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Table ill-A.). Continued
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Device/Fio2
Description
Clinical Implications
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Nasopharyngeal
Purpose: delivers supplemencal 02 inco
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The catheter is changed daily.
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catheter
the patient's oropharynx, which acts as
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Fio23S Nasal cal1-
an anatOmiC reservoir. This method is
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nula, above
sometimes used with pediatric patients,
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RA
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:II 21 % Fio21
who may dislodge a nasal cannula.
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1 Ipm ... 24% Fio2!
Consists of: a soft tube with several distal
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2 Jpm "" 28% Fio"
holes, lubricated and inserted through
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3 Ipm ... 32 % Fio�!
a nare until its distal tip is visible juSt
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4 Ipm ... 36% Fio2,
below the uvula. It is attached to an 0,
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5 Jpm ... 40% Fio2,
source via small-bore tubing and held
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6 Ipm ... 44% Fio2
in place with tape.
Open face mask/tent
Purpose: provides humidified,
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A significant amount of mixmg with RA occurs,
Fio, � 35-50%
supplemental 0, mixed with RA.
although the capaciry of the mask allows 02 to colleer
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Consists of: a mask with straps under the
about the nose and mouth.
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chin, contacts the cheeks, and is open
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It may be more comfortable than a closed face mask for
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over the patient's nose. It is secured
claustrophobic patients.
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with an elastic str:lP around the
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,\101srure may collect m the tubmg and should be
patient'S head. Ie connects to a
drained before moving the pmiem.
humidified 02 source with large-bore
•
The aerosol system is more cumbersome and may make
tubing (Figure 111-A.2).
mobilization of the patient more difficult than with
nasal prongs. Collaborate with nursing to determme
whether nasal prongs or a closed face mask can be used
when mobilizing the patient.
•
Titrate 02 appropriately to maintain 02 saturation as
indicated.
Closed face mask
Purpose: delivers supplemental 02 mixed
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The closed face mask imerferes with coughing, talking,
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S-61pm �40%
with RA. The mask has a small
eating, and drinking and may be very drying and
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Fioz' 6-7 Ipm ""
capacity but does allow for the
uncomfortable. Patients often remove the mask for
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X
50% Fio" 7-8
collecrion of 02 about the nose and
these reasons. Educate the patient on the importance of
Ipm ",. 60'% Fioz
mouth.
keeping [he mask in place.
Consists of: a dome�shaped mask
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covering the nose and mouth with
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ventilation holes on either side. An
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elastic strap around the patient's head
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secures it in place. Ir is connected to an
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02 source via small-bore tubing
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(Figure 1Tl-A.3).
Transtracheal
Purpose: used for long�term 02 therapy.
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Patients with severe bronchospasm, uncompensated
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catheter
Provides continuous supplemental 02
respiratory acidosis (pH <7.3), or steroid use higher
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1 Ipm ",. 28% Fio1,
mixed with RA.
than 30 mg per day are excluded from the use of this
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2 Ipm "" 36% Fioz'
Consists of: a small�bore catheter, which
device.
3 Ipm
z
= 44% Fio1,
is surgically inserted percuraneously
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The use of this device for 0z delivery is delayed for 1
4 Ipm "" 52% Fioz'
between the second and third tracheal
wk posroperatively because of the risk of subcutaneous
5 Ipm
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= 60% Fio1,
interspaces ro provide 02' It is held in
emphysema.
6 Ipm "" 68% Fioz
place by a narrow strap or chain
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This device requires care and attention to hygienic
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around the patient's neck. A low flow
maintenance. The most serious complication is tracheal
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rate (approximately one�half with rest
obstruction resulting from the accumulation of mucus
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and two-thirds with exercise) is used
on the outside of the catheter. which can be avoided by
instead of a nasal cannula system
rourine secretion clearance multiple times per day.
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owing to the continuous enrichment of
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There is also a risk of infection around the catheter site
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the anaromic dead space with 02'
and a risk of catheter dislodgement.
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