Welcome to the Specialized Medical Services respiratory training webinar series!
SMS is your Long Term Care (LTC) facility single source for oxygen, medical equipment, respiratory care services and supplies nationwide.
This respiratory module is for reference purposes and designed to provide a basic understanding of Oxygen Delivery Devices commonly used in Long Term Care.
It is still important to consult your local respiratory professional and follow physician orders when applying respiratory treatment.
At the completion of each training module, a short post test will be offered. Upon successful completion, you will receive a training certificate
recognizing your participation for your records.
Oxygen Delivery DevicesWebinar Training Session
Training Objectives
• Understand oxygen delivery devices– How they work
– When to use them
• Differentiate between flow rate and FI02
• Identify patient need for oxygen
What is an Oxygen Delivery Device?• Disposable supplies connected directly to the patient…
• …AND connected to O2 system that delivers O2 at specific flow rates
• Low‐Flow – Does not meet all inspiratory flow demands
– Prescribed in LPM or flow rate
– Delivers varying (Fi02) % of oxygen, generally between 24‐90%
• High‐Flow– Provides for patient’s entire inspiratory requirements
– Delivers consistent, predictable percent of oxygen
– Prescribed in Fi02 or % of inspired gas that is oxygen
Flow Rate vs. FIO2
• Flow Rate– The rate at which oxygen is flowing from an O2 system to the patient
– Measured in LPM
• FIO2 – Fraction of Inspired Oxygen
– The percentage of inhaled air that is oxygen
Types of Oxygen Delivery Devices
• Nasal Cannula (Low flow)• Simple 02 Mask (Low flow)• Venturi Mask (High flow)• High Concentration Mask (Low flow)
(Non Rebreathing or Partial Rebreathing)
• Aerosol Face/Tracheostomy Mask (High flow)• Conserving Cannulas (Low flow)• Trans‐tracheal Catheter (Low flow)• Accessories: 02 bleed in adapters,
tubing connectors, ear cushions
Oxygen Delivery DevicesLong Term Care Application for Adult
Delivery Device Flow FIO2 Range Patient Use
Nasal Cannula 1‐6 LPM 24‐40% Long‐term oxygen therapy
Reservoir Cannula 1/4‐4 LPM 22‐35% LTOT patients requiring higher efficiency
Simple Mask 5‐10 LPM 35‐50% Acute short‐term therapy requiring moderate FIO2
Venturi Mask (Air Entrainment Mask )
Flow rates vary basjet cap setting /
ed on selected manufacturer
24%, 28%, 31%35%, 40%, or 50%
Patients requiring specific Fi02
Reservoir Mask(Partial Rebreathing)
6‐10 LPM 40‐60% Emergencies, acute hypoxemia, moderate FIO2
Non‐Rebreathing Mask 10‐15 LPM 60‐90% Emergencies, respiratory failure
Aerosol Face or Tracheostomy Mask
6‐15 LPM 24‐90% Delivers high humidity oxygen
Transtracheal Catheter 1/4‐4 LPM 22‐45%
Patients who don't accept nasal cannula, higher flow requirements
Delivered Fi02 may vary based on patient breathing pattern
Nasal Cannula• Most common delivery device in LTC
• Flow Rate: usually prescribed at 1‐5 LPM
(High flow cannulas available)
• Fi02 increases at approx 3‐4% per liter flow– 1 liter = 24%
– 2 liters = 28%
• Fi02 decreases as patient breathes more room air
Nasal Cannula
Advantages
•Lightweight, comfortable, inexpensive for patient•Ideal for claustrophobic patients•Ideal for oxygen dependant patients requiring small amounts of oxygen and home/independent use
•Humidification (bubble bottle) not required up to 4 LPM
Disadvantages
•Nasal mucosal drying•Maximum estimated Fi02 approximately 40%•Not appropriate for patients in respiratory distress
Areas of Concern
•Must be prescribed in liters per minute (LPM), not Fi02•Flow rates greater than 6 LPM can be uncomfortable for patient (headaches, nose bleeds)•Possible water in the tubing or catheter from bubble bottle (humidifier) can be sprayed up into the patient’s nose (turn flow on before applying to patient).
