| Skill 14-4 | Administering Oxygen by Nasal Cannula | ||||||||||||||||||||||||||||||||||
A variety of devices are available for delivering oxygen to the patient. Each has a specific function and provides an associated concentration of oxygen. Device selection is based on the patient's condition and oxygen needs. A nasal cannula, also called nasal prongs, is the most commonly used oxygen delivery device for administering low-flow oxygen to infants, children, and adults in the hospital and community settings (Hess et al., 2021). Oxygen may be administered using a nasal cannula by a low- or high-flow system. A low-flow nasal cannula can be set to deliver oxygen flows of 1 to 6 L/min in usual circumstances and to deliver an increased flow of 10 to 15 L/min for short-term use (Hess et al., 2021). High-flow systems deliver oxygen flow greater than 30 L/min (up to 60 L/min) and up to 100% humidified oxygen (Hernández et al., 2017; Lu et al., 2019; Zemach et al., 2019). The cannula is a disposable plastic delivery tubing with two protruding prongs for insertion into the nostrils. The delivery tubing connects to an oxygen source with a flow meter and, as appropriate, a humidifier. Table 14-1 compares various oxygen delivery systems. Delegation Considerations The administration of oxygen by nasal cannula is not delegated to assistive personnel (AP). Reapplication of the nasal cannula during nursing care activities, such as during bathing, may be performed by assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, administration of oxygen by nasal cannula may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. Assessment Assess the patient's oxygen saturation level before starting oxygen therapy to provide a baseline for evaluating the effectiveness of oxygen therapy. Assess the patient's respiratory status, including respiratory rate, rhythm, effort, and lung sounds. Note any signs of respiratory distress, such as tachypnea, nasal flaring, use of accessory muscles, or dyspnea. Actual or Potential Health Problems and Needs Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include: Outcome Identification and Planning The expected outcome to achieve when administering oxygen by nasal cannula is that the patient will exhibit an oxygen saturation level within acceptable parameters. Other outcomes that may be appropriate include that the patient will not experience dyspnea and will demonstrate effortless respirations within an acceptable and appropriate range, without evidence of nasal flaring or use of accessory muscles. Implementation
Evaluation The expected outcomes have been met when the patient has demonstrated an oxygen saturation level within acceptable parameters; has remained free of dyspnea; and has demonstrated effortless respirations within an acceptable and appropriate range, without evidence of nasal flaring or use of accessory muscles. Documentation Guidelines Document your assessment before and after intervention. Document the amount of oxygen applied; the delivery method; and the patient's respiratory rate, oxygen saturation, and lung sounds. Sample Documentation Practice documenting the administration of oxygen by nasal cannula in Lippincott DocuCare. Developing Clinical Reasoning and Clinical Judgment Unexpected Situations and Associated Interventions
Special Considerations General Considerations
Community-Based Care Considerations
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2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.