Remote Primary Health Care Manuals

Giving oxygen

Table 6.3 Oxygen flow rates  

Oxygen delivery system Oxygen flow rate —
Infant under 1 year
 		 Oxygen flow rate —
Child 1–9 years
 		 Oxygen flow rate —
10 years and over		 Examples of medical conditions
Nasal prongs / cannula
(not humidified)		 1–2L/min 1–2L/min 2–4L/min
  • Bronchiolitis
  • Mild pneumonia
  • COPD
Target O₂ sats — 94–98%
Simple mask
(eg Hudson mask)		 5–10L/min
  • Bronchiolitis
  • Pneumonia
  • Chest pain with hypoxia or breathlessness
  • Moderate asthma
Target O₂ sats — 94–98%
Non-rebreather mask 10L/min 10–15L/min 15L/min
or more
  • Critically ill but adequate breathing — shock, major trauma, sepsis
Target O₂ sats — 94–98%
Make sure flow from wall/cylinder to mask is enough to keep reservoir bag fully inflated during whole respiratory cycle (inspiration and expiration)
Air-entrainment (venturi) mask
 		 Variable
L/min		 Variable
L/min		 Variable
L/min
  • COPD
  • Bronchiectasis
  • Morbid obesity
Target O₂ sats — 88–92%
Bag-valve-mask
(BVM)		 15L/min 15L/min 15L/min
  • Respiratory arrest
  • Cardiac arrest
  • Inadequate spontaneous ventilation
Target O₂ sats — 100%

How much oxygen to give (adult and child)

  • Important to check person's response to oxygen treatment often, and increase or decrease if needed. If not sure — medical consult
  • Aim for O₂ sats of 94–98%
  • If improving — use less oxygen via nasal prongs
  • If not breathing, or very poor respiratory effort — use bag-valve-mask at 8–15L/min
  • If critically unwell — use non-breather mask at 10–15L/min
  • If condition such as chest pain or respiratory condition (eg pneumonia, asthma) — first use simple oxygen mask (eg Hudson mask) at 5–10L/min
  • If moderate/severe COPD — use nasal prongs or air-entrainment (venturi) mask and less oxygen — aim for O₂ sats of 88–92%

Oxygen delivery devices

Nasal prongs/cannula — Figure 6.23

  • Uses
    • Oxygen needed for long periods. Lets person eat, drink, talk
    • Babies/young children with pneumonia who won’t tolerate face mask
  • Flow rate
    • 2L/min = 28% inspired oxygen concentration
    • 4L/min = 36% inspired oxygen concentration

Figure 6.23  

Nasal prongs.

Simple mask — Figure 6.24

  • Uses
    • Adults/older children with pneumonia or other moderate respiratory illness
  • Flow rate
    • 5–6L/min = 40% inspired oxygen concentration
    • 7–8L/min = 60% inspired oxygen concentration
    • Need to give over 4L/min (child) or 6L/min (adult) to remove expired air from mask and prevent rebreathing of CO2
    • Giving over 10L/min does not increase percentage of oxygen given

Figure 6.24  

Simple oxygen mask.jpg

Non-rebreather mask — Figure 6.25

  • Uses (for high flow oxygen)
    • Critically ill but adequate breathing — shock, major trauma, sepsis
  • Before using — make sure
    • Reservoir bag full
    • Mask seals properly around mouth and nose (strap tight)
  • Flow rate
    • 15L/min = 85–90% inspired oxygen concentration

Figure 6.25  

oxygen - reservoir bag.jpg

Air-entrainment (venturi) mask — Figure 6.26

  • Uses
    • Acute exacerbation of COPD
  • Flow rate
    • Gives 24%, 28%, 31%, 35%, 40%, or 60% inspired oxygen concentration
    • Oxygen must be set at recommended flow rate for required concentration
    • Flow rate listed on valve

Figure 6.26  

Venturi high flow mask.

Bag-valve-mask — Figure 6.27

  • Uses (for positive pressure ventilation)
    • Not breathing (apnoea), cardiac arrest, inadequate respiratory effort
  • Before using — make sure
    • Valve opens properly
    • Reservoir bag full
    • Mask seals properly around mouth and nose (essential)
    • Airway open (essential)
  • Flow rate
    • 15L/min = 90–100% inspired oxygen concentration

Figure 6.27  

oxygen - bag-valve-mask.jpg