(0))K(GEN(O)EN/ANP/AN

Oxygen
therapy
BASIC CONCEPTS
OXYGEN
THERAPY
It is the supply of gaseous oxygen with the appropriate methods, volumes and/or fractions for the purpose
to restore the normal blood rate and thus ensure the functioning of organs
vitals such as heart, brain and cells of the body.

Atmospheric air is approximately 21% OXYGEN . The composition of gases in the environment would be the following:

❖ Nitrogen 79%
❖ Oxygen 21%
❖ Other gases 10%
Oxygen therapy aims to increase the concentration of oxygen in
blood and tissues without producing
RESPIRATORY DEPRESSION

Breathing slowly or with insufficient force, so that you cannot

provide adequate ventilation and perfusion of the lungs.
Oxygen
therapy BASIC CONCEPTS

FiO2
Inspired Fraction of Oxygen
It is a fragment of the oxygen that we can breathe

The Fi02 of the environment is 21%

Of the 100% of the air mixture we breathe, 21% is Oxygen.

Our lung capacity only allows us this

The FiO2 delivered to a patient can be from 24% to 50%.

In order to prevent and treat the symptoms and complications of

hypoxia, whatever its etiology, the administration of oxygen to
concentrations greater than those of ambient air (21%), it should be the
first strategy implemented in patients .
 Oxygen
therapy
BASIC CONCEPTS FLOW
The flow is the amount of gas administered in this case of Oxygen.

We measure the flow in Liters per minute.

A certain Flow will indicate a certain FiO2.

Based on this fact, flow does not help to classify oxygen therapy systems:
LOW FLOW or HIGH FLOW

Measures the amount of oxygen available in the blood

OXYGEN SATURATION S02

is
measured in %. The optimal percentage is from 95%
Less than 95% there is a risk of oxygen deficiency in tissues = Hypoxia
 Oxygen
BASIC CONCEPTS
therapy HYPOXEMIA
Decrease in the concentration of O2 in the blood. Specifically in the causes: Anemia,
Asthma, COPD, Heart Defects, pneumonia, Pulmonary Fibrosis, among other lung n
diseases.

heme
 Oxygen
therapy red blood cells %

contain hundreds 3
of hemoglobin molecules that carry oxygen

HYPOXIA
It is the deficiency of sufficient oxygen in the tissues and cells to maintain bodily functions. It can be classified:
• Hypoxemic: Decrease in Oxygen in the Inspired Air.
• Anemic: Little amount of oxygen transported.
• Cytotoxic: Tissues incapable of using oxygen.
• Ischemic: Decreased blood flow.

Red blood
cell

Oxygen attaches to
heme in the
hemoglobin molecule
Oxygen
therapy HYPOXEMIA AND HYPOXIA
SIGNS AND SYMPTOMS
BASIC CONCEPTS
Polypnea, tachypnea, dyspnea, cyanosis, other signs of respiratory distress, respiratory arrest.

Mental confusion, agitation, lethargy, seizures.

Muscle incoordination, fatigue, dizziness, blurred vision.
Tachycardia, hypertension, arrhythmias, paleness, sweating, diaphoresis.
Multiple organ failure, cell death in tissues.
Oxygen
therapy
DEO2 ADMINISTRATION

GENERAL OXYGEN MANAGEMENT SYSTEMS

Oxygen is usually stored, for therapeutic use, in a hospital oxygen center or in bottles.

The oxygen intake is located, in the patient unit, next to the vacuum intake on the

patient's bedside.
In addition to oxygen, other devices should be used:

PRESSURE FLOWMETE HUMIDIFIER

GAUGE R
 Oxygen
therapy
DEO2 ADMINISTRATION

OXYGEN ADMINISTRATION PROCEDURE

set of They include techniques that allow oxygen to be transferred from the storage source to the patient's respiratory system.
a
PRECAUTIONS:
• Do not use electrical devices in poor condition in close proximity.
• Do not smoke or use flammable products to clean the system.
• Moisten the mouth and monitor the condition of the patient's nasal passages.
• Always respect medical instructions.

MATERIAL RESOURCES:
Central oxygen intake or oxygen bullet.
Pressure gauge, flowmeter and humidifier with water
sterile distilled.
System to use: low flow or high flow
 Oxygen
therapy
DEO2 ADMINISTRATION

OXYGEN ADMINISTRATION PROCEDURE

1. Prepare the necessary equipment, wash your hands, put on gloves.
2. Check the operation of the oxygen system and fill the humidifier.
3. Explain the procedure to the patient. Place him in Fowler's position, or supine, (when using the oxygen tent).
Prepare the oxygen application device and adapt it to the patient. The mask is placed over the mouth and nose. The cannulas are inserted
into the nostrils, the tent is placed over the entire bed or over the patient's head.
4.
Open the oxygen at the prescribed flow and ensure the correct operation of the system: no leaks at the connections, no strange
sounds (beeps), water from the humidifier.
Place some folded gauze over the patient's ears, with the mask and nasal cannula, to protect them from rubbing against the rubber
5.
band.
Once oxygen therapy has started, explain to the patient the effects that they may notice (dryness of the mucous membranes,
6.
oppression of the device, feeling of claustrophobia, etc.) and the symptoms that they should report to healthcare personnel
(dizziness, drowsiness or restlessness).
Initially control and monitor vital signs: heart rate and blood pressure.
7.
Monitor the appearance of signs and symptoms related to altered oxygenation: dyspnea, tachypnea, tachycardia, headache,
cyanosis, use of accessory muscles in breathing, agitation, confusion
10. Settle the patient and collect the equipment. Wash your hands and record the procedure in your history
8. Nursing.
SECRETIONS ASPIRATION

