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1 Assess the patient’s condition and level of oxygen therapy required, e.g. facemask, humidified oxygenation, nasal cannulas. To ensure that the appropriate method for delivery of oxygen is chosen to suit the patient’s condition (O’Driscoll et al. 2008, C).

2 Explain to the patient why they require oxygen therapy and the benefits and problems thereof. To minimize apprehension and anxiety and improve understanding of treatment. E

3 Attach oxygen tubing to the correct port on the wall oxygen or cylinder, and not to the medical air port. To ensure proper oxygen delivery and prevent hypoxia if connected to medical air port (NPSA 2007, C).

Procedure

4 Set oxygen flowmeter to required setting (L/min) and check oxygen is flowing through system by using fingertips. To ensure system is working properly. E

5 Either:

Apply a nasal cannula by gently placing the nasal prongs of the cannula into the patient’s nostrils, draping the tubing over the patient’s ears and sliding the fit connector up under the chin to hold the tubing securely in place.

Or:

Apply an oxygen mask by placing the mask over the patient’s mouth and nose, then pull the elastic strap over the head and adjust the strap on both sides to secure the mask in a position that seals it against the face. To ensure the mask or cannula is applied correctly to enable the patient to receive the oxygen. E

Postprocedure

6 Check that the patient is comfortable. To ensure patient comfort. E

7 Record that oxygen therapy has been commenced, time and flow rate. To maintain accurate records (NMC 2009, C).

Problem-solving table 10.1 Prevention and resolution (Procedure guideline 10.1)

Postprocedural considerations

Immediate care

Consider talking to the patient and the family with regard to assisting patient if they remove the mask for a drink, how to put the mask back on and possible psychological issues regarding feeling claustrophobic with the mask, and the reasons for oxygen therapy. Document what percentage of oxygen was commenced and the patient’s related observations, and continue to monitor the patient’s respiratory status.

Ongoing care

For patients requiring oxygen therapy for more than 24 hours, humidification should be commenced to protect airway defences (Carroll 1997, Ward and Park 2000) as well as general comfort of the patient. Mobilizing patients sitting out in chairs rather than lying or even sitting up in bed will help prevent atelectasis and aid removal of secretions. Ensuring that postoperative patients have effective pain relief will allow for early ambulation, as well as deep breathing and other basic exercises which will help prevent postoperative atelectasis or possible chest infections (Shelledy and Mikles 2002). Preoperative education from physiotherapists and nursing staff about the benefits of these exercises and reinforcement postoperatively will also be of benefit. Accurate and frequent monitoring of vital signs and recording of observations as well as oxygen concentration and flow rates administered to the patient in conjunction with a Modified Early Warning System (MEWS) score allows for early identification and referral of patients at risk of deterioration (NICE 2007).

Documentation

Baseline vital signs and oxygen flow rates or concentrations administered as well as the patient’s response to therapy must be recorded (NICE 2007).

Education of patient and relevant others

Patients should be educated regarding the necessity of keeping their oxygen masks on, and ambulatory patients must recommence oxygen with the help of nurses after mobilizing.

Before sending a patient home on oxygen, healthcare providers must be sure the patient and family members understand the dangers of smoking in an oxygen-enriched environment. An increased amount of oxygen in the environment increases the speed at which things burn once a fire starts. Oxygen can saturate clothing, fabric, hair, beards and anything in the area. Even flame-retardant clothing can burn when the oxygen content increases. It is important to keep all flames and heat sources away from oxygen