Oxygen Delivery Systems

Low flow systems

Do not meet the patients inspiratory flow demands.
Normal inspiratory flow rate is 25 to 30 L/min
Additional flow comes from RA (room air)

 Nasal Cannula and Nasal Catheters

Delivers 24 to 44% oxygen at 1 to 6 L/min
1 = 24
2 = 28
3 = 32
4 = 36
5 = 40
6 = 44

 Nasal Catheters
measured from nose to ear, lubricated and inserted to just above the uvula
**deep insertion can cause air swallowing and gastric distension **must be
repositioned every 8 hours to prevent breakdown

 Transtracheal Catheters
 Delivers low flow rates (1 to 3 L/min) directly to the trachea through a
small incision
 Requires less oxygen (lower flows) because the upper airway deadspace
is bypassed

**Can develop infection and irritation at site and there is a risk of accidental removal
**If pt becomes SOB or has increased **Flush with saline**
**Cleaning Rod **reposition

 Cannulas
better tolerated
may be humidified but often not if run @ less than 5 L/min
there are two types of O2-conserving cannulas
 Nasal reservoir
reservoir just below the nose stores ~ 20 mL of O2
allows for lower flows because of increase O2 delivery

 Pendent reservoir
pendent stores O2 must exhale through nose

**HFNC - 6-15 lpm

  Simple masks
Delivers 35 to 55 % O2 at flows of 5 to 12 L/min
**Must never be used at flows less than 5 L/min to prevent rebreathing of CO2

 Partial Rebreathing Masks

Delivers 35 to 60 % O2 at flow rates of 8 to 15 L/min
**Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times

 Non-rebreathing Mask
Delivers 60 to 90% O2 at flow rates of 8 to 15 L/min (NBRC says 100%)
**Flow rate must be sufficient to keep bag 1/3 to 1/2 inflated at all times
Is equipped with a one-way valve that does not allow exhaled gas into the
reservoir
One way valves are located on both expiratory ports of the mask to prevent
RA entrainment

The percentage of O2 delivered by a low flow device is variable because RA is

entrained.
FiO2 will vary depending on the patients RR, pattern and VT
Patients who have variable ventilatory patterns, RR >25 and VT that vary outside of
300-770mL, should not use a low flow system

High Flow Oxygen Systems

 Methods for setting up high flow oxygen
1) air entrainment mask
2) mechanical aerosol systems
3) Gas Injection Nebulizer- need high flow flowmeters
4) High FiO2 Misty Ox- for FiO2 of .60+
5) Blender and titration system

High flow O2 systems provide all of the inspiratory flow required by the patient at
consistent FiO2s
These devices are normally attached to nebulizers
(Venti-mask may or may not be)

 Venturi Mask or air-entrainment masks provide FiO2’s from 24 to 50%

Increasing flow will not alter FiO2 (precise)
The size of the entrainment port determines FiO2
The larger the port, the more RA entrained, the lower the FiO2
  Aerosol Mask
Delivers 21-100% FiO2 depending on nebulizer setting
Flow rates of 8 to 15 L/min
On 100% the device will probably not meet flow demands.(>60%) (No air
entrained so flow = flowmeter setting)

 Face Tent
21% to 40% depending on nebulizer setting
Flow rates of 8 to 15 L/min
Used mainly for patients who can not tolerate a mask

 T-Piece (T-tube, Briggs adapter)

21-100% depending on nebulizer setting
Flow rates of 8 to 15 L/min
Used on intubated or trached patients
Allows use 50 mL of reservoir tubing to maintain FiO2 Adequate flow is demonstrated
by visible mist out of the reservoir

 Trach Mask
35-60% O2 depending on nebulizer setting
Flow rates of 10 to 15 L/min
**Adequate flow shown by mist flowing out the exhalation port at all times

 Oxygen Tent
21 -50% at flow rates of 10 to 15 L/min
Used mainly on children with croup or pneumonia
Problem with leakage
Fire hazard

 Important Points
**High FiO2’s (>.60) may not meet the patient’s inspiratory flow demands
To insure adequate flow with stable FiO2’s, a special made high flow device should be
used or two flowmeters set up to provide at least 40 L/min total flow

**A restriction, such as a kink, or water in the tubing, causes back-pressure into the
nebulizer. This decreases the amount of RA entrained and INCREASES the delivered
FiO2.
**Increasing flow on a high flow device will not increase FiO2, only total flow