oxygen therapy part 2 oxygen delivery systems p1

of 8

Respiratory CareAdults

Oxygen therapy part 2: Oxygen delivery systemsEdited by Edda Hensler, Senior Lecturer in Nursing, University of Brighton, and Lesley Broad,

Matron for Integrated Respiratory Services at Buckinghamshire Healthcare NHS Trust

©2020 Clinical Skills Limited. All rights reserved

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

PI

BPM

%SpO2

The medical team will assess the patient and decide on the appropriate saturation target.

Most people are not at risk of carbon dioxide retention (hypercapnia) and will therefore have a target of 94-98%. Patients who are identified to be at risk of carbon dioxide retention will need a lower target of 88–92 per cent and may include patients who suffer from chronic lung conditions such as COPD, cystic fibrosis, bronchiectasis or chronic asthma. Monitor the effectiveness of oxygen therapy by observing the patient, by using pulse oximetry and, where necessary, by carrying out blood gas analysis (see Part 1 for more details).

Edda suggests incorporating oral/nasal suctioning into the revised respiratory/oxygen therapy series, see her email of 14/11/18 at 10.59

Nursing staff play a key role in assessing a patient’s need for oxygen and monitoring their response to oxygen therapy, so that the patient receives the correct amount. The aim of this procedure is to give an overview of the various oxygen delivery devices to aid appropriate use and safe delivery.

Oxygen is a potentially life-saving medicine for hypoxaemic patients (O’Driscoll et al., 2017). However, giving too much oxygen to certain patient groups and in some situations may cause harm. Research has shown that there is scope to improve healthcare professionals’ understanding of safe oxygen use, specifically the need for monitoring oxygen therapy based on an individualised oxygen prescription. Given the high number of adverse incidents related to oxygen therapy, such as accidental connection of oxygen tubing to air flowmeters (NHSI, 2018a; NHSI, 2016), it is recommended that all acute trusts should include basic training in oxygen use in the mandatory training programme for all clinical staff (O’Driscoll et al., 2017). Training should include the safe use of the different oxygen delivery devices.

The normal range of oxygen saturation in the blood (SpO2) of healthy, awake adults, measured by pulse oximetry, is 96–98 per cent (O’Driscoll et al., 2017). The aim of oxygen therapy is to correct potentially harmful hypoxaemia and to maintain patients’ oxygen saturation within a range that is appropriate for them, bearing in mind any underlying conditions they have (see O’Driscoll et al., 2017). This means that for all acutely ill patients the target is to achieve normal or near-normal oxygen saturation, apart from those at risk of carbon dioxide retention (hypercapnia) (see Part 1 of this series) or those receiving palliative care (O’Driscoll et al., 2017).

It is important to remember that there is no evidence that oxygen therapy improves the sensation of breathlessness if the patient is not hypoxaemic (O’Driscoll et al., 2017). In non-hypoxaemic patients, opioids and non-pharmacological measures such as a hand-held fan, may be considered for patients with malignancy or other causes of chronic severe breathlessness (O’Driscoll et al., 2017).

When treating the critically ill patient, oxygen therapy is only one element of resuscitation. Treatable causes such as bronchospasm, an obstructed airway or acute heart failure need to be prioritised. Interventions will be aimed at increasing cardiac output, circulating blood volume and correcting severe anaemia. Further harm must be avoided by avoiding medication that may reduce respiratory function such as opioids.

Oxygen, as supplied for therapeutic purposes, is a medicine, and should be prescribed before being administered (BNF, 2020). However, if the patient

requires oxygen therapy in an emergency, give it without delay and document the oxygen given afterwards, following local policy.

This guideline, the second of a three-part series on oxygen therapy, describes usage of the different oxygen delivery devices. Part 1, on key principles and documentation, covers how to monitor and stop oxygen therapy, including when it may be harmful. Part 3 describes humidification of oxygen. All three parts should be read in conjunction with each other.

Follow local policy relating to infection control and use of personal protective equipment (Loveday et al., 2014). Remember that oxygen administration poses a hazard as it supports combustion in the presence of heat and fuel (see also the clinicalskills.net series on Medical gases).

