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NT Skills Update: USE OF OXYGEN

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VOL: 98, ISSUE: 48, PAGE NO: 29

WHAT IS IT?
WHAT IS IT?
- Oxygen (O2) is a colourless, odourless, tasteless gas that makes up 21 per cent of the atmosphere. Additional O2 can save lives when administered correctly.


- It should be prescribed in writing with flow rate, method of delivery, duration and monitoring clearly stated.


- Normal cellular function needs adequate O2 supply. This depends on adequate ventilation, gas exchange and circulatory distribution.


WHEN AND WHY IT IS USED
- In critical situations, such as massive trauma and acute severe asthma, if there is no evidence of ventilatory failure (CO2 not raised) high flow oxygen can be administered.


- In acute respiratory emergencies where there is a risk - or evidence - of ventilatory failure controlled O2 of 24-28 per cent is administered.


- Domiciliary use. Chronic respiratory failure, for example, requires long-term O2 therapy (LTOT) and short-burst O2 therapy to control symptoms.


SAFETY AND MONITORING
- A no-smoking policy is imperative as oxygen promotes combustion.


- Patients with chronic lung disease with hypercapnia need hypoxaemia to stimulate respiration. Supplemental oxygen could cause them to stop breathing.


- Patients on LTOT should be warned to call for medical help if drowsiness or confusion occurs.


- Inappropriate dosing can have serious consequences.


- O2 therapy should always be monitored. Pulse oximetry will confirm an adequate O2 flow rate but will not exclude dangerous hypercapnia. Arterial blood gases are required for this purpose and will confirm eligibility for long-term O2 therapy.


INFECTION CONTROL
- Nasal cannulas/simple masks: for single patient use but do not represent clinically important risks of infection. Need not be routinely replaced during a single admission in the acute situation (see local clinical procedures and guidelines).


- High-flow systems employing humidifiers and aerosol generators applied to artificial airways can pose an infection risk (see local procedures for replacement guidelines).


DELIVERY METHODS AND MASKS
- Cylinder, liquid tank or concentrator. Depending on the system used 24-100 per cent of O2 can be administered.


- Nasal cannulas: best for a low flow of O2. Patient can eat, sleep, talk and expectorate without discontinuing treatment. High flow can cause nasal pain and crusting.


- Simple masks: fit over the mouth and nose delivering increased concentrations of O2. High-concentration masks can deliver up to 60 per cent of inspired O2, allowing some rebreathing. The inspired O2 cannot be prescribed accurately and the masks can be uncomfortable for long periods.


- Venturi masks: safer and more accurate in controlling the inspired O2 concentrations in the range of 24-60 per cent.


- Transtracheal: involves administering O2 percutaneously through a catheter inserted into the suprasternal trachea.


- Humidified oxygen: used when delivering directly to the trachea. When O2 is given by mask or prongs, the nose usually humidifies it, but extra humidification is desirable when high flow rates are required.


RESEARCH AND DEVELOPMENT
Murphy, R. et al (2001)
Emergency oxygen therapy for the breathless patient. Emergency Medicine Journal; 18: 6, 421-423.


WEBSITES
British Thoracic Society: www.brit-thoracic.org.uk


Royal College of Physicians Clinical Effectiveness and Evaluation Unit. Guidelines Database: www.rcplondon.ac.uk
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