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OXYGEN DELIVERY DEVICES Oxygen Delivery Devices RsCr 220

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OXYGEN DELIVERY DEVICES Oxygen Delivery Devices RsCr 220 Powered By Docstoc
					                                                                         Oxygen Delivery Devices
                                                                                       RsCr 220

OXYGEN DELIVERY DEVICES
   Indicated for use:
        Correcting hypoxemia
        Decreased workload hypoxemia has on the heart
        Acute myocardial infarction
        Severe trauma
        Post anesthesia recovery

   Precautions and or possible complications (Support saturations with least FiO2)
       May depress ventilation in some patients with chronic hypercapnia (CO2
        retainers)
       May cause atelectasis, oxygen toxicity with long term use
       In premature infants, can cause Retinopathy of Prematurity (ROP)

LOW FLOW DEVICES
Defined as a device that does NOT meet all the inspiratory flow demands of the patient.
Do NOT confuse low flow with low oxygen concentrations (FiO2). Some low flow
will supply high oxygen percentage. Some high flow will provide low oxygen percentage.
      FiO2 can vary with:
         Patient’s respiratory rate and pattern
         Flow of gas from the equipment
         Equipment reservoir

   1. NASAL CANNULA delivers FiO2 of 24 - 44% with
      flowrates for 1 - 6 liters per minute. A humidifier is
      used with liter flows > 4 LPM or for patient comfort.
      Higher flows can cause nosebleeds and headaches.
      Should use “Cannula Cushions” for sore ears. They are
      easy to set up and are well tolerated by patients but
      good for only low FiO2.
      Rule of Thumb: For each liter of flow, add 4% to FiO2

   2. NASAL CATHETERS are seldom used
   3.TRANSTRACHEAL CATHETERS are seldom seen in the hospital situation
   4. RESERVOIR and PENDANT RESERVOIR cannulas are seldom seen in
   hospital. Are designed for oxygen conservation and low flow home use.

   5. SIMPLE MASK delivers FiO2 of 40 - 50% with liter flows
     of 5 - 12 LPM. Liter flow must be at least 5 LPM to ensure
     that CO2 is being flushed out of the mask. Good for patients
     with blocked nasal passages and mouth breathers. The masks
     are difficult to tolerate with skin irritation and at meal times.
     Guard against aspiration. A humidifier is optional.




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                                                                 Oxygen Delivery Devices
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6. NON-REBREATHE MASK delivers FiO2 of 50 - 70%. This mask utilizes 3 one-
  way valves and a bag reservoir to supply the highest possible oxygen concentration
  of any of the masks. Flow can set to meet the patient’s maximum inspiratory needs
  and so the bag should not completely deflate on inspiration. A tight fit is necessary
  to deliver a high FiO2. A PARTIAL REBREATHE MASK (FiO2 40 – 60%) can
  be achieved by removing valves from the mask. PALS recommends that you
  remove the valves on infants and children to prevent possible suffocation.




6. TRACHEOSTOMY MASK Similar to a simple mask designed to fit over neck
  area than mouth and nose. Usually is supplied by the large blue tubing from a
  heated aerosol setup.

 TRANSPORT TEE (or trach Tee)is the method used to oxygenate an intubated or
 a trached patient during transport. It
 fits with the ET tube or can be
 adapted for use with a trach mask. It
 supplies oxygen though oxygen
 tubing while attached to a portable
 oxygen tank (flow 6-10 LPM).



7. FACE TENT Often used with post-operative patients who are claustrophobic with
  a simple mask. Occasionally used but limited to low oxygen levels and low aerosol
  humidity.




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                                                                     Oxygen Delivery Devices
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HIGH FLOW DEVICES
   Will give a guaranteed FiO2 no matter what the patient’s venilatory pattern is. It is
   consistent and predictable. They meet or exceed the peak inspiratory flow of the
   patient. (Flow is at least 4X the patient’s minute ventilation, or >60 L/min)
   Do NOT confuse high flow with high oxygen concentrations (FiO2).

   1. VENTURI MASK delivers FiO2 of 24 - 50%. It is important that the appropriate
     liter flow is used for each setting to guarantee accuracy. External ports must remain
     open to entrain room air.




   2. AEROSOL (MIST MASK) SYSTEM delivers FiO2 from 28 -100% when FiO2
                                            is greater than 50% they must be set up in
                                            tandem. This device delivers humidity along
                                            with oxygen. If the upper airway is
                                            bypassed, ie intubated or tracheostomy
                                            patients, then the aerosol needs to be heated
                                            with an electric heater to provide adequate
                                            humidity. This prevents drying of mucosa,
      plugs, altered cilia function and humidity deficit. Aerosols may be used in
      conjunction with aerosol facemasks, face tents, trach collars, or T-Pieces.