The different types of oxygen delivery devices described here are:

• Nasal cannulae, which deliver oxygen directly into the patient’s nares. These are suitable for stable patients, but are not recommended for patients in respiratory distress or in acute severe hypoxaemia.• The simple mask, which is used when a higher concentration of oxygen is required, which cannot be delivered via a nasal cannula, and where there is no access to a Venturi system. It may be used for type 1 respiratory failure. The flow rate must be at least 5 L/min to avoid carbon dioxide building up and resistance to breathing. • The fixed performance mask (also called a Venturi mask or fixed concentration mask). This type of mask is the most accurate way of administering a specific concentration of oxygen and therefore suitable for patients with raised carbon dioxide levels. • The high-concentration reservoir mask (also called a non-rebreathe mask) delivers approximately 60-80 per cent of oxygen to self-ventilating patients (O’Driscoll et al., 2017). This mask is the choice for short-term treatment of critical illness.

High-flow oxygen uses high flow rates for oxygen delivery of up to 99 per cent oxygen using specialist equipment. This may be used as an alternative to reservoir mask treatment in patients with acute respiratory failure without hypercapnia (O’Driscoll et al., 2017).

This procedure will outline how to select the correct device and the advantages and disadvantages of each. If supplemental oxygen therapy is insufficient to maintain the patient’s target saturations, as shown by severe hypoxaemia and/or hypercapnia with respiratory acidosis, then supported ventilation needs to be considered (non-invasive and invasive ventilation).

Patient assessment

60%15L/MIN

40%12L/MIN

35% 8L/MIN

28% 4L/MIN

24% 2L/MIN

60%15L/MIN

40%12L/MIN

35% 8L/MIN

28% 4L/MIN

24% 2L/MIN

Seek medical advice if your patient appears to require increasing oxygen therapy or if the National Early Warning Score or Track and Trigger Score is rising

Blue Venturi valve 24% 2–3 L/min

White Venturi valve 28% 4–6 L/min

Yellow Venturi valve 35% 8–12 L/min

Red Venturi valve 40% 10–15 L/min

Green Venturi valve 60% 12–15 L/min

Nasal cannulae 1 L/min



Nasal cannulae or simple face mask at 5-6 L/min

Or simple face mask at 7-10 L/min

Reservoir mask at 15 L/min

If a reservoir mask is needed, seek medical input immediately For Venturi masks, the higher flow rate is required if the respiratory rate is >30

Signs of respiratory deterioration:• Rise in respiratory rate

• Decrease in SpO2

• Increasing oxygen dose needed to maintain SpO2 within range

• Rise in National Early Warning Score/Track and Trigger Score

• Drowsiness

• Headache

• Flushed face

• Flapping tremor

Signs of CO2 retention:

Seek medical adviceAll patients must have arterial blood gas analysis (ABG) or earlobe blood gas (ELBG) within 1 hour of increased oxygen

!

of 8

?

%SpO2 /min

SpO2 /min

?

%SpO2 /min

SpO2 /min

Respiratory Care

Adults

Oxygen therapy part 2: Oxygen delivery systems Page 2

Starting oxygen with target saturation of 94–98 per cent

Maintaining the target saturation (adapted from O’Driscoll et al., 2017)

Starting oxygen with target saturation of 88–92 per cent

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution

Where possible, record the patient’s oxygen saturation before starting oxygen therapy, but do not remove oxygen from an acutely unwell patient to obtain a reading on air. If the target saturation is 94–98 per cent, choose the appropriate delivery device to achieve the prescribed target saturation. Monitor SpO2 for the first 5 minutes and then at a minimum interval of 4 hours. There is no need for repeat blood gases for these patients, provided they stay within the target range.

If the target saturation is 88-92 per cent, consider use of a “fixed- performance” oxygen delivery device to give oxygen in a controlled way. In addition to monitoring oxygen saturation, take blood gases after 30–60 minutes (O’Driscoll et al., 2017).

