Oxygenation (1)

Oxygenation is the process by which oxygen (O₂) is delivered to body tissues and carbon dioxide (CO₂) is removed. For this to occur effectively, both the respiratory and cardiovascular systems must function properly—they work together as one continuous gas exchange and transport system.

🫁 Respiratory Physiology: Structure and Function

The respiratory system consists of the upper and lower airways, lungs, alveoli, and respiratory muscles.

Its main purpose is ventilation (air movement in and out) and gas exchange (O₂–CO₂ diffusion in alveoli).

• Work of breathing (WOB): The energy needed to inhale and exhale. WOB increases with airway obstruction (asthma, COPD) or stiff lungs (fibrosis, pulmonary edema).
• Lung volumes:
• Tidal Volume (TV): Air inhaled/exhaled in one breath (~500 mL).
• Residual Volume (RV): Air left in lungs after exhalation.
• Vital Capacity (VC): Maximum exhalation after full inspiration.
• Forced Expiratory Volume (FEV₁): Air expelled in 1 second; important in diagnosing airway diseases.
• Pulmonary circulation: Blood flow between heart and lungs. The right ventricle pumps deoxygenated blood to the lungs, where gas exchange occurs, then oxygenated blood returns via the pulmonary veins to the left atrium.

🌬️ Respiratory Gas Exchange

• Oxygen Transport: O₂ enters the alveoli → diffuses into capillaries → binds to hemoglobin (Hb) in red blood cells. Hemoglobin carries ~97% of oxygen; the rest dissolves in plasma.
• Carbon Dioxide Transport: CO₂ (a metabolic waste product) travels back to the lungs via three forms: dissolved in plasma, as bicarbonate (HCO₃⁻), or bound to hemoglobin.
• Regulation of Ventilation: The respiratory center in the medulla oblongata controls breathing by detecting CO₂, O₂, and pH levels in the blood.
• High CO₂ (hypercapnia) → increases respiratory rate.
• Low CO₂ (hypocapnia) → slows breathing.
• In COPD, chronic high CO₂ levels cause the body to rely on low O₂ (hypoxic drive) as the main breathing stimulus—so giving too much O₂ can suppress respirations.

❤️ Cardiovascular Physiology

Oxygenated blood from the lungs must circulate efficiently through the body to deliver oxygen to tissues and remove CO₂.

• Myocardial Pump: The heart’s rhythmic contractions move blood throughout the body.
• Myocardial Blood Flow: Coronary arteries supply the heart muscle itself; blockage causes angina or myocardial infarction.
• Coronary Artery Circulation: Originates from the aorta; provides continuous oxygenation to cardiac tissue.
• Systemic Circulation: Left heart → aorta → body tissues → returns via veins to right heart.
• Blood Flow Regulation: Controlled by heart rate, preload, afterload, and contractility.
• Conduction System: Electrical pathway that stimulates coordinated contractions (SA node → AV node → Bundle of His → Purkinje fibers).
• Disruption causes dysrhythmias like atrial fibrillation or heart block, which can decrease oxygen delivery to tissues.

⚙️ Factors Affecting Oxygenation

1. Physiological Factors:

These directly alter the blood’s ability to transport or utilize oxygen.

• Decreased Oxygen-Carrying Capacity:
• Caused by anemia (low Hb), CO poisoning, or blood loss.
• Leads to fatigue, pallor, and shortness of breath.
• Hypovolemia:
• Low blood volume from dehydration or hemorrhage → less O₂ transport and hypotension.
• Decreased Inspired Oxygen Concentration:
• Occurs at high altitudes or with airway obstruction, poor ventilation, or malfunctioning oxygen equipment.
• Increased Metabolic Rate:
• Fever, exercise, pregnancy, or hyperthyroidism increase O₂ demand.
• If demand exceeds supply, results in hypoxia (low tissue oxygen).

Effective oxygenation depends on both proper respiratory movement and cardiac function.

When the chest wall, lungs, or heart are affected by disease, trauma, or other conditions, the entire process of gas exchange can be compromised.

The nurse must recognize these problems early and understand their underlying causes to plan appropriate interventions.

