Skill 49

Oxygen Therapy

Nasal Cannula, Oxygen Mask, T Tube, or Tracheostomy Collar

Oxygen therapy is the administration of supplemental oxygen (O₂) to a patient to prevent or treat hypoxia. Selection of the type of oxygen delivery system depends on the level of oxygen support that the patient needs, based on the severity of the hypoxia and the disease process. A nasal cannula is a simple, effective, and comfortable device for delivering oxygen to a patient. The two tips of the cannula, about 1.5 cm ( inch) long, protrude from the center of a disposable tube and are inserted into the nostrils.

The simple face mask is used for short-term oxygen therapy. It fits loosely and delivers oxygen concentrations from 40% to 60%. A plastic face mask with a reservoir bag and a Venturi mask are capable of delivering higher concentrations of oxygen.

Patients with an artificial airway require constant humidification to the airway. The two devices that supply humidified gas to an artificial airway are a T tube and a tracheostomy collar. The T tube, also called a Briggs adapter, is a T-shaped device with a 15-mm (-inch) connection that connects an oxygen source to an artificial airway such as an endotracheal (ET) tube or tracheostomy. A tracheostomy collar is a curved device with an adjustable strap that fits around the patient’s neck.

Delegation Considerations

The skill of applying a nasal cannula or oxygen mask (not adjusting oxygen flow rate) can be delegated to nursing assistive personnel (NAP). The skill of administering oxygen therapy to a patient with an artificial airway cannot be delegated to NAP. The nurse is responsible for assessing the patient’s respiratory system, the patient’s response to oxygen therapy, and the setup of the oxygen therapy and liter flow, including the adjustment of oxygen flow rate. The nurse directs the NAP by:

▪ Informing how to safely adjust the device (e.g., loosening the strap on the oxygen cannula or mask).

▪ Instructing to inform the nurse immediately about any changes in vital signs; changes in level of consciousness (LOC); skin irritation from the cannula, mask, or straps; patient complaints of pain or breathlessness; any increase in anxiety; and increased secretions associated with the oxygen delivery device.

▪ Instructing on patient-specific variations for application or adjustment of the T tube or tracheostomy collar (e.g., methods to avoid pressure or pulling on the artificial airway, methods for handling accumulated secretions in devices).

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