OXYGEN THERAPY

INTRODUCTION:-
Oxygen, a gas found in the air we breathe, is necessary for human life. Some people with breathing
disorders can’t get enough oxygen naturally. They may need supplemental oxygen, or oxygen therapy.
People who receive oxygen therapy often see improved energy levels and sleep, and better quality of life.
DEFINITION:-
Oxygen is required by all tissues to support cell metabolism; in acute illness, low tissue oxygenation
(hypoxia) can occur due to a failure in any of the systems that deliver and circulate oxygen. Hypoxia is an
indication to start oxygen therapy; this can be a life-saving intervention, but given without appropriate
assessment and ongoing evaluation, it can also be detrimental to patients’ health (Ridler et al, 2014).
INDICATION:-
Oxygen therapy is prescribed for people who can’t get enough oxygen on their own. This is often because of
lung a condition that prevents the lungs from absorbing oxygen, including:
 chronic obstructive pulmonary disease (COPD)
 pneumonia
 asthma
 bronchopulmonary dysplasia, underdeveloped lungs in newborns
 heart failure
 cystic fibrosis
 sleep apnea
 lung disease
 trauma to the respiratory system
SYMPTOMS OF LOW OXYGEN:-
When you aren’t getting enough oxygen, you’ll experience a host of symptoms, including:
 rapid breathing
 shortness of breath
 fast heart rate
 coughing or wheezing
 sweating
 confusion
 changes in the color of your skin
If you experience any of these symptoms, seek immediate medical attention.
TYPE OF OXYGEN THERAPY:-
There are a number of different types of oxygen therapies that can be used. These include:
 oxygen gas
 liquid oxygen
 oxygen concentrators
  hyperbaric oxygen therapy
OXYGEN GAS:-
Oxygen gas can be stored in a portable tank. These are called compressed gas systems. A larger stationary
concentrator is used within the home, and a smaller oxygen tank can be taken to use outside the home. The
smaller tanks might be used along with oxygen-conserving devices so that the oxygen supply lasts longer.
The oxygen is delivered in pulses, not continuously.
LIQUID OXYGEN:-
Liquid oxygen also can be stored in a portable tank. Liquid oxygen is more highly concentrated, so more
oxygen can fit in a smaller tank. This is helpful for people who are very active, but it will evaporate if it isn’t
used in a timely manner. These tanks are refillable.
Both liquid oxygen and oxygen gas are available for home delivery in many locations.
OXYGEN CONCENTRATORS:-
Oxygen concentrators are less portable than the other options. An oxygen concentrator is a device that takes
oxygen from the room, concentrates it for therapeutic use, and removes other naturally occurring gases. The
benefits of concentrators are that they are less expensive and don’t require filling like tanks. Portable
versions are available. However, most models are too large to be truly portable.
Oxygen is distributed from the tank through a tube. It enters the lungs through nasal tubes, a face mask, or a
tube inserted directly into the person’s windpipe.
HYPERBARIC OXYGEN THERAPY:-
Hyperbaric oxygen therapy is unlike the other methods of oxygen therapy. People will breathe in pure
oxygen in a pressurized room or chamber. In the hyperbaric chambers, the air pressure is increased to three
or four times the normal air pressure levels. This increases the amount of oxygen delivered to the body’s
tissue. This type of oxygen delivery is often used to treat wounds, serious infections, or bubbles of air in
your blood vessels. Hyperbaric therapy should be carried out carefully so that blood oxygen levels don’t
become too high.
DELIVERY METHODS OF OXYGEN:-
The most common delivery method is the nasal cannula, which consists of a tube that runs through both
nostrils. Other delivery methods include:
 the non-rebreather mask
 the incubator (for infants)
 continuous positive airway pressure (CPAP)

ARTICLES USED FOR OXYGEN ADMINISTRATION

o Oxygen source - oxygen cylinder/central supply

 o Oxygen application device - oxygen face mask, oxygen hood, nasal pongs, nasal catheters,
oxygen tent or canopy.

