A Clinical Guide to Blen: Optimizing Oxygen Therapy

CONDUCT.EDU.VN offers A Clinical Guide To Blen, aiming to improve oxygen therapy through the provision of supplemental oxygen in a manner that is both safe and effective. This resource serves as an essential guide for healthcare professionals, students, and organizations seeking to understand and implement best practices in oxygen delivery, ensure patient safety, and optimize treatment outcomes. This article will cover the best practices and applications of oxygen therapy.

1. Understanding Oxygen Therapy

Oxygen therapy is a crucial medical intervention designed to increase the amount of oxygen available to the body’s tissues. This becomes necessary when a patient’s respiratory system is compromised, hindering its ability to absorb sufficient oxygen from the air. Conditions leading to this include pneumonia, asthma, chronic obstructive pulmonary disease (COPD), and heart failure. Supplying supplemental oxygen helps in various ways, including relieving hypoxemia, which is low oxygen levels in the blood, reducing the work of breathing, and maintaining adequate oxygenation of vital organs. According to the American Thoracic Society, oxygen therapy is a cornerstone in managing respiratory distress, helping patients maintain a quality of life when faced with chronic respiratory conditions.

2. Key Definitions in Oxygen Therapy

Understanding the terminology used in oxygen therapy is critical for healthcare professionals. Here are some essential terms:

FiO2 (Fraction of Inspired Oxygen): The percentage or fraction of oxygen in the gas mixture being delivered to the patient. Room air is approximately 21% FiO2.
PaCO2 (Partial Pressure of CO2 in Arterial Blood): A measure of carbon dioxide levels in arterial blood, indicating the effectiveness of ventilation. Normal range is 35-45 mmHg.
PaO2 (Partial Pressure of Oxygen in Arterial Blood): A measure of oxygen levels in arterial blood, reflecting how well oxygen is being transferred from the lungs to the blood. The normal range is 80-100 mmHg.
SaO2 (Arterial Oxygen Saturation): The percentage of hemoglobin in arterial blood that is saturated with oxygen, measured from a blood specimen.
SpO2 (Peripheral Oxygen Saturation): An estimate of arterial oxygen saturation measured non-invasively via pulse oximetry.
HME (Heat Moisture Exchange) Product: A device used to retain heat and moisture in the respiratory system, reducing moisture loss in the patient’s airway.
High Flow: Oxygen delivery systems that meet or exceed the patient’s peak inspiratory flow rate (PIFR), ensuring a precise FiO2.
Humidification: The process of adding moisture to a gas to prevent drying of the airways.
Hypercapnea: An elevated level of carbon dioxide in the blood.
Hypoxaemia: A lower than normal level of oxygen in the arterial blood.
Hypoxia: A condition where tissues do not receive enough oxygen.
Low Flow: Oxygen delivery systems that do not meet the patient’s total ventilatory requirements, leading to the entrainment of room air and dilution of FiO2.
Minute Ventilation: The total volume of gas inhaled or exhaled per minute, typically measured in liters per minute.
PIFR (Peak Inspiratory Flow Rate): The maximum flow rate of air during inspiration, measured in liters per second.
Tidal Volume: The amount of air that moves in and out of the lungs with each breath, measured in milliliters (6-10 ml/kg).
VQ (Ventilation-Perfusion) Mismatch: An imbalance between alveolar ventilation and pulmonary capillary blood flow.

3. Infection Control Measures

Infection control is paramount during oxygen therapy to prevent the spread of pathogens, especially in healthcare settings. According to the Centers for Disease Control and Prevention (CDC), standard precautions must be followed, which include hand hygiene, use of personal protective equipment (PPE), and proper cleaning and disinfection of equipment. During aerosol-generating procedures, such as nebulization, healthcare workers should use N95 respirators to minimize the risk of airborne transmission.

