SKILL

14-4 Administering Oxygen by Nasal Cannula

There are a variety of devices for delivering oxygen to the patient. Each has a specific
function and oxygen concentration. 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. The cannula is a disposable plastic device with
two protruding prongs for insertion into the nostrils. The cannula connects to an
oxygen source with a with a flow meter and, many times, a humidifier. It is commonly
used because the cannula does not impede eating or speaking and is easily used in the
home. Disadvantages of this system are that it can easily be dislodged and can cause
dryness of the nasal mucosa. A nasal cannula is used to deliver from 1 L per minute to
of oxygen. Table 14-1 compares amounts of delivered oxygen for these flow rates.

Equipment
 Flow meter connected to oxygen
supply
 Humidifier with sterile distilled
water (optional for low-flow
system)
 Nasal cannula and tubing
 Gauze to pad tubing over ears
(optional)

Assessment
Assess patient’s oxygen saturation level before starting oxygen therapy to provide a baseline
for evaluating the effectiveness of oxygen therapy. Assess patient’s respiratory status,
including respiratory rate, effort, and lung sounds. Note any signs of respiratory distress,
such as tachypnea, nasal flaring, use of accessory muscles, or dyspnea.
 SKILL Administering Oxygen by Nasal Cannula (continued)
14-4

BOX 14-1 Oxygen Delivery System

AMOUNT DELEVERED FiO₂ PRIORITY NURSING
METHOD (FRACTION INSPIRED OXYGEN) INTERVENTIONS

Nasal Cannula Low Flow Check frequently that both prongs are in
1 L/min = 24% patient’s nares.
2 L/min = 28% Never deliver more than 2-3 L/min to
3 L/min = 32% patient with chronic lung disease.
4 L/min = 36%
5 L/min = 40%
6 L/min = 44%
－
Simple mask Low Flow Monitor patient frequently to check
6－10 L/min = 35%－60% placement of the mask.
(5 L/min is minimum setting) Support patient if claustrophobia is
concern. Secure physician’s order to
replace mask with nasal cannula during
meal time.

Partial rebreather Low Flow Set flow rate so that mask remains two
mask 6－15 L/min = 70%－90% thirds full during inspiration.
Keep reservoir bag free of twists or kinks.

Nonrebreather Low Flow

mask 6－15 L/min = 60%－100% Maintain flow rate so reservoir bag
collapses only slightly during inspiration.
Check valves and rubber flaps are
functioning properly (open during
expiration and closed during inhalation).
Monitor Sa0₂ with pulse oximeter.

Venturi Mask Low Flow Requires careful monitoring to verify FiO₂

4－10 L/min = 24%－55% at flow rate ordered.
Check that air intake valves are not
blocked.

NURSING Determine the related factors for the nursing diagnoses based on the patient’s current
status. Appropriate nursing diagnoses may include:
DIAGNOSIS
 Impaired Gas Exchange

 Ineffective Breathing Pattern

 Ineffective Airway Clearance

Other nursing diagnoses that may be appropriate include:

 Risk for Activity Intolerance

 Decreased Cardiac Output

 Excess Fluid Volume

OUTCOME The expected outcome is that the patient will exhibit an oxygen saturation level
IDENTIFICATION within acceptable parameters. Other outcomes that may be appropriate include the
AND PLANNING following: patient will not experience dyspnea; and patient will demonstrate
effortless respirations in the normal range for age group, without evidence of nasal
flaring pr use of accessory muscles.
SKILL
14-4 Administering Oxygen by Nasal Cannula(continued)

IMPLEMENTATION

ACTION RATIONALE RATINGS

1. Identify the patient using at least two Positive identification of the patient is
methods. essential to ensure the intervention is
administered to the correct patient.

2. Explain what you are going to do and the Explanation relieves anxiety and facilitates
reason to the patient. Review safety cooperation. Oxygen supports combustion.
precautions necessary when oxygen is in
use. Place “No Smoking” signs in
appropriate areas.

3. Perform hand hygiene. Hand hygiene deters the spread of

microorganisms.

4. Connect nasal cannula to oxygen setup Oxygen forced through a water reservoir is
with humidification, if one is in use. Adjust humidified before it is delivered to the
flow rate as ordered by physician. Check patient, thus preventing dehydration of the
that oxygen is flowing out of prongs. mucous membranes. Low-flow oxygen does
not require humidification.

5. Place prongs in patient’s nostrils. Place Correct placement of the prongs and fastener
tubing over and behind each ear with facilitates oxygen administration and patient
adjuster comfortably under chin or around comfort. Pads reduce irritation and pressure
patient’s head, with adjuster at the back of and protect the skin.
the head or neck. Place gauze pads at ear
beneath tubing as necessary.

6. Adjust the fit of the cannula as Proper adjustment maintains the prongs in
necessary. Tubing should be snug but not the patient’s nose. Excessive pressure from
tight against the skin. tubing could cause irritation and pressure to
the skin.

7. Encourage patient to breathe through Nose breathing provides for optimal delivery
the nose, with mouth closed. of oxygen to patient. The percentage of
oxygen delivered can be reduced in patients
who breathe through the mouth.

8. Reassess patient’s respiratory status, These assess the effectiveness of oxygen

including respiratory rate, effort, and lung therapy.
sounds. Note any signs of respiratory
distress, such as tachypnea, nasal flaring,
use of accessory muscles, or dyspnea.
9. Perform hand hygiene. Hand hygiene deters the spread of
microorganisms.
10. Put on clean gloves. Remove and clean
cannula and assess nares at least every 8 The continued presence of the cannula
hours, or according to agency causes irritation and dryness of the mucous
recommendations. Check nares for membranes.
evidence of irritation or bleeding.
 SKILL
14-4 Administering Oxygen by Nasal Cannula (continued)

The expected outcome is met when the patient demonstrates an oxygen

EVALUATION
saturation level within acceptable parameters. In addition, the patient
remains free of dyspnea, nasal flaring, or accessory muscle use and
demonstrates respiratory rate and depth within normal ranges.

DOCUMENTATION

Guidelines Document your assessment pre- and post intervention. Document the
amount of oxygen applied, the patient’s respiratory rate, oxygen saturation,
and lung sounds.

Sample Documentation

Unexpected Situations and  Patient was fine on oxygen delivered by nasal cannula but now cyanotic,
Associated Interventions and thee pulse oximeter reading <93%: Check to see that the oxygen tubing
is still connected to the flow meter and the flow meter is still on the
previous setting. Someone may have stepped on the tubing, pulling it from
the flow meter, or the oxygen may have accidentally been turned off.
Assess lung sounds to note any changes.
 Areas over ear or back of head are reddened: Ensure that areas are

adequately padded and that tubing is not pulled too tight. If available, a
skin care team may be able to offer some suggestions.
 When dozing, patient begins to breathe through the mouth: Temporarily

place the nasal cannula near the mouth. If this does not raise the pulse
oximeter reading, you may need to obtain an order to switch the patient to
a mask while sleeping.

Special Considerations

Home Care  Oxygen administration may need to be continued in the home setting.
Consideration
Portable oxygen concentrators are used most frequently. Caregivers require
instruction concerning safety precautions with oxygen use and need to
understand the rationale for the specific liter flow of oxygen.
 To prevent fires and injuries, take the following precautions:

- Avoid open flames

- Place “No Smoking” signs in conspicuous places in the patient’s home.
Instruct the patient and visitors about the hazard of smoking when
oxygen is in use.
- Check to see that electrical equipment used in the room is in good
working order and emit no sparks.
- Avoid using oils in the area. Oil can ignite spontaneously in the presence
of oxygen.