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OXYGEN THERAPY EQUIPMENT AND ADJUNCTS

The main components of an oxygen delivery system are:

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Oxygen Source

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Compressed Gas Cylinders

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Liquid Oxygen in Cryogenic Containers

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Oxygen from Concentrating

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Pressure Reducing Valve

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Patient Outlet

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Flow Meter

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Oxygen Delivery Device at the Patient Interface

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Low Flow O2 Therapy

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High Flow O2 Therapy

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+/- Humidity Therapy

Guiding Principles

There are many factors to consider when choosing the most appropriate oxygen source for patients/clients in their environment (e.g., from hospital to home).

For example:

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Continuous flow versus oxygen conserving devices (e.g., test patient on specific conserving devices to ensure the therapy meets the patient’s requirements).
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Patient physiological needs (e.g., of a neonate with congenital heart disease versus a pregnant female).
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Patients physical abilities (e.g., strength to use equipment).
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Patients cognitive ability (e.g., patient/client ability tounderstand and use and demonstrate use).
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Environmental Considerations (e.g., site assessment for open flames in the home).
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Geographic considerations (e.g., remote patients and availability of back-up systems and supplies).

For more information please refer to Acute Oxygen Therapy: A Review of Prescribing and Delivery Practices (nih.gov)

Did You Know?

Not all oxygen conserving devices work the same way.
For example some regulators are battery-operated, while others are pneumatically powered.

Oxygen Delivery at the Patient/Client Interface

Low Flow Oxygen Delivery Devices

Low flow oxygen delivery devices provide a variable FiO2 depending on the patient’s/client’s inspiratory demands. As the inspiratory demands increase, ambient air is entrained and the FiO2 is diluted.

Examples of low flow devices include:

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Nasal Cannula
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Nasal Catheter
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Transtracheal Catheter
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Simple Mask
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Partial Rebreather Mask
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Non-Rebreather Mask

Nasal Cannula

Today’s nasal cannula has evolved to be the most common appliance for oxygen therapy. Permutations of the standard device include:

  • models sized for neonatal and pediatric patients,
  • incorporation with eye glasses,
  • a single prong for sidestream sensing of exhaled carbon dioxide,
  • reservoir systems (moustache and pendant) used primarily in long-term ambulatory care,
  • a sensor to allow flow only on inspiratory demand (also used primarily in long-term ambulatory care),
  • high-flow designs for adult and neonatal/pediatric patients.

Did You Know?

Low Flow Oxygen delivery devices could still deliver a high FiO2?

Theoretically, a reservoir mask set at 10 -15 L/min, could provide an FiO2 of 1.0 if it fit properly to a patient’s face and met the patient’s inspiratory flow demands on every breath.

High Flow Oxygen Delivery Devices

High flow oxygen delivery devices will provide a fixed FiO2 (0.24 – 1.0) regardless of the patient’s/client’s inspiratory demands.

Some examples of high flow devices include:

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Air Entrainment Mask (Venturi);
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Air Entrainment Nebulizer;
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Nasal High Flow Oxygen Therapy;
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Invasive Mechanical Ventilators;

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Non-Invasive Ventilation Machines;

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Resuscitation Bags; and
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Hyperbaric Oxygen Chambers.

Did You Know?

Nasal High Flow Oxygen Therapy (NHF) can be an alternative to standard high-flow face mask (HFFM) oxygen therapy. It provides delivery of up to 60 L/min of heated and humidified, blended air and oxygen via wide-bore nasal cannula.

Mouth breathing does not significantly decrease the FiO2 delivered by nasal prongs.

Oxygen Therapy and Humidity

Humidity refers to the water vapour content of a gas. In a healthy individual air is delivered to the alveoli at Body Temperature and Pressure Saturated (BTPS). Much of the humidification of the air we inspire normally takes place via the nasal passages and upper airway. When a patient receives a supplemental medical gas it is generally cool and dry and can cause drying of the secretions and mucosa potentially leading to airway obstruction and tissue injury. A goal of humidity therapy is to minimize or eliminate the humidity deficit that may occur when a patient/client breaths a dry
medical gas. Humidity therapy is therefore an integral part of oxygen therapy.

Ideally inspired gas should be humidified to 37 C and 44 mg H2O/L (Wattier & Ward, 2011. p. 265). This ensures patient comfort and promotes respiratory health by optimizing mucocilliary function and the clearance of secretions. There are several types of humidifiers that can be used with low or high flow oxygen therapy devices.

Clinical Signs and Symptoms of Inadequate Airway Humidification

  • Atelectasis

  • Dry, non-productive cough

  • Increased airway resistance

  • Increased incidence of infection

  • Increased work of breathing

  • Substernal pain

  • Thick dehydrated secretions

Low Flow Oxygen Humidifiers

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Molecular Humidity – bubble type humidifiers, bubble-diffuser type humidifiers used with nasal cannula.

