Editing Nursing Skills and Procedures (section)

== Oxygen Administration Devices ==

Oxygen is a drug and requires an order, including device, flow rate, and target saturation. Humidification is generally added above about 4 L/min to prevent mucosal drying and epistaxis. Safety measures include no smoking, no petroleum-based products near the face, no open flame, avoidance of static-generating synthetic fabrics, secured cylinders, and functioning fire safety equipment.

{| class="wikitable"
! Device !! Typical flow !! Approximate FiO2 !! Key points
|-
| Nasal cannula || 1 to 6 L/min || about 24 to 44 percent || Comfortable, allows eating and talking. Assess nares and ears for pressure injury.
|-
| Simple face mask || 5 to 10 L/min || about 40 to 60 percent || Minimum of 5 L/min is required to flush exhaled carbon dioxide from the mask.
|-
| Partial rebreather || 6 to 11 L/min || about 60 to 75 percent || Reservoir bag must not fully collapse on inspiration.
|-
| Nonrebreather || 10 to 15 L/min || about 80 to 95 percent || One-way valves; keep the reservoir bag inflated. Used for acute severe hypoxemia.
|-
| Venturi mask || per color-coded adapter || 24 to 60 percent, precise || The most accurate delivery. Preferred when a precise low concentration is needed, as in chronic obstructive pulmonary disease.
|-
| High-flow nasal cannula || up to 60 L/min || up to about 100 percent || Heated and humidified, provides some positive pressure, tolerated better than a mask.
|}

Application notes: in a patient with chronic obstructive pulmonary disease, the nurse does not withhold oxygen from a hypoxemic patient, but titrates to a target saturation commonly around 88 to 92 percent and monitors for rising carbon dioxide with decreasing level of consciousness. Deteriorating mental status in a patient receiving oxygen is a respiratory emergency, not a sedation issue. If a nonrebreather reservoir bag is collapsing, the nurse increases the flow rate.

=== Related airway skills ===
For tracheostomy care, the nurse uses sterile technique, keeps a spare tube of the same size and one size smaller plus an obturator at the bedside, secures new ties before removing old ties, and holds the tube during tie changes. If the tube becomes dislodged, the nurse retracts the stoma with a curved hemostat and attempts reinsertion using the obturator; if the airway cannot be reestablished, the nurse covers the stoma and ventilates with a bag-mask over the mouth and nose while calling for help. Suctioning is applied only on withdrawal, for no more than about 10 to 15 seconds per pass, with hyperoxygenation before and after, and the patient is never suctioned routinely on a schedule but rather when adventitious sounds, secretions, or desaturation indicate need. Saline instillation before suctioning is not recommended.