A low flow oxygen delivery system provides supplemental oxygen at flow rates that do not meet the child’s total inspiratory demand. As a result, the child inhales a mix of oxygen and room air, making the delivered FiO₂ (fraction of inspired oxygen) variable. These systems are commonly used for mild to moderate respiratory distress and are generally well-tolerated.
Low flow Oxygen delivery system
Simple Masks
Semirigid and have vents within the mask to enable dilution of 02.
Indications
- Medium-flow oxygen desired, mild-to-moderate respiratory distress
- When increased oxygen delivery for short
period(<12 hours)
Contraindications
Poor respiratory efforts, apnea, severe hypoxia
Advantage
High concentration can be given.
Disadvantages
- In low concentrations (<4 L), it can cause exhaled CO, to be rebreathed.
- Uncomfortable
- Require tight seal
- Do not deliver high FiO2
- FiO2 varies with eating, drinking, and communication
- Difficult to keep in position for long duration
- Skin breakdown
Venturi Masks or Hudson Masks
On the bottom of the mask is a barrel with holes in the side. The position and size of these holes determine the percentage of O, that is administered to the child. These masks are available in 24, 28, 35, 40, and 60%
Advantages
- Provide a fixed concentration of O2, safely.
- For example, chronic lung condition reduces the risk of rebreathing the exhaled СО2.
Disadvantages
- Expensive
- Need to be discarded if a higher or lower concentration of O2, is required
Nonbreathing Masks
These masks are used in emergency situation as they have a large reservoir that enables only O2 to be breathed by the child, preventing the inhalation of the mixed gases, the percentage administered is approximately 99. The initial amount of O2, flow through this mask should be set at 15 L but it is important to make sure that the bag attached to the mask is inflated before putting the mask on the child.
Indications
High FiO2, requirement >40%
Contraindications
Poor respiratory efforts, apnea, severe hypoxia
Advantages
- Highest possible FiO, without intubation
- Suitable for spontaneously breathing patients with severe hypoxia
Disadvantages
- Expensive
- Require tight seal, uncomfortable, interfere with eating and drinking, not suitable for long-term use
- Malfunction can cause CO, buildup,
suffocation
Nasal Cannula or Prongs
These are small plastic tubes that are inserted into each nostril. If the child is very young then, the prongs need to be secured with tape on the cheeks.
Advantages
- Often tolerated well by children
- They can continue to feed and play without mask coming in the way and can be easily observed.
Disadvantages
It is difficult to give a higher flow rate of 0, as humidification is said to be inadequate, and nasal mucosa became uncomfortable for the patient.
Tracheostomy Mask
A tracheostomy mask, sometimes referred to as a tracheostomy collar, is a small mask that fits over the patient’s tracheostomy site. An adjustable elastic strap that fits around the patient’s neck holds it in place.
The mask has an exhalation port that remains patent at all times and a port that connects to the oxygen source with large-bore tubing. The flow rate is usually set at 10 L/min, with a nebulizer set at the appropriate oxygen concentration.
Head Boxes (Hood)
The box is placed over the top of the infant’s head and also his or her upper body.
Advantages
- It will enable the administration of 02 to an infant if he or she will not tolerate nasal prongs or masks or a higher percentage of 02 is required than can be administered through other methods.
- It allows the nurse to be able to see the baby.
Disadvantages
- The O2 going into the head boxes can be variable and the concentration changes if the top of the box is opened often to care the baby.
- O2 could be blown directly onto the face of the baby. Cold air can cause the diving reflex and can precipitate bradycardia episodes.
Criteria for Selection of Oxygen Delivery Method
Oxygen delivery method selected depends on:
- Age of the patient
- Oxygen requirements/therapeutic goals
- Patient tolerance to selected interface
- Humidification needs
Nurse’s Responsibility in 02 Administration
Prevention of accidents and complications:
- Any child receiving O, therapy should not play friction toys or use a nylon or wool blanket.
- O, concentration must be measured near the child’s head with an analyzer.
Prolonged exposure to the high concentrations can be toxic to certain tissue (retina in preterm babies and lungs in all children). - Observe the child constantly and monitor for any complications.
Assessment and documentation:
- Proper recording of the procedure includes time of starting, amount of flow,
and duration. - Assess the airway and position the child accordingly.
- Clinical assessment and documentation, including, but not limited to, cardio-vascular, respiratory, and neurological systems, should be done at the commencement of each shift and with any change in patient condition.
- Check and document oxygen equipment setup at the commencement of each shift and with any change in patient condition.
- Hourly checks should be made for the following:
- Oxygen flow rate
- Patency of tubing
- Humidifier settings (if being used).
Hourly checks should be made and recorded on the patient observation chart for the following (unless otherwise directed by the treating medical team):
- Heart rate
- Respiratory rate
- Signs of respiratory distress, such as nasal flaring
- Oxygen saturation
Weaning from oxygen:
- Unless clinically contraindicated, an attempt to wean the child from oxygen therapy should be attempted at least once per shift.
- Criteria for weaning:
- Child is clinically stable.
- Vital parameters are within normal limits.
- No signs of respiratory distress.
- Taking oral feed.
- Child is alert and conscious, skin is pink.
- Monitor the child continuously after cessation of oxygen therapy.
General Guidelines for Commencing/Increasing/Stopping Oxygen Therapy
Commencement or increase of oxygen therapy:
- Oxygen therapy should be commenced if:
- SpO2, is <92% (PaO2<80 mm Hg) in patients without cyanotic heart disease.
- SpO2, is <70% (Pa02, <37 mm Hg) in patients with cyanotic heart disease who have had cardiac surgery.
- SpO2, is < 60% (PaO2, <32 mm Hg) in patients with cyanotic heart disease who are waiting for cardiac surgery.
- <91% in premature and newborn neonates.
- Persistently <90% for infants with bronchiolitis.
- Reduction or cessation of oxygen therapy.
Oxygen therapy should be reduced or ceased if: - SpO2, is ≥92%.
- SpO2, is ≥90% for infants with bronchiolitis.
- The child with cyanotic heart disease reaches their baseline SpO2.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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