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Oxygenation

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Oxygenation OXYGEN -A PRESCRIBED DRUG Must be written legibly by the doctor Prescription should be dated by the doctor Doctor must indicate duration of O2 therapy – PowerPoint PPT presentation

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Title: Oxygenation


1
Oxygenation
  • OXYGEN -A PRESCRIBED DRUG
  • Must be written legibly by the doctor
  • Prescription should be dated by the doctor
  • Doctor must indicate duration of O2 therapy
  • The O2 concentration must be prescribed
  • The flow rate must be prescribed

2
Indication for Oxygen Therapy
  • Acute Respiratory Failure
  • Acute myocardial infarction (M.I.)
  • Cardiac Failure
  • Shock (bacteraemia, cardiogenic, haemorrhagic)
  • Hypermetabolic state induced by trauma, burns or
    sepsis
  • Anaemia
  • Cyanide poisoning
  • During CPR
  • During anaesthesia for surgery

3
0xygen Delivery Systems
4
Basic Components of a oxygen delivery system
  • Piped or portable cylinder oxygen supply
  • A reduction gauge
  • Flow meter (litres/ minute)
  • Disposable tubing of varying diameter and width
  • Mechanism for delivery (mask or cannula)
  • Humidifier (to warm and moisten the O2)

5
Methods of Administrating O2
  • Simple semi-rigid masks
  • Nasal cannula catheter
  • Fixed performance masks or high-flow masks
    (Venturi)
  • T-piece circuit
  • Paediatric circuits - Headbox or hood


    - O2 tent/ cot
  • Tracheostomy mask
  • Mechanical ventilation
  • Continuous Positive Airway Pressure (CPAP)

6
Humidification of O2
  • RATIONALE
  • Normal air travelling through the airways is
    warmed, moistened and filtered by epithelial
    cells of the nasopharynx.
  • The air entering the trachea will have a relative
    humidity of 90 and a temperature of between
    32-36c
  • Oxygenation will cause dehydration of the mucus
    membranes and pulmonary secretions
  • Humidity is essential for patients who
    endotracheal or tracheostomy tube.

7
Humidification Requirements
  • The inspired gas must be delivered to the trachea
    between 32-36c and have a water content of 33-43
    g/m
  • The set temperature should remain constant
  • Humidification and temp should not be affected by
    the flow rate
  • Safety alarms should guard against overheating,
    over hydration and electric shock
  • No increased resistance to respiration
  • Wide bore tubing (elephant) should be used to
    allow sufficient formation of water vapour

8
Health and Safety Issues with O2
  • Medical gas cylinders have to conform to colour
    coding
  • O2 is combustible
  • Oil and grease around connections should be
    avoided
  • Alcohol, ether and inflammatory liquids should be
    kept separate from O2
  • No electrical device near O2 tent
  • No smoking
  • Fire extinguisher needs to be available
  • Care with using defibrillator near high O2
    concentrations

9
Potential problems
  • CO2 narcosis
  • CO2 level in the blood normally influences
    respiration.
  • Patients who are hypercapnic (gtCO2) e.g chronic
    bronchitis, have their brain chemoreceptors no
    longer sensitive to gt levels of CO2
  • Instead the lt PaO2 becomes the respiratory drive
    (hypoxic drive)
  • High levels of supplementary O2 may lead to
    respiratory depression/ unconsciousness/ death

10
Potential problems of O2
  • Oxygen toxicity
  • This follows after prolonged O2 therapy (gt 24
    hours)
  • There is decreasing lung compliance from
    haemorrhagic interstitial and intra-alveolar
    oedema
  • This ultimately leads to fibrosis of lung tissue
  • gt 24 hours and gt 50 O2 therapy should be avoided

11
Potential problems of O2
  • Retro lental fibroplasia
  • This is a disease affecting premature babies
    weighing under 1200g (28 weeks gestation)
  • Immature babies exposed to high concentration of
    O2 within the first 3-4 weeks of life.
  • O2 causes the immature blood vessels to
    vasoconstrict, resulting in neovascularisation,
    haemorrhaging and blindness

12
Principles of Suctioning
  • Three primary suctioning techniques are
  • oropharyngeal and nasopharyngeal suctioning
  • orotracheal and nasotracheal suctioning
  • suctioning an artificial airway
  • Where there is copious oral secretions, first
    remove with Yankaur suction device.
  • Oropharynx and and trachea are considered
    sterile.
  • The mouth is considered clean, therefore
    suctioning of oral secretions should be performed
    after suctioning of the oropharynx and trachea