o Humidifier

o Flow meter

o Gauze pieces

o Adhesive tapes

o ‘No-smoking’ board

o Spanner to remove main valve of oxygen supply

o Bowl with water to check the patency the tube

PROCEDURES:-
1. Starting oxygen therapy
The following procedure should be followed when starting oxygen therapy in patients who are acutely ill
(not those in peri-arrest):
 Ensure pulse oximetry is available to monitor response to oxygen therapy
 Document baseline observations including saturations, respiratory rate, blood pressure and pulse
 Note respiratory effort, colour, level of consciousness
 Check that there is a prescription for oxygen with a stated target saturation range (except in peri-
arrest situation)
 Where there is no known risk of carbon dioxide retention (target 94-98%), start oxygen therapy using
a reservoir mask at 10-15L/min. Where there is a risk of carbon dioxide retention (target 88-92%),
start oxygen therapy using a 28% Venturi device and mask
 Ensure delivery device is connected via tubing to oxygen supply and turned on to the appropriate
flow rate (if cylinder, check fill level of cylinder and be aware of duration time)
 Explain procedure to the patient and gain consent where possible. In patients who are acutely sick,
this may not be possible and clinicians should act in the patient’s best interests
 Place the oxygen mask on the patient’s face, adjusting the nose clip and elastic straps to ensure a
close fit
 Reassure the patient – if the patient is very breathless, oxygen masks can feel very claustrophobic
  Monitor response to oxygen therapy – recheck oxygen saturations, vital signs, colour and level of
consciousness
 Titrate oxygen according to oxygen saturations (Fig 4) to maintain saturations within prescribed
target range. Allow five minutes at each dose before further adjustment. Sudden withdrawal of
oxygen in a patient with hypercapnia leads to rebound hypoxaemia

Document all adjustments to inspired oxygen (FiO2), with saturations recorded

2. Ongoing care of patients requiring oxygen therapy in the acute setting

 Continue to monitor oxygen saturations at least four times a day. Always record saturations at rest
and document FiO2 in situ at the time
 Patients requiring >28% oxygen for more than 24 hours can have oxygen delivered via a
humidification system for comfort and to avoid the drying of secretions
 Stable patients may be more comfortable with nasal cannulae but care must be taken to ensure
saturations remain in the target range
 Patients requiring increasing doses of oxygen to maintain saturations within range, or with signs of
respiratory deterioration (increasing respiratory rate, drowsiness, headache, tremor, increasing early
warning score) require prompt medical review and further assessment including monitoring of
arterial blood gas
 Help the patient to stay in an upright position to maximize ventilation unless contraindicated by
underlying clinical problems, for example, spinal or skeletal trauma
 Give other prescribed therapies, such as nebulised bronchodilation, diuretics, ventilatory support
 Refer for respiratory physiotherapy if patients have difficulty clearing thick secretions
 Observe potential pressure areas, particularly behind the ears, from nasal cannula tubing or mask
elastic and ensure skin is protected and pressure is relieved by altering the position of the tubing or
using padding
 Be aware of the drying effect of oxygen on oral and nasal mucosa; encourage patients to maintain
adequate oral fluid intake where appropriate, and provide water-based lubricant gel to relieve nasal
drying. Do not use oil-based preparations such as Vaseline or petroleum jelly
 Consider discontinuing oxygen therapy once the patient has stable saturations (at least two
consecutive recordings) within their target range on low-dose oxygen (for example, 1-2L/min via
nasal cannula). Monitor saturations for five minutes after stopping oxygen and recheck after one
hour
3. Competencies required for delivering oxygen therapy
 Be aware of, and understand, local oxygen policy/guidelines
 Demonstrate a basic understanding of oxygen physiology, normal and abnormal values
  Be able to discuss the indications for oxygen and the potential risks
 Demonstrate an ability to use oxygen equipment safely, including an awareness of fire risks and
cylinder use.
 Demonstrate an ability to use a pulse oximeter to determine oxygen saturations
 Demonstrate accurate monitoring and recording of oxygen therapy
 Be able to recognize changes in a patient’s respiratory status
 Understand how to use oxygen in emergency situations, for example, cardiac arrest
Registered nurses (basic plus)
 Demonstrate an understanding of target range prescriptions and applications to different patient
groups
 Demonstrate an ability to assess suitability of delivery devices for individual patients and recognize
when a change of device is needed
 Be able to correctly identify and set up a range of oxygen-delivery devices
 Understand how to select appropriate oxygen/driving gas for nebulizer therapy
 Demonstrate accurate recording of adjustments to the oxygen dose and the patient’s response
 Recognize the need for escalation of treatment/medical review and further assessment
CONCLUSION:-
Administration of oxygen is a process of providing the oxygen supply to child for the treatment of low
concentrations of oxygen in the blood. Children with respiratory dysfunctions are treated with oxygen
inhalation to relieve hypoxia. The oxygen administration treats the effects of oxygen deficiency but it does
not correct the underlying disease.