Respiratory Care

Adults

Oxygen therapy part 2: Oxygen delivery systems

Nasopharynx

DisadvantagesAdvantages

Less restrictive and lighter in weight than a mask

There is no danger of rebreathing carbon dioxide

Patients may feel less claustrophobic than when wearing a mask Cannulae are less likely to be knocked off or to fall off

Cannulae are often cheaper than simple face masks

Patients can eat, drink and talk while receiving oxygen

The prongs have the potential to become blocked with secretions

Can cause dry mucous membranes

They do not deliver a consistent concentration of oxygen

Not recommended for patients in respiratory distress or in acute severe hypoxaemia

The patient’s upper airway must be patent for cannulae to be used

Cannulae cannot be used to deliver nebulised medicines

Oxygen delivery via a nasal cannulaAdvantages and disadvantages of nasal cannulae

Nasal cannulae are suitable for stable patients, but are not recommended for patients in respiratory distress or in acute severe hypoxaemia.

The nasal cannula has two soft prongs that arise directly from the oxygen tubing and should be inserted into the patient’s nares. Oxygen flows from the cannulae into the patient’s nasopharynx, which acts as an anatomical reservoir. For this reason, never cut the tip of the prongs.

Page 3 of 8


Nasal cannulae deliver oxygen directly into the patient’s nares. They are useful when a patient needs low to moderate oxygen therapy, usually a maximum of 4 litres per minute (O’Driscoll et al., 2017), to correct hypoxaemia, such as in postoperative care on general surgical wards. The performance and variation of nasal cannulae for medium-concentration oxygen therapy is broadly similar to that of the simple face mask (O’Driscoll et al., 2017). The concentration of oxygen delivered to the patient depends on several factors, including the flow rate of oxygen given, the patient’s respiratory pattern, the amount of room air being breathed in through the nose and mouth, and the volume of the patient’s nasopharynx, all of which dilute the oxygen to a different extent with each breath. If delivery of a precise concentration of oxygen is important, use a fixed performance mask with the appropriate Venturi valve.

Remove tape and scissors and associated labels--these were copied over from children’s procedure. Fill the space left with observation chart as for other delivery systems

Observation/National Early Warning Score chart

Gem

10

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

O2

SpO2

?

%SpO2 /min

SpO2 /min

Oxygen

Flowmeter

Nasal cannula

Saturation monitor Pulse oximetry probe

Nasal cannulae: equipment

Gem

10

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

O2

Oxygen Simple face mask Oxygen tubing

Flowmeter Saturation monitor


SpO2

?

%SpO2 /min

SpO2 /min

Pulse oximetry probe

Respiratory Care

Adults


Fitting the oxygen tubing Breathing

Simple face mask: equipment

Remind patients to breathe in through their nose and out through their mouth for maximum effectiveness (Woodrow, 2007). If your patient’s condition or level of consciousness deteriorates, you may be required to change the method of delivery to a mask (Olive, 2015). Although nasal cannulae cannot be used to deliver nebulised medication, air-driven nebulisers can be given to patients while continuing low-flow oxygen therapy via nasal cannulae.

Fit the oxygen tubing over the ears and bring the tubes together under the chin using the sliding connector. Check that the patient is comfortable and that the nasal cannulae are not too tight, because they can cause soreness to the nares of the nose or the tops of the ears (Olive, 2015; Dougherty & Lister, 2015; Woodrow, 2007).

A simple face mask is used when a higher concentration of oxygen is required, which cannot be delivered via nasal cannulae. Not all areas have access to a Venturi system (see below) and may therefore use a simple mask instead. A simple mask should have a minimum flow rate of 5 litres per minute in order to prevent rebreathing of exhaled carbon dioxide. The rate and depth of the person’s breathing will affect the concentration of oxygen delivered.

Page 4 of 8


60%15L/MIN

40%12L/MIN

35% 8L/MIN

31% 6L/MIN

28% 4L/MIN

24% 2L/MIN

Gem

10

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

O2

Oxygen

Venturi mask

Appropriate Venturi mask barrels

Oxygen tubing

Flowmeter

SpO2

?

%SpO2 /min

SpO2 /min

Saturation monitor


60%15L/MIN

40%12L/MIN

35% 8L/MIN

31% 6L/MIN

28% 4L/MIN

24% 2L/MIN


The different-coloured Venturi barrels have different-sized holes, and it is the size of the holes that determines the ratio of air and oxygen

Adults

SpO2

?