4. Target SpO2 Values

Appropriate SpO2 targets vary based on the patient’s condition. The following values serve as a general guide:

Patients Without Cyanotic Congenital Heart Disease or Chronic Lung Disease: 94-98% (PaO2 between 80 and 100 mmHg).
Post-Cardiac Surgery for Cyanotic Heart Disease: > 70% (PaO2 37 mmHg).
Unrepaired Congenital Cyanotic Heart Disease: > 60% (PaO2 32 mmHg).
Premature and Term Neonates: 91-95%.
(More information is available on CONDUCT.EDU.VN via Oxygen saturation SpO2 level targeting in neonates)
Infants with Bronchiolitis: ≥ 90% (link to Bronchiolitis CPG).

It’s important to individualize SpO2 targets based on the patient’s overall clinical condition and medical history. Any deviation from these target ranges should be clearly documented.

5. Indications for Initiating Oxygen Therapy

Oxygen therapy is indicated in several clinical scenarios to correct or prevent hypoxemia. The primary indications include:

Documented Hypoxia/Hypoxaemia: Confirmed by SpO2 readings or blood gas analysis (PaO2).
Respiratory Distress: Characterized by dyspnea, tachypnea, bradypnea, apnea, pallor, cyanosis, lethargy, restlessness, and use of accessory muscles (nasal flaring, intercostal or sternal recession, tracheal tug).
Acute or Emergency Situations: Where hypoxemia or hypoxia is suspected. More information can be found on CONDUCT.EDU.VN via the Assessment of Severe Respiratory Conditions guideline.
Short-Term Therapy: Such as post-anesthetic recovery or after surgical procedures.
Palliative Care: To improve comfort.

Healthcare providers should carefully assess the patient’s clinical condition to determine the necessity and appropriateness of oxygen therapy.

6. Nurse-Initiated Oxygen Therapy Protocols

Nurses often play a critical role in initiating and adjusting oxygen therapy under standing medical orders. Key points include:

Avoiding Hypoxaemia and Hyperoxaemia: Treatment should be initiated or adjusted to maintain SpO2 within target ranges.
SpO2 Thresholds: Oxygen is typically not needed if SpO2 is ≥ 92%, but it may be required if SpO2 falls below this level in patients without cyanotic heart disease.
Varying Oxygen Therapy: Nurses can adjust oxygen concentration and flow in most cases without specific medical orders, though medical directives take precedence.

Nurses should be guided by specific protocols that consider the patient’s age, clinical condition, and the trajectory of their illness.

7. Essential Patient Assessment and Documentation

Comprehensive patient assessment and thorough documentation are vital for effective oxygen therapy management. Recommended practices include:

Airway Assessment: Ensuring the airway is open and optimized (e.g., head tilt, chin lift).
Clinical Assessment: Regular assessment of cardiovascular, respiratory, and neurological systems, documented at the start of each shift and with any change in patient condition.
Equipment Checks: Documentation of oxygen equipment setup at the commencement of each shift, including flow rate, tubing patency, and humidifier settings.
Hourly Monitoring: Continuous monitoring and recording of heart rate, respiratory rate, respiratory distress (using descriptive assessments), and oxygen saturation. Continuous pulse oximetry is advised for unstable patients.
MET Criteria: Monitoring and adherence to individual Medical Emergency Team (MET) criteria.

Continuous monitoring and accurate documentation support timely and appropriate adjustments to oxygen therapy.

8. Oxygen Weaning Strategies

Weaning from oxygen therapy should be considered as soon as the patient’s condition stabilizes. Key steps include:

Clinical Stability: The child should appear clinically well, with vital signs within normal limits, minimal respiratory distress, adequate oral intake, and normal level of consciousness.
Trial Off Oxygen: Cease oxygen therapy entirely and observe the patient for about 5 minutes.
Reassessment: If SpO2 falls below 92% (or specific target), restart oxygen therapy at the lowest flow rate needed to maintain target SpO2.
Post-Wean Monitoring: Continuous pulse oximetry for 30 minutes post-cessation of oxygen therapy, followed by intermittent SpO2 monitoring every 30 minutes, then hourly for 2 hours.