SECRETIONS ASPIRATION
Oxygen
therapy

Procedure by which secretions are extracted from the respiratory tree by means of a Nelaton probe connected to
a suction source, with prior aseptic technique that introduces the probe through the nose, mouth or endotracheal tube with the
in order to have the airway permeable.

EQUIPMENT
Flexible, sterile aspiration probes, of different calibers and with aspiration control hole
Portable or wall-mounted aspirator and container for secretions.
Sterile and non-sterile gloves.
Deposit for biological waste and material.
5 ml syringe.
Compresses
Normal saline

• No
WHAT NOT TO DO
• No
insert the probe by forcing it
• No
aspirate for more than 5-10 seconds (from insertion to removal of the probe) use the same probe to perform aspirations through
• No
different orifices
• No
perform aspirations for more than 3 minutes
endotracheal
use a probe whose diameter is greater than half the diameter of the tube
Oxygen
therapy
SECRETIONS ASPIRATION

OROTRACHEAL AND NASOTRACHEAL

ASPIRATIONS
Prepare all the material and check the correct operation of the vacuum cleaner. Wash
your hands.
Greet and explain the procedure to the patient
Place the patient in the semi-Fowler position (if
applicable)
Put on gloves and adapt the suction probe, Connect the aspirator and adjust the pressure
negative according to the
recommendations:
• Adults: 115-150 mmHg. // Children: 95-115 mmHg. // Babies: 50-95 mmHg.
Put on sterile gloves.
Open the aspiration probe and connect the proximal end to the vacuum tubing, without touching the
rest of the probe.
Moisten the distal end of the probe in the sterile solution (water).
Insert the probe without aspirating:
• For orotracheal aspiration, through the mouth on one side of the oropharynx
WHEN TO
For nasotracheal suction, insert the tube gently through a choana and direct it towards the
VACUUM
floor of the mouth Visible secretions in the
Start aspiration (close the probe hole) intermittently by gently rotating the probe as it is removed. Tubular mouth
breathing sounds,
The process should not exceed 5-10 seconds. gurgling or harshros.
Clean the probe with gauze and the internal tubing with aspiration of the solution Sudden
sterile dyspnea.
Roncus on auscultation.
Assess once again the need to aspire again especially in the upper airway Drop in
Encourage the patient to cough and take deep breaths. oxygen saturation
Record the characteristics of the aspiration at the end of the procedure
 Oxygen
therapy
SECRETIONS ASPIRATION

ENDOTRACHEAL ASPIRATIONS
Handwashing.
Take the sterile probe and connect it to the aspirator without removing the distal part of the container.
Place a sterile field in the work area.
Put on sterile gloves and roll the probe in your dominant hand.
Instill 5 ml of sterile physiological saline with the syringe through the tube to fluidize secretions.
Lubricate the proximal part of the tube with sterile physiological saline. E Introduce the tube through
the endotracheal tube, without aspiration, to the trachea or as far as possible.
Start aspiration intermittently, rotating and removing the probe
so far
Immediately
• Discard the aspiration probe.
• Consider suctioning the mouth, with a new probe. WHEN TO
• Let the patient recover, assess oxygen monitoring and the rest of the VACUUM
hemodynamic parameters. Visible secretions in the tube
• Check the effectiveness of the aspiration and the need to continue with the process.
orotracheal
• If the aspiration cycle has finished, discard the used probes, clean the tubing with antiseptic Tubular breathing sounds,
solution and aspirate.
gurgling or harshros
• Leave the material for a new aspiration ready at the head of the bed, it could be urgently
needed.
Sudden
dyspnea
Roncus on auscultation, especially in
• Make sure to leave the patient with the same respirator parameters.
• Assess the quantity and characteristics of the material aspirated and Record the procedure, the upper airway
incidents, characteristics and changes in secretions.
Oxygen
therapy

NEBULIZATIONS
NEBULIZATIO
N

1.
2.
3.
Oxygen
therapy

This is the set of devices that transform liquids (saline, water,

drugs, etc.) in aerosols so that they can be inhaled by the patient.

ADVANTAGES
Rapid local relief, medications can be administered even if the patient is unconscious, the medication is absorbed directly into the
circulatory tree .

