Oxygen workshop

Outline
Oxygen Delivery Workshop
New Graduate Induction Day 2014
•  Define hypoxia
•  Outline management of the hypoxic patient
Michelle Abbott
Anthea Johnstone
•  Role of intubation
Physiotherapy Department "
•  Outline the difference between oxygen and flow
•  Describe oxygen delivery methods
What is hypoxia?
Poor ventilation
•  Definition:- the body, or a region of the body, is
deprived of adequate oxygen supply
•  Rate and depth of ventilation effects the amount
of alveoli participating in gas exchange
•  Can air get into the lungs?
•  Differs from hypoxemia (low PaO2)
•  Causes:•  poor ventilation
•  poor gas exchange
•  anaemia
•  low cardiac output
•  inspiratory muscle strength, airway patency (eg
OSA)
•  Are the alveoli ventilating
•  COPD/emphysema
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Poor gas exchange
Anemia
•  Haemoglobin increases the oxygen-carrying
capacity of blood by about 40-fold
•  Must be considered when assessing adequacy
of SpO2
•  Oxygen diffuses
passively into the blood
via pressure gradient
•  Decreased partial
pressures will effect the
binding eg altitude
•  What conditions will
effect gas exchange?
http://rrapid.leeds.ac.uk/ebook/04-breathing-01-1.html
http://www.123rf.com/stock-photo/haemoglobin.html
Low cardiac output
SpO2
•  Decreased blood flow will effect the delivery of
O2 to the tissues
•  Percentage of Hb bound to oxygen
•  Is the heart filling adequately?
•  Can it pump effectively? To lungs and to body?
•  Ischemic hypoxia – embolic event eg MI, or
progressive disease like PVD in diabetes
•  Measured by pulse
oximeter
http://homecaremag.com/senior-care-products/abcs-pulse-oximetry
•  Oxygen saturation does not directly reflect
tissue oxygenation eg anaemia
•  Effected by pH, Temp, DPG
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What level is SpO2 a concern?
Approach to hypoxic patient
•  Optimise A-B-C in emergency situation
•  Airway patency needs to be established
•  SpO2 quick easy measurement
•  If hypoxia present need to provide O2
regardless of underlying cause
•  Need thorough assessment skills to determine
the cause of hypoxia
How much oxygen do we give?
Oxygen resuscitation
•  Acutely hypoxic patient:-
•  If the patient in conscious:-
•  High concentration O2 required for all (face mask)
•  Hypoxia will kill faster then hypercapnia
•  Titrate once adequate saturation achieved
•  Chronic hypoxic patient:•  Ensure titration to saturation level desired
•  Utilise most effective means for that patient
•  Always start with Hudson mask application
•  Progress to Bag-Valve-Mask device if required
•  Don’t need to provide ventilation through BVM
•  If the patient is unconscious:•  Ensure airway patency is assessed
•  Intubation vs not?
•  Always use BVM
•  How would you know if CO2 is an issue??
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Flow vs oxygen
Equipment
•  What is our flow rate during inspiration?
•  Increasing oxygen improves what?
•  What will providing extra flow achieve?