🫁 Conditions Affecting Chest Wall Movement

Normal breathing requires unrestricted chest expansion. Several conditions can limit this motion:

1. Pregnancy – The enlarged uterus pushes the diaphragm upward, reducing lung expansion. Breathing becomes more shallow, especially in the third trimester.
2. Obesity – Excess chest and abdominal fat restricts diaphragmatic movement and lung expansion, leading to decreased ventilation and increased work of breathing.
3. Musculoskeletal Abnormalities – Conditions like kyphosis, scoliosis, or pectus excavatum distort the chest wall, limit lung expansion, and reduce ventilation efficiency.
4. Trauma – Flail chest (fractured ribs), pain, or chest wall injury restricts deep breathing and coughing, increasing the risk of atelectasis and pneumonia.
5. Neuromuscular Diseases – Disorders like myasthenia gravis, Guillain-Barré syndrome, or spinal cord injury weaken respiratory muscles, making breathing difficult.
6. Central Nervous System (CNS) Alterations – Damage to the medulla or spinal cord (C3–C5) can impair respiratory drive or diaphragmatic control, leading to hypoventilation.
7. Chronic Lung Disease – Long-term COPD or emphysema causes barrel chest, loss of elasticity, and air trapping, all of which increase the effort required to breathe.

🌬️ Alterations in Respiratory Functioning

1. Hypoventilation

Occurs when alveolar ventilation is inadequate to meet the body’s oxygen demands or remove enough CO₂.

• Causes: drug overdose, sedation, neuromuscular impairment, chest trauma, COPD.
• Results in hypercapnia (↑CO₂) and respiratory acidosis.
• Signs: shallow breathing, confusion, lethargy, low O₂ sat.

2. Hyperventilation

When ventilation exceeds metabolic needs, the body removes CO₂ faster than it is produced.

• Causes: anxiety, pain, infection (fever), metabolic acidosis, head injury.
• Results in hypocapnia (↓CO₂) and respiratory alkalosis.
• Signs: rapid breathing, light-headedness, tingling in extremities.

3. Hypoxia

A condition of inadequate tissue oxygenation at the cellular level.

• Causes: ↓Hb, ↓O₂ intake, impaired diffusion, or decreased perfusion.
• Early signs: restlessness, tachycardia, anxiety.
• Late signs: cyanosis, confusion, bradycardia.
• Chronic hypoxia causes clubbing of fingers and barrel chest (seen in COPD).

❤️ Alterations in Cardiac Functioning

Oxygen delivery depends on a healthy heart that pumps effectively. Cardiac problems can impair perfusion and lead to systemic hypoxia.

1. Disturbances in Conduction – Abnormal electrical activity (e.g., atrial fibrillation, heart block) causes irregular rhythm and reduced cardiac output.
2. Altered Cardiac Output – The heart cannot pump enough blood to meet body needs.
• Normal CO = HR × Stroke Volume.
• ↓CO → tissue hypoxia, fatigue, hypotension.
3. Left-Sided Heart Failure – Blood backs up into the lungs → pulmonary congestion, crackles, dyspnea, orthopnea.
4. Right-Sided Heart Failure – Blood backs up in systemic circulation → jugular vein distension (JVD), edema, hepatomegaly, ascites.
5. Impaired Valvular Function – Stenosis or regurgitation causes turbulent blood flow and decreased efficiency, producing murmurs.
6. Myocardial Ischemia – Reduced blood flow to coronary arteries leads to angina (reversible) or myocardial infarction (MI, irreversible).

💉 Nursing Knowledge Base – Factors Influencing Oxygenation

Several modifiable and nonmodifiable factors influence oxygenation across the lifespan:

1. Developmental:
• Infants → immature lungs; small airways easily obstructed.
• Older adults → decreased elasticity, weaker cough, reduced cilia activity.
2. Lifestyle Factors:
• Nutrition: Poor nutrition or anemia → ↓Hb = ↓O₂ transport.
• Hydration: Dehydration → thick secretions; adequate fluids = easier clearance.
• Exercise: Increases O₂ demand; strengthens heart and lungs.
• Smoking: Causes vasoconstriction, airway inflammation, CO buildup.
• Substance Abuse: Alcohol and drugs depress respiratory center or weaken heart muscle.
• Stress: Increases metabolic rate and O₂ consumption; may lead to hyperventilation.
3. Environmental:
• Air pollution, allergens, occupational dust, and secondhand smoke worsen oxygenation.

🧠 Critical Thinking and Professional Standards

Nurses use clinical judgment based on national standards and research. Key professional organizations that guide oxygenation-related care include:

• AHRQ – Promotes patient safety and quality care.
• ACS – Provides prevention guidelines for lung and heart-related cancers.
• AHA – Focuses on cardiovascular health and resuscitation standards.
• ALA / ATS – Research and education on lung diseases like COPD and asthma.
• ANA – Sets ethical and professional standards for nursing practice.

