OXYGEN, ADMINISTRATION OF Purpose: Supplemental oxygen may be required to meet metabolic demands of students who have chronic respiratory or cardiac conditions. Oxygen therapy treats or prevents hypoxia by administering oxygen at concentrations greater than the level found in ambient air. Additional Authority: Nevada Revised Statute, Nevada Nurse Practice Act, School Nurse Advisory Opinion, CCSD Regulation 5150 - Health and Welfare: Students Scope: School Nurses, Specialized Procedure Nurses, contracted licensed staff (RN, LPN), and qualified, trained unlicensed assistive personnel (UAP) Responsible Party: Health Services Director Distribution: Health Services Coordinators, School Nurses, Specialized Procedure Nurses, First Aid Safety Assistants, Health Services Department Secretarial Staff POLICY 1.0 Policy Statements 1.1 Oxygen may be administered during school-related activities that do not involve the use of open flames such as home economics, cooking, or electrical sparks. 1.2 Oxygen titration can only be performed by a licensed nurse. 1.2.1 Qualified, trained unlicensed personnel (UAP) may assist with oxygen administration but are not permitted to titrate dosage. 1.2.1.1 Initial and monthly verification of training by the school nurse is required.
1.2.2 New LHCP orders must be obtained annually. 1.2.3 Parent signature is required for every new and revised order. 1.3 General Guidelines WARNING! Oxygen can increase risk of fire and explosion. Observe the following safety precautions: 1.3.1 Do not smoke or allow open flames, heaters or radiators near oxygen. 1.3.2 Never permit oil, grease or highly flammable material to come in contact with oxygen cylinders, liquid oxygen valves, regulators or fittings. 1.3.3 Do not lubricate with oil or other flammable substances, and do not handle equipment with greasy hands or rags. 1.3.4 Never put anything over a gas cylinder. 1.3.5 Know the identity of the home oxygen supply company, contact person, posting the telephone in an obvious place. 1.3.6 Defective equipment must be returned to the authorized company for replacement. 1.3.7 Spare oxygen should be readily available, based on the student s needs. It should be stored safely in a secure location. 1.3.8 Extra tubing and tank, such as wrenches, must be kept in an easily accessible location. 1.3.9 If using oxygen gas, the tank must be securely placed in a stand and cannot be allowed to fall.
1.3.10 Notify fire department of oxygen on campus. 1.3.11 Post OXYGEN IN USE signs on door. 2.0 General Guidelines for Administration of Oxygen 2.1 A nasal cannula is used to deliver a low to moderate concentration of oxygen. It can be used as long as nasal passages are open. A deviated septum, swelling of the nasal passages, mucus, or polyps may interfere with adequate oxygen intake, and a nasal cannula should not be used to deliver oxygen in those instances. 2.2 An oxygen mask can deliver higher or lower concentrations of oxygen than the nasal cannula and is useful when nasal passages are blocked. 2.3 A tracheostomy collar is one means of delivering oxygen or humidified air via the tracheostomy. The tracheostomy collar may be used with a humidifying device and tubing to prevent dry and/or thick secretions from plugging the tracheostomy and to administer oxygen to the student. 2.4 The appropriate equipment checklist must be completed prior to bus transportation or upon arrival to school if the parent/guardian provides transportation. 3.0 Oxygen Available Sources and Equipment Information 3.1 Oxygen Gas 3.1.1 Pure oxygen gas is stored under pressure in a metal tank or cylinder. Tanks come in different sizes, ranging from small and portable, to large and stationary.
3.1.2 The tank size used by the student depends on the amount of oxygen flow needed. The amount of oxygen in the tank is indicated by the pressure gauge on the tank. 3.2 Oxygen Concentrator 3.2.1 This is an electrically-powered machine that removes nitrogen from room air and concentrates the remaining oxygen for delivery to the student. An oxygen concentrator requires an electrical outlet and is not portable. Some units may contain a backup battery in the event of a power failure. Each unit has an air filter that requires periodic cleaning. Additional equipment for oxygen concentration systems include the following: 3.2.1.1 Humidification source 3.2.1.2 Oxygen tubing, cannula, mask or tracheostomy collar. 3.2.1.3 Emergency oxygen tank for power failure 3.3 Oxygen Liquid 3.3.1 Oxygen liquid systems utilize a thermal storage container that keeps the pure oxygen as a liquid at minus 300 degrees Fahrenheit. A smaller, portable, insulated container usually is used to deliver the oxygen to the student. Depending on the prescribed liter flow for the student, the insulated container may require refilling from the larger storage tank. 3.4 Additional equipment for both gas and liquid systems includes the following:
3.4.1 Tank stand or carrier 3.4.2 Regulator with pressure gauge and flow meter 3.4.3 Wrench for gas tank valve 3.4.4 Humidification source 3.4.5 Oxygen tubing, nasal cannula, mask or tracheostomy collar/port. 4.0 Procedural Steps: Nasal Cannula ESSENTIAL STEPS KEYPOINTS-PRECAUTIONS 1. Review LHCP order 2. Perform hand washing Follow Universal Precautions 3. Assemble equipment: Make sure a proper adaptor is O2 source available for the O2 source. Check Cannula and tubing that the tank has enough oxygen. Humidity source if needed Attach humidifier if ordered. Check Adaptor to connect tubing that all pieces are secured tightly to to prevent leaks. Oxygen source 4. Explain procedure to student. 5. Attach cannula tubing to O2 source securely. 6. Set liter flow on the flow-meter as prescribed by the licensed health care provider. Turn on the O2 source. 7. Check cannula prongs to make sure O2 is being delivered. 8. Insert prongs into the student s nose. Make sure both prongs are in the nostrils. A highly visible information card stating oxygen liter flow must be attached to the regulator. A high oxygen flow may irritate the nose and may induce coughing or vomiting. Never deliver more than 5 liters of oxygen through a nasal cannula. Report any changes in student s condition to parent/guardian and School Nurse. Standard nasal cannula flow rate is 1-5 liters/min Gently insert prongs into the student s nostrils. Loop the tubing over each ear then under the chin; secure by sliding the clasp up under the chin. Make sure that it is comfortable for the student. If the student is not comfortable, the cannula tubing may be secured behind the head rather
