SUBJECT: OXYGEN (O 2 ) THERAPY COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Medications POLICY NUMBER: 512 Effective Date: August 31, 2006 1. GENERAL CONSIDERATIONS A. Individuals on continuous oxygen therapy shall have access to all non-smoking Individual areas within the hospital (shall not be denied based solely on Individual s use of oxygen). B. Oxygen (O 2 ) is an odorless, tasteless, colorless, transparent gas that is slightly heavier than air. C. There is always a danger of fire where oxygen is being used. D. Avoid using oils or grease around oxygen connections. E. Eliminate antiseptic tinctures, alcohol, and oil/petroleum products (e.g. petroleum jelly) in the immediate oxygen environment. F. Do not permit any electrical devices (radios, heating pads, electric razors) in or near an oxygen tent. G. Keep the oxygen cylinders secured in an upright position and away from heat. H. Oxygen can be administered from an oxygen tank or oxygen concentrator. Oxygen supplied to the Individual from a tank is controlled by using a pressure regulator that shows the amount of oxygen left in the tank and a flow meter that regulates oxygen in liters per minute. An oxygen concentrator has a flow meter only. I. Oxygen is given to relieve hypoxemia or hypoxia. J. Continuous oxygen therapy shall be administered upon the order of a physician. 2. TRAINING All nursing service personnel assigned to areas where oxygen is located will be formally trained in its use and function within 30 days of assignment. After the initial training, return demonstration will be required bi-annually (every 2 years). 3. ASSESSMENT -Suspect need for oxygen when Individuals predisposed to impaired gas exchange have: 1. Tachypnea 2. Tachycardia or arrhythmias. -1-
3. A change in level of consciousness. -Early use of oxygen therapy may prevent development of: 1. Cyanosis - occurs as a late sign. 2. Labored respiration s - indicates severe respiratory distress. 3. Myocardial stress - increase in heart rate and stroke volume (cardiac output) is the primary mechanism for compensation for hypoxemia or hypoxia. -The use of the pulse oximeter is the easiest and least invasive method of monitoring/assessing Individual response to oxygen therapy. -Individual safety shall be considered. 1. Individual safety will be addressed in the nursing care plan. 2. Licensed personnel knowledgeable of oxygen policies and procedures will directly supervise Individual when oxygen therapy occurs away from the infirmary unit. 4. NURSING INTERVENTIONS A. Select the appropriate form of oxygen therapy after obtaining oxygen saturation via the pulse oximeter and assessing the Individual's current oxygenation status and acid-base balance. Choices are: 1. Low concentration - appropriate for Individuals prone to retain carbon dioxide (chronic obstructive pulmonary disease, drug overdose). Such Individuals may be dependent on hypoxemia (hypoxic drive) to maintain respiration. If hypoxemia is suddenly reversed, hypoxic drive may be lost. Respiratory arrest may then occur. 2. High concentration - appropriate in Individuals not predisposed to carbon dioxide retention. B. Monitor response to therapy by pulse oximeter evaluations. C. Increase or decrease the fraction of inspired oxygen (FIO 2 ) concentration, as appropriate, to correct pulse oximeter to Individual norms. Note: Oxygen toxicity should always be of concern in the Individual receiving inspired concentration over 6 L/min. (60%) for longer than 24 hours. 5. EVALUATION A. Monitor Individual s response to oxygen therapy by using pulse oximeter (by attaining desired oxygen concentration) and by the decreased work of breathing. B. Check Individual for hypoxia; i.e., decreased LOC, increase heart rate, arrhythmias, restlessness, perspiration, diaphoresis, use of accessory muscles, yawning or flared nostrils and cyanosis. C. Observe Individual s skin integrity to prevent skin breakdown on pressure points from oxygen delivery system. 6. EQUIPMENT A. Oxygen source (tank or oxygen concentrator) B. Pressure regulator/flow meter -2-
