Oxygen Delivery Devices RsCr 220

OXYGEN DELIVERY DEVICES Indications for use: Correction of hypoxemia Decreases the workload which hypoxemia has on the heart Acute myocardial infarction Severe trauma Post anesthesia recovery Precautions & or possible complications (Support SaO2 with least FiO2) May depress ventilation in some patients with chronic hypercapnia (CO 2 retainers) May cause atelectasis (60% O2) in partially obstructed patient Oxygen toxicity (> 50% O2 in < 24-48 hours Can cause Retinopathy of Prematurity (ROP) in premature infants A. 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 flow will supply high O2 percentage & some high flow will provide low O2 percentage.) FiO2 can vary with: Patients respiratory rate & pattern Flow of gas from the equipment Equipment reservoir 1. NASAL CANNULA delivers O2 percentage of 24 44% with flow rates of 1 - 6 liters per minute. A humidifier is used with flow rates > 4 LPM or for patient comfort. Higher flow can cause nosebleeds and headaches. Recently, improved humidifiers has allowed for higher flows and higher FiO2 s to be delivered via nasal O2 Increasing the oxygen flow by 1L/min will increase the inspired O2 concentration by approximately 4%. 1L/min: 24% 2L/min: 28% 3L/min: 32% 4L/min: 36% 5L/min: 40% 6L/min: 44%

Oxygen Delivery Devices RsCr 220

2. SIMPLE MASK delivers O2 percentage of 40 - 50% with flow rates of 5 - 12 LPM. Flow rates must be at least 5 LPM to ensure that CO2 is being flushed out of the mask. Good for patients with blocked nasal passages and mouth breathers. Masks are difficult to tolerate with skin irritation and at meal times. Guard against aspiration. A humidifier is optional. 3. NON-REBREATHER MASK delivers O2 percentage of 50 - 70%. Utilizes 3 one-way valves and a bag reservoir to supply the highest possible oxygen concentration of any of the masks. Flow can be set to meet the patients maximum inspiratory needs. Bag should not completely deflate on inspiration. A tight fit mask is necessary to deliver a high FiO2. 4. PARTIAL REBREATHER MASKS (O2 percentage of 40 60%) can be achieved by removing valves from the mask. PALS recommends that you remove the valves on infants and children to prevent possible suffocation.

partial rebreather

non-rebreather

5. TRACHEOSTOMY MASK Similar to a simple mask, but designed to fit over neck area. Usually is supplied by the large blue tubing from a heated aerosol setup. 6. TRANSPORT TEE (or trach Tee) is the method used to oxygenate an intubated patient or patient with tracheostomy during transport. It fits onto the ET tube or can be adapted for use with a trach mask. It supplies oxygen through oxygen tubing while attached to a portable oxygen tank (flow 6-10 LPM).

Oxygen Delivery Devices RsCr 220

B. HIGH FLOW DEVICES Will give a guaranteed FiO2 no matter what the patients venilatory pattern is. It is consistent and predictable. They meet or exceed the peak inspiratory flow of the patient. (Flow is at least 4X the patients minute ventilation, or > 60 L/min) Do NOT confuse high flow with high oxygen concentrations (FiO2). 1. VENTURI MASK delivers O2 percentage of 24 - 50%. It is important that the appropriate flow rate is used for each setting to guarantee accuracy. External ports must remain open to entrain room air.

2. AEROSOL (MIST MASK) SYSTEM delivers O2 percentage of 28 - 100%. When FiO2 is greater than 0,5 they must be set up in tandem. This device delivers humidified oxygen. If the upper airway is bypassed, i.e. intubated or tracheostomy in situ, then the aerosol needs to be heated with an electric heater to provide adequate humidity. This prevents drying of mucosa, mucus plugs, altered cilia function and humidity deficit. Aerosols may be used in conjunction with aerosol facemasks, face tents, trach collars, or T-Pieces.

C. MORE ON HIGH FLOW SYSTEMS An oxygen delivery device that meets or exceeds the inspiratory flow demands of the patient. I.E.> 30 Lpm total flow delivered Examples:

Oxygen Delivery Devices RsCr 220

-Venti-mask or air entrainment mask -Large volume jet nebulizers (Aerosol Mist) Characteristics -Provide stable and reliable O2 percentage. Usually low concentrations 24 to 50% -Only precise if total flow from the unit is > 30 Lpm (Need to meet pt demand) Advantages -Precise and stable -Patients resp rate and tidal vol have no effect on FIO2 Disadvantages -May be difficult to achieve FIO2s > 0,5 -Uncomfortable. 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 patients normal breathing system is bypassed (ET Tube or trach mask) A double nebulizer setup is one way to increase flow with high FIO2s. D. MONITORING THE EFFECTIVENESS OF OXYGEN THERAPY Pulse Oximetry Arterial Blood gas Work of Breathing Tidal Volume & Respiratory Rate Pulse & Blood Pressure E. LIMITATIONS OF A HIGH FLOW SYSTEM: The size of the jet may inhibit the ability to increase source gas flow. Many systems cannot deliver more than 12 liters of source flow. Downstream back pressure may inhibit the amount of room air entrainment. Water in the tubing causes backpressure resistance. This can cause the FIO2 to be inaccurate. (increased)

Oxygen Delivery Devices RsCr 220

F. OTHER LESS COMMONLY USED O2 DELIVERY DEVICES Infant head hood and incubators used with a nebulizer (large jet) used with heated humidifier Pendant or reservoir nasal cannula used primarily in home care conserves oxygen so that less is needed to achieve prescribed FIO2 Nasal Biflow a small resevoir cup instead of prongs Patient demand systems and transtracheal catheters Croup tents used to deliver O2 and cool mist Blenders (O2 blenders) allows for mixing of air & O2 for a desired O2% Newer devices: Vapotherm: http://vapotherm.inquisiq.com/default.asp http://www.oxyarm.com/ourProducts_oxyarm.shtml http://www.oxyarm.com/ourProducts_oxymask.shtml

G. HYPERBARIC OXYGEN THERAPY Monoplace chambers Clear plexiglass tube that patient is placed in Multiplace chambers RT and nurses accompany patient in chamber Indications: 1. Carbon monoxide poisoning 2. Decompression sickness (the bends) 3. Air embolism 4. Cyanide poisoning 5. Gas gangrene 6. Improve wound healing (decubitus ulcers) 7. Refractory osteomyelitis 8. Thermal burns 9. Improves skin grafting success 10. Severe anaerobic infections H. OTHER GASES OF NOTE:

Oxygen Delivery Devices RsCr 220

Carbogen: o Usually 95% oxygen and 5% carbon dioxide o Treats singultus (hiccups) o Provides a challenge to stimulate breathing in some patients Heliox o Useful with ventilators and in ER o Upper airway narrowing o Croup o Asthma o Stridor o Tracheal tumors Nitric Oxide o Treatment of neonates with hypoxic respiratory failure associated with pulmonary hypertension