SDE: Clinical Guidelines Ch7T

Clinical Procedure Guidelines for Connecticut School NursesPrintable version | Back to Contents
7
Specialized Health Care Procedures

T. Oxygen Therapy

Definitions

Oxygen administration refers to a supplemental source of oxygen above the normal 21 percent oxygen concentration found in room air.

Continuous oxygen: The student has a treatment order to be on a continuous source of supplemental oxygen that needs to be maintained throughout the school day and during transportation to and from school.

Intermittent oxygen: The student has a treatment order to use a prescribed amount of PRN oxygen based on objective clinical assessment date (such as decreased Sa02, increased respiratory rate, or increased respiratory effort).

Emergency oxygen: Requires a standing physician order to administer oxygen to any student under emergency medical situations (such as seizure activity or acute respiratory distress).

Purpose

Oxygen administration in school is indicated to treat either acute or chronic hypoxia as prescribed by a treatment procedure authorization.

Methods

Nasal Cannula: Plastic tube that connects on one end to an oxygen source (tank) with the other end having two short prongs that each fit into the nostrils. Generally indicated as an option for planned use of continuous or intermittent oxygen.

Mask: A plastic facemask with tubing connected to an oxygen source. The two main sizes of oxygen masks are pediatric and adult. They are generally indicated for emergency situations.

Tracheostomy Mask: A plastic mask designed to fit over a tracheostomy cannula and secured by an elastic strap around the neck (over the tracheostomy ties). This may be indicated for planned use of continuous or intermittent oxygen.

Mechanical Ventilation: A variety of portable mechanical ventilation devices may be used for children who attend school. They are attached to the student via a tracheostomy and may or may not involve the routine delivery of supplemental oxygen.

Ambu Bag (Manual Resuscitation): In a case of extreme medical emergency (i.e., severe oxygen desaturation, impending respiratory failure, or respiratory or cardiac arrest), oxygen can be delivered at full flow (> 10 L/min.) with an Ambu Bag using an appropriately sized sealed face mask or fitted directly onto a tracheostomy cannula.

Equipment

Per provider’s order and IHCP and ECP.

Procedure

High pressure tanks (standard metal oxygen tanks)

  1. Require a regulator that has:
    1. A valve to turn the oxygen source on and off.
    2. A flow meter to measure and adjust the flow of oxygen.
    3. A pressure gauge to determine the amount of oxygen remaining in the tank.
  2. Open the tank by turning the valve at the top counterclockwise until the needle on the pressure gauge moves.
  3. Set the flow meter to the prescribed rate (liters/minute) by turning the dial to the number or until the ball rises to the correct level on the scale.
  4. If using a nasal cannula:
    1. Place prongs into nose so they follow the curve of the nostrils.
    2. Secure around back of ears.
    3. Adjust below the chin.
  5. If using a face mask:
    1. Place mask over nose and mouth.
    2. Secure with elastic strap around the head and above the ears.
    3. The mask needs to be comfortably, but firmly against the face:
      1. Any space between the mask and face dilutes the intended concentration of oxygen.
      2. For students unable to tolerate the elastic strap around their head, the mask can be held against the face without the strap (only appropriate for a limited period of time).
  6. If using a tracheostomy mask:
    1. Follow the same procedure as a facemask, except cover the tracheostomy cannula with the mask and secure it around the neck.
  7. If using an Ambu Bag:
    1. Turn oxygen flow rate > 10 L/min.
    2. Administer by either face mask or tracheostomy connection:
      1. Either option requires a tight seal to the airway.
      2. Rate and force of manual resuscitation breaths is determined by CPR certified personnel.
  8. To close the tank:
    1. Disconnect oxygen from the student;
    2. Turn valve clockwise until it cannot go any further. The flow meter should steadily decrease to zero, indicating that no oxygen is flowing (or leaking) from the tank (referred to as “bleeding” the tank off).
    3. Turn the flow meter dial to zero.
  9. Tank needs to be stored in a secured upright position to prevent it from falling or tipping over.
  10. Storage area for oxygen tank must be free of petroleum products.

Liquid oxygen tanks

  1. Portable liquid oxygen tanks can be refilled from a home-based liquid oxygen system.
  2. These tanks are student specific and only indicated as part of an IHCP.
  3. These tanks are used following the same procedural steps listed above and require the same safety considerations.

Delegation Considerations

  1. Initiation of oxygen therapy: registered nurse (RN), practical nurse, (LPN), or respiratory therapist (RT).
  2. Monitoring of oxygen therapy:
    1. Continuous or long-term oxygen use that does not require continuous pulse oximetry (see Pulse Oximetry): RN, LPN, RT, physical therapist, occupational therapist, teacher, or other certified personnel.
    2. Continuous, intermittent, or emergency that requires continuous or frequent assessment of pulse oximetry or respiratory status: RN, LPN, or RT.

Select Nursing Considerations

  1. Oxygen may be drying to the airway mucosa. Humidification systems are often indicated with long-term or continuous use.

    Important Safety Precautions:
    Numerous safety precautions that are associated with the storage and maintenance of oxygen in the school setting. School districts should consult with their town’s fire marshal.

  2. Skin assessments around tubing or elastic straps are indicated.
  3. The presence of any source of supplemental oxygen requires strict fire safety guidelines.
  4. “Oxygen in Use” signs should be posted at the entrance of all building sections, classrooms, or nursing offices; on vehicles during transportation of students; and wherever oxygen is stored or potentially used.
  5. Oxygen supply vendor-contact information should be kept readily available.
  6. Any oxygen tank that is heard hissing or noted to be leaking needs to be replaced promptly.
  7. Checking monthly to ensure that they have an adequate supply to use in an emergency situation is a reasonable option.
  8. Emergency (“stock”) high-pressure oxygen tanks should not lose oxygen if they are not being used or if they were turned off properly.
  9. Tanks noted to be less than half-full or expired should be refilled or replaced.

Reference

Bowden, V.R., and Greenberg, C.S. (2008). Pediatric Nursing Procedures, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins.

 




Content Last Modified on 3/29/2017 10:02:37 AM