•  Non-rebreather mask
•  Oxymiser
•  Trache mask
•  Hudson mask
•  Trache shield
•  Venturi mask
•  Humidified nasal prongs
•  Face tent
•  NIV
•  Rebreather mask
•  Bag-valve-mask (BVM)
Oxymiser
Nasal Cannula
•  Able to provide small
amounts of
supplemental oxygen
•  Disposable reservoir
cannula
•  Provides improved
saturations at lower
flows
•  Apply 0.5-4L/min
•  FiO2 dependent on
patients TV and RR
•  Nasal Cannula
•  Used for chronic
hypoxic patients
http://www.myrespiratorysupply.com/respiratory-care-nasal-cannula-c-10_21.html
•  Flow rates (0.5-12L/
min)
http://www.chadtherapeutics.com/usa/Disposable-Conservers/Oxymizer.html
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Hudson Mask
Venturi Mask
Nebuliser Mask
•  Ensure have the correct
mask (small holes vs
large)
Hudson Mask
•  First port of call to
providing increased
oxygen supply
•  Mixes air with oxygen
to provide a specific
FiO2
•  2 diluters:•  White 0.35-0.5 FiO2
•  Green 0.24-0.3 FiO2
•  Flow rates 5-12L/m
•  Amount of O2 required
on connectors
•  FiO2 dependent on
patient RR and TV
http://www.safetytec.ie/mueller/catalog/
index.php?main_page=index&cPath=25
http://www.chinamedevice.com/Suppliers/5847/VenturiMask-459876.html
http://www.mountainside-medical.com/pediatricoxygen-mask-with-7-foot-tubing.html
Face Tent
Partial Rebreather Mask
•  Provides O2 to the
nose and mouth without
the discomfort of a
mask
•  Hudson mask with a
reservoir bag
•  Used for patients with
burns/facial trauma or
anxiety
•  Exhalation ports in
mask
•  Allows higher FiO2
(0.6-0.8)
•  Flow rates 6-15 L/min
•  Flow rates 8-15L/min
http://www.salterlabs.com/index.cfm?
fuseaction=products.product&product_id=74&category_id=12
http://quizlet.com/10599579/med-surge-chapter-30-flash-cards/
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Non-rebreather Mask
•  Delivers highest FiO2
without assisting
ventilation (0.95-1.0)
•  Valves over expiratory
ports
•  Flow rates 10-15L/min
http://emsnewbie.com.s167718.gridserver.com/2010/06/ep-4-airways-and-reports/
http://www.studyblue.com/notes/note/n/zack-exam-2/deck/5954679
Bag-Valve-Mask (BVM)
Trache shield (TS)
•  Used in resuscitation
situations
•  Provides positive
pressure ventilation
•  Common complications
•  Air in stomach
•  Over-ventilation
•  Flow rate 15L/min
•  Direct connection to
tracheostomy tube
Pressure
relief valve
Reservoir
bag
Oxygen
tubing
•  Oxygen delivery
method of choice for
tracheostomy pt’s
•  MUST be used with
humidification
Exhalation
port
Air
cushion
mask
•  Flow dependent on
FiO2
http://www.tracheostomy.com/forum/showthread.php?t=25117&page=2
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Trache Mask
Humidified nasal prongs
•  Designed to sit over the
tracheostomy
•  Attach directly to
humidified circuit
•  MUST be used in
conjunction with
humidification
•  Prevents drying of
airways
•  Assists mucocilary
movement and
therefore secretions
clearance
•  Can attach nebuliser
port
•  Flow rates dependent
on desired FiO2
http://www.tracheostomy.com/faq/equipment/mask.htm
•  Flow rates 0.5-70L/min
Humidified bases
•  Ward use bases –
standard flow only
•  3 lights to show heat
•  1 cord to plug into
circuit
http://www.fphcare.co.nz/respiratory/adult-and-pediatric-care/optiflow/
Humidified circuits
•  Airvo
•  Increased use though
organisation
•  Flow rates 2-60L/min
•  If using nasal prongs/
TS MUST use batman
connector with air and
oxygen blended
•  If using a venturi
connector MUST use a
nebuliser mask
http://www.fphcare.com.au/products/airvo/
http://www.fphcare.com.au/products/mr810-humidifier/
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Humidified terminology
•  Standard Flow = total flow rate < 30L/min
•  Batman connectors with normal flow meters (15L/
min)
•  Venturi connector with FiO2 > 0.4
•  Airvo with flow rate < 30L/min
•  High Flow = flow rate >30L/min
•  Batman connectors with HIGH flow meters (60L/min)
•  Venturi connector with FiO2 < 0.4
•  Airvo with flow rate > 30L/min
Non-invasive ventilation (NIV)
•  Positive pressure ventilation
•  Implemented after multidisciplinary decision
(medical team, outreach nursing staff,
physiotherapists)
•  Oxygen entrained through machine (acute) or
through mask (home based machines)
Lets rank all these devices into high or low flow
and high or low oxygen concentration
•  FiO2 delivered accurate and variable
•  High flow rates to create positive pressure
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