Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxia. Oxygen delivery systems are classified as stationary, portable, or ambulatory, and oxygen can be administered by mask, nasal cannula, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.
The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Oxygen therapy is frequently ordered in the home care setting, as well as in acute care.
Some of the conditions that oxygen therapy is used for include:
- documented hypoxemia
- severe respiratory distress (e.g., acute asthma or pneumonia)
- severe trauma
- acute myocardial infarction
- short-term therapy, such as post-anesthesia recovery
Hyperbaric oxygen therapy is used in the following conditions:
- gas gangrene
- decompression sickness
- air embolism
- smoke inhalation
- carbon monoxide poisoning
- cerebral hypoxic event
Oxygen supports combustion, therefore no open flame or products that are combustible should be permitted when oxygen is in use. These include petroleum jelly, oils, and aerosol sprays. A spark from a cigarette, electric razor, or other electrical device could easily ignite oxygen-saturated hair or bedclothes around the patient. Explosion-proof plugs should be used for vaporizers and humidifier attachments.
Care must be taken with oxygen equipment used in the home or hospital. Cylinders should be kept in carts, or have collars for safe storage. If not stored in a cart, smaller canisters may be lain on the floor. Knocking cylinders together can cause sparks, so bumping them should be avoided. In the home, the oxygen source must be placed at least 6 ft (1.8 m) away from flames or other sources of ignition, such as a lit cigarette. Oxygen tanks should be kept in a wellentilated area. Oxygen tanks should not be kept in the trunk of a car. Use "No Smokingxygen in Use" signs to warn visitors not to smoke near the patient.
Special care must be given when administering oxygen to premature infants, because of the danger of high oxygen levels causing retinopathy of prematurity or contributing to the construction of ductus arteriosis. PaO2(partial pressure of oxygen) levels greater than 80 mm Hg should be avoided.
Patients who are undergoing a laser bronchoscopy should have concurrent administration of supplemental oxygen to avoid burns to the trachea.
The procedure discussed is the administration of oxygen therapy other than with mechanical ventilators and hyperbaric chambers.
In the hospital, oxygen is supplied to each patient room and is available via an outlet in the wall. Oxygen is delivered from a central source through a pipeline in the facility. A flow meter attaches to the wall outlet to access the oxygen. A valve regulates the oxygen flow and attachments may be connected to moisturize the oxygen flow. In the home, the oxygen source is usually an oxygen canister or an air compressor. Whether in home or hospital, plastic tubing connects the oxygen source to the patient. Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. Another delivery option is transtracheal oxygen therapy, which involves a small flexible catheter inserted in the trachea or windpipe through a tracheostomy tube. In this method, the oxygen bypasses the mouth, nose, and throat, and a humidifier is required at flow rates of 2.1 pt (1 l) per minute and above. Other oxygen delivery methods include tents and specialized infant oxygen delivery systems.
A physician's order is required for oxygen therapy except in emergency use. The need for supplemental oxygen is determined by inadequate oxygen saturation, as determined by blood gas measurements, pulse oximetry, or clinical indications. No special preparation of the patient is required to administer oxygen therapy.
Once oxygen therapy is initiated, periodic assessment and documentation of oxygen saturation levels is required. If the patient is using a mask or a cannula, gauze can be tucked under the tubing to prevent irritation of the cheeks or the skin behind the ears. Water-based lubricants can be used to relieve dryness of the lips and nostrils.
Complications from oxygen therapy used in appropriate situations are infrequent. Respiratory depression, oxygen toxicity, and absorption atelectasis are the most serious complications with overuse of oxygen.
Delivery equipment may present other problems. Perforation of the nasal septum as a result of using a nasal cannula and nonumidified oxygen has been reported. In addition, bacterial contamination of nebulizer and humidification systems can occur, potentially leading to the spread of pneumonia. High-flow systems that employ heated humidifiers and aerosol generators, especially when used by patients with artificial airways, also pose a risk of infection.
The patient demonstrates adequate oxygenation through pulse oximetry, blood gases, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit "aerophagia" or "air hunger," as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated.
Health care team roles
Team members include the physician, nurse, and respiratory therapist. Respiratory therapy technicians and nursing assistants who are adequately trained may check and document that oxygen therapy is being used appropriately and the oxygen flow is as ordered.
- Physicians are responsible for ordering oxygen therapy. The prescription must include the flow rate and when the patient will need to use the oxygen.
- Nurses are responsible for assessing patients, ensuring that oxygen therapy is initiated as prescribed, monitoring oxygen delivery systems, and recommending changes in therapy.
- Respiratory therapists may assess patients, initiate and monitor oxygen delivery systems, and recommend changes in therapy.
Patient education involves instructing patients regarding the safe use of oxygen. Patients must be advised not to change the flow rate of oxygen unless directed to do so by the physician. Patients in the home setting are directed to notify the suppliers when replacement oxygen supplies are needed.
A physician should be notified and emergency services may be required if the following develop:
- frequent headaches
- cyanotic (blue) lips or fingernails
- slow, shallow, difficult, or irregular breathing
Combustionurning or fire. Objects that are combustible ignite easily.
Cyanosislue, gray, or dark purple discoloration of the skin caused by a deficiency of oxygen.
Flow meterevice for measuring the rate of a gas, especially oxygen, or liquid.
Oxygen non-metallic element occurring free in the atmosphere as a colorless, odorless, tasteless gas.
Oxygenationaturation with oxygen.
Branson, Richard, et al. Respiratory Care Equipment. 2nd ed. Philadelphia: Lippincott, 1999.
Burton, George G., et al. Respiratory Care: A Guide to Clinical Practice. 4th ed. Philadelphia: Lippincott, 1997.
Dunne, Patrick J., and Susan L.McInturff. Respiratory Home Care: The Esentials. Philadelphia: F. A. Davis Company, 1998.
Pagana, Kathleen D., and Timothy J. Pagana. Diagnostic Testing and Nursing Implications. 5th ed. St. Louis: Mosby, 1999.
Wilkins, Robert, et al. Clinical Assessment in Respiratory Care. 4th ed. St. Louis: Mosby, 2000.
Crockett, A. J., and J. M. Cranston et al. "A review of long-term oxygen therapy for chronic obstructive pulmonary disease." Respiratory Medicine 95 (June 2001): 437-443.
Eaton, T. E., et al. "An evaluation of short-term oxygen therapy: the prescription of oxygen to patients with chronic lung disease hypoxic at discharge." Respiratory Medicine 95 (July 2001): 582-587
Kelly, Martin G., et al. "Nasal septal perforation and oxygen cannulae." Hospital Medicine 62, no. 4 (April 2001): 248.
Ruiz-Bailen M, M. C. Serrano-Corcoles and J. A. Ramos-Cuadra. "Tracheal injury caused by ingested paraquat." Chest 119, no. 6 (June 2001): 1956-7
American Association for Respiratory Care 11030 Ables Lane, Dallas, Texas 75229. <<a href="http://www.aarc.org">http://www.aarc.org>.
American Lung Association 1740 Broadway, New York, NY 10019-4374. (800) LUNG-USA. <<a href="http://www.lungusa.org">http://www.lungusa.org>.
Maggie Boleyn, RN, BSN
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