Following these standards ensures safe, evidence-based interventions for patients with respiratory or cardiac compromise.

The assessment phase is the foundation of nursing care. Effective assessment involves listening to the patient (“through their eyes”), collecting a detailed nursing history, performing a focused physical exam, and reviewing diagnostic tests that confirm or rule out respiratory or cardiovascular impairment.

🩸 Nursing History

A thorough respiratory history reveals the origin, severity, and duration of symptoms, along with risk factors for oxygenation problems.

Health Risks

• Cardiac or respiratory diseases (e.g., asthma, COPD, heart failure).
• Surgery or anesthesia history—especially chest, heart, or upper airway procedures.
• Family history of genetic lung disorders (e.g., cystic fibrosis, alpha-1 antitrypsin deficiency).

Pain

• Ask about chest pain—onset, location, duration, and relation to breathing or movement.
• Sharp pain on inspiration → pleural involvement.
• Crushing pressure → possible cardiac origin.
• Pain limits chest expansion, leading to shallow respirations and risk of atelectasis.

Fatigue

• Often an early sign of chronic hypoxia.
• Evaluate activity tolerance: “Can you climb stairs without resting?”
• Fatigue may also result from anemia, poor cardiac output, or sleep disorders (e.g., OSA).

Dyspnea

• The subjective sensation of breathing difficulty or “air hunger.”
• Ask about severity (0–10 scale), timing (rest vs exertion), and triggers (lying flat, anxiety).
• Observe for use of accessory muscles, nasal flaring, cyanosis, or restlessness.
• Orthopnea: inability to breathe comfortably lying down—common in heart failure.

Cough

• Determine duration, frequency, and character:
• Dry cough → irritation, viral infection, or ACE inhibitors.
• Productive cough → assess color, consistency, odor of sputum.
• Bloody sputum (hemoptysis) → possible TB, lung cancer, or pulmonary embolism.

🌎 Extended Nursing History

Environmental Exposures

• Exposure to dust, smoke, chemicals, mold, or allergens at home or work can irritate lungs.
• Example: miners → pneumoconiosis; painters → chemical pneumonitis.
• Ask about pets (can trigger asthma or allergies).

Smoking

• Document type, amount, and duration (e.g., pack-years = packs/day × years smoked).
• Include use of e-cigarettes, vaping, or smokeless tobacco.
• Teach cessation strategies—nicotine replacement, counseling, support groups.

Respiratory Infections

• Identify frequency, duration, and treatment response.
• Chronic bronchitis is defined as productive cough ≥3 months per year for 2 consecutive years.
• Ask about vaccination status (influenza, pneumococcal).

Allergies

• Ask about allergens (pollen, dust, animal dander, medications, food) and reactions (sneezing, wheezing, anaphylaxis).
• Important to document drug allergies—especially antibiotics and latex sensitivity.

Medications

• Identify any prescribed, OTC, or herbal remedies that affect oxygenation:
• Bronchodilators, corticosteroids, antihypertensives (β-blockers), opioids, sedatives.
• ACE inhibitors → chronic cough.
• Opioids & benzodiazepines → respiratory depression.

🔍 Physical Examination

A focused respiratory and cardiac assessment uses four techniques: inspection, palpation, percussion, and auscultation.

1. Inspection:
• Observe breathing rate, rhythm, and effort.
• Note use of accessory muscles, posture (tripod position), symmetry of chest movement, and color of skin/lips (cyanosis).
• Inspect for deformities (barrel chest, kyphosis).
2. Palpation:
• Assess chest wall expansion and tactile fremitus (vibration).
• Detect tenderness, crepitus (air under skin), or masses.
• Feel for pulse quality, temperature, and edema (cardiac output clues).
3. Percussion:
• Evaluate underlying tissue density:
• Resonance → normal lung.
• Dullness → fluid or consolidation (pneumonia).
• Hyperresonance → trapped air (emphysema, pneumothorax).
4. Auscultation:
• Listen for normal breath sounds (vesicular, bronchial, bronchovesicular).
• Abnormal (adventitious) sounds:
• Crackles (rales): fluid in alveoli.
• Wheezes: narrowed airways (asthma).
• Rhonchi: thick secretions, often clear with coughing.
• Pleural friction rub: inflamed pleura rubbing together.
• Also assess heart sounds, rate, and rhythm.