Simple 02 Mask
• Designed for short‐term use
• Flow Rate: prescribed at 5‐8 LPM
• Fi02 varies from 35%‐55%
• Minimum flow rate: 5 LPM– Flushes out expired air
– Minimizes carbon dioxide
Simple O2 Mask
Advantages
•Quick and easy to set up and apply•Comfortable, easy to use, inexpensive
Disadvantages
•Non specific, varying Fi02 (35%‐55%) ‐ Dependant on patient’s inspiratory flows•Maximum Fi02 estimated at 50%•Not intended for long term use
Areas of Concern
•Liter flow rates must be set at 5 lpm or higher to prevent risk of C02 buildup•Can make patient feel claustrophobic if having breathing difficulty
Venturi Mask• High‐flow device
• Fi02 is variable based on adapter or dial selection
– From 24%‐50%
• See mask packaging insert for flow rate and corresponding Fi02 selection
• For patients who require specific percentage of O2
Venturi Mask
Advantages
•Administers a specific, accurate Fi02•Determined by air entrainment adapter or dial on end of mask•Benefits oxygen sensitive patients
Disadvantages
•Fi02 delivered only available to specific mask adapters•Uncomfortable for some patients
Areas of Concern
•Do not cover the air entrainment ports on the mask adapters with bed linen or resident clothing. This can alter the delivered Fi02 significantly
•Color coded adaptor are not universal. Different companies may designate different colors for delivered Fi02’s.
•Verify adapter/dial Fi02 setting and liter flow before administering to resident.•May cause pressure build up if humidifier bottle used
High Concentration Mask• High percent of O2 for short‐term or emergencies
• Utilizes one‐way valves andbag reservoir
• Achieves highest percent of O2 in low‐flow delivery device
• Flow rate adjusted to meetpatient’s inspiratory needs
High Concentration MaskPartial Vs. Non‐Rebreathing
• Partial Rebreathing– Does NOT incorporate one way valves
– Patient may re‐breathe portions of exhaled gases
– Range of O2 delivered is 40 to 60 percent
• Non‐Rebreathing – Incorporates one way valves
– Only allows patient to draw in O2 from reservoir bag
– Must maintain sufficient flow rate to keep reservoir bag from completely deflating
– Range of O2 delivered is approximately 60‐90 percent
High Concentration MaskPartial or Non‐Rebreathing
Advantages
•Delivers high percentage of oxygen in short period of time•Usually meets or exceeds the inspiratory flow demands of the patient
Disadvantages
•CO2 buildup if flow is inadequate•Need high flow oxygen equipment to maintain
Areas of Concern
•Do not allow for reservoir bag to collapse•Adjust flow rate based on patient breathing pattern
Aerosol Face or Tracheostomy Mask
• Similar to simple mask design,can be applied to tracheostomy opening
• Provide both oxygen and high humidity
• Supplied by large bore tubing
Aerosol Face or Tracheostomy Mask
Advantages
•Delivers high percentage of oxygen in short period of time•Delivers high humidity output
Disadvantages
• Fi02 delivered can vary based on patient breathing pattern and air entrainment setting on nebulizer jar, when high volume source is air compressor, not oxygen
• Uncomfortable to some patients•CO2 buildup if flow inadequate (aerosol mask)
Areas of Concern
•Large bore tubing can be heavy•Must have high flow power source to move aerosol
Conserving Devices
• Store a reservoir of O2– More efficient use during inhalation
• Operates without electronics,batteries, switches or flow controls
• Designed for O2 conservation – Less is needed to achieve prescribed Fi02
Transtracheal Catheter• Catheter inserted through surgically placed opening in neck
• Allows for low oxygen flows to achieve adequate 02 sats vs.nasal cannula
• Avoids aesthetic issue of nasal cannula on face
Oxygen Delivery Accessories
1. 02 connecting tubing2. 02 Bleed In Adapter3. 02 tubing connector4. Ear Cushions5. Nut & Nipple Adapter
1. 2.
3. 4.
5.
Monitoring the Effectiveness of Oxygen Therapy
• O2 vital sign assessments– Pulse Oximetry
– Arterial Blood Gases
– Work of Breathing
– Tidal Volume and Respiratory Rate
– Pulse and Blood Pressure
• Maintain par levels of supplies
• Change delivery devices routinely
Steps to Follow
• Identify patient need
• Verify MD prescription– Delivery system, liter flow, duration
• Use appropriate equipment and delivery device
• Monitor efficacy for benefit & continued need
• Follow best practice and safety guidelines
Oxygen Therapy Sample Orders
• ‘Continuous oxygen @ 2 LPM via nasal cannula to maintain 02 sat level of 89% or greater
• Venturi mask @ 28%
• Non‐rebreathing mask at 12 LPM. Check 02 saturation levels Q 30 minutes
Session Review
• Understand oxygen delivery devices– How they work
– When to use them
• Differentiate between flow rate and FI02
• Identify patient need for oxygen
• Consult your respiratory professional as needed
1‐800‐786‐3656
Other Oxygen Delivery Device Resources
• AARC Clinical / Technical References
www.aarc.org
• Manufacturers’ product materialCarefusion www.carefusion.com
Chad www.chadtherapeutics.com
Hudson Teleflex www.teleflexmedical.com
Salter Labs www.salterlabs.com
Transtracheal Systems www.TT02.com
Thank You!
Take our post‐session quiz and print your certificate of completion