9. Perform handwashing. than under the chin. 5.0 Procedural Steps: Mask Device ESSENTIAL STEPS KEYPOINTS-PRECAUTIONS 1. Review LHCP order 2. Perform handwashing. Follow Universal Precautions. 3. Assemble equipment: Oxygen source and back-up Appropriate size mask and tubing Humidity source, if needed 4. Explain procedure at the student s level of understanding. 5. Set oxygen flow on flow meter to the rate prescribed by the licensed health care provider. Do not change setting without first contacting the licensed health care provider. By encouraging the student to assist in the procedure, the caregiver helps the student achieve maximum selfcare skills. Excessive flow rates may cause irritation to the skin. A highly visible information card stating oxygen liter flow must be attached to the regulator. Oxygen liter flow must be ordered at a set liter flow rate (example: 6 liters per minute). 6. Turn on the oxygen source. A simple face mask flow rate is 5-10 liters/min. A non-rebreather face mask flow rate is 8-10 liters/min 7. Check that oxygen flow is coming out of the mask. 8. Place the mask over the student s nose and mouth. 9. Perform handwashing. Hold mask up to your cheek to feel gas flow. If no flow is felt, check oxygen supply, connections, flow rate, and tubing for obstruction. Tighten the elastic band over the student s head and pinch mask over the bridge of the nose for a good fit. Make sure that the student is comfortable with the mask and that the mask does not touch the eyes. 6.0 Procedural Steps: Tracheostomy Collar ESSENTIAL STEPS KEY POINTS-PRECAUTIONS
1. Review LHCP order. 2. Perform hand washing. Follow Universal Precautions. 3. Assemble equipment: Nebulizer/humidifier Tubing Tracheostomy collar Oxygen tubing Graduated adaptor Oxygen source, if ordered 4. Explain procedure at the student s level of understanding. By encouraging the student to assist in the procedure, the caregiver helps the student achieve maximum selfcare skills. 5. Assemble humidification device. There are several types of humidification devices. Check student-specific guidelines and assemble according to specific instructions. 6. Dial liters of oxygen as ordered. Some students may require only compressed air. 7. Connect to compressed air/oxygen source. Turn on oxygen source. Do not change setting without first contacting the licensed health care provider. A highly-visible information card stating oxygen liter flow must be attached to the regulator. Oxygen liter flow will be ordered as a set liter flow rate (example: 3 liters per minute) based on the student s needs. 8. Connect to heater and/or humidifier if required. Place one end of wide-bore tubing on the collar and the other on the humidifier or heater. 9. With compressed air/oxygen source on, look at mist at the end of tubing. You should see a fine mist when held up to the light. 10. Place collar on student s neck over tracheostomy tube in the midline. *Unlicensed persons cannot titrate oxygen. Some students may use cool mist. With prolonged humidification, moisture collection in the tubing can block the flow of air/oxygen and may require periodic removal. If mist is not seen, check that all connections are on securely and compressed air/oxygen is flowing. Turn on higher flow, and then return to flow ordered to see if mist is present. Adjust tracheostomy collar so that it is snug but not uncomfortable for
student. 11. Perform handwashing. Report any changes in student s condition to School Nurse and parent/guardian. POSSIBLE COMPLICATIONS OBSERVATIONS 1. The student shows any of the following signs of respiratory distress: Shortness of breath or rapid breathing rate Agitation Blueness or pallor of the lips, nails, or ear lobes Retractions at the neck or chest Confusion, dizziness, or headache Rapid or pounding pulse REASONS/ACTIONS Stay calm and reassure student. Check student: Position student to open airway. Make sure mouth, nose, or tracheostomy tube are not obstructed by food or mucus Check tracheostomy tube placement Make sure collar is not out of position or obstructing tracheostomy tube Check equipment: Check oxygen flow - if flow is weak or inadequate Tank is not empty or defective. If empty or defective, replace with back-up tank Valve, regulator, and flow meters are on proper settings Tubing is not blocked or kinked Check all connections from oxygen source to student Tubing, mask, cannula, and collar are not blocked Humidifier bottle is properly attached Tubing is not obstructed by water collection from condensed mist Empty water from tubing frequently when using mist 2. The equipment and oxygen flow are Call 911. Notify school/nurse and
adequate, but the student continues to show signs of respiratory distress, becomes unconscious, or has a respiratory arrest. 3. Administer blow-by oxygen as ordered by LHCP. 4. Redness, dryness, or bleeding of the skin. parent/guardian. Begin CPR, if needed. Blow-by oxygen is a passive delivery of high flow oxygen given to the student by removing the mask/nasal cannula/trach collar from the oxygen tubing and then placing only the oxygen tubing up to the nose/mouth or stoma. The stoma is the usual site for students with tracheostomies. May be due to irritation from the device or from insufficient humidity. Notify the parent/guardian to discuss health problem with their licensed health care provider. Never use powders or petroleum products on the student s face. 7.0 Documentation 7.1 Document procedure in the electronic health record (Healthmaster) and the Medicaid billing system (EdPlan), if applicable. 8.0 References, Sources, Bibliography 9.0 Authorizations Health Services Director (Print) Signature Date