Supplemental Oxygen

Question 1

Respiratory Meds: Supplemental Oxygen

Answer 1

Treatment for hypoxemia when PaO2 is unable to deliver adequate O2 to capillaries

Question 2

Respiratory Meds Delivery:

Answer 2

nasal cannula
mask
tent/hood
endotracheal tube
tracheostomy

Question 3

FDA states: “medical oxygen is defined as a:

Answer 3

prescription drug which requires a prescription in order to be dispensed except….for emergency use”

Question 4

Co-morbidities: Why are more patientsneeding supplemental oxygen?

Answer 4

Older patients

Multiple medical diagnoses

Pulmonary diagnoses are increasing in incidence and prevalence

Question 5

What are the advantages ofSupplemental Oxygen?
Oxygen during Exercise:

Answer 5

1) Decreases SOB
2) Decreases dynamic hyperinflation
3) Prolongs exercise tolerance
4) Improves sleep and mood
5) Increases mental alertness and stamina
6) Prevents/delays heart failure in severe lung disease

Question 6

Oxygen Equipment =

Answer 6

pulse oximeters
oxygen concentrator
oxygen tanks

nasal cannulas
venti-mask
partial re-breather mask
non re-breather mask
mask + nasal cannula

Question 7

Oxygen Delivery Device - low flow nasal cannula

Answer 7

1-6 L/min

FiO2 = 25-40

Question 8

Oxygen Delivery Device - high flow nasal cannula

Answer 8

30-60 L/min

FiO2 = 100

Question 9

Oxygen Delivery Device - venti-mask

Answer 9

2-15 L/min

FiO2 = 24-60

Question 10

What is the FiO2 and flow rate for the simple face mask ?

Answer 10

flow = 6-10 L/min

FiO2 = 35-50

Question 11

What is the FiO2 and flow rate for non rebreather?

Answer 11

flow = 10-15 L/min

FiO2 = 80-90

Question 12

Respiratory Meds: Supplemental O2 Dose

Answer 12

L/min
> rest, activity, exercise

Hours/day

Supply system
> tank of compressed air, liquid O2 reservoir

Dose/Duration/Frequency = depends on patient and desired SpO2

Question 13

SpO2 Targets:

Answer 13

Pulmonary Dysfunction: <88%
Normal Value: 94 – 98%

Question 14

Benefits of supplemental O2 =

Answer 14

Increased exercise tolerance

Decreased morbidity due to improved oxygenation of tissue

Improved quality of life

Question 15

Risks of O2 =

Answer 15

Fire
Dry nose
Airway irritation
Oxygen toxicity - hyperoxia

Question 16

FiO2 =

Answer 16

Fraction of inspired Oxygen

Room Air = 20 to 21%

Minute Ventilation @ Rest = 6-8 L air/minute

Question 17

Supplemental Oxygen: Flow Rate = Low Flow Oxygen

Answer 17

Supplies oxygen at flow rates that are lower than patient’s inspiratory demand

Fraction of Inspired Oxygen (FIO2) varies with respiratory rate (RR) and tidal volume (TV) = LFNC supplements O2 needs

1 – 6 L/min

Question 18

Supplemental Oxygen: Flow Rate = High Flow Oxygen

Answer 18

More precise O2 delivery

FiO2 does not vary with respiratory rate and tidal volume = exceeds O2 needs

Up to 60 L/min

Question 19

Effective Oxygen therapy is about =

Answer 19

finding a balance between delivering the lowest FiO2 in order to achieve normal oxygen saturations for the patient

Question 20

Low Flow Oxygen - nasal cannula

Answer 20

1-6 L/min

Delivers approximately 25-40% FIO2

Simple and safe

Connected to an O2 source and regulated by a flow meter

Easily mobile when connected to portable O2 tanks

Can be humidified = usually when >3 liters/min flow

Question 21

High Flow Nasal Cannula (HFNC)

