When is oxygen contraindicated

We also created a video overview of the oxygen administration flowchart, which you can watch below. We do this by using high quality, clinically accurate, and educationally sound products written by leading national educators. You must enable JavaScript in your browser to view and post comments.

More EMS1 Articles. More Oxygen Administration News. More Product news. More Oxygen Administration Videos. Make EMS1 your homepage.

How to buy patient handling devices eBook. The pediatric general assessment triangle. More than EMS courses and videos totaling over continuing edcuation hours! Do the new federal vaccine mandates apply to EMS?

Anyone involved in the administration of oxygen should be aware of potential hazards and side effects of this medication. Oxygen should be administered cautiously and according to the safety guidelines listed in Table 5.

Oxygen is essential to life, but as a drug it has both a maximum positive benefit and an accompanying toxicity effect. The toxic effects from oxygen therapy can occur based on the condition of the patient and the duration and intensity of the oxygen therapy. For example, with normal lung function, a stimulation to take another breath occurs when a patient has a slight rise in PaCO 2. The slight rise in PaCO 2 stimulates the respiratory centre in the brain, creating the impulse to take another breath.

In some patients with a chronically high level of PaCO 2 , such as those with chronic obstructive pulmonary disease COPD , the stimulus and drive to breathe is caused by a decrease in PaO 2. This is called a hypoxic drive.

When administering oxygen to patients with known CO 2 retention, watch for signs of hypoventilation, a decreased level of consciousness, and apnea. Oxygen therapy can have harmful effects, which are dependent on the duration and intensity of the oxygen therapy. See Table 5. Never deprive any patient of oxygen if it is clinically indicated.

With respect to implementation, it must be noted that factors beyond physician decision influence the use of supplemental oxygen. Appropriate institutional policies, standards of care, and educational efforts to all hospital providers must be enacted in order to reduce the unnecessary use of supplemental oxygen.

In the opening case, the patient is acutely ill and requires further workup. For years, clinicians have erred on the side of using supplemental oxygen, without recognizing its dangers. However, over a century of evidence from pathophysiologic experiments and randomized trials across multiple clinical settings have associated hyperoxemia with adverse outcomes and increased mortality. Professional societies are adopting this evidence into their guideline recommendations, and clinicians should use supplemental oxygen judiciously in their daily practice.

Do you think this is a low-value practice? Skip to main content. Published Online First October 23, Disclosures The authors have nothing to disclose. Hospital Medicine. Current Issue. Menu Close. Note : Oxygen therapy should not be delayed in the treatment of life threatening hypoxia. Note: In most low flow systems the flow is usually titrated on the oxygen flow meter and recorded in litres per minute LPM. Where the Airvo2 is used as an oxygen delivery device the flow from this device is independent to the flow of oxygen.

Oxygen therapy can be delivered using a low flow or high flow system. All high flow systems require humidification. The type of humidification device selected will depend on the oxygen delivery system in use, and the patient's requirements. The humidifier should always be placed at a level below the patient's head. Please consult user manuals for any other models in use. Has two modes:. When commencing therapy on a new patient, ensure the disinfection cycle was performed.

An orange traffic light confirms the AIRVO 2 has not been cleaned and disinfected since last use, and is not safe for use on a new patient. Follow the instructions in the disinfection kit manual :. Click to view the delivery mode quick reference table. This system is simple and convenient to use. Simple nasal prongs are available in different sizes. To ensure the patient is able to entrain room air around the nasal prongs and a complete seal is not created the prong size should be approximately half the diameter of the nares.

Select the appropriate size nasal prong for the patient's age and size. For nasal prong oxygen without humidification a maximum flow of:. With the above flow rates humidification is not usually required. However, if humidification is clinically indicated - set up as per the recommended guidelines for the specific equipment used. As with the other delivery systems the inspired FiO2 depends on the flow rate of oxygen and varies according to the patient's minute ventilation.

If the required flow rate exceeds those as recommended above this may result in nasal discomfort and irritation of the mucous membranes. Therefore, humidification of nasal prong oxygen therapy is recommended.

For nasal prong oxygen with humidification a maximum flow of:. Optiflow nasal prongs are compatible for use in humidified low or high flow oxygen delivery. See guide below for recommended patient sizing and flow rates. Fisher and Paykel Optiflow nasal cannula junior range Four sizes of prongs:. See Appendix A for further information regarding appropriate junior range sizing: Fisher and Paykel Optiflow junior range sizing guide.

RT circuit - click here for instructions for use. This valve has been designed to minimize the risk of excessive pressure being delivered to the infant in the event that the nasal prongs seal around the infant's nares while the mouth is closed. The image below is of the RT circuit. RT Circuit and O2 stem - click here for instructions for use. High Flow in approved areas only.

Optiflow Nasal Prong junior and standard humidification and flow rate guide for Airvo. At RCH both simple face masks in various sizes and tracheostomy masks are available. The minimum flow rate through any face mask or tracheostomy mask is 4 LPM as this prevents the possibility of CO 2 accumulation and CO 2 re-breathing.

Select a mask which best fits from the child's bridge of nose to the cleft of jaw, and adjust the nose clip and head strap to secure in place. Oxygen via intact upper airway via a simple face mask at flow rates of 4LPM does not routinely require humidification. Additionally in some conditions eg. Asthma , the inhalation of dry gases can compound bronchoconstriction. A non-rebreathing face mask has an oxygen reservoir bag and one-way valve system which prevents exhaled gases mixing with fresh gas flow.

The non-rebreathing mask system may also have a valve on the side ports of the mask which prevents entrainment of room air into the mask. While a specific FiO 2 is delivered to the patient the FiO 2 that is actually inspired by the patient ie what the patient actually receives varies depending on:.

At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly neonatal intensive care unit.