Oxygen Delivery and Airway Care
Devices, safety, and spotting hypoxia early
Oxygen devices
| Device | Flow | Approx. FiO₂ | Key points |
|---|---|---|---|
| Nasal cannula | 1–6 L/min | 24–44% | Each L/min adds ~4%. Check ears and nares for pressure injury. |
| Simple face mask | 5–10 L/min | 35–55% | Minimum 5 L/min to flush out exhaled CO₂. |
| Non-rebreather mask | 10–15 L/min | 60–80%+ | Reservoir bag must stay inflated; one-way valves. Short-term, high need. |
| Venturi mask | Per adaptor | 24–60% | Most precise FiO₂: useful in COPD. |
| High-flow nasal cannula | up to 60 L/min | 21–100% | Heated, humidified; reduces work of breathing. |
| CPAP / BiPAP | Pressure-set | Set | BiPAP for hypercapnic COPD exacerbation; CPAP for sleep apnea and pulmonary edema. Patient must be alert and able to protect the airway. |
Signs of hypoxia
Early
- Restlessness, anxiety
- Tachycardia, tachypnea
- Confusion, irritability
- Rising BP
Late
- Cyanosis
- Bradycardia, hypotension
- Dysrhythmias
- Lethargy, coma
A newly restless or confused patient: check oxygenation before giving a sedative.
Oxygen safety
- No smoking, candles, or open flames; post "oxygen in use".
- Secure cylinders upright in a stand or cart.
- Water-based lubricant only on lips and nares (no petroleum jelly).
- Avoid prolonged high FiO₂ (oxygen toxicity); give the lowest FiO₂ that meets the target.
Incentive spirometer
- Sit upright; exhale normally.
- Seal lips around the mouthpiece.
- Inhale slowly and deeply to raise the piston.
- Hold the breath 3–5 seconds, then exhale.
- Repeat 10 times every hour while awake; cough afterwards (splint incisions).
Suctioning (adult)
- Suction only when needed (secretions heard or seen, ↓ SpO₂, ↑ airway pressure).
- Pre-oxygenate; sterile technique for artificial airways.
- Wall pressure ~100–150 mmHg; apply suction only while withdrawing.
- Each pass ≤10–15 seconds; limit passes; reoxygenate between.
- Stop for bradycardia, dysrhythmia or desaturation.
Tracheostomy
- Keep a spare trach (same size and one smaller) and obturator at the bedside.
- Humidify; trach care and dressing changes per policy; clean inner cannula.
- Accidental dislodgement (fresh trach <7 days): call for help, oxygenate by face/stoma; don't blindly reinsert a fresh trach unless trained.
Positioning
Dyspnea: high Fowler's or tripod position. One-sided lung disease: "good lung down" (better perfusion to the healthy lung), except in lung abscess or hemorrhage. ARDS: prone positioning as ordered.