Oxygenation: Respiratory : Providing Supplemental Oxygenation

Administering Oxygen via a Nasal Cannula

Purpose

1. Deliver low to moderate levels of oxygen to relieve hypoxia.

Assessment/Preparation

• Assess respiratory status (i.e., breath sounds, respiratory rate and depth, presence of sputum, arterial blood gases if available).
• Assess past medical history, noting chronic obstructive pulmonary disease (COPD). For clients with COPD, hypoxemia is often the stimulus to breathe because they chronically have high blood levels of carbon dioxide. If additional oxygen is needed, a low-flow system is essential to maintain slight hypoxemia so breathing is stimulated.
• Assess for clinical signs and symptoms of hypoxia: anxiety, decreased level of consciousness, inability to concentrate, fatigue, dizziness, cardiac dysrhythmias, pallor or cyanosis, dyspnea.

Equipment

• Oxygen source
• Flowmeter
• "No smoking" sign
• Humidifier and distilled water (for high-flow O₂ therapy)

Procedure

1. Review chart for physician's order for oxygen to ensure that it includes method of delivery, flow rate, titration orders; identify client.
   Rationale: Prevents potential errors.
2. Wash your hands.
   Rationale: Handwashing reduces transmission of microorganisms.
3. Identify client and proceed with 5 rights of medication administration (Fig. 1). Explain procedure to client. Explain that oxygen will ease dyspnea or discomfort, and inform client concerning safety precautions associated with oxygen use. Encourage him or her to breathe through the nose.
   Rationale: Oxygen is a drug and administering using the 5 rights avoids potential errors. Teaching helps ensure compliance with therapy.


Fig. 1: Check client's identification against physician's order.

4. Assist client to semi- or high Fowler's position, if tolerated.
   Rationale: These positions facilitate optimal lung expansion.
5. Insert flowmeter into wall outlet (Fig. 2). Attach oxygen tubing to nozzle on flowmeter. If using a high O₂ flow, attach humidifier (Fig. 3). Attach oxygen tubing to humidifier (Fig. 4).
   Rationale: Oxygen in high concentrations can be drying to the mucosa.


Fig. 2: Insert flow meter into wall unit.



Fig. 3: Attach humidifier to flow meter.



Fig. 4: Attach oxygen tubing to humidifier.

6. Turn on the oxygen at the prescribed rate (Fig. 5). Check that oxygen is flowing through tubing (Fig. 6).
   Rationale: Oxygen must be administered as prescribed.


Fig. 5: Set oxygen to prescribed rate.



Fig. 6: Ensure the oxygen is flowing through the tubing.

7. Hold nasal cannula in proper position with prongs curving downward (Fig. 7).


Fig. 7: Properly position nasal cannula with prongs curving downward.

8. Place cannula prongs into nares (Fig. 8).


Fig. 8: Place cannula prongs into nares.

9. Wrap tubing over and behind ears (Fig. 9).


Fig. 9: Wrap tubing around ears.

10. Adjust plastic slide under chin until cannula fits snugly (Fig. 10).


Fig. 10: Adjust plastic slide under chin until cannula fits snugly.

11. Place gauze at ear beneath tubing as necessary (Fig. 11).
    Rationale: Proper placement in nares ensures accurate administration. Note: The cannula permits some freedom of movement and does not interfere with the client's ability to eat or talk.


Fig. 11: Place gauze at ear to reduce irritation and promote comfort.

12. If prongs dislodge from nares, replace promptly.
    Rationale: To ensure correct oxygen delivery and prevent hypoxemia.
13. Assess for proper functioning of equipment and observe client's initial response to therapy.
    Rationale: Assessment of vital signs, oxygen saturation, color, breathing pattern, and orientation helps the nurse evaluate effectiveness of therapy and detect clinical evidence of hypoxia.
14. Monitor continuous therapy by assessing for pressure areas on the skin and nares every 2 hours and rechecking flow rate every 4 to 8 hours.
    Rationale: Permit early detection of skin breakdown or inadequate flow rate.

Sample Documentation
11/16/10	0800	P: Impaired gas exchange. I: O2 at 2 L/m via cannula started because sats dropped to 91%. RR 26 and c/o of dyspnea. Teaching regarding the importance of O2 and reinforced the importance of DB & using IS. E: O2 sats increased to 94%, rr18, states more comfortable. S. Roberts, RN

Lifespan Considerations

Infant and Child

• Isolettes (incubators) and tents may be used for administering oxygen and humidity to infants and newborns. It is difficult to maintain high concentrations of oxygen in an isolette or tent, but it is nonintrusive and nonirritating.
• Plan nursing care so tent or isolette is entered as little as possible to prevent oxygen levels from dropping.
• Children frightened by the oxygen tent may feel more secure with their favorite toy or blanket.

Home Care Modifications

• In-home oxygen supply is delivered by cylinders, liquid oxygen, or oxygen concentrators. Portable oxygen systems are available to increase independence and social activities.
• Equipment vendor and home care nurse should instruct client on how to use home oxygen equipment and how often the equipment must be filled.
• Instruct the client and family about the importance of not smoking in the area of oxygen use.
• The client should be informed about using an oxygen vendor whose services include:
  
  
  • Trained personnel to instruct the client in use and maintenance of the equipment
  • 24-hour emergency service
  • Monthly follow-up visits for equipment maintenance and client instruction
  • Vendor insurance billing
• Needing oxygen at home can be stressful for the client. Clients should be encouraged to share their fears and concerns. A local support group of clients using home oxygen may help them to discuss their feelings.
• For insurance to cover home oxygen, clients must have oxygen saturation below 88% to 90% on room air.