%SpO2 /min

SpO2 /min

Respiratory Care


Page 5 of 8


Advantages and disadvantages of a simple face mask Fitting a simple face mask

Secure the mask, ensuring a good seal around face and nose. Set the oxygen at the desired level using the flowmeter, in order to deliver the required concentration of oxygen. The rate and depth of the person’s breathing will affect the concentration of oxygen delivered, so careful respiratory assessment is required.

Venturi mask

Advantages Disadvantages

Lightweight and easy to apply

Inexpensive

Disposable/single-patient use

Can be used with the addition of a Venturi barrel if required

Can be used to deliver a higher concentration of oxygen than is possible with nasal cannulae

Can be used with humidification

Can be used for selected patients while nebulising medications

Possibility of drying or irritation of the eyes

Patient may need to remove mask when speaking

Not suitable for long-term use

Uncomfortable with patients who have suffered facial trauma

Not to be used on patients who have high risk of aspiration or airway obstruction

Mask may be loose fitting, leading to oxygen leaks

Claustrophobic for some patients

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

AIR

Venturi masks aim to deliver a constant oxygen concentration within and between breaths and are particularly suitable for patients with raised carbon dioxide (hypercapnia). The Venturi valves/barrels are colour-coded to indicate the oxygen concentration they provide at a given minimum flow rate. This information is printed on the Venturi barrel (see above). The high flow helps to flush out expired carbon dioxide from the Venturi mask so that rebreathing of carbon dioxide does not occur (Robinson & Scullion, 2009). The ambient air brought in from the surrounding environment provides humidification.

Edda wants Venturi section to follow this page, as per BTS mask escalator

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

AIR

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

AIR

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

5

O2

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

O2

Oxygen and air mixed

Oxygen

Air

Air

The Venturi principle Select the correct Venturi barrel

Choose the desired barrel/concentration based on the target oxygen saturation and the patient assessment and attach it to the mask and tubing. Use the 24% Venturi barrel at 2 litres per minute or the 28% barrel at 4 litres per minute for patients at risk of hypercapnia, such as those with COPD (O’Driscoll et al., 2017).

Advantages and disadvantages of a Venturi mask

Advantages Disadvantage• Delivers a specific concentration of oxygen to the patient, so it is a more accurate method of oxygen delivery than a simple mask

• Easy to use

• The noise of airflow may be disruptive to the patient and impedes the patient’s ability to communicate

The flow of oxygen through the Venturi barrel naturally sucks in (entrains) room air through small holes in the barrel; the air mixes with the oxygen and dilutes it to a fixed concentration. If the flow of oxygen increases, so does the amount of room air that is entrained and dilutes it, so the concentration of oxygen inspired by the patient remains constant.

24% 2L/MIN

Select the correct flow rate for the Venturi barrel Patients with a higher respiratory rate

Patients with a respiratory rate greater than 30 breaths/minute should have the flow rate set to 50 per cent above the minimum flow rate specified for the Venturi mask and/or packaging, so that it exceeds their inspiratory flow rate (O’Driscoll et al., 2017; Robinson & Scullion, 2009).

You must select the correct flow rate for the Venturi mask barrel being used. Increasing the flow rate does not increase the inspired oxygen concentration, as it is a fixed delivery device. If you want to adjust the flow rate, you must change to the appropriate barrel and adjust the oxygen at the flow meter.

Adults Respiratory Care


Page 6 of 8


EDDA: the section on high-flow oxygen needs to follow this page. This caption was suggested by the previous authors and could be a starting point? The oxygen can also be delivered using high-flow devices which can provide up to 100 per cent fraction of inspired oxygen (FiO2), with flow rates as high as 60 L/min. These devices are widely used in critical care areas, on respiratory wards and in enhanced recovery areas. (The gas delivered can be heated and humidified, so these systems are useful in patients with thick secretions, as well as those who benefit from a high flow of oxygen, such as those with high respiratory rates, or broken ribs.)

o2

15

10

5

1

OXY

GEN

per M

INU

TELI

TRES

o2

15

10

OXY

GEN

LITR

ESpe

rMIN

UTE

5

1

o 2 o2

160180

200

220

240

260

280

300

140120

100

80

60

40

20

0

0472

mm Hg

Monitor the patient closelyIf the patient’s respiratory rate is >30 per minute

Patients requiring controlled oxygen therapy via a Venturi mask are often acutely unwell and their condition can change rapidly. Monitor such patientsclosely and assess the extent to which oxygen therapy is maintaining their saturation within the target range and how their blood gases are affected. Report any concerns according to the NEWS2 protocol.

