Clinical Guidelines for Oxygen Therapy and Patient Monitoring:

 

Clinical Guidelines for Oxygen Therapy and Patient Monitoring:

1. DEFINITION & PURPOSE

Oxygen inhalation therapy is the administration of oxygen at concentrations greater than that in room air (21%) to treat or prevent symptoms of hypoxia (low oxygen in tissues).


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Main purposes:

  • Maintain adequate oxygenation of tissues and vital organs.
  • Relieve symptoms of hypoxia: dyspnea, restlessness, cyanosis.
  • Decrease work of breathing and work of the heart.
  • Prevent complications of severe hypoxia (arrhythmias, brain damage, death).

2. INDICATIONS FOR OXYGEN THERAPY

Oxygen must always be given on a doctor’s order (except in emergencies), with dose, method and duration specified.

Common indications:

  1. Respiratory problems
    • Acute respiratory distress / failure
    • Pneumonia, bronchial asthma (severe attack)
    • COPD exacerbation (with strict control)
    • Pulmonary edema
    • Atelectasis, lung collapse
    • Pulmonary embolism
  2. Cardiac conditions
    • Myocardial infarction (MI)
    • Congestive heart failure (CHF)
    • Shock states (cardiogenic, septic, hypovolemic)
  3. Conditions causing hypoxia or low Hb
    • Severe anemia
    • Carbon monoxide poisoning
    • Major trauma, hemorrhage
    • Post‑operative period (especially thoracic, abdominal, cardiac surgeries)
  4. Peri‑operative / ICU
    • During anesthesia and immediate post‑anesthesia period
    • Patients on mechanical ventilation
    • Critically ill and unconscious patients

3. COMMON METHODS OF OXYGEN ADMINISTRATION

You should know at least the basic devices and their usual flow rates:

  1. Nasal cannula / nasal prongs
    • FiO₂ ≈ 24–44%
    • Flow rate: 1–6 L/min
    • For mild to moderate hypoxia; patient can eat, drink, talk.
  2. Simple face mask
    • FiO₂ ≈ 40–60%
    • Flow rate: 5–10 L/min
    • For moderate hypoxia; not suitable for CO₂ retention.
  3. Venturi mask
    • FiO₂ ≈ 24–50% (fixed, precise)
    • Used in COPD patients where accurate oxygen concentration is important.
  4. Partial rebreather mask
    • FiO₂ ≈ 40–70%
    • Flow: 6–10 L/min
  5. Non‑rebreather mask (NRBM)
    • FiO₂ up to 90–95%
    • For severe hypoxia/emergency situations.
  6. Nasal catheter, oxygen tent, oxygen hood (for infants)
    • Less common in modern practice but may be in some settings.

(Choice of device is based on order, severity of hypoxia, patient condition, and institutional policy.)

4. EQUIPMENT NEEDED (GENERAL)

  • Oxygen source:
    • Wall outlet / central supply OR
    • Oxygen cylinder with pressure regulator and flowmeter
  • Humidifier bottle with sterile distilled water (for flow > 3–4 L/min)
  • Appropriate delivery device:
    • Nasal cannula / mask / Venturi mask / NRBM etc.
  • Connecting tubing
  • Adhesive tape / ties / straps to secure device
  • Pulse oximeter for SpO₂ monitoring
  • Suction apparatus (if needed)
  • PPE as per hospital policy
  • “No Smoking / Oxygen in Use” warning board

5. PRELIMINARY ASSESSMENT

Before starting therapy, assess:

  • Doctor’s order: flow rate (L/min), device, duration, target SpO₂.
  • Respiratory status:
    • Rate, depth, rhythm of respirations
    • Use of accessory muscles
    • Breath sounds
    • Presence of wheeze, crackles, stridor
  • Signs of hypoxia:
    • Restlessness, anxiety, confusion
    • Cyanosis (lips, nail beds)
    • Tachycardia, hypertension (early), bradycardia, hypotension (late)
  • SpO₂ on room air.
  • Level of consciousness
  • Associated conditions:
    • COPD, chronic CO₂ retention
    • Cardiac disease, anemia, trauma
  • Nasal/oral condition:
    • Blocked nostrils, sores, skin integrity, mucosal dryness

6. NURSING PROCEDURE FOR OXYGEN INHALATION THERAPY

(Example: Administration by nasal cannula / mask – adapt as per device and hospital protocol)

A. Preparation of Patient and Environment

  1. Explain the procedure to the patient (and family):
    • Purpose of oxygen therapy
    • Device to be used
    • Need to avoid tampering with flow or device.
  2. Ensure safety:
    • Place “OXYGEN IN USE – NO SMOKING” sign near bed.
    • Remove sources of ignition: cigarettes, lighters, matches, candles, electrical heaters.
  3. Position the patient:
    • Semi‑Fowler’s or high Fowler’s (if not contraindicated) to ease breathing.
    • Turn head to midline, support with pillows.
  4. Hand hygiene:
    • Wash hands and wear gloves if required.

B. Preparation of Equipment

  1. Check oxygen source:
    • If cylinder: check label, color code, pressure gauge (enough gas).
    • If central line: check outlet and test flow.
  2. Attach flowmeter to outlet or cylinder regulator.
  3. Attach humidifier bottle:
    • Fill with sterile distilled water up to marked level.
    • Connect humidifier to flowmeter outlet.
  4. Connect delivery device (nasal cannula/mask) to humidifier via tubing.
  5. Set prescribed flow rate on flowmeter:
    • Turn knob until the ball is at required L/min marking.
    • Check for bubbling in humidifier (indicates oxygen is flowing).

