s inspired gas  FiO2 is constant or fixed

7 Fixed or Variable FiO2?  Variable FiO2  The device provides only SOME of the inspired gas  The pt must draw the rest from the surrounding environment (room air)  What happens if we mix O2 with room air?  Dilutes the delivered O2  lowers FiO2  The result = variable FiO2 from breath to breath depending on pt demands

8 Low Flow Systems:  Uses low flows (< 8 Lpm)  They are variable systems therefore the pts demands will affect the FiO2

9 Low Flow Systems: Nasal cannula  Delivers an F IO 2 of 0.24 to 0.40  Used with flow rates of ¼ to 8 L/min  F IO 2 depends on how much room air the patient inhales in addition to the O 2.  Device is usually well tolerated.  Humidifier should be used with flows > 4 Lpm 9

10 Nasal Prongs / Cannula Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10

11 How to Estimate the FiO2 for Nasal Cannula:  FiO2 = 21% + (4 x #Lpm)  Example : What is the approximate FiO2 when the flow meter is set at 2 Lpm?  FiO2 = 21% + ( 4 x Lpm)  FiO2 = 21% + ( 4x 2)  FiO2 = 29%

12 Reservoir Systems  Incorporate a mechanism to gather and store O2 between pt breaths  Pts draw from this reservoir when their inspiratory flows exceed the oxygen flow delivered by the device  Instead of diluting with room air, they dilute with O2  results in a higher FiO2

13 Reservoir Systems Reservoir cannula  Designed to conserve oxygen  Nasal reservoir  Pendant reservoir  Can reduce oxygen use as much as 50% to 75%  Humidification usually not needed 13

14 Moustache Reservoir Cannula

15 Pendant Reservoir Cannula

16 Reservoir Systems Reservoir masks  Most commonly used reservoir systems  Three types  Simple mask  Partial rebreathing mask  Nonrebreathing mask Inc. Inc. 16

17 Simple Mask Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17

18 Partial and Non - Rebreathers Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18

19 High Flow Systems  Supply a given (or fixed) O 2 concentration at a flow equaling or exceeding the patient’s peak inspiratory flow  Use air-entrainment or blending system to mix air and oxygen at very specific ratios to determine a specific oxygen concentration  Can ensure a fixed F IO 2 19

20 Air Entrainment or Venti Mask Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20

21 High Flow Jet Nebs

22 22 Equipment for Aerosol Therapy Airway appliances  Aerosol mask  Face tent  T-tube  Tracheostomy mask All used with large-bore tubing

23 23 Equipment for Bland Aerosol Therapy

24

25 How do we know what to use?  Nasal Cannula  Uses :  Stable pts requiring low FiO2  Home care pts requiring long term O2  Advantages  Adults, peds and infants  Easy to apply  Disposable, inexpensive  Well tolerated  Can eat with them in place

26 How do we know what to use?  Nasal Cannula  Disadvantages  Easily dislodged  High flows uncomfortable  Can cause dryness and bleeding  Variable FiO2s

27 How do we know what to use?  Reservoir (NRBR)  Uses  Emergencies  Unstable pts (MI)  Acute hypoxemia  Smoke inhalation / CO poisoning  CHF

28 How do we know what to use?  Reservoir (NRBR)  Advantages  High FiO2  Adults and peds  Quick and easy to apply  Disposable and inexpensive  Disadvantages  Uncomfortable  Can’t eat with mask on  Risk of aspiration if pt vomits  Potential suffocation hazard

29 How do we know what to use?  Venti mask  Uses:  Unstable pts requiring precise low FiO2  Pts with variable RR and Tidal Volume  Advantages:  Easy to apply  Disposable and inexpensive  Stable, precise FiO2  Disadvantages:  Uncomfortable  Can’t eat with mask on  Noisy  Risk of aspiration if pt vomits

30 How do we know what to use?  Large Volume (Jet) Nebulizers  Uses:  Pts with artificial airways  Pts with supraglottic swelling  To help mobilize secretions  Advantages:  Provides humidification  Provides fixed FiO2  Disadvantages:  FiO2 varies with back pressure (ie condensation in tubing)  Increased risk for infection

31 FYIs  O2 is a prescribed drug  For every connection there is a possibility for a leak  Vasoline and O2 don’t mix  use a water based lubricant to treat nasal and lip dryness  When in doubt, call RT, we are there to help!!

32 Questions?


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