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Oxygen Management

Oxygen Management

Things to consider:

When using nasal cannula, take care not to put undue pressure on the nasal tissue from tightening the attachment too much

Methods

Nasal Cannula:
  • Plastic tube that connects on one end to an oxygen source (tank) with the other end having two short prongs that each fit into the nostrils
  • Generally indicated as an option for planned use of continuous or intermittent oxygen
Mask:  
  • A plastic facemask with tubing connected to an oxygen source
  • The two main sizes of oxygen masks are pediatric and adult. They are generally indicated for emergency situations
Tracheostomy Mask:
  • A plastic mask designed to fit over a tracheostomy cannula and secured by an elastic strap around the neck (over the tracheostomy ties)
  • This may be indicated for planned use of continuous or intermittent oxygen
Mechanical Ventilation:
  • A variety of portable mechanical ventilation devices may be used for children who attend school
  • They are attached to the student via a tracheostomy and may or may not involve the routine delivery of supplemental oxygen
Ambu Bag (Manual Resuscitation):
  • In a case of extreme medical emergency (i.e., severe oxygen desaturation, impending respiratory failure, or respiratory or cardiac arrest), oxygen can be delivered at full flow (> 10 L/min.) with an Ambu Bag using an appropriately sized sealed face mask or fitted directly onto a tracheostomy cannula
High pressure tanks (standard metal oxygen tanks): (standard metal oxygen tanks):

Require a regulator that has:
  1. A valve to turn the oxygen source on and off

  2. A flow meter to measure and adjust the flow of oxygen

  3. A pressure gauge to determine the amount of oxygen remaining in the tank
Procedure:
  1. Open the tank by turning the valve at the top counterclockwise until the needle on the pressure gauge moves

  2. Set the flow meter to the prescribed rate (liters/minute) by turning the dial to the number or until the ball rises to the correct level on the scale

If using a nasal cannula:

  1. Place prongs into nose so they follow the curve of the nostrils
  2. Loop the head attachment around the student’s ears  
  3. Adjust below the chin

If using a face mask:

  1. Place mask over nose and mouth
  2. Secure with elastic strap around the head and above the ears
  3. The mask needs to be comfortably, but firmly against the face:
    1. Tighten the straps until you can easily fit one finger between the strap and the student’s face
    2. Any space between the mask and face dilutes the intended concentration of oxygen
  4. For students unable to tolerate the elastic strap around their head, the mask can be held against the face without the strap (only appropriate for a limited period of time)

If using a tracheostomy mask:

  1. Follow the same procedure as a facemask, except cover the tracheostomy can­nula with the mask and secure it around the neck

If using an Ambu Bag:

  1. Turn oxygen flow rate > 10 L/min
  2. Administer by either face mask or tracheostomy connection:
    1. Either option requires a tight seal to the airway
  3. Rate and force of manual resuscitation breaths is determined by CPR certified personnel
To close the tank:
  1. Disconnect oxygen from the student
  2. Turn valve clockwise until it cannot go any further. The flow meter should steadily decrease to zero, indicating that no oxygen is flowing (or leaking) from the tank (referred to as “bleeding” the tank off)
  3. Turn the flow meter dial to zero
  4. Tank needs to be stored in a secured upright position to prevent it from falling or tipping over
  5. Storage area for oxygen tank must be free of petroleum products
Liquid oxygen tanks
  1. Portable liquid oxygen tanks can be refilled from a home-based liquid oxygen system
  2. These tanks are student specific and only indicated as part of an IHCP
  3. These tanks are used following the same procedural steps listed above and require the same safety considerations

References:

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Connecticut State Department of Education.  (2012). Clinical Procedure Guidelines for Connecticut School Nurses.  Available at:  http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf.

 

Acknowledgement of Reviewers:

Rachel Gallagher, RN, MSN, CPNP, NCSN
Director of Health Services
Milwaukee Public Schools

Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Jill Krueger, RN, BSN
Director/Health Officer
Forest County Health Department

Carole Wegner, MSN, RN
Clinical Nurse Specialist
Tracheostomy/Home Ventilator Program
Children's Hospital of Wisconsin

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