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Humidity is not indicated at flows less than 4 L/min (BTS Guidelines, 2008).

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The use of humidity is not recommended with reservoir type masks as condensates may affect the function of the mask (parts stick together).

High Flow Oxygen Humidifiers

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Molecular Humidity
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Passover-type (+/- wick, +/- heater) (e.g., used to humidify trach mask systems, incubators).
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Aerosol Humidity
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air entraining jet nebulizers (+/- baffles, +/- heaters)
GLOSSARY

(ATP) Ambient Temperature and Pressure = (STP) standard temperature and pressure = 0C and 1 atmosphere

BTPS = Body Temperature and ambient Pressure Saturated = 37 °C, 1 atmosphere, and 44 mg H2O/L

Conserving Devices - How long liquid and cylinder systems last before refilling depends on the amount of oxygen a person uses. Conserving devices extend the length of time. Oxygen systems deliver oxygen continuously during inspiration and exhalation. Conserving devices can be programmed to deliver oxygen during inspiration only, therefore reducing the amount wasted during exhalation.

Cryogenic Vessel - A static or mobile vacuum insulated container designed to contain liquefied gas at extremely low temperatures. Mobile vessels could also be known as "Dewars". Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/compliance-enforcement/good-manufacturing-practices/guidance-documents/gmp-guidelines-0031/document.html

Drug Identification Number (DIN) - a computer-generated eight-digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada. A DIN uniquely identifies the following product characteristics: manufacturer; product name; active ingredient(s); strength(s) of active ingredient(s); pharmaceutical form; route of administration. Retrieved from: www.hc-sc.gc.ca/dhp-mps/prodpharma/activit/fs-fi/dinfs_fd-eng.php

Fractional Distillation - the process of separating the portions of a mixture by heating it and condensing the components according to their different boiling points. Retreived from: http://medical-dictionary.thefreedictionary.com/fractional+distillation

Medical gas - (either a single gas or a mixture of gases) is a gas that requires no further processing in order to be administered, but is not in its final package (e.g., liquefied oxygen) and is known as a bulk gas. Retrieved from: http://ccinfoweb2.ccohs.ca/legislation/documents/stds/csa/cmgpi12e.htm

Manifold (rampe) - Equipment or apparatus designed to enable one or more medical gas containers to be filled at a time.

REFERENCES

  1. American Thoracic Society (2020) Clinical Practice Guideline: Home Oxygen Therapy for Adults with Chronic Lung Disease.  Retrieved from: https://www.atsjournals.org/doi/pdf/10.1164/rccm.202009-3608ST
  2. Becker, D. E., & Casabianca, A. B. (2009). Respiratory monitoring: physiological and technical considerations. Anesthesia Progress, 56(1), 14-20. doi: 10.2344/0003-3006-56.1.14.
  3. Cairo, J., M. & Pilbeam, S., P., (2017) Mosby’s Respiratory Care Equipment (10th ed.). St. Louis, MO: Mosby.
  4. Canadian Standards Association. (2016). Z305.12-06 (R2012) - Safe Storage, Handling, and Use of Portable Oxygen Systems in Residential Buildings and Health Care Facilities. Retrieved from: https://www.csagroup.org/store/search-results/?search=all~~Safe%20Storage,%20Handling,%20and%20Use%20of%20Portable%20Oxygen%20Systems%20in%20Residential%20Buildings%20and%20Health%20Care
  5. Cousins JL, Wark PA, McDonald VM. Acute oxygen therapy: a review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis. 2016;11:1067-1075. Published 2016 May 24. doi:10.2147/COPD.S103607
  6. Gardenshire, D. (2020). Rau’s Respiratory Care Pharmacology. (10th ed.). St. Louis, MO: Mosby Inc.
  7. Kacmarek, R. M., Stoller, J.K. Heuer, A. J. (2021). Egan’s Fundamentals of Respiratory Care. (12th ed.). St. Louis, MO: Mosby.
  8. Mariciniuk, D. D., Goodridge, D., Hemandez, P., Rocker, J., Balter, M., Bailey, P., Brown, C. (2011). Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: A Canadian Thoracic Society clinical practice guideline. Canadian Respiratory Journal, 18(2), 69–78. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC3084418/
  9. Ministry of Health and Long-Term Care. Policy and Procedures Manual for the Assistive Devices Program (May 2016). Conflict of Interest. Retrieved from: Policies and Procedures Manual of the Assistive Devices Program (gov.on.ca)
  10. O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings. BMJ open respiratory research, 4(1), e000170. Retrieved from: https://doi.org/10.1136/bmjresp-2016-000170
  11. Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-based medicine: what it is and what it isn't. British Medical Journal, 312, 71-72. Retrieved from: www.bmj.com/cgi/content/full/312/7023/71