Answer 21

Adjustable FiO2: 28% to 100% via an O2 blender

Adjustable Flow Rate: 10 - 60 L/Min; typically used in 30-60 range

Provides humidity

Question 22

HFNC - goals of Hi-Flow

Answer 22

treat hypoxemia

decrease WOB

provide adequate humidity for a trached patient

Question 23

Benefits of HFNC compared to a mask =

Answer 23

patient comfort

patient can communicate more easily

can eat and drink without changing O2 devices

allows for easier oral care maintenance

adjustable FiO2

meets their inspiratory demands = decrease work of breathing - by adjusting flow

Question 24

High Flow: Venturi Face Mask (Venti Mask)

Answer 24

Mask connected to a Venturi entrainment port device that mixes a specific volume of air and O2 (“dial-a-flow”) = Each valve tells you what flow is needed to achieve the desired FiO2

Precise levels of oxygen, humidification not needed

Question 25

High Flow: Venturi Face Mask (Venti Mask) Disadvantages =

Answer 25

eating and talking uncomfortable air leakage skin and eye irritation

Question 26

High Flow: Venturi Face Mask (Venti Mask) colors and rates =

Answer 26

white: flow = 4-6L/min FiO2 = 28% yellow: flow = 8-10L/min FiO2 = 35% red: flow = 10-12L/min FiO2 = 40% green: flow = 12-15L/min FiO2 = 60%

Question 27

Oxymizer pendant vs mustache =

Answer 27

Mustache (20 L/min) Pendant (15 L/min)

Question 28

Oxymizer =

Answer 28

Conserves O2 through the use of a reservoir as it stores O2 during exhalation and delivers an O2 bolus during inhalation = long term use to decrease flow and increased oxygen concentration Provides more O2 with less flow than other devices Self-humidifying

Question 29

Low Flow: Aerosol Mask

Answer 29

Connected to wide bore tubing that receives aerosolized O2 from a nebulizer Two holes for exhalation FIO2: 40% - 60% Flow: 6-15 L/min Humidification may be needed Short term use = replaced by nasal cannula Used for high concentration of oxygen; no breathing assistance needed

Question 30

Low Flow: Aerosol Mask Disadvantages =

Answer 30

Eating and talking Rebreathing exhaled air

Question 31

Rebreathing Mask 2 types =

Answer 31

Aerosol mask with a reservoir bag = 1 Liter volume to store pure oxygen Partial Rebreather Non-Rebreather

Question 32

Rebreathing Mask Disadvantages =

Answer 32

Eating and talking Skin irritation Air leakage from the mask

Question 33

Low/High Flow: Non-Rebreather Face Mask

Answer 33

FiO2: 60-90% FIO2 10 - 15 L/min Works using a one-way valve that prevents exhalation into the reservoir bag and allows inhalation of nearly pure O2 Used for short term, hospital situation

Question 34

Low/High Flow: Non-Rebreather Face Mask Disadvantages =

Answer 34

Eating = desaturate when mask is off Risk of hyperoxygenation

Question 35

Partial Rebreather =

Answer 35

FiO2: 40%-70% 6 – 10 L/min No valve in the mask = exhaled air may be inspired again Used for longer periods of time

Question 36

1 L/min nasal cannula = ___ FiO2

Answer 36

24%

Question 37

2 L/min nasal cannula =___ FiO2

Answer 37

28%

Question 38

3 L/min nasal cannula =__ FiO2

Answer 38

32%

Question 39

4 L/min nasal cannula =___ FiO2

Answer 39

36%

Question 40

5 L/min nasal cannula =___ FiO2

Answer 40

40%

Question 41

6 L/min nasal cannula =___ FiO2

Answer 41

44%

Question 42

10 L/min nasal cannula = ___ FiO2

Answer 42

60%

Question 43

>15 L/min nasal cannula = __ FiO2

Answer 43

80%