🧪 Diagnostic Tests

Common tests to assess oxygenation and respiratory function include:

• Pulse Oximetry (SpO₂): Noninvasive O₂ saturation monitor (normal 95–100%).
• Arterial Blood Gas (ABG): Measures pH, PaO₂, PaCO₂, HCO₃⁻—used to assess acid-base balance.
• Chest X-ray: Detects pneumonia, effusion, or structural abnormalities.
• CBC: Evaluates Hb, Hct, WBC (infection or anemia).
• Sputum Culture: Identifies infectious organisms.
• Pulmonary Function Tests (PFTs): Measure lung volumes and flow rates.
• ECG: Detects cardiac rhythm or ischemia affecting oxygen delivery.

Common tests to assess oxygenation and respiratory function include:

• Pulse Oximetry (SpO₂): Noninvasive O₂ saturation monitor (normal 95–100%).
• Arterial Blood Gas (ABG): Measures pH, PaO₂, PaCO₂, HCO₃⁻—used to assess acid-base balance.
• Chest X-ray: Detects pneumonia, effusion, or structural abnormalities.
• CBC: Evaluates Hb, Hct, WBC (infection or anemia).
• Sputum Culture: Identifies infectious organisms.
• Pulmonary Function Tests (PFTs): Measure lung volumes and flow rates.
• ECG: Detects cardiac rhythm or ischemia affecting oxygen delivery.

Divide the total number of cigarettes smoked per day by 20 (to get packs per day), then multiply by the number of years the patient has smoked.

👉 Example:

If a patient smoked 10 cigarettes a day for 15 years → (10 ÷ 20) × 15 = 7.5 pack-years.

In acute care settings, the nurse’s priority is to maintain a clear airway, improve ventilation, and promote effective oxygenation.

This involves techniques to manage dyspnea, remove secretions, expand the lungs, and support or replace the patient’s breathing if necessary.

Each intervention builds on your assessment findings and must be performed using sterile or aseptic technique when indicated.

🌬️ Dyspnea Management

Dyspnea is the subjective feeling of difficult or labored breathing.

Nursing care focuses on reducing anxiety, improving ventilation, and conserving energy.

• Positioning: High-Fowler’s or tripod position optimizes lung expansion.
• Oxygen Therapy: Administer per order to relieve hypoxia and maintain SpO₂ ≥ 92% (or patient baseline).
• Medication: Administer bronchodilators, steroids, or diuretics as prescribed.
• Energy Conservation: Provide rest between activities and assist with ADLs.
• Relaxation Techniques: Encourage pursed-lip breathing and diaphragmatic breathing to improve gas exchange and decrease work of breathing.

💨 Airway Maintenance

Airway patency is essential for adequate oxygenation.

• Suctioning removes secretions that obstruct airflow.
• Positioning the head and neck properly (sniffing position) keeps airways open.
• Oral hygiene reduces bacterial growth and prevents aspiration pneumonia.
• Hydration and humidification loosen thick secretions and keep mucous membranes moist.

💧 Mobilization of Pulmonary Secretions

Goal: Keep airways clear and prevent atelectasis or pneumonia.

1. Hydration: Thins secretions, making them easier to expectorate.
• Encourage 2–3 L/day of fluids (unless contraindicated by cardiac or renal disease).
2. Humidification: Adds water vapor to inspired air to prevent airway dryness.
• Required when using oxygen >4 L/min or mechanical ventilation.
3. Nebulization: Converts medications (e.g., bronchodilators) into mist for direct airway delivery.
4. Coughing & Deep-Breathing Techniques:
• Cascade cough: slow deep inhalation followed by a strong cough.
• Huff cough: used for COPD; exhale through open mouth to mobilize mucus gently.
• Diaphragmatic breathing: expands lower lungs, improving alveolar ventilation.

💪 Chest Physiotherapy (CPT)

Used for patients with large amounts of sputum or conditions like cystic fibrosis, bronchiectasis, or pneumonia.

1. Percussion: Rhythmic clapping on chest wall with cupped hands to loosen secretions.
2. Vibration: Fine, shaking movement during exhalation to move mucus toward larger airways.
3. High-Frequency Chest Wall Compression (HFCWC):
• A mechanical vest delivers rapid compressions to mobilize mucus.
4. Postural Drainage:
• Uses gravity to drain specific lung segments.
• Patient is positioned so the affected area is above the carina.
• Example: Trendelenburg for lower lobes, sitting upright for upper lobes.

