How Is Oxygen Administered.
Oxygen is administered in order to increase the oxygen content of the air. This is found to be helpful in certain conditions. Hypoxia is the name given to the condition where there is an insufficiency of oxygen in the blood. Some conditions that needs administration of oxygen are:
- Severe cases of Anaemia.
- Cardiac failure.
- After severe Haemorrhage.
- Shock and collapse.
- Certain diseases of the respiratory tract such as pneumonia.
- High altitudes where the oxygen content of the air is reduced.
HOW OXYGEN CAN BE ADMINISTERED
- By tube and funnel : this method is wasteful but may have to be used in an emergency.
- By nasal catheters
- By Tudor Edward’s spectacles
- By oxygen masks of two types
- By an oxygen tent
There are two types of oxygen masks, they are:
a) Those which provide a high concentration of oxygen and re-breathing of carbon dioxide. Examples are: Polymask and Pneumask.
b) Those which provide a slight increase in oxygen and do not permit re-breathing of carbon dioxide. Example are: Edinburgh mask and ventimask.
Things needed to set up a nasal catheters are:
- One or two catheters ; the size number for adult is 8 in a kidney dish.
- A gallipot with cotton wool swabs.
- One or two orange sticks or wooden applicators.
- Receiver for soiled swabs.
- A safety pin.
- A lubricant either petroleum jelly or cocaine ointment.
The oxygen cylinder, a glass Y-connection, rubber tubing, flow-meter bottle, humidifier or woulfe’s bottle half full of warm water is taken to the bedside.
How oxygen is administered with a nasal catheter
1. The first thing to do is to explain the procedures to the person or patient so that you can his co-operation.
2. If necessary, the nostrils should be cleaned with wool swabs on an orange stick.
3. The woulfe’s bottle should be connected to the cylinder of oxygen by a piece of rubber tubing and the cylinder turned ON to test the flow of oxygen. When the cylinder tap is turned ON, the oxygen should be seen bubbling through the water. The tap should be controlled so that the prescribed number of litres of gas per minute is flowing through the water.
4. The tips of the two catheters should be lubricated and passed into each nostril for about two inches and should be far enough to reach the naso-pharynx.
5. The two nasal catheters are then connected to the woulfe’s bottle by the Y-connection and a piece of rubber tubing.
6. If a single nasal catheter is used, the apparatus is setup the same way except that a straight glass connection is used instead of a Y-connection.
7. To maintain the apparatus in position, it is usually sufficient to fix the tubing to the pillow with a safety pin.
This is one of the methods which is used less commonly now, though it has the advantage of requiring very little special equipment.
Tudor Edward Spectacle
In Tudor Edward Spectacle, the requirement are the same with the administration by nasal catheters except that two small pieces of rubber tubing are used instead of the catheter. The spectacle frame provides support. The apparatus is in the shape of spectacle frames. Leading from the Y-connection which are two pieces of rubber tubing attached to fine metal tubes which help to form the spectacle frame.
From each side, a metal tube passes to each nostril and the lubricated rubber tubing attached and then passes about one and a half to two inches into the nostrils. The advantage of this apparatus is that it is less irritating to the person or patient than the nasal catheters. Disposable polythene adaptations of this apparatus in which the tubes are held in place by elastic which goes round the head of the patient.
These masks are made of light-weight polythene material and as they are difficult to sterilize, they should be destroyed after being used by one patient. The type of mask used and the rate of flow of oxygen are prescribed by the doctor and will vary according to the needs of the patient.
It is important that the oxygen should pass through water after leaving the cylinder and before reaching the patient. Moistening the oxygen in this way prevents drying the mucosa of the respiratory passages.
The face-piece can be made to fit closely around the nose and chin by bending the malleable wire to fit the nose and tightening the elastic. Patients find it comfortable to wear over a long period because it is so light in weight.
Administration By The Use Of An Oxygen Tent
This method is particularly useful for children who do not tolerate the other methods, and it is also used in chest injuries and after thoracic surgery.
The tent usually consists of a transparent plastic material which covers the top half of the bed completely. It is tucked in under the mattress at the top of the bed and at the sides, the front portion being rolled in with a sheet placed across the bed on top of the bedclothes. Ice is placed in the container beside the cylinder after apparatus is set up and a bucket is placed under the container to collect the water as the ice melts. A container of soda lime is connected to the circuit to absorb the carbon dioxide expired by the patient. It is important that the electrical equipment is properly maintained because an electric spark in an environment where the oxygen concentration is very high could cause an explosion.
The oxygen is turned ON full and allowed to flow freely for fifteen minutes. During this time, the concentration of oxygen in the tent rises to the required level. The tap is then turned OFF till the flow is at the prescribed level. For example : 3 to 4 litres per minute. Then the temperature inside the tent should be watched carefully to see that it does not become too high. The ideal temperature is about 18 degrees centigrade (64 degree F) . Nursing care of the patient is carried out through two sleeves in the tent, one on each side. These must be securely closed when it is not in use. The patient may require encouragement and reassurance while being nursed in the tent as he or she may sometimes have a shut-in feeling.
Administration Of Oxygen From A Main Source Of Supply
Oxygen is distributed to the wards from a main source of supply in so many hospitals. Pipes through which the oxygen is carried are inserted into the structure of the building or are being attached to the wall of the ward. There is an outlet with a control tap and a flow-meter attached behind each bed in the hospital.
After the oxygen has passed through the flow-meter , there is a metal tube that is attached to the apparatus, which is used to deliver the oxygen to the patient. For example nasal catheters, mask. Sometimes the oxygen is humidified before reaching the ward. If this does not happen, then the oxygen must be passed through a humidifier before passing it through the apparatus to be used.
Precautions To Be Taken When Oxygen Is Being Administered
1. A fresh cylinder must be identified by its colour and the written on it. Cylinders should be handled carefully because the oxygen inside is under considerable pressure.
2. Spare cylinders should always be at hand and empty ones marked “EMPTY”.
3. Prevention of explosion or fire using the following precautions below:
- There must be no naked flame near the patient. Examples are matches and cigarettes.
- Alcohol and ether must not be applied to the skin.
- Friction toys which might produce a spark must not be used by children in the oxygen tent.
- Oil must not be used to lubricate joints and fittings in any apparatus which is being used.
- Electrical apparatus close to the patient must be checked and maintained in safe working environment.