1. O2 Administration: Oxygen Therapy and Pulse Oximetry Gail M. Maier, PhD., R.N. Associate Director The Ohio State University Wexner Medical Center

2. Learning Objectives abbreviations and diagnostic tests that are used to monitor the patient’s oxygen levels. Describe the indications for oxygen therapy. Identify the proper technique for the following: Setting up a Venturi mask, low flow nasal cannula, and non-rebreather bag Obtaining the patient’s SpO2 with a pulse oximeter Demonstrate 2 low flow and 2 high flow oxygen delivery devices. Identify the 4 hazards of oxygen therapy Describe factors that affect the reading of a pulse oximeter. Examine At the end of this module, you will know how to:

3. O2 Therapy Common O2 therapy abbreviations:  PaO2: Partial pressure of O2 in the blood (Normal is 80 – 100 mmHg)  FiO2: Fraction of inspired O2 (Room air is 21% O2)  SaO2: Arterial O2 saturation (Normal is 95-100%)

4. Indications for Oxygen Therapy Treat hypoxemia Mild: PaO2 of 60-80 mm Hg Moderate: PaO2 of 40- 60 mmHg Severe: PaO2 below 40 mmHg Decrease the work of breathing Decrease myocardial demands

5. Setting up the delivery device Oxygen flow meter: indicates amount of oxygen patient is receiving Oxygen measured in liters per minute (LPM)

6. Oxygen connections O2 adjuster knob Christmas tree

7. Low Flow Oxygen Cannula

8. Low Flow Oxygen Mask and Catheters Other Low Flow Delivery Options Mask can be used for those who are only mouth breathers Delivers higher amounts of oxygen Uncomfortable for most patients Nasal catheters deliver oxygen at the same rates as a cannula. Uncomfortable for the patient

9. High Flow Oxygen Cannula

10. High Flow Venturi (Venti) Mask

11. Hazards of Oxygen Therapy Oxygen toxicity Alveolar damage can occur Provide only the level of O2 patient requires Denitrogenation absorption atelectasis Absence of nitrogen reduces alveoli’s ability to expand

12. Hazards of Oxygen Therapy O2 induced hypoventilation Seem primarily in patients with COPD who have a hypoxic drive to breathe Oxygen takes away stimulus to breathe Fire hazard

13. Oxygen Tanks Oxygen is stored at a high pressure in green tanks. Oxygen tanks are used for transporting patients on oxygen and when a wall hook-up isn’t available. Before using, check to make sure the PSI is above 300 PSI. If not, get a new tank. Do not lean tanks against the wall or roll them on the ground. This is a fire hazard. Transport them like this.

14. Monitoring oxygenation – Pulse Oximetry Pulse oximeter: non- invasive monitor Provides estimate of arterial blood oxyhemoglobin saturation levels SpO2 = oxygen saturation levels

15. Procedure for Pulse Oximeter Use Pulse oximeter readings taken with vital signs Place device snugly on the finger Earlobes or toe can be used Record the oxygen saturation shown on the monitor

16. How does a Pulse Oximeter work? Two different wavelengths of light are emitted Light passes through the finger and read by the oximeter

17. Factors affecting the reading

18. Checking for Accuracy Compare the SpO2 on the pulse oximeter with the patient’s arterial blood levels (if available) Match the pulse rate on the oximeter with the patient’s actual pulse rate

19. SpO2 and PaO2 Below is a chart comparing the SpO2 reading to what the likely PaO2 is. SpO 2 PaO 2 90%60 mmHg 80%50 mm Hg 70%40 mm Hg

20. Oxygen is essential to life so it is important that you understand what to look for that indicates the patient may be experiencing difficulties Oxygen therapy is a common type of therapy ordered for the patients. You will be responsible for helping set the oxygen devices up Summary

21. Thank you for completing this module If you have any questions, please let me know. Gail.Maier@osumc.edu

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