13
Principles of Suctioning
  • Use nasal approach, perform tracheal suctioning
    before pharyngeal suctioning (the mouth and the
    pharynx contains more bacteria than the trachea).
  • Frequency of suctioning is determined by
    continuous assessment
  • secretions may be identified through inspection
    or auscultation techniques
  • sputum is not produced continuously but occurs as
    a response to pathological conditions
  • there is no rationale for suctioning a patient
    routinely every 1-2 hours

14
Principles of Suctioning
  • Oropharyngeal suctioning removes secretions from
    the the pharynx via a catheter placed through the
    mouth or nostrils.
  • This type of suctioning is used when the patient
    is able to cough effectively but unable to clear
    secretions by expectorating or swallowing.
  • Procedure is carried out after the patient has
    coughed.
  • As the pulmonary secretions are reduced and there
    is less fatigue by the patient, the patient may
    then be able to expectorate or swallow the mucus

15
Oropharyngeal Suctioning
  • Measurements?
  • Always use the smallest diameter suction catheter
    possible to remove the secretions
  • For adults use catheters size 12-16 French gauge
  • For children use 8-12 catheter gauge
  • Insertion depth
  • For nasopharyngeal suctioning
  • measure the patients tip of nose or mouth to
    base of earlobe
  • Adults- insert about 16cm
  • Infants and young children- 4-8cm

16
Oropharyngeal Suctioning
  • Caution on patients with
  • nasopharyngeal bleeding or CSF
  • anticoagulant therapy or blood dyscrasia

17
Oropharyngeal Suctioning
  • Preparation
  • Review blood gases and So2 levels
  • Evaluate ability to cough
  • Check history for deviated septum, nasal polyps,
    nasal obstruction, traumatic injury, epistaxis or
    mucosal swelling

18
Oropharyngeal Suctioning
  • Implementation
  • Explain procedure
  • Inform that suctioning may cause transient
    coughing and gagging
  • Minimise anxiety and fear lt O2 consumption
  • Position in semi-Fowler position to promote lung
    expansion

19
Oropharyngeal Suctioning
  • Implementation
  • Turn on suction (80-120mmHg)
  • Excessive pressure may cause trauma
  • Occlude the end of connecting tube to check
    suction pressure.
  • Aseptic technique
  • Use lubricant if the catheter is passed through
    nasal passage

20
Oropharyngeal Suctioning
  • Implementation
  • Use your dominant hand to control the catheter
  • Use your other hand to control suction valve
  • Patient to cough and breath deeply before
    suctioning.
  • Coughing helps too loosen secretions
  • Deep breathing helps to minimise hypoxia

21
Oropharyngeal Suctioning
  • Special consideration
  • Alternate between nasal passages to minimise
    traumatic injury
  • Where repeated suctioning is required, a
    pharyngeal airway will help with catheter
    insertion, reduce trauma and promote patent
    airway
  • Rest patient after suctioning and observe

22
Oropharyngeal Suctioning
  • Complications
  • Dyspnoea may increase owing to hypoxia and
    anxiety
  • Bloody aspirate can result from prolonged or
    traumatic suctioning
  • Water soluble lubricants can minimise traumatic
    injury

23
Suctioning through an Oral Airway
  • Oral airway prevents obstruction of the trachea
    by a the displacement of the patients tongue
    into the oropharynx in the unconscious patient.
  • Incorrect insertion may force the patients
    tongue back into the oropharynx.
  • Apply the same principles of oropharyngeal and
    orotracheal suctioning as mentioned before.

24
Endotracheal Tube Suctioning
  • This may be required in critical care settings.
  • Patients sensitive to decreased O2 levels (head
    injuries or raising ICP) must be well ventilated
    and oxygenated prior to commencement of
    suctioning
  • Patients should receive briefly and with
    increasing frequency

25
Endotracheal/ Tracheostomy Tube Suctioning
  • Measurement of catheter
  • nasal trachea-measure from tip of nose to earlobe
    and along neck to thyroid cartilage
  • oral trachea- measure from mouth to mid sternum
  • Elevate head of bed with patient lying on their
    side or back
  • Usually requires 2 nursing staff to undertake
    procedure, one to carry out whilst the other
    ventilates patient with suctioning oxygen
  • Follow principles of nasorotracheal suctioning

26
Oronasotracheal Suctioning
  • Required when a patient with pulmonary secretions
    is unable to cough and does not have an
    artificial airway present.
  • A catheter is passed through the mouth or nose
    into the trachea.
  • The nose is the preferred route because the
    stimulation of the gag reflex is minimal
  • The entire procedure should be kept to a minimum
    of 5 seconds because O2 does not reach the lungs
    during suctioning
  • During rest periods, the supplemental O2 should
    be used on a patient

