Methods of Oxygen Administration
As a general rule, all patients oxygen saturation levels should stay above 90% unless otherwise directed. Oxygen saturation is measured by an oxygen saturation probe (O2 sat probe) that is usually placed on a patient's fingertip. If it is not reading appropriately, you can also place the O2 sat probe on the toes, the ear lobe, or even across the patient's forehead. As a patients oxygen demands increase, you must change the method that you deliver the oxygen. The types of equipment listed below are the most common types equipment you will see used. Each type of oxygen delivery system can only accommodate a certain amount of oxygen flow. Always keep in the back of your mind, "Why is my patient's oxygen demand increasing?" Something else is going on that should be looked into ! Does the patient have a history of COPD or are they developing septic shock or acute respiratory distress syndrome (ARDS)? Make a routine for how your perform your nursing respiratory assessments and be sure to always be thorough. Accurately count their respiratory rate and look for signs of shortness of breath. Think outside the box if your patient is deteriorating.
Nasal Cannula: This oxygen delivery system is meant for giving the patient 1-5 liters of oxygen per minute. The nasal cannula is a lightweight tubing that is inserted into the patient's nose with small, flexible prongs. This is the type of oxygen delivery system that you normally think of when you think of oxygen. Patients can be discharged home on oxygen via nasal cannula for long-term oxygen delivery.
Simple Mask: This oxygen delivery system is meant for giving the patient 6-10 liters of oxygen per minute. This mask is flexible and is placed over the patient's nose and mouth. If you have moved someone from a nasal cannula to a simple mask, be thinking to yourself, "What changed in my patient that is making their oxygen needs increase?" Are they having pain and breathing shallow? Are they developing a pneumonia? Have their lungs become fluid overloaded? Contact the doctor quickly if oxygen needs keep increasing!
Non-Rebreather Mask: This oxygen delivery system is meant for giving the patient 11-15 liters of oxygen per minute. This mask looks the same as the simple mask but has a clear reservoir (bag) on the end to increase the amount of oxygen delivered to the patient with each breath. Now you are bordering on the dangerous oxygen requirements! Really use those critical thinking skills to figure out what is going on with this patient's lungs! Next step after a non-rebreather mask is either bi-pap, high-flow nasal cannula, or intubation.
C-PAP: This oxygen delivery system gives patient oxygen in liters per minute or percentage of the air that is oxygen (meaning that the air delivered is 50% oxygen). CPAP stands for continuous positive airway pressure. This is most commonly prescribed at home for patients that have sleep apnea and need the added support of this "positive airway pressure." The muscles in these patients airways relax while they are sleeping and cause an "obstructive" sleep apnea. The extra pressure keeps their airway open and allows them to breathe normally. The doctor prescribes the set extra pressure that the c-PAP will deliver. In addition to this, the doctor will prescribe the amount of oxygen needed for the patient. Usually if someone is still showing signs of having respiratory failure with a non-rebreather mask, doctors will ask that the patient be placed on bi-PAP instead of c-PAP. C-PAP is usually more of a long-term care treatment. The mask for this treatment can either cover just the nose or cover the nose and mouth (like the bi-PAP mask below).
Bi-PAP: This oxygen delivery system gives patient oxygen in percentage of the air that is oxygen (meaning that the air delivered is 50% oxygen). This mode of oxygenation is very similar to c-PAP. There are settings on the bi-PAP that are set by the doctor called the inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). The doctor can also set a respiratory rate if they choose to which will force air into the patient. This is the highest oxygen that can be administered non-invasively (meaning not a tube down your throat). This mask covers both the nose and mouth and is very uncomfortable for patients to wear. This is your last effort and avoiding intubation!
High Flow Nasal Cannula: This oxygen delivery system is meant for giving the patient oxygen in two adjustable flows: percentage of oxygen and liters per minute. Example: The patient is on high flow at 55 liters per minute and 60% oxygen. The highest settings are 70 liters per minute and 100% oxygen. This delivery method helps to create some pulmonary end expiratory pressure (PEEP) by having such a large volume of oxygen flowing into the patient's nose. For best results, the patients should try and keep their mouths closed as to maintain better pressure in their lungs. This is similar to the regular nasal cannula, but the tubing is MUCH larger (even larger than the salter cannula). It is hooked up to a heated humidity system so the patient does not get dried out. This is a good alternative for patients who are not tolerating oxygen delivery via masks or bi-PAP. It does not work for everyone. Whether at the stage of bi-PAP or high flow nasal cannula, patients need to be monitored VERY closely for signs of worsening respiratory distress.
Ventilator: This oxygen delivery system gives patient oxygen in percentages of the air that is oxygen (meaning that the air delivered is 50% oxygen). The ventilator is hooked up to the patient via an endotracheal (ET) tube (meaning a tube in the trachea). Patients are sedated when inserting the ET tube by the provider. Patients are placed on the ventilator for a variety of reasons: they have exhausted their respiratory drive, there is an airway obstruction, when sedation is needed (surgery or intense withdrawals), and many other reasons. There are a variety of other settings that the doctor can play with as well. It can be set up to deliver the patient certain amount of volume per breath or a certain amount of pressure per breath. The ventilator can give mandatory breaths to patients, allow patients to take breaths on their own, or a combination of the two. Learn more about what you as a nurse can do to assist the physician during endotracheal intubation.
