Respiratory EducationNursing Oxygen Adjunct and Capnography Education

Andrew Rowe, BS, RRTPulmonary Services

Oxygen Therapy Adjuncts

Nasal Cannula Simple Mask Non-Rebreather Oxymask Aerosol Mask Trach Mask

Nasal Cannula

Maximum flow 6 LPM Variable FiO2 (25%-45%) Should be humidified at 3 LPM or

greater. Flow < 3 LPM no effect in

humidification of airflow.

Simple Mask ***Restricted flow mask!!!*** Minimum 6 LPM flow required for

use Necessary to flush expired CO2.

If >10 LPM needed to oxygenate upgrade adjunct to Non-rebreather.

Suggest an oxymask over simple mask due to flow restrictions and patient safety concerns.

Non-Rebreather Designed for higher oxygen demand and

acute respiratory failure. Should not be a long term fix for O2

requirement Long term O2 administration can be toxic

Absorption atelectasis Causes worse shunting of exchange

Flow should be at least 10 LPM, but enough to keep the bag inflated. Recommend 12-15L

Use gloved finger to occlude valve and inflate the bag before placing on the patient.

Oxymask Flow capabilities 1-15 LPM

1 LPM minimum required Can be humidified but not necessary

since it’s non specific to an oriface. Flowrate Fi02

1 LPM 24% - 27% 2 LPM 27% - 32% 3 LPM 30% - 60% 4 LPM 33% - 65% 5 LPM 36% - 69% 7 LPM 48% - 80% 10 LPM 53% - 85% 12LPM 57% - 89% >15LPM 60% - 90%

Aerosol Mask Managed by RT Uses a Venturi device to dial in a desired FiO2 Liter flow suggested on the bottle with desired FiO2 Take care not to lift tubing and ”drowning” with rainout If you notice water collection is excessive, call RT.

Trach Mask

Provides humidity for open trachs

Should not be used when speaking valve is on

Provides O2 and flow with the same Venturi setup as an aerosol mask.

Can be heated

Capnography Sidestream sampling

Measurement from oral pad attached to nasal cannula

Tiny pad for peds Waveform provides visual cues for a patient’s

ventilation efforts Monitors

EtCO2 (35-45 mmHg) SpO2 (>92% or 88-92% COPD) HR RR

IPI- Integrated Pulmonary Index indicator of patients status algorithm avg

EtCo2/SpO2 8-10 normal 4-7 caution, assess trends <4 acute issue needs assessment

Uses for Capnography PCA pump/Narcotic use

Anesthesia Patient Safety Foundation (APSF) suggests continuous EtCO2 monitoring in high risk patients post op over oximetry.

STOPBANG used to identify high risk patients. Conscious sedation Ventilation management/weaning Questions with hypoventilation/apnea/OSA (Next slide summary) CPR

EtCO2 < 10mmHg for 20 minutes after ACLS implemented can accurately predict death in patients in PEA.

Capnography vs. Oximetry

Capnography measures ventilation, while oximetry measures oxygenation Ventilation = CO2 exchange Oxygenation = O2 exchange

With capnography apnea periods are reflected immediately With oximetry there is a lag with breath-to-breath changes (can be 10 minutes or more)

Because of this lag, patient is already potentially in failure if acute change in SpO2 Supplemental oxygen used in hypoventilation or apnea can mask ventilation issues by keeping the

O2 level artificially high. This can delay acknowledgement or treatment of respiratory failure Best practice is to use capnography in conjunction with oximetry when ventilation issues such as

apnea, and/or hypoventilation are a concern. Encourage OSA patients to bring their home CPAP/BiPAP machines.

https://www.smiths-medical-education.com/smithsonlinetraining/other/controller.cfm?method=FileService.viewCourseFile&attachment=false&course_id=97AD22B8%2DB2FB%2D408C

%2DB1EC%2DA6152CE28EC7&fileID=DE9002FA%2D3A7A%2D47A0%2D8C02%2D0788048BB2CD

Questions ?

References

Smiths Medical Online Training. Capnography Self Test. 2012 https://www.smiths-medical-education.com/smithsonlinetraining/other/controller.cfm?method=FileService.viewCourseFile&attachment=false&course_id=97AD22B8%2DB2FB%2D408C%2DB1EC%2DA6152CE28EC7&fileID=DE9002FA%2D3A7A%2D47A0%2D8C02%2D0788048BB2CD

CareFusion Online Training. Oxymask One Mask pdf. 2015. http://www.carefusion.com/Documents/brochures/respiratory-care/airlife-products/RC_OxyMask-Adult_BR_EN.pdf