7.6 : Administering Oxygen by Nasal Cannula

Oxygen therapy is critical to patient care, especially for those struggling with respiratory issues. This intervention increases the oxygen concentration in the lungs, enhancing the amount of oxygen transported to the body's tissues. One standard method of delivering supplemental oxygen is through a nasal cannula, a non-invasive device that provides low to medium oxygen concentrations.

Nasal Cannulas

A nasal cannula is a lightweight tube split into two prongs placed in the nostrils, connected to an oxygen source. This device allows patients to move about in bed, talk, cough, and eat without interrupting the oxygen flow. It can deliver up to 6 L/min; however, flow rates exceeding 4 L/min may cause air swallowing, irritation, and drying of the nasal and pharyngeal mucosa.

Equipment required equipment needed for this procedure includes:

1. Flow meter: Connected to the oxygen supply, it controls the oxygen rate.
2. Humidifier (optional): Filled with sterile distilled water, it adds moisture to the oxygen, preventing dryness of the mucous membranes.
3. Nasal cannula and tubing: Deliver oxygen from the source to the patient.
4. Gauze: Pads the tubing over the ears to prevent discomfort.
5. Personal Protective Equipment (PPE): Protects the healthcare provider from contamination.

Step-by-step procedure

Following a step-by-step guide can streamline the process of administering oxygen via a nasal cannula:

1. Preparation: Gather all necessary equipment near the patient's bed to save time and facilitate the process.
2. Hygiene and safety measures: Perform hand hygiene and don PPE to prevent the spread of microorganisms.
3. Patient identification: To avoid errors, confirm the patient's identity by checking the ID band and bed number.
4. Privacy: Close the curtains and door to provide privacy to the patient.
5. Explanation and safety precautions: Inform the patient about the procedure, its purpose, and safety measures such as "No Smoking" signs to prevent fires.
6. Connect and check: Connect the nasal cannula to the oxygen setup with humidification (if used), adjust the flow rate as ordered, and ensure oxygen flows out of the prongs.
7. Placement: Place the prongs in the patient's nostrils, position the tubing comfortably, and use gauze pads at the ears if necessary.
8. Adjustment: Ensure the cannula fits correctly - it should be snug but not tight against the skin.
9. Breathing Instructions: Encourage the patient to breathe through their nose with their mouth closed for optimal oxygen delivery.
10. Assessment: Continually monitor the patient's respiratory status, noting any signs of respiratory distress.
11. Post-Procedure Hygiene: Remove PPE and perform hand hygiene post-procedure.
12. Maintenance: Regularly clean the cannula and assess the nostrils for irritation or bleeding.

Benefits and Limitations

The nasal cannula offers several advantages: It is easy to apply, comfortable for long-term use, and allows patient mobility. However, high flow rates can cause dryness and irritation, and the delivered oxygen concentration can vary depending on the patient's breathing pattern.