Successful weaning involves careful observation and monitoring to ensure the patient can maintain adequate oxygenation without supplemental oxygen.

9. Selecting the Appropriate Oxygen Delivery Method

The choice of oxygen delivery method depends on various factors, including the patient’s age, oxygen requirements, tolerance, and humidification needs.

Age of the Patient
Oxygen Requirements/Therapeutic Goals
Patient Tolerance to Selected Interface
Humidification Needs

Quick Reference Table for Mode of Delivery

Delivery Method	Flow Rate	FiO2 (Approximate)	Humidification	Considerations
Nasal Prongs (Low Flow)	0-2 LPM (Infants/Children <2)	24-28%	Not Required	Monitor for nasal irritation; Patency of nares.
	0-4 LPM (Children >2)	28-35%	Not Required	Monitor for nasal irritation; Patency of nares.
	Up to 1 LPM (Neonates)	24-28%	Not Required	Monitor for nasal irritation; Patency of nares.
Nasal Prongs (Humidified)	Up to 4 LPM (Infants/Children <2)	24-35%	Required	Use humidification for higher flows to prevent mucosal drying.
	Up to 6 LPM (Children >2)	30-40%	Required	Use humidification for higher flows to prevent mucosal drying.
	Up to 10 LPM (Adolescents ≥ 30kg)	35-50%	Required	Use humidification for higher flows to prevent mucosal drying.
Simple Face Mask	5-8 LPM	35-50%	Optional	Minimum flow of 5 LPM to prevent CO2 rebreathing. Monitor mask fit.
Non-Rebreather Mask	10-15 LPM	60-80%	Not Recommended	Ensure reservoir bag remains inflated. Primarily for short-term use in emergencies.

The specific delivery method should be selected based on the individual patient’s requirements and clinical status.

10. Low-Flow Oxygen Delivery Systems

Low-flow systems do not meet the patient’s entire ventilatory requirements, causing room air to be mixed with the delivered oxygen, thereby diluting the FiO2. Common low-flow devices include:

Simple Face Mask
Non-Rebreather Face Mask
Nasal Prongs (Low Flow)
Tracheostomy Mask
Tracheostomy HME Connector
Isolette (Neonates)

Flow rates in low-flow systems are typically titrated in liters per minute (LPM).

11. High-Flow Oxygen Delivery Systems

High-flow systems deliver the patient’s entire ventilatory demand, ensuring a precise FiO2. Examples of high-flow devices include:

Ventilators
CPAP/BiPaP Drivers
Face Mask or Tracheostomy Mask with Airvo2 Humidifier
High-Flow Nasal Prong (HFNP) Therapy
(More information is available on CONDUCT.EDU.VN via High Flow Nasal Prong therapy (HFNP))

12. The Importance of Humidification

Humidification is essential when delivering oxygen therapy, particularly with high-flow systems, to prevent complications related to dry air. Cold, dry air can increase heat and fluid loss, damage mucous membranes, and thicken secretions.

Indications for humidification include:

Thick, copious secretions.
Non-invasive and invasive ventilation.
Nasal prong flow rates > 2 LPM (under 2 years) or > 4 LPM (over 2 years).
Nasal prong flow rates > 1 LPM in neonates.
Facial mask flow rates > 5 LPM.
Patients with tracheostomies.

12.1 Fisher & Paykel MR850 Humidifier

The Fisher & Paykel MR850 Humidifier delivers gas as close to body temperature as possible, with two modes:

Invasive Mode: Delivers saturated gas at 37 degrees Celsius (44mg/L), suitable for patients with bypassed airways, invasive ventilation, tracheostomy attachments, or CPAP in NICU.
Non-Invasive Mode: Delivers gas at 31-36 degrees Celsius (>10mg/L), suitable for patients receiving face mask therapy, non-invasive ventilation (CPAP/BiPAP), or nebulizer masks.

