Seminar On

OXYGEN DELIVERY
SYSTEMS

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Submitted On
2-7-19
 OXYGEN DELIVERY SYSTEMS

INTRODUCTION
Oxygen therapy is a means to provide oxygen according to target saturation

rates (as per physician orders or hospital protocol) to achieve normal or near normal

oxygen saturation levels for acute and chronically ill patients (British Thoracic Society,

2008). Those administering oxygen must monitor the patient to keep the saturation levels

within the required target range. Oxygen should be reduced or discontinued in stable

patients with satisfactory oxygen saturation levels.

Clients who have difficulty ventilating all areas of their lungs, those whose

gas exchange is impaired, or people with heart failure may benefit from oxygen therapy

to prevent hypoxia.

Oxygen therapy is prescribed by the primary care provider, who specifies the

concentration method of delivery and depending on the method liter flow per min. The

concentration is of more importance than the liter flow per minute. When administering

oxygen is an emergency measure, the nurse may initiate the therapy without a primary

care provider’s order.

Oxygen is supplied in several ways. In hospitals and long term care facilities,

it is usually piped into wall outlets, at the client’s bedside making it readily available for

use at all times. Tanks /cylinders of oxygen under pressure are also frequently available

for use when oxygen is either unavailable or impractical.

 Attach the flow meter to the wall outlet, exerting firm pressure. The flow meter

should be in the off position.

 Fill the humidifier bottle with distilled or tap water in accordance with agency

protocol. This can be done before coming to the bedside . Some humidifier

bottles come pre-filled by the manufacturer.

 Attach the humidifier bottle to the base of the flow meter.

 Attach the prescribed oxygen tubing and delivery device to the humidifier.

 Regulate the flow meter o the prescribed level. The line for the prescribed flow

rate should be in the middle of the ball of the flow meter.

Oxygen Delivery Systems

There is a wide variety of devices available to provide oxygen support. Delivery systems

are classified as low-flow or high-flow equipment, which provide an uncontrolled or

controlled amount of supplemental oxygen to the patient (British Thoracic Society,

2008). Selection should be based on preventing and treating hypoxemia and preventing

complications of hyper-oxygenation. Factors such as how much oxygen is required, the

presence of underlying respiratory disease, age, the environment (at home or in the

hospital), the presence of an artificial airway, the need for humidity, a tolerance or a

compliance problem, or a need for consistent and accurate oxygen must be considered to

select the correct oxygen delivery device (British Thoracic Society, 2008).
Before administering Oxygen check:

 The order for oxygen including twice and the liter flow rate(liter/min) or the

percentage of oxygen.

 The levels of oxygen (PaO2) and PCO2 – 35-45mmHg and

 Whether the client has COPD.

NASAL CANNULA [low flow system]

Nasal cannula(nasal prongs) consists of a small bore tube connected to two short prongs

that are inserted into the nose to supply oxygen directly from a flow meter or through

humidified air to the patient. It is used for short- or long-term therapy (i.e., COPD

patients), and is best used with stable patients who require low amounts of oxygen.

Advantages:

 Can provide 24% to 40% O2 (oxygen) concentration.

 Most common type of oxygen equipment.

 Can deliver O2 at 1 to 6 litres per minute (L/min).

 It is convenient as patient can talk and eat while receiving oxygen. May be

drying to nares if level is above 4 L/min.

 Easy to use, low cost, and disposable.

Disadvantages:

 Easily dislodged

 not as effective is a patient is a mouth breather or has blocked nostrils or a

deviated septum or polyps.

A mask fits over the mouth and nose of the patient and consists of exhalation ports

(holes on the side of the mask) through which the patient exhales CO2 (carbon dioxide).

These holes should always remain open. The mask is held in place by an elastic around

the back of the head, and it has a metal piece to shape over the nose to allow for a better

mask fit for the patient. Humidified air may be attached if concentrations are drying for

the patient.

Advantages:

 Can provide 40% to 60% O2 concentration.

 Flow meter should be set to deliver O2 at 6 to 10 L/min.

 Used to provide moderate oxygen concentrations.

 Efficiency depends on how well mask fits and the patient’s respiratory

demands. Readily available on most hospital units. Provides higher

oxygen for patients.

Disadvantages:

 Difficult to eat with mask on.

 Mask may be confining for some patients, who may feel claustrophobic

with the mask on.

NON – BREATHER MASK (high-flow system)

Consists of a simple mask and a small reservoir bag attached to the oxygen tubing

connecting to the flow meter. With a re-breather mask, there is no re-breathing of

exhaled air. It has a series of one-way valves between the mask and the bag and the

covers on the exhalation ports. On inspiration, the patient only breathes in from the
reservoir bag; on exhalation, gases are prevented from flowing into the reservoir bag and

are directed out through the exhalation ports.

Advantages:

 With a good fit, the mask can deliver between 60% and 80% FiO2 (fraction of

inspired oxygen).

 The flow meter should be set to deliver O2 at 10 to 15 L/min.

 Flow rate must be high enough to ensure that the reservoir bag remains partially

inflated during inspiration.

Disadvantages:

 These masks have a risk of suffocation if the gas flow is interrupted.

 The bag should never totally deflate.

 The patient should never be left alone unless the one-way valves on the

exhalation ports are removed.

 This equipment is used by respiratory therapists for specific short-term, high

oxygen requirements such as pre-intubation and patient transport.

 They are not available on general wards due to:

1. the risk of suffocation

2. the chance of hyper-oxygenation, and

3. their possible lack of humidity.

 The mask also requires a tight seal and may be hot and confining for the patient.

The mask will interfere with talking and eating.

The bag should always remain partially inflated. The flow rate should be high enough to

keep the bag partially inflated.

Advantages:

 Can deliver 10 to 12 L/min for an O2 concentration of 80% to 90%.

 Used short term for patients who require high levels of oxygen.

Disadvantages:

 The partial re-breather bag has no one-way valves, so the expired air mixes with

the inhaled air.

 The mask may be hot and confining for the patient and will interfere with eating

and talking.

FACE TEND (low-flow system)

The mask covers the nose and mouth and does not create a seal around the nose.

Advantages:

 Can provide 28% to 100% O2 Flow meter should be set to deliver O2 at a

minimum of 15 L/min.

 Face tents are used to provide a controlled concentration of oxygen and increase

moisture for patients who have facial burn or a broken nose, or who are are

claustrophobic.

Disadvantages:

 It is difficult to achieve high levels of oxygenation with this mask.

High-flow system consisting of a bottle of sterile water, corrugated tubing, a drainage

bag, air/oxygen ratio nebulizer system, and a mask that works with the corrugated

tubing. The mask may be an aerosol face mask, tracheostomy mask, a T-piece, or a face

tent. The key is that the flow of oxygen exceeds the peak inspiratory flow rate of the

patient, and there is little possibility for the patient to breathe in air from the room

Advantages:

 The system can provide 24% to 60% O2 at 4 to 12 L/min.

 Delivers a more precise level of oxygen by controlling the specific amounts of

oxygen delivered.

 The port on the corrugated tubing (base of the mask) sets the oxygen

concentration.

 Delivers humidified oxygen for patient comfort.

 It does not dry mucous membranes.

Disadvantages:

 The mask may be hot and confining for some patients, and it interferes with

talking and eating.

 Need a properly fitting mask. Nurses may be asked to set up a high-flow system.

 In other instances, respiratory therapists may be responsible for regulating and

monitoring the high-flow systems.