🌬️ Positive Expiratory Pressure (PEP) Therapy

Patient exhales against resistance through a device to keep alveoli open and move secretions.

Used in COPD, cystic fibrosis, or after surgery to prevent atelectasis.

Solmed Pty Limited ACAPELLA CHAPTER 1 - AN INTRODUCTION TO PHYSIOLOGY AND VIBRATORY PEP THERAPY - Solmed Pty Limited

🌈 Maintenance and Promotion of Lung Expansion

1. Ambulation:
• Early mobilization prevents atelectasis and VTE, stimulates deep breathing, and improves circulation.
2. Positioning:
• High-Fowler’s → maximizes chest expansion.
• 45° semi-Fowler’s → ideal for most bedrest patients.
• Side-lying or prone → used to improve oxygenation in certain lung conditions (e.g., ARDS).
3. Incentive Spirometry (IS):
• Encourages sustained deep inhalation to expand alveoli.
• Prevents postoperative atelectasis.
• Use: exhale normally → place mouthpiece → inhale slowly and deeply → hold breath 3–5 seconds → repeat 10 times/hour while awake.

🧹 Suctioning Techniques

Used when patients cannot clear secretions independently.

Performed with sterile technique for lower airway access.

• Oropharyngeal & Nasopharyngeal:
• For patients able to cough but unable to clear secretions completely.
• Non-sterile for mouth, sterile for nose.
• Orotracheal & Nasotracheal:
• Used when patient cannot cough effectively; catheter inserted through nose or mouth into trachea.
• Maintain sterile technique and limit suction time to <10 seconds.
• Tracheal Suctioning:
• For patients with tracheostomy or endotracheal tube.
• Requires strict aseptic technique to prevent infection.
• Pre-oxygenate before suctioning and monitor for desaturation or bradycardia.

🫁 Artificial Airways

Used to maintain a patent airway and support ventilation.

1. Oral Airway:
• Prevents obstruction by keeping the tongue from blocking the pharynx.
• Used in unconscious patients only.
2. Endotracheal (ET) Tube:
• Inserted through the mouth into the trachea to provide a secure airway for short-term mechanical ventilation.
• Placement confirmed by chest x-ray and CO₂ detector.
3. Tracheostomy:
• Surgical opening into trachea for long-term ventilation or airway management.
• Requires sterile suctioning, humidified O₂, and meticulous skin care around stoma.

💨 Ventilation and Chest Tubes

• Invasive Mechanical Ventilation:
• Machine (ventilator) takes over breathing through ET or trach tube.
• Nurses monitor sedation, oxygen settings, and alarms; prevent ventilator-associated pneumonia (VAP).
• Noninvasive Ventilation (NIV):
• Uses mask interface (CPAP or BiPAP).
• CPAP: Continuous positive airway pressure—keeps alveoli open.
• BiPAP: Provides higher pressure during inspiration and lower during exhalation—useful for COPD or heart failure.
• Chest Tubes:
• Drain air, blood, or fluid from pleural space.
• Water-seal chamber: prevents backflow of air.
• Bubbling: indicates air evacuation (expected initially).
• Keep system below chest level and monitor for leaks or sudden cessation (may indicate obstruction).

The nurse’s role in oxygenation implementation is to promote optimal oxygen delivery, ensure patient safety during oxygen therapy, and support long-term respiratory recovery through education and training.

This phase includes maintaining oxygenation in acute settings, using oxygen therapy devices correctly, performing cardiopulmonary resuscitation (CPR), and teaching restorative breathing exercises for home management.

🌬️ Maintenance and Promotion of Oxygenation

The goal is to maintain adequate oxygen levels in the blood and prevent tissue hypoxia.

Nurses assess oxygen needs continuously and use oxygen therapy and airway maintenance strategies to restore normal breathing patterns.

💨 Oxygen Therapy

Oxygen is a medication that requires a provider’s order (except in emergencies).

It’s used to relieve hypoxemia, improve tissue oxygenation, and decrease the work of breathing.

• Indications: Hypoxia, respiratory distress, anemia, shock, cardiac arrest.
• Target Saturation: Typically SpO₂ 92–100%, or 88–92% for COPD patients (to avoid suppressing hypoxic drive).

⚠️ Safety Precautions for Oxygen Therapy

Oxygen supports combustion—it doesn’t burn but makes fires burn faster.

