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Oxygen Therapy

Jennifer Oliverio RRT, BSc

Clinical Educator

Respiratory Services

Alberta Childrens Hospital

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O2 Initiation O2 is a drug. A Dr.s order is required to initiate O2 tx

except in emergency situations

Order should include specific SpO2 or O2 flow rate/FiO2

O2 can be started without an order if hypoxia is

suspected. Dr. must be contacted ASAP

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Humidification Standard wall set-up for O2 requires humidification

(bubble humidifier/ cold neb)

Assess fluid level in humidifier with each RNassessment. Change 3x/week + prn

Portable O2 set-up: DO NOT incorporate humidity (risk ofwater spilling into delivery device)

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Bubble Humidifier

Use at flowrates < 10 LPM

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Monitoring O2 to be treated as a drug so need to ensure the rights:

Patient

Drug (O2)

Route (device)

Dose (flow/FiO2)

Documentation

Reason

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Monitoring Any changes to FiO2 or flow rate must be documented,

including respiratory assessment

Dr. should be notified if previously stable pt exhibitsrespiratory instability or O2 needs exceed device

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Safe Handling of O2 Cylinders should be placed in secure holder to prevent

tipping/ falling when not in use

When transporting pt on O2, cylinder must be securedin a carrier attached to bed, strecher, wheelchair or crib

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Transporting pts on O2 Ensure adequate O2 supply in tank for anticipated

length of time

Switch to wall O2 if available at destination and TURNTANK OFF!

May need to bring 2 tanks for pts requiring high flow

Change cylinders at 500 psi

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Devices Nasal cannula

Simple O2 Mask

Non- rebreathing mask

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Nasal Cannula FiO2 0.22-0.40

Prongs should not completely occlude the nares-

multiple sizes available **Ensure pt nares are patent**

Use with bubble humidifier

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Nasal Cannula SizesSize Max Flow

Premature (< term) 2 LPM

Neonate (>1400 g) 2 LPM

Infant (newborn, term) 2 LPM

Intermediate Infant

(3-12 mo)

2 LPM

Pediatric (>1yr) 3 LPM

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Simple O2 Mask FiO2 0.35-0.50

****Minimum 5 LPM O2 flow!!!!******

Cant really titrate O2

Pt cant eat/ drink

Use with bubble humidifier

Gently press on metal bar to conform to pts face. Do

NOT pinch!

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Partial Non- Rebreathing Mask FiO2 0.60-0.90 (depending on mask fit)

Minimum 5 LPM for infant/child, 10 LPM for teens.

Match flow to need

Reservoir bag and one-way valve limit amount ofRA inspired and dilution of FiO2

Gently press on metal bar to conform to pts face.

Do NOT pinch!

DO NOT USE WITH HUMIDITY

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Helpful Tips

No child or infant likes strangers

No child or infant likes things on their face

If they are no tupset with you putting on a mask or prongs be

concerned!

You may need to have parents help you hold the child or you

may need to bunny the child for a short time until they get

used to the therapy

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Place the child sideways across their lap with the childs legs held

between the parents legs.

Place the childs arm closest to the parent behind the parents back

The parent can use one arm to hold the free arm of the child andthe other hand to hold device in place/ or the childs head still

The Parent Hold

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Bunny

snuggly wrap a blanket around the arms and torso of

the infant/child

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