For faculty use only Educator s name Score Date ATI Skills Modules Checklist for Oxygen Therapy Student s name Date Verify order Patient record Assess for procedure need Identify, gather, and prepare equipment and supplies Administering oxygen therapy (oxygen source, delivery device, flow meter, extension tubing, sterile water, humidifier, small gauze pads) Preparing an oxygen cylinder (oxygen cylinder, securement device, O-ring cylinder, oxygen wrench, regulator, oxygen delivery device) Removing the regulator from a portable tank (oxygen cylinder, regulator, cylinder key) Apply principles of aseptic practice Hand hygiene Personal protective equipment Disposal of waste Communicate effectively Privacy Patient identification Patient teaching Ensure consent form has been signed Provide for a safe environment Body mechanics Equipment placement Patient safety
Nasal cannula Insert prongs of nasal cannula into nares. Gently bring tubing up and around ears. Bring tubing down under chin and secure with plastic slide. Pad tubing where needed. Provide skin care to nares every 4 hours or per policy. Simple mask Place elastic band around head. Adjust mask to fit snugly and form a secure seal. Nonrebreather mask flow rate high enough to inflate the reservoir bag partially. Place elastic and around head and adjust mask to fit snugly and form a secure seal.
Face tent Add sterile water to humidifier. Attach face tent tubing to humidifier. Connect humidifier to flow meter and adjust Place face tent under chin, then over mouth and nose. Place elastic band over head and adjust for a loose fit. Venturi mask Attach color-coded adapter for prescribed oxygen Connect tubing to adapter. Connect oxygen tubing to flow meter and adjust to a high Place elastic and around head and adjust mask to fit snugly and form a secure seal. Preparing an oxygen cylinder Place cylinder in secure, upright position. Remove protective seal and O-ring gasket from neck of cylinder. Using oxygen wrench, briefly open valve to release small amount of oxygen, then close valve. Place O-ring on top pin of regulator. Attach regulator to cylinder. Tighten regulator on cylinder. With oxygen wrench, slowly turn cylinder release valve to open tank. Check pressure gauge to determine amount of oxygen in tank. Attach oxygen delivery device tubing to adapter on regulator.
Preparing an oxygen cylinder (continued) Open regulator and adjust to prescribed oxygen Position oxygen delivery device on patient. Removing the regulator from a portable tank Assure cylinder is in secure location. Reduce regulator flow rate to 0. Disconnect all tubing. Close valve to regulator. Increase flow rate to bleed off remaining oxygen. Release seal on regulator and remove from cylinder. Store regulator and cylinder in secure location.
Documentation Document per facility policy Date and time oxygen therapy was initiated Method of oxygen delivery (cannula, simple mask) Flow rate in L/min Patient s response to oxygen therapy and any adverse reactions Condition of the patient s skin where delivery device rests (ears, nose) Respiratory assessment findings before and after oxygen therapy Patient and family teaching done