Use the above guide for recommended flow rates in this group of patients (O’Driscoll et al., 2017). For more information on use of flowmeters, refer to the clinicalskills.net series on Medical gases.

%SpO2

If patient is already on: 24% Venturi, 2 L/min

28% Venturi, 4 L/min




Switch to: 3 L/min 6 L/min 12 L/min 15 L/min

Change to high-concentration reservoir mask (rebreathe mask) if 60% Venturi is not sufficient

60%15L/MIN

40%12L/MIN

35% 8L/MIN

28% 4L/MIN

24% 2L/MIN

Advantages Disadvantages

Permits the delivery of oxygen at high flow rates

Suitable for patients breathing spontaneously with hypoxaemia

Easy to apply and, for patients with suspected spinal or head trauma, masks with elasticated ear loop bands can be applied without moving the patient

Can be claustrophobic for some patients

Cannot be used to provide humidification

Close monitoring of the reservoir bag is required to ensure it remains inflated at all times

Impedes the patient’s ability to speak and to eat and drink

Not suitable for patients who have suffered injuries to the mouth or those who are unable to breathe without assistance

Advantages and disadvantages of reservoir mask Fitting the reservoir mask

Turn on the oxygen at the flowmeter to 15 L/min, and check the patency of the bag. To do this, occlude the inspiratory valve, allowing the reservoir bag to fill, and then squeeze the bag to test the valve. If the reservoir bag does not empty, discard it and test another one. Apply the mask to the patient’s face and secure it, ensuring a good seal around face and nose. Ensure that the oxygen is at the desired level to ensure that the reservoir bag does not empty completely at the end of inspiration. The minimum flow rate is 10 L/min.

A high-concentration reservoir mask is designed for short-term emergency treatment of patients who are breathing spontaneously, as a holding measure until more appropriate interventions become available. A non-rebreathe mask should be kept at the bedside and on resuscitation trolleys for immediate use in the event of acute deterioration in respiratory function. The patient will require close monitoring for signs of deterioration (refer to Part 1 of this series). It is vital that staff know when to select this type of mask, how to check the valve between the mask and the bag for patency before using it, and how to set it up correctly (see below). If not safely set up, it can cause retention of carbon dioxide. This mask permits the delivery of oxygen at high flow rates: the reservoir bag and the mask’s oxygen port together allow an inspired oxygen concentration level of between 60 and 80 per cent or above, at a flow rate of 15 litres per minute (BTS, 2017). The patient draws gas from the oxygen-rich reservoir and displaces exhaled gases such as carbon dioxide through the exhalation ports.

Beac

onM

edas

OXYGEN

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

AIR

Adults Respiratory Care


Page 7 of 8


Gem

10

cal 6

0 p

.s.i. at 2

0°C

-L m

in - re

ad

at ce

ntre

of b

all

1

15

10

5

O2

O2SpO2

?

%SpO2 /min

SpO2 /min

Non-rebreathe maskOxygen

Oxygen tubing

Flowmeter


Saturation monitor


High-concentration reservoir mask (non-rebreathe mask)

The oxygen flow to a reservoir mask must be sufficient—at least 10 to 15 litres per minute—to ensure that the oxygen reservoir bag does not collapse during inspiration, or the patient will not receive the increased concentration of oxygen they require.

o2

15

10

5

1

OXY

GEN

per M

INU

TELI

TRES

o2

15

10

OXY

GEN

LITR

ESpe

rMIN

UTE

5

1

o 2 o2

Some patients receiving oxygen via a mask may swap to nasal cannulae to maintain oxygen therapy while they are eating, drinking or receiving nebulised medication as appropriate. Replace the mask afterwards.