C. Application of Device

1. Nasal cannula

  1. Check patency of nostrils; provide gentle nasal care if needed.
  2. Place tips of cannula into patient’s nostrils (curved side down).
  3. Loop tubing over ears and under chin or behind head.
  4. Adjust slide/strap to secure but not too tight.
  5. Ensure patient is comfortable; check for kinks in tubing.

2. Simple face mask / Venturi / NRBM

  1. Check mask size; edges should fit comfortably.
  2. Place mask over nose and mouth.
  3. Secure with elastic strap around head; adjust to avoid pressure on ears.
  4. In NRBM, ensure reservoir bag is inflated before placing on face (flow usually ≥ 10–15 L/min initially).
  5. Ensure no air leaks at sides as much as possible.

D. During the Procedure (Ongoing Care)

  1. Monitor patient:
    • Vital signs (RR, HR, BP, temperature).
    • SpO₂ at prescribed intervals.
    • Level of consciousness and comfort.
    • Signs of improvement or deterioration.
  2. Observe the device and equipment:
    • Correct position of cannula/mask.
    • Tubing not kinked or compressed.
    • Adequate bubbling in humidifier.
    • Water level in humidifier (refill with sterile water as needed).
    • No water collected in tubing (drain away if present).
  3. Airway maintenance:
    • Encourage coughing and deep breathing (if conscious).
    • Perform suction (oral/nasopharyngeal) if secretions present and patient cannot clear.
  4. Skin and mucous membrane care:
    • Inspect ears, cheeks, nose, and over bony prominences for redness or breakdown.
    • Pad with gauze where tubing applies pressure.
    • Provide mouth care and lubricate lips with water‑based lubricant (no oil‑based products).
  5. Humidification and hydration:
    • Ensure humidifier is functioning (especially with high‑flow oxygen > 3–4 L/min).
    • Encourage oral fluids if not contraindicated to prevent dryness.
  6. Avoid interruption of therapy:
    • Teach patient not to remove device without informing nurse.
    • If device must be removed briefly (e.g., for meals with mask), ensure safe alternative (e.g., nasal cannula) if ordered.

E. After Care and Documentation

  1. Make patient comfortable:
    • Re‑check position, comfort, temperature, dryness of mucosa.
    • Replace or adjust devices as needed.
  2. Turn off equipment properly if oxygen is discontinued:
    • Close cylinder or central supply; turn off flowmeter.
    • Remove device and clean/replace as per policy.
  3. Document:
    • Date and time therapy started / modified / stopped.
    • Device type, flow rate (L/min), and FiO₂ if known.
    • Patient’s baseline and subsequent vital signs and SpO₂.
    • Response to therapy (improvement/worsening of symptoms).
    • Any complications or adverse effects.
    • Patient teaching given.

7. NURSING RESPONSIBILITIES IN OXYGEN THERAPY

(At least 7 – with brief explanation)

  1. Check and follow the doctor’s order accurately
    • Correct device, flow rate, duration, and target SpO₂.
    • Clarify any doubtful order before starting.
  2. Ensure safety and fire precautions
    • Display “No smoking / Oxygen in use” sign.
    • Keep patient and environment free from fire hazards (no flames, no smoking, caution with electrical equipment and oils).
  3. Maintain accurate oxygen delivery
    • Set and verify correct flow rate.
    • Ensure device is appropriate, well‑fitted, and secured.
    • Avoid frequent disconnections or interruptions.
  4. Continuous assessment and monitoring
    • Monitor respiratory status, SpO₂, vital signs.
    • Watch for signs of hypoxia or hyperoxia.
    • Recognize early signs of deterioration and inform physician promptly.
  5. Prevent and detect complications
    • Watch for oxygen toxicity (mainly with high concentrations for prolonged time).
    • Observe for CO₂ retention in COPD patients (drowsiness, headache, confusion).
    • Prevent skin breakdown and mucosal dryness with good care and humidification.
  6. Maintain airway and promote effective breathing
    • Position patient optimally (semi/high Fowler’s unless contraindicated).
    • Encourage deep breathing and coughing exercises.
    • Provide suctioning if needed.
  7. Provide comfort and patient education
    • Explain device and therapy to reduce anxiety.
    • Instruct not to adjust flow or remove mask/cannula without notifying staff.
    • Teach breathing techniques if appropriate (e.g., pursed‑lip breathing in COPD).
  8. Equipment care and infection control (extra but important)
    • Use clean/sterile water in humidifiers as per protocol.
    • Change tubing and masks as per policy to prevent infection.
    • Practice hand hygiene and PPE measures.
  9. Accurate documentation and communication
    • Record all relevant observations and interventions.
    • Communicate changes in patient condition during handover.

8. KEY POINTS TO REMEMBER

  • Oxygen is a drug: always require order (except life‑threatening emergencies).
  • Use lowest effective concentration to achieve adequate oxygenation (usually SpO₂ 92–96% in most adults; follow local protocols; COPD may have lower targets).
  • Avoid high oxygen in chronic CO₂ retainers (COPD) without close monitoring.
  • Always use humidification for high‑flow oxygen (> 3–4 L/min) to prevent mucosal dryness.
  • Never use oil‑based products (like petroleum jelly) near oxygen delivery devices because they increase fire risk.
  • Check for kinks, disconnections, and leakage in tubing frequently.
  • Observe for pressure sores at ears, cheeks, nose and adjust devices.
  • Maintain strict no‑smoking policy around patients receiving oxygen.
  • Always keep cylinders secured upright, handle carefully, and close valve when not in use.
  • Evaluate effectiveness: improvement in dyspnea, color, mental status, SpO₂, vital signs.
  • Stop or adjust therapy only with proper order and gradual weaning when indicated.

 


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