C. Humidifier bottle & sterile water D. Oxygen delivery system (cannula, mask) E. Pulse Oximeter F. Sterile distilled water G. "Oxygen IN USE" signs H. Oxygen may be administered by nasal cannula or various types of face masks. It may also be administered via endotracheal or tracheal tube, T-piece, or hyperinflation bag (ambu bag). I. Paper bag, hospital wash basin to store disposable equipment between treatments. 7. PROCEDURE NURSING ACTIONS A. Assess the Individual's respiratory rate and level of consciousness (LOC). B. Post "OXYGEN IN USE signs on the Individual's door and in view of Individual and visitors. C. Show the nasal cannula/mask to the Individual and explain the procedure. D. Make sure the humidifier is filled to the appropriate mark with sterile water. E. Attach the connecting tube from the cannula/mask to the humidifier outlet. RATIONALE/PRECAUTIONS A. Oxygen by nasal cannula administration is often used for Individuals prone to CO 2 retention. Oxygen may depress the hypoxic drive of these Individuals (evidenced by a decreased respiratory rate, altered mental status, and further PaCO 2 elevation). B. To inform Individuals & hospital personnel in the area of oxygen use. C. Individual teaching & elicit cooperation. Teaching to include the hazards: & hospital regulation regarding oxygen in use. E. When using nasal cannula, if Individual complains of dryness inside nose apply a water- soluble lubricant like K-Y jelly. F. Set the flow rate at prescribed liters/minute. F. Approximate oxygen concentrations delivered by nasal cannula are: 1 liter = 24% 2 liters = 28% -3-
3 liters = 32% 4 liters = 36% 5 liters = 40% G. Place the tips of the cannula in the Individual nose or place the mask over the Individual's nose and mouth and under the chin. Adjust straps. H. Adjust flow to prescribed rate. Note: because a nasal cannula is a low flow system (Individual s tidal volume supplies part of the inspired gas), oxygen concentration will vary, depending on the Individual s respiratory rate and tidal volume. Note: Individuals who require low, constant concentrations of oxygen and whose breathing pattern varies greatly may need to use a venturi mask, particularly if they are carbon dioxide retainers. 8. GENERAL CONSIDERATIONS/INFECTION CONTROL A. Do not use extension cords (oxygen concentrator). B. Oxygen concentrator filter: Remove the filter of the (oxygen concentrator) weekly, place in clear plastic bag, send to Central Supply with requisition for cleaning and re-issue. (Do not clean filters on the unit). C. Wipe tubing and nasal cannula/mask with a clean cloth or gauze sponge moistened with water only. Wipe tubing first and nasal prongs/mask last. D. Check humidifier water level every 4 hours, if low, discard remaining water. Rinse out bottle with sterile water and discard. Fill bottle with sterile water to appropriate line marked on bottle. E. Change all disposable items every 48 hours including humidifier bottle, cannula/mask with tubing should be changed every 72 hours. At same time wipe oxygen concentrator (if used) with a clean cloth or gauze sponge moistened with water only. Between use, disposable items will be stored in a paper bag labeled with Individual s name and date in indelible ink. Paper bag will be placed in a clean hospital wash basin labeled with Individual s name F. If you experience any problems with equipment, complete a work order request and take it to Central Supply. G. Do not use alcohol or oil based products around oxygen dispensing equipment. 9. DOCUMENTATION -4-
A. Document Individual s oxygen administration and reaction/outcome on medication administration record per N.P. 500. Additional notes may be placed in an Wellness and Recovery note. B. Document any Individual teaching on the Health Education Record. 10. GENERAL SAFETY 1. Smoking is not allowed by the Individual when receiving oxygen therapy or within 15 feet of user and/or his oxygen delivery system. 2. Post Oxygen in Use signs on the entryways to area(s) of oxygen use. 3. No sources of open flame including candles shall be permitted in area where oxygen is being used. 4. Know the location of the nearest fire extinguisher. 5. If a fire occurs in the area, turn off oxygen immediately and remove user and deliver system from the area. 6. Do not run oxygen tubing under clothing, bedding, furniture or carpets. 7. Oxygen tanks must be kept upright & secured to either an oxygen hand truck, the wall or in a wheelchair attachment. 8. Make sure oxygen delivery system is turned off when not in use. 9. Visitors to the Individual and/or area of oxygen use shall be notified of the hazard of oxygen use ( Oxygen in Use sign). -5-