Nurses must strictly follow safety principles:

• No smoking or open flames near oxygen equipment.
• Keep oxygen ≥10 feet from heat sources (stoves, candles, heaters).
• Avoid petroleum-based products on lips or face; use water-based lubricants.
• Ensure equipment (tubing, humidifier) is clean and dry to prevent infection.
• Verify correct flow rate and humidification (if >4 L/min).
• Use signage: “OXYGEN IN USE.”

🧯 Supply of Oxygen

Hospitals use central wall oxygen systems or portable cylinders:

• Wall Outlets: Provide a continuous regulated flow; connect via flowmeter.
• Cylinders: Used for transport or backup; ensure cylinder is secured upright and turned off when not in use.

Home settings use oxygen concentrators that filter nitrogen from ambient air.

😷 Methods of Oxygen Delivery

Different devices deliver varying concentrations of oxygen based on the patient’s condition.

1. Nasal Cannula (Low-Flow)

• Delivers 1–6 L/min (24–44% FiO₂).
• Allows eating and talking; comfortable for long-term use.
• Downside: Can dry mucosa—add humidification if >4 L/min.

2. High-Flow Nasal Cannula (HFNC)

• Delivers heated, humidified oxygen at up to 60 L/min.
• Provides precise FiO₂ control and slight positive pressure.
• Used for severe hypoxemia, post-extubation, or respiratory failure.

3. Oxygen Masks

• Simple Face Mask: 6–12 L/min (35–50%). Short-term use; avoid CO₂ rebreathing.
• Partial Rebreather Mask: 10–15 L/min (60–90%); reservoir bag should remain partially inflated.
• Nonrebreather Mask: 10–15 L/min (60–100%); one-way valves prevent room air entry—used for critical hypoxia.
• Venturi Mask: Delivers precise O₂ concentrations (24–50%)—ideal for COPD.
• Face Tent/Tracheostomy Collar: For humidified O₂ in facial trauma or trach patients.

❤️ Restoration of Cardiopulmonary Functioning: CPR

Cardiopulmonary Resuscitation (CPR) is a life-saving intervention that restores oxygen delivery to vital organs when the heart or breathing stops.

• C–A–B Sequence:
• C – Compressions: 100–120/min, depth 2 in (5 cm).
• A – Airway: Tilt head, lift chin.
• B – Breathing: 2 rescue breaths after every 30 compressions.
• Use AED (defibrillator) as soon as available.
• Continue until return of spontaneous circulation (ROSC) or provider takes over.
• Post-CPR Care: Maintain airway, provide oxygen, monitor rhythm, and prepare for advanced life support (ACLS).

🧘‍♀️ Restorative and Continuing Care

For patients recovering from chronic or post-hospital respiratory conditions.

1. Respiratory Muscle Training

• Involves exercises or devices that strengthen inspiratory and expiratory muscles.
• Example: Incentive spirometer, resistive breathing trainers.
• Beneficial for patients with COPD, neuromuscular weakness, or post-surgery.

2. Breathing Exercises

• Promote lung expansion and control breathing patterns.
• Teach daily practice to prevent future complications.

a. Pursed-Lip Breathing:

• Inhale through nose → exhale slowly through pursed lips.
• Keeps airways open longer, reduces dyspnea, improves CO₂ elimination.
• Common in COPD management.

b. Diaphragmatic Breathing:

• Hand on abdomen; inhale deeply allowing abdomen to rise → exhale slowly.
• Strengthens diaphragm, decreases work of breathing, enhances ventilation.

3. Home Oxygen Therapy

• Prescribed for chronic hypoxemia (PaO₂ < 55 mmHg or SpO₂ < 88%).
• Delivered via concentrator or portable tank.
• Teach safety:
• Keep away from flames/heat.
• Don’t alter flow rate.
• Check tubing daily for kinks or leaks.
• Regularly clean cannula and humidifier bottle.
• Encourage mobility and normal activities while maintaining oxygen safety.

⚙️ Safety Guidelines

• Know the patient’s baseline vital signs and SpO₂ range before interventions.
• Limit suctioning to 2 passes per session to prevent mucosal trauma and hypoxia.
• Perform tracheal suctioning before pharyngeal suctioning—reduces contamination.
• Use caution with head-injured patients—suctioning may increase intracranial pressure.
• Do NOT instill saline into airways before suctioning—increases infection risk.
• Follow institutional policy before stripping/milking chest tubes.
• Most serious tracheostomy complication: Airway obstruction.
• COPD patients: Avoid high O₂ levels (>3 L/min via cannula); may suppress hypoxic drive.