The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [364]
T-piece circuit
The T-piece circuit is a simple, large-bore, non-rebreathing circuit which is attached directly to an endotracheal or tracheostomy tube (Figure 10.7B). Humidified oxygen is delivered through one part of the T and expired gases leave through the other part. This device may be used as part of the weaning process when a patient has been ventilated previously by a mechanical ventilator (Bersten et al. 2009).
Figure 10.7 (A) Oxygen analyser. (B) T-piece. (C) Oxygen (elephant) tubing. (D) Warm bath humidifier. (E) Flow generator oxygen and air Drager bellows.
Assessment and recording tools
Clinical assessment including but not limited to cardiac, pulmonary and neurological status is essential. Observations for respiratory rate, oxygen saturation, heart rate and blood pressure need to be recorded on observation charts as well as documenting the oxygen flow rate and method of delivery, for example mask or nasal cannulas. Other assessment methods include arterial blood gas sampling within a critical care environment or for a patient with acute deterioration (NICE 2007).
Pharmacological support
Oxygen cylinders and equipment may be ordered from the pharmacy whilst other medical equipment comes from external sources via stores and needs to be ordered before stocks run out to ensure ready availability in the event of an emergency. Nebulizers and broncholitic agents may improve respiratory status.
Domiciliary oxygen and portable oxygen
Some patients are so disabled by chronic respiratory disease that they require continual supplementary oxygen at home. Low-flow oxygen given over a period of time improves the prognosis of some patients (Benditt 2000).
Long-term oxygen may be prescribed for treatment of COPD, cystic fibrosis, interstitial lung disease, neuromuscular and skeletal disorders, pulmonary hypertension and palliation in lung cancer. It may be provided in the form of cylinders. The problem with this is that the cylinders need changing frequently. Oxygen condensers (concentrators) are far more economical than cylinders. A condenser consists of a compressor powered by electricity. The condenser works by drawing in room air that is passed through a bacterial filter and a sieve bed. The sieve bed contains zeolite which has an affinity with nitrogen and when under pressure works by removing nitrogen and other gases, concentrating oxygen and delivering it through a meter at the front of the compressor.
The oxygen can be delivered to the patient by nasal cannulas or mask (Esmond 2001).
Liquid oxygen
The use of liquid oxygen in a portable cylinder has been developed for portable oxygen delivery. The patient is provided with a large tank in their own home from which smaller cylinders can be filled.
Specific patient preparations
Oxygen delivery to the patient should be explained, including what equipment is to be used (such as a mask or nasal cannula) and the importance of keeping the apparatus in place. The patient should know of the flammability of oxygen and the dangers of any naked flames/lit cigarettes in their immediate vicinity. The nurse should instruct the patient to notify him or her of increasing distress, air hunger, nausea, anxiety, dry nasal passages or ‘sore throat’ (due to drying).
Procedure guideline 10.1 Oxygen therapy
Essential equipment
Piped/wall oxygen and medical air
Oxygen flow meter/regulator
Oxygen cylinders for transport of patients
Ambu-bag for emergencies
Nasal cannulas
Selection of oxygen masks
Oxygen tubing, varying lengths and types
Oxygen analysers
Optional equipment
Non-invasive equipment in non-critical care areas (essential within critical care environments)
High-flow O2 and medical air mixers for use in HDU setting
Humidification equipment
Cold water bubble humidifiers
Medicinal products
Asthma inhalers or nebulizers
Oxygen as prescribed for patient
Nicotine patches to aid smoking cessation
Preprocedure
Action Rationale