i bc27f85be50b71b1 (241 page)

Table ill-A.). Continued

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Device/Fio2

Description

Clinical Implications

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Nasopharyngeal

Purpose: delivers supplemencal 02 inco

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The catheter is changed daily.

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catheter

the patient's oropharynx, which acts as

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Fio23S Nasal cal1-

an anatOmiC reservoir. This method is

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nula, above

sometimes used with pediatric patients,

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RA

Z

:II 21 % Fio21

who may dislodge a nasal cannula.

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1 Ipm ... 24% Fio2!

Consists of: a soft tube with several distal

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2 Jpm "" 28% Fio"

holes, lubricated and inserted through

7-

3 Ipm ... 32 % Fio�!

a nare until its distal tip is visible juSt

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4 Ipm ... 36% Fio2,

below the uvula. It is attached to an 0,

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5 Jpm ... 40% Fio2,

source via small-bore tubing and held

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6 Ipm ... 44% Fio2

in place with tape.

Open face mask/tent

Purpose: provides humidified,

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A significant amount of mixmg with RA occurs,

Fio, � 35-50%

supplemental 0, mixed with RA.

although the capaciry of the mask allows 02 to colleer

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Consists of: a mask with straps under the

about the nose and mouth.

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chin, contacts the cheeks, and is open

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It may be more comfortable than a closed face mask for

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over the patient's nose. It is secured

claustrophobic patients.

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with an elastic str:lP around the

•

,\101srure may collect m the tubmg and should be

patient'S head. Ie connects to a

drained before moving the pmiem.

humidified 02 source with large-bore

•

The aerosol system is more cumbersome and may make

tubing (Figure 111-A.2).

mobilization of the patient more difficult than with

nasal prongs. Collaborate with nursing to determme

whether nasal prongs or a closed face mask can be used

when mobilizing the patient.

•

Titrate 02 appropriately to maintain 02 saturation as

indicated.

Closed face mask

Purpose: delivers supplemental 02 mixed

•

The closed face mask imerferes with coughing, talking,

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S-61pm �40%

with RA. The mask has a small

eating, and drinking and may be very drying and

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z

Fioz' 6-7 Ipm ""

capacity but does allow for the

uncomfortable. Patients often remove the mask for

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X

50% Fio" 7-8

collecrion of 02 about the nose and

these reasons. Educate the patient on the importance of

Ipm ",. 60'% Fioz

mouth.

keeping [he mask in place.

Consists of: a dome�shaped mask

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covering the nose and mouth with

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ventilation holes on either side. An

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elastic strap around the patient's head

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secures it in place. Ir is connected to an

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02 source via small-bore tubing

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(Figure 1Tl-A.3).

Transtracheal

Purpose: used for long�term 02 therapy.

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Patients with severe bronchospasm, uncompensated

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catheter

Provides continuous supplemental 02

respiratory acidosis (pH <7.3), or steroid use higher

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1 Ipm ",. 28% Fio1,

mixed with RA.

than 30 mg per day are excluded from the use of this

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2 Ipm "" 36% Fioz'

Consists of: a small�bore catheter, which

device.

3 Ipm

z

= 44% Fio1,

is surgically inserted percuraneously

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The use of this device for 0z delivery is delayed for 1

4 Ipm "" 52% Fioz'

between the second and third tracheal

wk posroperatively because of the risk of subcutaneous

5 Ipm

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= 60% Fio1,

interspaces ro provide 02' It is held in

emphysema.

6 Ipm "" 68% Fioz

place by a narrow strap or chain

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This device requires care and attention to hygienic

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around the patient's neck. A low flow

maintenance. The most serious complication is tracheal

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rate (approximately one�half with rest

obstruction resulting from the accumulation of mucus

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and two-thirds with exercise) is used

on the outside of the catheter. which can be avoided by

instead of a nasal cannula system

rourine secretion clearance multiple times per day.

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owing to the continuous enrichment of

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There is also a risk of infection around the catheter site

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the anaromic dead space with 02'

and a risk of catheter dislodgement.

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