1. OXYGEN INHALATION

2. DEFINITION

3. Administration of oxygen is a process of providing the 02 supply to child for the treatment of low concentration of 02 in the blood. Children with respiratory dysfunctions are treated with oxygen inhalation to relieve anoxaemia or hypoxaemia (deficiency of oxygen in the blood). The normal amount of oxygen in the arterial blood should be in the range of 80 to 100 mm of Hg. If it falls below 60 mm of Hg; irreversible physiologic effects may occur. The oxygen administration treats the effects of oxygen deficiency but it does not correct the underlying causes

5. PURPOSES OF
OXYGEN
INHALATION

6. To manage the condition of hypoxia
To -maintain the oxygen tension in blood plasma
To increase the oxy hemoglobin in red blood cells
To maintain the ability of cells to carry out the normal metabolic function
To reduce the risk of complications

7. COMMON
INDICATIONS
FOR
OXYGEN
ADMINISTRATION

8. Cyanosis: Bluish discoloration of skin, nail buds, mucus membranes, resulting from a decreased amount of oxygen in the hemoglobin of the blood.

9. Breathlessness or labored breathing: By some diseases such as - emphysema, pulmonary embolism, coronary thrombosis etc.

10. Anemia
Diseases such as - pulmonary edema, pneumonia, chest trauma etc
Environment with low oxygen content e.g. high attitudes
Poisoning with chemicals that alter the tissues ability to utilize oxygen e.g. cyanide poisoning
Hemorrhage

11. ARTICLES
NEEDED
FOR
OXYGEN
ADMINISTRATION

12. Oxygen source - 02 cylinder, central supply

13. Oxygen instrument according to methods like – oxygen mask, oxygen hood, nasal prongs, nasal catheter, oxygen tent or canopy

14. Humidifier

15. Flow meter

16. Gauze pieces
Adhesive tape

17. ‘No smoking' signs

18. Spinner to open the main valve of oxygen cylinder

19. Bowel with water to check the patency of the tube

20. METHODS OF
OXYGEN
ADMINISTRATION

21. Oxygen administration depends upon the condition of child, age, concentration desired, facilities available and the preference of the doctor. Oxygen administration can be given continuously or intermittently. It depends on the requirement of the child. It is given in 40 to 60 percent concentration. There are following methods of oxygen administration

22. ADMINISTRATION OF 02 BY NASAL CATHETER
This is very common method of 02 administrations in hospital settings. A catheter is inserted into the nostril reaching up to the uvula and is held in place by adhesive tapes
This catheter does not interfere with the Childs freedom to eat, to talk and to move on the bed. Catheter no. 4 to 6 is used and it should be 7.5 to 10 cm inserted in the naso pharynx. The catheter should be removed every 8 hourly, and new catheter should be inserted by using other nostril alternatively. Catheter method is used for the older children. The amount of oxygen should be 4 liter per minute

24. ADMINISTRATION OF OXYGEN BY THE MASK
Today, there are various face masks available that cover the Childs mouth and nose for 02 administration. The mask size should be according to the child's size. It should be properly fitted and if it does not fit properly, 02 will be lost from the mask. It should be removed after every four hours and-wine the face. The masks are advantageous for those patients who are unable to breathe through nose. The flow of oxygen should be about 2-3 litre for young children and 1-2 litre/minute for the infants.

26. ADMINISTRATION OF OXYGEN BY THE TENT METHOD
The oxygen tent method consists of a canopy over the patients bed, that cover the patient fully or partially. Oxygen tent is made up of plastic material, transparent and prevent absorption of oxygen. The lower part of the canopy is tucked under the bed to prevent the escape of oxygen. There are certain advantages and disadvantages for using a oxygen tent method.
Oxygen tent provides the environment for the patient with controlled oxygen concentration, temperature regulation and humidity control.

28. PROCEDURES

29. Assemble the 02 headbox
Place the headbox properly covering head, face and neck.
Seal the opening of headbox around neck to minimize 02 leaking
Attach thermometer probe to head box via aperture or use disposable thermometer

30. Adjust 02 and air flow rates to achieve prescribed oxygen concentration the total flow should be between 6 and 8 liters per minute to prevent accumulation of carbon dioxide in the head box.
Place sensor of oxygen analyzer into headbox alongside infant's nose (within 8 cm) to check oxygen concentration in headbox

31. NURSING PRINCIPLES

32. Monitor oxygen concentration hourly
Check frequently for loose connections in the circut
Ensure position of oxygen analyzer sensor is close to infant's nose and not in mainstream of the oxygen hose
Maintain the infant's head inside the headbox
Fill humidifier to appropriate level with distilled water PRN

33. G. Maintain inspired gas temperature as indicated below
Weight in kg
Temperature=C
All procedures through open incubator doors or with infant partially out of the incubator should be carried out with the infant in headbox or with a mask connected to gas supply, and close to the infant's nose.

34. DISADVANTAGES
It creates a feeling of isolation.
It requires high volume of oxygen which is not easily available.
When tent is opened, there is loss of 02 concentrations
It has more chances of fire.
It requires more time and cleanliness to maintain a tent.

35. COMPLICATIONS OF
0XYGEN
ADMINISTRATIONS

36. Infection: By using the contaminated equipments, the causative organisms can be present in such places as tracheotomy or endotracheal tubes, catheters, humidifying water and masks etc.
Drying of mucus membrane of the respiratory tract: It can occur when oxygen is administered without sufficient humidity. It can cause irritation and drying of the mucus membrane.
Combustion (fire) : 02 itself does not burn, but it supports combustion.

37. Oxygen toxicity: Symptoms of toxicity includes tracheal irritation and cough.
Atelectasis: Collapse of alveoli develops as a result of increased oxygen concentration in the inspired air. This is due to elimination of nitrogen.
Oxygen induced apnoea: The carbon dioxide is washed off completely from the blood by a high concentration of oxygen. The respiratory center is not stimulated sufficiently.

38. Asphyxia: Patient who receives 02 by masks and close tents must be protected from asphyxia.
Retrolental fibroplasia: The hazards of oxygen may affect the eyes. It is noted in premature infants who have a high concentration of oxygen inhalation.
Some others are - Bronchopulmonary, dysplasia, respiratory depression, seizure disorders and epilepsy.

39. IMPORTANT
INSTRUCTIONS
FOR
OXYGEN
INHALATION

40. Oxygen should be prescribed in specific dose
Oxygen should be prescribed in specific dose. It acts as a drug and cause oxygen toxicity.
Always use humidifier and regulator.
All the articles should 'be cleaned and use the disposable nasal catheter and change the nasal
catheter every 8 hourly.
Lubricate the nasal catheter before inserting.

41. Control valve of cylinder should be adjusted only when catheter is out of nose. or during oxygenation, do not alter the valve.
Discontinue of oxygen should be gradually.
Leave a calling signal or bell near the patient while going away from the patient.
Keep in close observation conditions, which can interfere with the flow of oxygen from the source to the patient.
Keep ready one cylinder to prevent the deprivation of oxygen.

42. Give oxygen in low concentration to the premature babies to prevent the. retrolental fibroplasia.
Continuously monitoring of patient to find out the oxygen toxicity symptoms.
Empty cylinder should mark "empty" and keep separately from full cylinders.

43. While oxygen administration, paste the "No Smoking" signs, near the patient bed or on the door.
Proper recording and reporting should be followed