Oxygen Delivery Devices

Nursing considerations:

• Most comfortable device; allows eating, drinking, and talking
• Appropriate for mild hypoxia (SpO₂ 88–94% range depending on patient condition)
• Flow above 4 L/min should use humidification to prevent mucosal drying
• FiO₂ is imprecise — affected by mouth breathing and respiratory rate
• Nasal prongs should sit just inside the nostrils; check skin behind ears and nares for pressure injury

Nursing considerations:

• Minimum flow of 5 L/min required to flush exhaled CO₂ from the mask
• Side vents allow room air entrainment, reducing FiO₂ precision
• Must be removed for eating, drinking, and oral medications — switch to NC during meals if oxygenation allows
• Assess mask fit to avoid air leaking around the edges

Nursing considerations:

• Delivers the most precise FiO₂ — preferred when controlled O₂ is essential (COPD, type II respiratory failure)
• Works by entraining a fixed ratio of room air through jet ports — the adapter color specifies both the FiO₂ and required flow rate
• Particularly important in COPD patients at risk of hypercapnia — avoid overshooting FiO₂ targets (excess O₂ worsens CO₂ via V/Q mismatch, not loss of "hypoxic drive")
• FiO₂ remains stable regardless of breathing pattern

Nursing considerations:

• Highest FiO₂ achievable without mechanical ventilation or HFNC
• Reservoir bag must remain inflated at all times — inflate before applying
• One-way valves prevent exhaled CO₂ from re-entering the reservoir bag
• Used for serious hypoxia, CO poisoning, respiratory emergencies
• If the bag deflates with inspiration, increase flow rate
• Not appropriate for long-term use — patient should be reassessed for escalation or de-escalation of therapy

Nursing considerations:

• Delivers heated and humidified oxygen — reduces mucosal drying and improves tolerance at high flows
• High flow provides a small degree of PEEP (~1 cmH₂O per 10 L/min) and flushes nasopharyngeal dead space
• FiO₂ and flow are set independently — allows precise titration
• Used in acute hypoxic respiratory failure, post-extubation, high-risk procedures
• Requires specialized equipment (Optiflow or equivalent heated humidifier system)
• Monitor closely — HFNC failure requiring intubation can be rapid

• Titrate to target SpO₂ — typical targets: 94–98% (general), 88–92% (COPD/hypercapnic risk). Follow the provider order.
• Never give "more oxygen is better" — hyperoxia causes vasoconstriction, worsened outcomes in MI and stroke, and can precipitate hypercapnia in COPD (via V/Q mismatch and the Haldane effect — titrate to 88–92%, do not withhold O₂).
• Ensure humidification at higher flows to prevent mucosal injury.
• Assess skin integrity regularly — nasal cannula prongs, mask edges, and tubing cause pressure injuries.
• Verify connections and reservoir bag inflation before applying any mask device.
• Document: device type, flow rate/FiO₂ setting, SpO₂ response, and patient tolerance.