12.2 AIRVO 2 Humidifier

The AIRVO 2 Humidifier also has two modes:

Junior Mode: Uses a Junior Tube and Chamber Kit for Optiflow Junior Infant and Paediatric Nasal Prongs, with a minimum flow rate of 2 LPM.
Standard Mode: Uses a standard Tube and Chamber Kit for Optiflow adult nasal prongs, nebulizer masks, or tracheostomy masks, with a minimum flow rate of 10 LPM.

Ensure the AIRVO 2 Humidifier is cleaned and disinfected between patients.

13. Detailed Delivery Mode Guidelines

13.1 Nasal Prong Oxygen Therapy

Nasal prongs are a simple and convenient method for delivering oxygen, allowing therapy to continue during feeding/eating without the risk of CO2 re-breathing.

13.1.1 Nasal Prongs Without Humidification

For nasal prong oxygen without humidification, maximum flow rates are:

2 LPM in infants/children under 2 years.
4 LPM for children over 2 years.
1 LPM for neonates.

At these flow rates, humidification is typically not required.

Care and Considerations:

Position the nasal prongs along the patient’s cheek and secure with adhesive tape.
Position tubing over the ears and secure behind the patient’s head, ensuring straps and tubing are away from the patient’s neck to prevent airway obstruction.
Check nasal prongs and tubing for patency.
Check nares for patency and clear with suction as needed.
Change adhesive tape weekly or more frequently as required.

13.1.2 Nasal Prongs With Humidification

If flow rates exceed the recommended limits for non-humidified prongs, humidification is recommended to prevent nasal discomfort and irritation.

For nasal prong oxygen with humidification, maximum flow rates are:

4 LPM in infants/children under 2 years.
6 LPM for children over 2 years.
10 LPM for adolescents ≥ 30kg.

13.2 Optiflow Nasal Prongs With MR850 Humidifier

Optiflow nasal prongs can be used with humidified low- or high-flow oxygen delivery. The MR850 Humidifier should be set to Invasive Mode for Nasal Prongs Therapy.

Fisher and Paykel Optiflow nasal cannula junior range includes four sizes:

Premature
Neonate
Infant
Paediatric

The Fisher and Paykel Optiflow nasal cannula standard range includes three sizes:

Small
Medium
Large

13.3 High Flow

For high-flow systems:

Flow of 2 L/kg/min up to 12kg, plus 0.5 L/kg/min for each kg above 12kg (to a maximum of 50 LPM).
FiO2 21-50% (using a blender).
FiO2 above 50% requires PICU review.

14. Face Mask Oxygen Therapy

14.1 Simple Face Mask

The FiO2 inspired via a simple face mask varies based on the patient’s inspiratory flow, mask fit/size, and respiratory rate. A minimum flow rate of 4 LPM is required to prevent CO2 accumulation.

14.2 Nebulizer Mask / Tracheostomy Mask / Tracheostomy Direct Connection

These masks are designed for use with the AIRVO 2 Humidifier to ensure accurate oxygen concentrations (21-95%). Patients requiring FiO2 greater than 50% require PICU medical review.

14.3 Non-Rebreathing Face Mask

A non-rebreathing face mask delivers a high concentration of FiO2 (> 60%) via an oxygen reservoir bag and one-way valve system. Ensure the reservoir bag remains inflated and the flow rate is adequate to maintain inflation during the entire respiratory cycle.

15. Tracheostomy Oxygen Delivery

For spontaneously breathing tracheostomy patients requiring oxygen flow rates less than 4 LPM, options include:

OXY-VENT™ with Tubing: Adaptor sits over the TRACH-VENT™ and connects to the oxygen source.
TRACH-VENT+™: Hudson RCI HME with integrated oxygen side port.

HMEs are used without a heated humidifier circuit and should be changed daily or as needed.

16. Incubator Use for Oxygen Therapy

At RCH, oxygen therapy via an isolette is primarily used in the Butterfly neonatal intensive care unit.

17. Important Considerations and Precautions

Supplemental oxygen addresses hypoxemia but does not improve ventilation or treat the underlying cause.
Be cautious of high FiO2 use in patients with reduced minute ventilation.
Normal SpO2 values may mask rising blood carbon dioxide levels (hypercapnea).
Children with cyanotic congenital heart disease typically have SpO2 between 60-90% in room air; avoid increasing SpO2 > 90% unless necessary.

