Oxygen Administration & Safety · 2019-02-08 · Connected to large bore, corrugated tubing Aerosol mask Trach dome Also called a trach mask or trach collar Can be connected to oxygen

Oxygen Administration & SafetyAn Inservice from Northwest Respiratory Services

Objectives:

During this presentation you will learn:

Medical conditions which will require oxygen therapy

How oxygen is prescribed and delivered

Oxygen delivery systems and oxygen interfaces

Safe use and handling of oxygen therapy equipment

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Northwest Respiratory Services - 10/13

Room air is made up of 21% oxygen

Oxygen in the blood is measured as SpO2

Medicare considers an SpO2 of 88% or less as qualifying for supplemental O2

There are other instances where O2 may be ordered and covered by insurance

Oxygen in not flammable, but it does support combustion

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Oxygen Overview


Medical Conditions That Require O2

Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)

Pulmonary Hypertension (HTN)

Pulmonary Fibrosis

Lung Cancer

Cardiac Compromise

Acute Myocardial Infarction (MI)

Congestive Heart Failure (CHF)

Angina

Severe Trauma

Major loss of blood volume in the body

Shock


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Oxygen is a prescription drug

Supplemental oxygen is measured in:

Liters Per Minute (LPM)

FiO2 (A percentage of oxygen)

Orders are typically given as:

Liter flow

Percentage of oxygen

Keep oxygen saturation (SpO2) a certain

percentage

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How Oxygen is Prescribed


Compressed Gas Cylinders (Tanks)

Concentrator

Liquid Oxygen

Oxygen Interface

How Oxygen is Delivered


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Compressed Gas Cylinders

Pressurized gas

Filled at 2000 PSI (pounds per square inch)

Oxygen from tanks is 99.8% pure

Transported via wheeled carts or cylinder bags

Stored in cylinder racking to prevent tipping

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Oxygen Delivery Systems


Require a regulator and washer to work properly

Regulators contain a flow rate dial and deliver oxygen continuously

Standard—up to 8 lpm

Hi-flow—up to 15 lpm

Pediatric—fractions of a liter up to 2 lpm

Conserving Devices

Regulators designed to conserve oxygen supply

Supply O2 only on inhalation instead of continuously

Must be ordered by M.D. as not all patients tolerate

Washers

Washers supplied by NRS are made of aluminum and Buna N, other types of washers are made of Brass & Viton

If made of nylon or polyethylene do not reuse. If reused, excess torque required to create seal may possibly deform the gasket and increase the likelihood of a leak that could ignite (refer to NIOSH/FDA article issued April 24, 2006)


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Changing Cylinders

1. Make sure the regulator is turned off.

2. Using the cylinder wrench, turn the valve on top clockwise (to the right) to close the cylinder before changing out.

3. Open regulator and allow oxygen to flow until the pressure gauge reads zero (in the red area).

4. Spin the bar counterclockwise (to the left), and lift the regulator off the tank.

5. Secure empty cylinders in the racks, trying to keep the full and empty cylinders separate (white seals around the valve are full).

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6. Fill out the cylinder tag with the appropriate resident’s full name and room number, and place around the valve.

7. Remove the white seal from the valve of the full cylinder.

8. Slide the regulator onto the valve, making sure to align the two pegs on the regulator with the corresponding holes in the valve.

9. Spin the bar clockwise (to the right) until the regulator tightens to the cylinder valve making a seal.

10. Using the cylinder wrench, turn the valve on top counterclockwise (to the left) to open the cylinder. The pressure gauge should now be reading around 2000psi and be in the green area.


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Concentrators

Runs on electricity

Produces oxygen by removing nitrogen from the

room air, leaving just oxygen and trace gases

Oxygen produced is 95% pure

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Oxygen flow controlled by a flow meter

Most range from 0 to 5 lpm

Hi-flow—up to 10 lpm

Pediatric—fractions of a liter up to 2 lpm

Maintenance

External filter to be cleaned weekly or as needed

Concentrator must be checked by NRS staff every 6 months to ensure proper operation and oxygen purity

Preventative maintenance is performed every 10,000 hours and is due according to the NRS sticker attached to the machine, or per manufacturer recommendations


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Liquid Oxygen (LOX)

Cryogenically frozen oxygen

-260° F (Danger of frostbite)

99.8% pure oxygen

Requires no electricity to run the equipment

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LOX Stationary

Larger vessel that holds around 41-45 liters of LOX

Used as the primary source of oxygen in a residence

The flow knob and spout on top are used to deliver oxygen

The top also has a interface for filling portable units

Stationary is filled by O2 supplier (NRS) weekly, or as needed

LOX Portable

The portable can provide 8 hours of oxygen at 2 lpmwhen full

The unit is filled from the interface on top of the stationary

A flow knob and spout are used to deliver oxygen

The contents gauge is used by holding on side of the strap and measuring the weight of the portable


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Filling a LOX Portable

1. Check that fill connections on stationary and portable are clean and dry.

2. Hold the portable with both hands and position the base over the matching contoured area on top of the stationary.

3. Lower the portable down making sure fill connections mate, and press straight down. Then, open the vent lever to engage the filling process.

