Oxygen Delivery Devices

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OXYGEN DELIVERY DEVICES

Indications 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 flow
will 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% with

flowrates for 1 - 6 liters per minute. A humidifier is used
with liter flows > 4 LPM or for patient comfort.
Higher flows can cause nosebleeds and headaches.
Should use “Cannula Cushions” for sore ears. They are
easy to set up and are well tolerated by patients but
good 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 used
3. TRANSTRACHEAL CATHETERS are seldom seen in the hospital situation
Catheter placed through surgically placed opening between 2 and 3rd tracheal
ring.
Allows for low flows to achieve adequate 02 versus nasal 02
Called “SCOOP”
Sometimes used for home 02 delivery
4. RESERVOIR and PENDANT RESERVOIR cannulas are seldom seen in
hospital. Are designed for oxygen conservation and low flow home use.

5. SIMPLE MASK delivers FiO2 of 40 - 50% with liter flows

of 5 - 12 LPM. Liter flow must be at least 5 LPM to ensure
that CO2 is being flushed out of the mask. Good for patients

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with blocked nasal passages and mouth breathers. The masks are difficult to
tolerate with skin irritation and at meal times. Guard against aspiration. A
humidifier is optional.

6. NON-REBREATHER MASK delivers FiO2 of 50 - 70%. This mask utilizes 3

one-way valves and a bag reservoir to supply the highest possible oxygen
concentration of any of the masks. Flow can set to meet the patient’s maximum
inspiratory needs and so the bag should not completely deflate on inspiration. A
tight fit is necessary to deliver a high FiO2. A PARTIAL REBREATHER MASK
(FiO2 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

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 a
heated aerosol setup.

TRANSPORT TEE (or trach Tee)is the method used to oxygenate an intubated or
a trached patient during transport. It
fits with the ET tube or can be
adapted for use with a trach mask. It
supplies oxygen though oxygen
tubing while attached to a portable
oxygen tank (flow 6-10 LPM).

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

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HIGH FLOW DEVICES

Will give a guaranteed FiO2 no matter what the patient’s 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 patient’s minute ventilation, or >60 L/min)
Do NOT confuse high flow with high oxygen concentrations (FiO2).

1. VENTURI MASK delivers FiO2 of 24 - 50%. It is important that the appropriate

liter flow is used for each setting to guarantee accuracy. External ports must remain
open to entrain room air.

2. AEROSOL (MIST MASK) SYSTEM delivers FiO2 from 28 -100% when FiO2
is greater than 50% they must be set up in tandem.
This device delivers humidity along with oxygen. If
the upper airway is bypassed, ie intubated or
tracheostomy patients, then the aerosol needs to be
heated with an electric heater to provide adequate
humidity. This prevents drying of mucosa, plugs,
altered cilia function and humidity deficit. Aerosols
may be used in conjunction with aerosol facemasks, face tents, trach collars, or T-
Pieces.

MONITORING THE EFFECTIVENESS OF OXYGEN THERAPY

• Pulse Oximetry
• Arterial Blood gases
• Work of Breathing
• Tidal Volume and Respiratory Rate
• Pulse and Blood Pressure

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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
1. venti – mask or air entrainment mask
2. large volume jet nebulizers (Aerosol
Mist)
characteristics
- Provide stable and reliable FIO2. 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
- 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 increase

flow 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: 1

40 – 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 MIXING

RATIO IN STEP 1.
(source gas flow = the setting on the thorpe tube meter)

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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) = 33

28-21 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 flow
if 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 FIO2
to be inaccurate. (increased)

• Low end : 24, 26 air entrainment masks have specific

FIO2’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

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OTHER LESS COMMONLY USED O2 DELIVERY DEVICES

A. Infant head hood and incubators

1. used with a nebulizer (large jet)
2. used with heated humidifier
B. Pendant or reservoir nasal cannula
1. used primarily in home care
2. conserves oxygen so that less is needed
to achieve prescribed FIO2
C. Nasal Biflow
1. a small resevoir cup instead of prongs
D. Patient demand systems and transtracheal
catheters
E. Croup tents
1. used to deliver O2 and cool mist
F. Incubators
G. 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

Indications
1. Carbon monoxide gas poisoning
2. Decompression sickness (the bends)
3. Air embolism
4. Cyanide poisoning
5. Gas gangene
6. Improve wound healing (decubitus ulcers)
7. Refractory osteomyelitis
8. Thermal burns
9. Improves skin grafting success
10. Severe anaerobic infections

OTHER GASES OF NOTE:

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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