MONITORING THE EFFECTIVENESS OF OXYGEN THERAPY
   Pulse Oximetry
   Arterial Blood gases
   Work of Breathing
   Tidal Volume and Respiratory Rate
   Pulse and Blood Pressure



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                                                                      Oxygen Delivery Devices
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MORE ON HIGH FLOW SYSTEMS
An oxygen delivery device that meets or exceeds the inspiratory flow demands of the
patient. I.E.> 30 lpm total flow delivered
    Examples
        1. venti – mask or air entrainment mask
        2. large volume jet nebulizers (Aerosol Mist)
        characteristics
            - Provide stable and reliable FIO2. Usually low
               concentrations 24 to 50%
            - only precise if total flow from the unit is > 30
            lpm (Need to meet pt demand)
        advantages
            - precise and stable
            - pt’s rr and Vt have no effect on FIO2
        disadvantages
            - may be difficult to achieve higher FIO2’s >50%
            - uncomfortable, etc.
        The size of the entrainment port determines the delivered FIO2.
            - the larger the port the lower the FIO2
            - the smaller the port the greater the FIO2
        The size of the jet determines the FIO2 delivered
            - the smaller the jet the lower the FIO2.

NOTE: A heater must be added to the aerosol mist when the
patient’s normal breathing system is bypassed (ET Tube or
trach mask)

       A double nebulizer setup is one way to increase flow with high FIO2s.

CALCULATING TOTAL FLOW DELIVERED USING A HIGH FLOW SYSTEM.
  is it at least 30 l/m air entrained vs. air delivered?

       STEP 1:       DETERMINE AIR-OXYGEN MIXING RATIO (Entrainmnet)
                     FORMULA: 100 – FIO2 = X : 1
                               FIO2 – 21

       EXAMPLE: at 40%         100 – 40 = 60 = 3.2: 1
                                 40 – 21 19
                  for every 1l delivered, 3.2 liters room air gets entrained.

       STEP 2:       CALCULATE TOTAL FLOW BASED UPON THE MIXING
                     RATIO IN STEP 1.
                     (source gas flow = the setting on the thorpe tube meter)



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                                                                       Oxygen Delivery Devices
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FORMULA: TOTAL FLOW = entrainment (source gas flow x mixing ratio) + source
          gas flow

       EXAMPLE: 7 L/M X 3.2 + 7 L/M = 29.4 L/M

       EXAMPLE: 100 – 28 = 72 = 10 : 1             3 X 10 + 3 = 33
                28-21      7                     source gas flow = 3

       STEP 3:        ask yourself is the total flow greater than 30lpm?
                      if it is not then increase the source flow
                      if it is -: then the system is ok (a high flow)


LIMITATIONS OF A HIGH FLOW SYSTEM:
     1. The size of the jet may inhibit the ability to increase source gas flow. Many
        systems can not deliver more than 12 liters of source flow.
     2. Downstream back pressure may inhibit the amount of room air entrainment.
        Water in the tubing causes backpressure resistance. This can cause the FIO2 to
        be inaccurate. (increased)

              Low end : 24, 26 air entrainment masks have specific FIO2’s
              28, 30, 35, 40, 45, 50 high end

Entrainment ratios
     100%                 0:1

     60%                  1:1

     40%                  3:1
     35%                  5:1
     30%                  8:1
     28%                 10:1
     24%                 25:1




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                                                                     Oxygen Delivery Devices
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OTHER LESS COMMONLY USED O2 DELIVERY DEVICES

           A. Infant head hood and incubators
                   1. used with a nebulizer (large jet)
                   2. used with heated humidifier
           B. Pendant or reservoir nasal cannula
                   1. used primarily in home care
                   2. conserves oxygen so that less is needed
                        to achieve prescribed FIO2
           C. Nasal Biflow
                   1. a small resevoir cup instead of prongs
           D. Patient demand systems and transtracheal
              catheters
           E. Croup tents
                   1. used to deliver O2 and cool mist
           F. Incubators
           G. Blenders (O2 blenders)
                   allows for mixing of air & O2 for a desired %


       HYPERBARIC OXYGEN THERAPY

           Monoplace chambers
                    - Clear plexiglass tube that pt is placed in
           Multiplace chambers
                    - RT and nurses accompany pt in chamber

           Indications
                    1.    Carbon monoxide gas poisoning
                    2.    Decompression sickness (the bends)
                    3.    Air embolism
                    4.    Cyanide poisoning
                    5.    Gas gangene
                    6.    Improve wound healing (decubitus ulcers)
                    7.    Refractory osteomyelitis
                    8.    Thermal burns
                    9.    Improves skin grafting success
                    10.    Severe anaerobic infections

OTHER GASES OF NOTE:

Carbogen:
   o Usually 95% oxygen and 5% carbon dioxide
   o Treats singultus (hiccups)
   o Provides a challenge to stimulate breathing in some patients



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                                                                  Oxygen Delivery Devices
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Heliox
   o Useful with ventilators and in ER
   o Upper airway narrowing
          o Croup
          o Asthma
          o Stridor
          o Tracheal tumors

Nitric Oxide
   o Treatment of neonates with hypoxic respiratory failure associated with pulmonary
       hypertension




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