17.1 Potential Complications of Oxygen Use

CO2 Narcosis: Respiratory depression in patients with chronic hypercapnea.
Pulmonary Atelectasis
Pulmonary Oxygen Toxicity: Damage to the alveolar membrane with high concentrations of oxygen (>60%) inhaled for more than 48 hours.
Retinopathy of Prematurity (ROP): Affects premature neonates, potentially leading to visual impairment and blindness.
Substernal Pain: Chest pain and breathing difficulties with prolonged elevated oxygen pressures.

17.2 Oxygen Safety

Oxygen supports combustion; therefore, smoking is prohibited near oxygen equipment.
Avoid aerosol sprays in the same room.
Turn off oxygen when not in use.
Secure oxygen cylinders safely to prevent injury.
Do not store oxygen cylinders in hot places.
Keep oxygen equipment out of reach of children.
Avoid petroleum products or byproducts while using oxygen.

18. FAQ on Clinical Guide to Blen and Oxygen Therapy

What is the primary goal of oxygen therapy?
The primary goal is to maintain adequate oxygenation of tissues and vital organs by relieving hypoxemia and reducing the work of breathing.
When is oxygen therapy indicated?
Oxygen therapy is indicated for documented hypoxia, respiratory distress, acute emergencies, short-term therapy post-surgery, and palliative care.
What are the target SpO2 ranges for patients without cyanotic heart disease?
The target SpO2 range is typically 94-98%.
How do nurses initiate oxygen therapy without a specific medical order?
Nurses can initiate oxygen therapy based on standing medical orders, primarily when SpO2 falls below 92%.
What factors influence the choice of oxygen delivery method?
Factors include the patient’s age, oxygen requirements, tolerance, and humidification needs.
What are the maximum flow rates for nasal prongs without humidification in infants and children under 2 years?
The maximum flow rate is 2 LPM.
Why is humidification important in oxygen therapy?
Humidification prevents drying of the airways, reduces heat and fluid loss, and keeps secretions thin and easy to clear.
What is CO2 narcosis, and how does it relate to oxygen therapy?
CO2 narcosis occurs in patients with chronic respiratory obstruction, where high oxygen concentrations can reduce respiratory drive, leading to respiratory depression and increased PaCO2.
What safety precautions should be taken when using oxygen equipment?
Precautions include prohibiting smoking, avoiding aerosol sprays, turning off oxygen when not in use, securing oxygen cylinders, and avoiding petroleum products.
How often should patient assessment and documentation be performed during oxygen therapy?
Comprehensive patient assessment and documentation should be done at the commencement of each shift and with any change in patient condition, with hourly checks for specific parameters.

19. Additional Resources

For further information on best practices in oxygen therapy, consider the following resources:

Centers for Disease Control and Prevention (CDC): www.cdc.gov
American Thoracic Society: www.thoracic.org
Fisher & Paykel Healthcare: www.fphcare.com

20. Conclusion

Mastering the clinical guide to Blen ensures healthcare providers can deliver safe, effective, and patient-centered oxygen therapy. By understanding the indications, delivery methods, and potential complications, medical professionals can optimize patient outcomes and improve quality of life. This comprehensive guide is vital for anyone involved in respiratory care.

For more detailed guidance and resources, visit CONDUCT.EDU.VN to explore additional articles and guidelines tailored to your specific needs. At CONDUCT.EDU.VN, we understand the challenges in finding reliable guidelines and standards of care. That’s why we offer a comprehensive resource to address these concerns, ensuring you can access the information you need quickly and efficiently.

Address: 100 Ethics Plaza, Guideline City, CA 90210, United States

Whatsapp: +1 (707) 555-1234

Website: CONDUCT.EDU.VN

We encourage you to visit conduct.edu.vn today to discover how we can help you provide the best possible care.