NEWS key0 1 2 3

DATETIME

≥2521-2418-2015-1712-14

9-11≤8

≥97 on O295-96 on O293-94 on O2

≥93 on air88-9286-8784-85≤83%

≥2521-2418-2015-1712-149-11≤8

≥9694-95 92-93

≤91

DATETIME

A+BRespirationsBreaths/min

DATE OF BIRTH:

FULL NAME:

3

31

2

CBloodPressuremmHgScore usessystolic BP only

3

A=AirO2L/min Device

3

12

3

12

3

12

2

DATE OF ADMISSION:

≥97 on O295-96 on O293-94 on O2≥93 on air88-9286-8784-85≤83%

≥9694-95 92-93≤91

A=AirO2L/min Device

A+BSpO2 Scale 1Oxygen saturation (%)

Air or oxygen?

SpO2 Scale 2†

Oxygen saturation (%)Use Scale 2 if target range is 88-92% eg in hypercapnic respiratory failure

†ONLY use Scale 2 under the direction of a qualified clinician

30/11600 16301700

BETTY LILIAN KIBBLE

17/5/1929 28/9/2019

2823

16

97 98

94

2 L/MIN24%

o2

15

10

5

1

OXY

GEN

per M

INU

TELI

TRES

o2

15

10

OXY

GEN

LITR

ESpe

rMIN

UTE

5

1

o 2 o2

o2

15

10

5

1

OXY

GEN

per M

INU

TELI

TRES

o2

15

10

OXY

GEN

LITR

ESpe

r MIN

UTE

5

1

o 2 o2

To help control breathing rates and improve breathlessness, breathing techniques such as purse breathing (breathing out against pursed lips) and pacing can help. See Key Reading for more information.

2 L/MIN24%

Respiratory Care

Adults


All masks: start to apply oxygen Reassure the patient

Long-term problems: (a) Pressure sores (b) Dehydration and need for mouth care

Compare your observations to the target range

Begin by asking the patient to hold the mask so that it covers the mouth and nose. It is important to position the mask correctly or it will not deliver an accurate concentration of oxygen. When the mask feels comfortable for the patient, use the elastic strap to hold it in position (inset). Consider using a paediatric mask for petite patients to ensure a good fit.

Stay with the patient until the oxygen therapy is tolerated. Some patients experience a sense of claustrophobia with the mask on their face. A calm and reassuring approach by the healthcare professional can alleviate this. Oxygen therapy compromises the patient’s independence; provide a call bell. Give the patient an oxygen information sheet as appropriate (see Key reading).

Patients are at risk of developing pressure sores to the nasal bridge, on the tops of the ears and under the chin, which may require protection with a hydrocolloid dressing or foam ear protectors. Check pressure areas regularly. There is a greater risk of pressure damage to the ear if the patient wears hearing aids and spectacles.

Oxygen therapy can dehydrate exposed membranes in the respiratory tract. Encourage patients to keep their mouth moist and clean by taking frequent sips of water, brushing the teeth or using a mouthwash (which may need to be prescribed). If the patient is unable to maintain their own mouth care or fluid intake, you will need to carry out mouth care for them.

Page 8 of 8


Assess whether oxygen therapy is maintaining the patient’s saturation within the target range determined during the earlier assessment (O’Driscoll et al., 2017; RCP, 2012) and record your observations (see also Part 1 of this series).

Patients can also become anxious when oxygen is no longer required, especially if they remain breathless on exertion. Allow patients to recover from exertion, and record saturations when they are at rest.

Anxiety following weaning from oxygen therapy

Tick if saturation not indicated

(Saturation is indicated in almost all casesexcept for palliative terminal care)

88-92% 94-98% Other

Circle target oxygen saturation

SIGNATURE / PRINT NAME DATEddmmyy

PHARM

08

12

18

22

DRUG(Refer To Trust Oxygen Policy)

OXYGEN

Add call bell to bed from next pic

New pic 6--use pic 1 from original part 3, but without the elephant tubingcaption is blue text in caption belowTitle: Anxiety follow-ing weaning from oxygen

Also include white text box with red border with the following text:

To help control breathing rates and improve breathlessness, breathing techniques such as purse breathing (breathing out against pursed lips) and pacing can help. See Key Reading for more information.

oxygen therapy part 2 oxygen delivery systems p1

Documents