4. Hold the portable down to ensure proper and safe filling.

5. Open and close the vent lever periodically during filling to prevent ice build-up and freezing of parts.

6. When filling, a hissing sound will emit. When this sound changes to a sputter the portable is full.


7. Close the vent lever on the portable to

stop filling, and press the release button

on the stationary to dislodge the

portable while lifting up by the strap.

8. If the portable becomes stuck on the

stationary, leave the portable attached

with vent lever closed and allow

connections to warm until portable can

be dislodged.

9. Leave portable attached to stationary

and call NRS immediately if any of these

methods do not work and the portable

or stationary is leaking liquid oxygen.


Portable Fill Logs

Must be filled out to ensure proper and accurate

billing for the resident

Enter all required information including:

Facility name at the top

Resident name – Complete first and last name

Room number

Date

Place checkmark for each fill during a specific day

Signature for each fill performed

Please print legibly to prevent mix-ups and

follow up calls by the billing office staff


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Nasal Cannula

Used for liter flows up to 6 lpm

Range from about 24-44% Oxygen

1 lpm=24%, 2 lpm=28%, 3 lpm=32%, 4 lpm=36%, 5 lpm=40%, 6 lpm=44%

Humidifier bottle recommended on flows greater than 3 lpm, and pediatric patients

Can be used on liter flows <3 lpm, however in adults the effectiveness is questionable

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Oxygen Interfaces


Simple Mask

For liter flows of 5-10 lpm

DO NOT use at a liter flow less than 5 lpm as

risk of patient re-breathing CO2 (waste

product of breathing), causing sleepiness and

disorientation

Delivers about 35-55% oxygen

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Non-Rebreather & Partial-

Rebreather Masks

Can be used for liter flows greater

than 8 lpm, but operates best for

+10 lpm

Has a reservoir bag to increase

oxygen percentage delivered

Bag must stay inflated

DO NOT wean liter flow below 8 lpm

If not operated with sufficient flow,

patient can re-breathe CO2

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Venturi Mask

Used with variable flowrates

Also called air entrainment or percentile lock mask

Can be used for liter flows less then 5 lpm

FiO2 (percentage of oxygen) is set on dial

Use dial to determine what liter flow to run

To wean the amount of oxygen you adjust the percentage, then adjust liter flow accordingly

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Other Oxygen Interfaces Oxygen pendant or Oxymizer

Both are worn in nose like a nasal cannula. However, they are larger since they have a reservoir for oxygen

This reservoir helps increase oxygen delivered to patients with a higher liter flow

High humidity devices

Used with oxygen or RA

Connected to large bore, corrugated tubing

Aerosol mask

Trach dome

Also called a trach mask or trachcollar

Can be connected to oxygen line via special adapter

Face tent (or Face bucket)

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Liquid Oxygen

When dealing with liquid oxygen exercise caution as the extreme cold can result in frostbite to any exposed skin

During filling operations or if a piece of equipment malfunctions, be sure to avoid contact with the fill connections or any source of leaks

Seek immediate medical attention if exposed to liquid oxygen

Do not store LOX equipment near a flame or heat source

Compressed Gas Cylinders

Always turn the regulator and cylinder off when not in use to prevent the chance of an oxygen leak

Do not store cylinders near a flame or heat source of any kind

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Safe Use and Handling of

Oxygen Therapy Equipment


Oxygen Safety and Fire Hazard

Oxygen does not explode and cannot burn by itself. However, fire will occur when oxygen exists in combination with a combustible or flammable material and a source of ignition

To prevent the chance of a fire, follow these rules: Do not permit the use of open flames or burning

tobacco in a room where oxygen is used or stored

Do not use heavy, oily lotions, creams, or hair dressings around oxygen equipment

Do not use aerosol sprays, grease, or petroleum based products on or near any oxygen equipment or tubing

Do not leave oxygen equipment turned on when not is use

Do not store oxygen equipment or containers near radiators, heat ducts, steam pipes, or other sources of heat

Make sure your facility has fire extinguishers nearby and that smoke alarms are operational


Questions?


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Documents

Oxygen Administration & Safety · 2019-02-08 · Connected to large bore, corrugated tubing Aerosol mask Trach dome Also called a trach mask or trach collar Can be connected to oxygen