PROCEDURE
Handwashing
Fill the nebulizer reservoir with the indicated solution.
Connect the distal part of the nebulizer (oxygen silicone) to the oxygen intake.
4. Explain procedure to patient, if applicable.
5. Place the patient in the Fowler position according to their health status.
6. Check that the patient is free of secretions
7. Place the mask on the patient trying to cover the nose and mouth.
8. Regulate the intensity of the nebulizations
9. When nebulization is finished, close the oxygen valve and remove the patient's mask.
Oxygen
therapy
DEVICES
LOW FLOW SYSTEMS
This type of oxygen therapy is recommended for people who DO NOT need a large amount of oxygen. Through this system it is possible
to supply oxygen to the airways at a flow of up to 8 liters per minute or with FiO2 (Fraction of
Inspired Oxygen) of 60%.
These systems are characterized by the patient inhaling air enriched with O2 at the same time as
ambient air.

NASAL
CANNULA
They are used when the patient must breathe through the nose. It is a plastic tube that unfolds at one end,
FLOW FiO2
with two holes that adapt to the nose. It is placed on the cheeks, and behind
the ears and head of the patient. If the patient breathes through the mouth, 1L/min 24%
the treatment will not be effective. 2L/min 28%

case will apply a 3L/min 32%

It is necessary to observe if there is nasal irritation (in lubricant) and the 4L/min 36%
which condition of the skin to avoid pressure ulcers.
This system facilitates the free use of the mouth (to speak, eat, etc.). 5L/min 40%
 Oxygen
therapy
5 -6L/min
DEVICES
6-7L/min SIMPLE MASK
7-8L/min It is used to deliver oxygen quickly and for short periods of time.
It covers the patient's nose, mouth and chin. It adjusts through the back FLOW FiO2
40%
strap and front metal pin.
50% Contains side holes for air circulation
60% PRECAUTIONS
• Monitor for possible air leaks, especially into the user's eyes.
• Assess the nasal and oral mucosa and moisturize if necessary.

6 L/min 60%
7 L/min 70%
8 L/min 80%
9 L/min 90%
MASK WITH RESERVOIR FLOW
10 L/min FiO2
100%
It consists of a mask with the same characteristics as the simple mask to which a reservoir bag with a maximum capacity of 750 ml to 1 liter is added, as
 Oxygen
therapy
well as a connection to the oxygen source and a unidirectional valve in the direction of inspiration that prevents exhaled air from entering the patient's
reservoir bag. allows to provide a higher oxygen concentration.
 Oxygen
therapy
DEVICES

HIGH FLOW SYSTEMS

High-end systems flow are capable of supplying a high concentration of oxygen, above what a person is capable of
In addition, they provide the patient's total inspiratory requirement, so not air enriched with O2 and needs the joint inspiration of
ambient air, unlike low-flow devices.
Being indicated in more serious cases, in hypoxia situations caused by respiratory failure, pulmonary emphysema, acute lung edema or pneumonia.

The Venturi mask, the most common in this type of oxygen therapy, has different adapters that serve to supply exact and different levels of

DEVENTURI MASK
oxygen, according to color. Provides a constant and exact FiO2 level .
FLOW FiO2
PRECAUTIONS 3L/min 24%
• Monitor possible air leaks, mainly towards the user's eyes.
6L/min 28%
• Regularly check that the mask is in the correct position.
• Assess the support points in order to prevent PUs. 8L/min 31%
12L/min 35%
10L/min 40%
15L/min 50%
Oxygen
therapy TRACHEOSTOMY SHOP
• This is a plastic device that fits around the tracheostomy neck.
DEVICES • It provides a high degree of humidity, with accumulated condensation being
necessary at least every 2 hours.
• It is easy to install, lightweight, disposable and transparent.
users with
CARE
• Extreme hygiene must be exercised on the collar, since there is a significant risk removal of
of infection.
• It is necessary to fit the mask correctly over the stoma, since the entry of
Ambient air reduces oxygen concentration.
• It is advisable to check the presence of fluid in the reservoir chamber more frequently, since its
absence would dry out the mucosa and concentrate the secretions.

FACIAL SHOP HOOD

Useful for patients who do not tolerate masks or in case • It consists of a bell-shaped plastic device that
of facial trauma. covers the head.
In some users it produces a great feeling of heat and • Provides moisture
confinement. • Difficulty feeding infants n
 Oxygen
therapy
COMPLICATIONS
Below are the main oxygen: complications that can occur in therapy with

❖ OXYGEN TOXICITY It is caused by exposure to co High oxygen concentrations, for periods prounded
of time. Symptoms appear such as: general malaise, cough, nausea, vomiting and increased respiratory rate.

RESPIRATORY DEPRESSION Hypercapnia (Increase in carbon dioxide C02) caused by oxygen toxicity is one of the factors that
can generate changes in the central nervous system, producing alterations in the state of consciousness. It can even cause
respiratory depression and apnea.

ARTERIAL HYPOTENSION Faced with high Inspired Oxygen Fractions (FIO2), reflex vasodilation occurs, which leads to a
secondary decrease in blood pressure.

INFECTIONS Following the guidelines, it is suggested to routinely change the equipment every two or three days, in order to
minimize the risk of cross contamination, caused by viral and/or bacterial agents, which can generate infections in patients.