27
Principles of Oronasotracheal Suctioning
  • To remove secretions from the trachea and bronchi
  • Insertion of a catheter is made through the
    mouth, nose, tracheal stoma, tracheostomy tube or
    endotracheal tube
  • Tracheal suctioning stimulates the cough reflex

28
Oronasotracheal Suctioning
  • procedure promotes optimal exchange of O2 and Co2
  • prevent pooling of secretions that could lead to
    pneumonia
  • performed frequently as the condition warrants
  • procedure requires strict aseptic technique

29
Oronasotracheal Suctioning
  • Measurements?
  • Always use the smallest diameter suction catheter
    possible to remove the secretions
  • For adults use catheters size 12-16 French gauge
  • For children use 8-12 catheter gauge
  • For nasotracheal suctioning
  • Adults- insert catheter about 20 cm
  • Older children- 14-20cm
  • Young children and infants- 8-14cm

30
Oronasotracheal Suctioning
  • Positioning
  • Place patient in Fowler or semi-Fowler position
    for conscious patient
  • Turning patients head to right will help
    catheter advance to left main stem bronchus or
    vice versa.
  • If resistance is felt after catheter insertion,
    the catheter has probably hit the carina. Pull
    catheter back 1 cm before applying suction.

31
Lower Airway Suctioning
  • Preparation
  • Explanation to patient
  • Collection of required materials
  • Checking that suction equipment is in working
    order

32
Lower Airway Suctioning
  • Assess vital signs, breath sounds, general
    appearance to establish a baseline
  • Review arterial and O2 sat levels
  • Evaluate ability to cough and deep breath, this
    will help move secretions up the
    tracheo-bronchial tree

33
Oronasotracheal Suctioning
  • Nasotracheal suctioning requires an assessment
    for deviated septum, nasal polyps, nasal
    obstruction, nasal trauma, epistaxis or mucosal
    swelling
  • Wash hands
  • Explain procedure (including possibility of
    gagging and coughing to patient)

34
Oronasotracheal Suctioning
  • Reassure patient to reduce anxiety, promote
    relaxation and minimise O2 demand
  • Place patient in a semi-Fowler position to
    promote lung expansion and productive coughing

35
Oronasotracheal Suctioning
  • Implementation
  • Insert catheter aseptically, during inspiration
    and coughing by patient, the epiglottis will be
    open the passage into trachea
  • Use your dominant hand, and roll the catheter
    between thumb/ forefinger
  • Rotation prevents catheter from pulling tissues
    during exit

36
Oronasotracheal Suctioning
  • Apply intermittent suctioning on withdrawal of
    the catheter.
  • Never suction for more than 5-10 seconds in order
    to prevent hypoxia
  • Observe and allow patient to rest before next
    suctioning
  • Always use a clean sterile catheter for each
    episode of suctioning

37
Oronasotracheal Suctioning
  • Encourage patient to cough between sessions
  • Observe secretions, if thick, clear catheter by
    tipping into sterile saline solution with suction
  • Observe for arrhythmias, if present, stop
    suctioning and ventilate patient

38
Lower Airway Suctioning
  • After Suctioning
  • Hyper oxygenate patient who is on a ventilator
  • Readjust FiO2
  • Assess for upper airway suctioning
  • Always change gloves and catheters before
    re-suctioning
  • Auscultate lungs bilaterally, taking vital signs

39
Lower Airway Suctioning
  • Potential problems
  • Hypoxaemia
  • Dyspnoea
  • Anxiety could change respiratory patterns
  • Cardiac arrhythmias resulting from hypoxia, and
    vagal nerve stimulation in tracheo-bronchial tree
  • Tracheal or bronchial trauma resulting from
    prolonged suctioning

40
Lower Airway Suctioning
  • Patients at Risk
  • compromised cardiovascular or pulmonary status
  • history of nasopharyngeal bleeding
  • recent tracheostomy
  • blood dyscrasias
  • caution for ICP since it can lead to gt ICP

41
Lower Airway Suctioning
  • If patient has laryngospasm or bronchospasm
    during suctioning-
  • disconnect the suction catheter to act as an
    AIRWAY

42
Principles of Lower Airway Suctioning
  • Evaluation
  • Amount and colour of sputum
  • Consistency and odour of secretions
  • Complications
  • Patients response to procedure

43
Principles of suctioning
44
REFERENCES
  • Jean Smith-Temple and J.Y.Johnson (1998) Nurses
    Guide to Clinical Procedures (3rd edition)
    Lippincott Philadelphia,U.S.A
  • Potter and Perry (2001) Fundamentals of Nursing
    (5th edition) MosbyU.S.A
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