Oxygen Therapy Jennifer Oliverio RRT, BSc Clinical Educator Respiratory Services Alberta Children’s Hospital

2 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

3 Humidification Standard wall set-up for O2 requires humidification (bubble humidifier/ cold neb) Assess fluid level in humidifier with each RN assessment. Change 3x/week + prn Portable O2 set-up: DO NOT incorporate humidity ( risk of water spilling into delivery device)

4 Bubble Humidifier Use at flowrates < 10 LPM

5 Monitoring O2 to be treated as a drug so need to ensure the rights: Patient Drug (O2) Route (device) Dose (flow/FiO2) Documentation Reason

6 Monitoring Any changes to FiO2 or flow rate must be documented, including respiratory assessment Dr. should be notified if previously stable pt exhibits respiratory instability or O2 needs exceed device

7 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 secured in a carrier attached to bed, strecher, wheelchair or crib

8 Transporting pts on O2 Ensure adequate O2 supply in tank for anticipated length of time Switch to wall O2 if available at destination and TURN TANK OFF! May need to bring 2 tanks for pt’s requiring high flow Change cylinders at 500 psi

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10 Devices Nasal cannula Simple O2 Mask Non- rebreathing mask

11 Nasal Cannula FiO Prongs should not completely occlude the nares- multiple sizes available **Ensure pt nares are patent** Use with bubble humidifier

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13 Nasal Cannula Sizes SizeMax 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

14 Simple O2 Mask FiO ****Minimum 5 LPM O2 flow!!!!****** Can’t really titrate O2 Pt can’t eat/ drink Use with bubble humidifier Gently press on metal bar to conform to pt’s face. Do NOT pinch!

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16 Partial Non- Rebreathing Mask FiO (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 of RA inspired and ↓ dilution of FiO2 Gently press on metal bar to conform to pt’s face. Do NOT pinch! DO NOT USE WITH HUMIDITY

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18 Helpful Tips No child or infant likes strangers No child or infant likes things on their face If they are not upset 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

19 Place the child sideways across their lap with the child’s legs held between the parents legs. Place the child’s arm closest to the parent behind the parent’s back The parent can use one arm to hold the free arm of the child and the other hand to hold device in place/ or the child’s head still The Parent Hold

20 Bunny snuggly wrap a blanket around the arms and torso of the infant/child

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