BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:

Transcription

1 Page 1 of 6 DEFINITION: Oxygen is a colorless, odorless, and tasteless gas that makes up about 20% of the air we breathe. Oxygen is essential to human, animal, and plant life. This training is intended for MAP-certified staff, RN, and LPN, and is to be provided by a respiratory therapist, agency nurse, or by the company providing the oxygen. Oxygen is a medication and must have a physician s order to administer. Staff must review and understand specific individual oxygen protocols that are ordered by the physician. Oxygen therapy is the administration of oxygen at concentrations greater than that of room air and is used to treat or prevent hypoxemia (low oxygen in the blood). Oxygen therapy may be needed for individuals with COPD, heart disease, pneumonia, or severe anemia; those on hospice; or those who may have problems breathing secondary to a neuromuscular disorder. It may be delivered via an oxygen cylinder or an electrical/portable device called a concentrator. Oxygen must be obtained through a certified company that supplies oxygen to residences. A physician may order that an individual on oxygen be monitored via pulse oximetry, with set parameters (see training in Medical Procedure Manual and attach if required by individual protocols). Oil-based lip balms or lotions should not be used on the individual with oxygen. Evidence associated with adverse effects of oxygen therapy remain minimal. Most of the problems associated with oxygen therapy involve the equipment and are not due to the therapy. Review individual specific oxygen and/or health protocols if applicable. Inadequate Oxygenation: An individual on oxygen must be carefully monitored for signs and symptoms of low oxygenation. These may include: Increase in breathing rate Increase in heart rate Restlessness/agitation Blue-tinged lips

2 Page 2 of 6 Blue-tinged fingernail beds Low pulse oximetry reading (refer to physician s order) Chest pain If an individual experiences any of the above symptoms, the physician must be notified in order to determine the proper course of action. Staff must also notify the program manager, program nurse, and/or on-call manager as appropriate. PROCEDURES: In order to maintain effective infection control measures, hands must be washed and clean technique must be used when applying oxygen. This minimizes the risk of spreading infection. Applying Oxygen with a Cylinder: 1. Clear valve by first removing protective covering. 2. Open cylinder for about one second (counterclockwise/lefty-loosey). 3. Attach oxygen pressure regulator. 4. Check to be sure pressure is at zero and flow meter off. 5. Replace plastic O ring gasket into the large valve opening at the top of the cylinder, if needed. 6. Place regulator on cylinder (slip it down). 7. Find the prongs on the regulator and seat them into the valve. 8. Hand-tighten the screw until the regulator is snug (fairly tight). Cylinder 9. SLOWLY open the cylinder one full turn. You should not hear air leaking; release pressure on dial if you have to undo it).

3 Page 3 of Check the pressure gauge to determine how much pressure is in the cylinder. Full psi; above 500 is okay; 200 is 'empty' 11. Attach delivery device and tubing to the flow meter. 12. Adjust the flowmeter (clockwise) to the appropriate rate on dial or in window. 13. Verify O2 flow by listening and feeling for oxygen flow through the delivery device. 14. Apply nasal cannula or face mask on individual (see Medical Procedure Manual). Applying Oxygen with a Concentrator: 1. Make sure manufacturer instructions are adhered to. 2. Attach nipple adapter or water bottle (if humidification is ordered) to the concentrator outlet tube and attach the oxygen tubing to the nipple outlet. 3. If a humidifier bottle is recommended, attach a bottle that is filled with distilled water. Center the threaded cap on the humidifier bottle under the threaded outlet tube on the concentrator. Turn the cap on the humidifier bottle until it is tightly screwed onto the outlet tube. 4. Turn machine ON. The alarm will sound for a few seconds until the proper pressure is reached. 5. Adjust the oxygen flow rate by turning the liter control knob until the Concentrator flow is at the prescribed number. 6. Apply nasal cannula or face mask on individual (see Medical Procedure Manual).

4 Page 4 of 6 When adjusting the flow meter on the oxygen cylinder or concentrator, be sure to adjust according to the physician s order. Too little oxygen or too much oxygen can have a detrimental impact on an individual s health. Maintenance of the Concentrator: ONCE A WEEK: 1. Remove the filter. 2. Wash in warm water and a non-lotion dish liquid. 3. Rinse the filter thoroughly with warm water. 4. Gently squeeze water from the filter, then pat dry with a clean towel. 5. Reattach the filter when completely dry. Oxygen tubing is to be changed every two weeks or as needed. Oxygen tubing is not to be in contact with the ground. Safe Handling Procedures: Proper handling and storage of oxygen tanks or cylinders are needed to avoid accidents or fire hazards. Although oxygen tanks do not burn on their own, they are considered a fire hazard when they get in contact with a heating source or any form of flammable substance. Oxygen tanks are under high pressure. Damage to a tank caused by a simple accident, like knocking the tank over, can trigger the cylinder to shoot across the room erratically, causing serious injury or property damage. To keep everyone safe, oxygen tanks must be stored safely and kept in the appropriate environment. To store oxygen, find a cool place that is at least 10 feet away from a heating source to use as a storage space for oxygen tanks. A heating source can be anything close to a heater, fireplace, oven, or even a huge, sunny window.

5 Page 5 of 6 Keep the oxygen tanks in an upright and stable position. It is recommended that the cylinders are stored in racks. Oxygen tanks are generally heavy and can cause damage if they fall on any object or person. Place a "no smoking" sign in the general vicinity outside the storage area. Store the oxygen tanks in a well-ventilated area. See to it that the area is large enough to allow for cool air to surround the tanks. Small areas such as closets have limited airflow, which makes them prone to catching on fire should any of the oxygen vent out of the tanks. Do not store the oxygen tanks in a room where electrical items are being used. This is particularly important for spaces that also store hair dryers, electric razors, and electric blankets. Avoid storing them in rooms with too much grease or oil or with any flammable liquid that may spill or be used near the oxygen tanks. Empty cylinders must be isolated from filled cylinders. Place valve protectors on cylinders when they are not connected for use. Transporting Oxygen: When an individual needs to be transported in a car or van, the oxygen must be kept secure at all times. An oxygen tank can be attached to a carrier on a wheelchair or stored in the racks provided on the vans. Smoking: Anyone on oxygen is advised not to smoke and should be encouraged to quit smoking. They can use the Nicotine patch or gum, with a physician s order in place. There are support groups the individual can attend to help with smoking cessation. If an individual must smoke, then they should be encouraged to: Disconnect the oxygen Wait 10 minutes Go outside to smoke

6 Page 6 of 6 DOCUMENTATION: In MAR Document in Medical Note any signs and symptoms of low oxygenation. Consider the use of PRN medication as indicated. Notify physician, program nurse, and program manager. EMERGENCY PROCEDURE GUIDELINES: Call 911 for: Anyone on oxygen therapy who becomes extremely short of breath, turns cyanotic (blue) quickly, experiences chest pain, is unresponsive, and/or has a low oxygen level with parameters below the physician order. Notify the physician, program manager, program nurse, and/or on-call system. All trainings must be kept on site at the program and sent to the Administration Office at 10 Christy s Drive.