11/13/24, 7\:18 PM Guide | Administration of oxygen

Administration of oxygen

Table of contents

Oxygen

The administration of supplemental oxygen is indicated for hypoxaemia. It is important to remember administering oxygen
does not treat the underlying cause of the hypoxaemia, and a thorough clinical assessment should be performed to identify
the cause.
Most hospital drug charts have a section for oxygen prescribing, including target oxygen saturations, oxygen delivery
device and desired
2.
For more information, see our guides to oxygen prescribing and oxygen delivery devices.

Oxygen cylinders

Oxygen cylinders are used in areas without a piped supply of oxygen (e.g. in pre-hospital settings or when transferring patients
in hospital).
In the UK, BOC supplies the majority of portable oxygen cylinders. Common sizes of BOC cylinders include\:
CD (460 litres) or ZD (600 litres)\: a small cylinder often found in emergency bags
HX (2300 litres) or ZX (3040 litres)\: a larger cylinder
Figure 1. A CD oxygen cylinder from BOC containing 460 litres of oxygen
These oxygen cylinders have integral valves which regulate pressure and control oxygen
may require a valve/oxygen cylinders
available from BOC.
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Calculating the duration of oxygen supply
Oxygen cylinders contain a
administered to the patient.
For example, a CD cylinder (containing 460L) will last approximately 30 minutes in a patient being given 15 L/min of
oxygen (460/15 = 30).
It is important to know the amount of portable oxygen available when administering oxygen using a cylinder. Further
oxygen cylinders may be required. In 2023, a national patient safety alert was raised due to incidents of patients coming
to harm because of a lack of portable oxygen (e.g. cylinders running out or being used when empty).

Piped oxygen

Most hospitals have a medical gas pipeline system to deliver oxygen to the patient's bedside and other clinical areas (e.g.
theatres) using a wall port and oxygen

Oxygen safety

When administering oxygen, there are several important safety considerations\:
Fire risk\: although oxygen is not
atmospheric oxygen concentration can increase with supplemental oxygen if there is inadequate ventilation. Patients must
not smoke or vape. Oxygen must not be used in an area with potential ignition sources.
Oil/grease (portable cylinders)\: oil or grease-based products (including hand creams and moisturisers) must not come into
contact with the cylinder due to the risk of ignition.
Compressed gas (portable cylinders)\: portable oxygen cylinders contain compressed oxygen and should not be damaged
or dropped. If possible, store oxygen cylinders in holders.
Risk of running out of oxygen (portable cylinders)\: ensure adequate oxygen supplies are available and monitor usage,
especially when transferring patients, even for short distances. Cylinders should be changed when the contents gauge
reaches the red zone as the remaining volume can quickly reduce.

Gather equipment

Gather the appropriate equipment\:
Oxygen cylinder (if being used instead of a piped supply)
Appropriate oxygen delivery device\: mask, nasal cannula, nebuliser etc
Pulse oximeter
The patient's oxygen prescription (in their drug chart)

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
“ Y o u r o x y g e n l e v e l s a r e a l i t t l e l o w . W e w a n t t o
g i v e y o u o x y g e n t h r o u g h a m a s k t o h e l p b r i n g t h e m b a c k u p . T h e m a s k m a y m a k e y o u r t o n gu e a n d m o u t h f e e l a l i t t l e d r y . W e
w i l l m o n i t o r y o u r o x y g e n l e v e l s t h r o u gh o u t u s i n g a p r o b e o n y o u r
b l o o d t o c h e c k y o u r o x y g e n l e v e l s .
"
Gain consent to proceed with oxygen administration.

Choose an appropriate mask and

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Check the patient's target oxygen saturations (usually 94-98%, or 88-92% in those at risk of type 2 respiratory failure) - this
may be written on their drug chart.
Choose an appropriate oxygen mask and
Nasal cannulae\: 2 - 4 L/min (for patients with mild hypoxaemia who only need low-
Simple face mask\: 5 - 10 L/min
Venturi mask\: COPD)
Non-rebreather mask\: 15 L/min (for critically unwell patients)
When using a non-rebreather mask, the reservoir bag must be
reservoir bag, obstruct the valve with your
For more information on the dioxygen
prescribing and oxygen delivery devices.
Oxygen can also be used with a bag-valve-mask (BVM) during resuscitation and ventilation. For more information, see our
guide to airway equipment.

Administer oxygen

Portable cylinder

These instructions are for a BOC cylinder with an integral valve (CD/ZD/HX/ZX) commonly used in UK hospitals. Di
cylinders will have di
an oxygen cylinder if you have not been trained.
If possible, a portable oxygen cylinder should be set up away from the patient.
1. Ensure your hands are clean and any alcohol gel has evaporated before you handle the cylinder.
2. Check the cylinder contains oxygen (this will be marked on the cylinder) and perform a quick visual inspection to ensure that
the cylinder is undamaged.
3. Check the cylinder's expiry date and contents gauge (Figure 2). Do not use the cylinder if it has expired or is empty.
Figure 2. The contents gauge of a CD portable oxygen cylinder (this cylinder is empty)
4. Check the cylinder is o
5L/min - no oxygen should come out of the cylinder. Return the
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5. Connect the oxygen tubing attached to the mask/nasal cannula to the cylinder outlet (the small metal outlet - Figure 4).
6. Slowly open the cylinder valve using the handwheel (Figure 5)
7. Select an appropriate
8. Place the oxygen mask or nasal cannula on the patient
Figure 3. The
Troubleshooting
If no oxygen is being delivered to the patient, check the oxygen cylinder is switched on (using the valve in Figure 5) and that a

the mask, as the tubing can become dislodged, especially if the patient is moving.

Piped oxygen

In a piped oxygen system, a
indicate the current
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Figure 6. A
1. Connect the oxygen tubing attached to the mask/nasal cannula to the
2. Turn the valve to start the
3. Adjust the valve until the ball is in the middle of the line of the desired
Figure 7. The ball of the
In neonatal settings, micro
L/min).
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To complete the procedure…

Explain to the patient that oxygen is now being administered.
Monitor the patient, including oxygen saturations and arterial blood gas (if required). Titration of the
di
Dispose of PPE appropriately and wash your hands.
Document that oxygen has been administered (including indication,
prescription chart.

Reviewers

Dr Sachin Ananth
Internal Medicine Trainee and Lead Respiratory Author at Geeky Medics
E R df & A d E itt D b
Source\: geekymedics.com
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