Children will receive oxygen therapy as ordered by a healthcare prescriber or as needed in emergency situations for identified respiratory compromise and/or respiratory distress (Chart 80-1).
The healthcare prescriber will specify the delivery mode, amount of oxygen in liters per minutes or milliliters per minute, or as the fraction of inspired oxygen (FiO2) as appropriate.
Oxygen therapy may be administered by a respiratory therapist, registered nurse (RN), licensed practical nurse (LPN), or appropriately trained family caregiver.
In the inpatient setting, children receiving oxygen therapy will be monitored by clinical blood gas analysis (see Chapter 19) as ordered by the healthcare prescriber or by continuous or intermittent pulse oximetry to monitor child’s oxygen saturation levels and to adjust oxygen administration levels as needed (see Chapter 94).
Selection of the oxygen administration device will be based on the child’s condition, preference, age, and ability to use a specific device.
Oxygen may be administered by the use of a nasal cannula, mask, or hood when the oxygen level is below normal or the demand is increased (Table 80-1).
Nasal cannulas are contraindicated in children with nasal obstruction (e.g., nasal polyps and choanal atresia).
Partial rebreathers or nonrebreather masks are not appropriate for use in the neonatal population.
Restrict the use of ignition sources in child’s room (e.g., sparking toys, cigarettes, candles) when oxygen is in use.
Secure pressurized gas cylinders of oxygen in upright position.
During oxygen administration, the child should not wear clothing made of synthetic fabric that can build up static electricity.
Oils and oil-based petroleum products should not be used on the child when oxygen is in use. These products are known to ignite spontaneously when used around oxygen (e.g., petroleum jelly should not be used around the child’s face).
CHART 80-1 Indications for Oxygen Administration
Hypoxemia documented by invasive or noninvasive assessment.
Defined in infants and children as:
Arterial oxygen tension (PaO2) <65 torr on room air, and/or
Arterial oxygen saturation (SaO2) <90% on room air, and/or
Arterial PaO2 or SaO2 below desired range for child’s specific condition
Defined in neonates as:
PaO2 <50 torr on room air, and/or
SaO2 <82% on room air
Any one of the following diagnoses or circumstances:
Myocardial infarction
Acute anemia
Methemoglobinemia
Carbon monoxide poisoning
Postanesthesia
Postcardiopulmonary or respiratory arrest
Reduced cardiac output
Hypotension
Tachycardia
Bradycardia
Cyanosis
Dyspnea
Chest pain
Acute neurologic dysfunction
Severe trauma
Oxygen source (e.g., wall outlet, pressurized gas cylinder, liquid oxygen, oxygen concentrator)
Appropriate-size oxygen delivery device (nasal cannula, masks, or hood)
Oxygen flowmeter
Oxygen tubing
Pulse oximeter (if ordered)
TABLE 80-1 Modes of Oxygen Delivery
Method of Delivery
Percentage of Oxygen Delivered
Liter Flow
Nursing Care Considerations
Nasal cannula, including high flow nasal cannula (HFNC) therapy
21% oxygen plus 3% per liter
0.5-6 L/minute
For HFNC rates >2 L/kg/min
Dries mucosa; give with humidification. Provides limited oxygen delivery. Easy to use and well tolerated. Child can eat and talk without altering FiO2. Contraindicated in children with nasal obstruction. In newborns and infants, flows should be limited to a maximum of 2 L/minute. Older children and adolescents can be maintained up to 6 L/minute.
HFNC is beneficial to children with bronchiolitis needing oxygen support.
Simple face mask
35-50% FiO2
4-8 L/minute
Good for short-term use (e.g., during procedures, for transport, in emergency situations). Eating disrupts oxygen delivery.
Partial rebreathing mask
40-60% FiO2
6-10 L/minute
Allows greater concentration of oxygen to be delivered. Eating disrupts oxygen delivery. Not appropriate for neonates.
Nonrebreathing mask
>60% FiO2
6-10 L/minute
Allows greater concentration of oxygen to be delivered. Eating disrupts oxygen delivery. Child inhales only from gases in the bag; thus, kinks in the tubing may cause hypoxia. Not appropriate for neonates.
Bag-valve mask
65-95% FiO2
10-15 L/minute
Excellent method for assisted ventilation. Mask is selected to fit over the child’s mouth and nose. Use only force and tidal volume necessary to just make the chest visibly rise.
Air-entrainment mask (AEM) and nebulizers
24-40% FiO2
3-15 L/minute
FiO2s are changed by selecting or changing the jet adapter or entrainment holes. Humidification of oxygen not required with mask use. Air-entrainment nebulizers share most features of AEMs but provide additional humidification and heat control and produce high noise levels in enclosed environments (e.g., hoods, incubators). Monitor child’s temperature if heated nebulizer is used.
Oxygen hood
Can deliver FiO2 up to 100%
2-3 L/kg/minute
Easy visibility and access to child. Need to remove infant for feeding and care. Need oxygen analyzer to gauge percentage of the oxygen delivered. Flows >7 L/minute are required to wash out carbon dioxide. Temperature in hood needs to be monitored. High gas flows may produce harmful noise levels.
Securement device such as paper tape or other adhesive materials
Nonsterile gloves
Goggles (if needed)
Humidification unit and sterile water (if ordered)
Use with oxygen hood: waterproof pad, extra baby blankets or bath blankets, warm sleepwear and hat for child, stimulating pictures to place on outside of hood (optional)
Identify the child, using two identifiers.
Assess child’s history to determine rationale for oxygen administration (e.g., chronic or acute pathologies).
Determine whether there are any contraindications or concerns related to a particular method of oxygen delivery or level of oxygen concentration; inappropriate oxygen flow can result in hypoxemia or hyperoxemia.
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