Administering oxygen

Oxygen is used throughout healthcare for patients of all ages, and is one of the most common drugs used in a medical emergency (National Institute for Health and Care Excellence, NICE, 2022). Nurse must be competent and able to understand the basic components of administering oxygen, as this is an essential skill. This is highlighted in the standards of proficiency for registered nurses (Nursing and Midwifery Council, 2018a), and is in line with the British Thoracic Society guideline for oxygen use in adults in healthcare and emergency settings (O’Driscoll et al, 2017).

Oxygen administration has been defined as:

Oxygen is classified as a drug, which must be prescribed and titrated towards the patient’s specific oxygen saturation range (Hiley

When assessing a patient’s respiratory system, a systematic assessment is required based upon several components. These including using the ‘look, listen and feel approach’ in conjunction with inspection, palpation, percussion and auscultation, as well as measuring the patient’s oxygen saturations and respiratory rate (UK Resuscitation Council, 2019). A full set of physiological observations should be recorded in line with the National Early Warning Score 2, documented appropriately and escalated if required (Royal College of Physicians, 2017). This systematic approach will allow the healthcare professional to assess the patient fully and commence a management plan for the patient to meet the patient’s requirements.

• personal protective equipment– appropriate to the specific risk assessment
• watch with a second hand, to count the respiratory rate in conjunction with the oxygen saturations
• oxygen saturation probe
• piped wall oxygen or cylinder oxygen
• oxygen flow meter or regulator
• oxygen tubing
• appropriate oxygen mask or nasal cannula or bag, valve and mask
• appropriate documentation (Davison et al, 2020)

1. Introduce yourself to the patient, and confirm that this is the correct patient. This can be done by asking the patient to confirm their details, as well as checking the identification band
2. Explain to the patient what you are intending to do and obtain consent
3. Decontaminate hands appropriately
4. Wear appropriate personal protective equipment if appropriate to the specific risk assessment
5. Assess the patient observations and use appropriate scoring system in line with the trust's policy and procedure e.g. National Early Warning Score 2 (Royal College of Physicians, 2017).
6. Make sure you have the appropriate oxygen saturation probe for the patient, that it is attached to the appropriate area of the body such as finger, ear, toe or foot and that the device has been calibrated correctly. Once attached rotate on a regular basis to prevent pressure ulcers (NHS England, 2018). The NHS Race and Health Observatory (2021) released recommendations and

There are several risks and complications regarding oxygen. Oxygen has no smell, taste or colour to it. Although, oxygen is not classed as combustible it can be very reactive, therefore should not be near naked flames or sparks, alcohol and other flammable liquids, and should be stored appropriately and safely. When not in use, it should be stood up in a locked environment (Health and Safety Executive, 2013).

Other considerations when caring for a patient who requires oxygen should include:

1. Avoiding any oil and grease around oxygen connections, including putting petroleum jelly on or around the mouth and nose 
2. Making sure no one smokes around oxygen and that a fire extinguisher is readily available at all times nearby (Health and Safety Executive, 2013). 

During a cardiac arrest or during elective cardioversion when using a defibrillator or automatic external defibrillator, the oxygen supply must be managed appropriately by a competent healthcare

Review the patient on a regular basis by undertaking a systematic assessment and documenting throughout, escalating where necessary to the appropriate healthcare professionals. Continuous skin assessment should also be carried out to check for any wounds or sores especially around the ears, mouth and nose, depending upon the equipment used. Once completed, everything must be documented within the patient records and signed on the patient’s prescription, as this is trust policy and in line with the Nursing and Midwifery Council’s (2018b) code of conduct.

References

Davison L, McSporran W, Brady G et al. Respiratory Care, CPR and blood transfusion. The Royal Marsden of Clinical Nursing Professional Edition, 10th edn. Hoboken:Wiley and Son Ltd; 2020.

Dhruve H, Davey C, Pursell J. Oxygen therapy: emergency use and long-term treatment. Pharm J. 2015;7(5).

Health and Safety Executive. Oxygen use in the workplace: Fire and explosion hazards. 2013. https://www.hse.gov.uk/pubns/indg459.pdf (accessed 9 November 2022)

Hiley E, Rickards E, Kelly CA. Ensuring the safe use of emergency oxygen in acutely ill patients. Nursing Times. 2019;115(4):18-21

McCoy RW. Options for home oxygen therapy equipment: Storage and metering of oxygen in the home. Respir Care. 2013;58(1):65-80. https://doi.org/10.4187/respcare.01932

National Institute for Health and Care Excellence. Oxygen. 2022. https://bnf.nice.org.uk/treatment-summary/oxygen.html (accessed 9 November 2022)

Nevin M, Faulds S. Oxygen Therapy: Venturi System. 2017. https://www.elsevierclinicalskills.co.uk/SampleSkill/tabid/112/Default.aspx/sid/1641 (accessed 9 November 2022)

NHS Improvement. Patient Safety Alert: Risk of harm from inappropriate placement of pulse oximeter probes. 2018. https://www.england.nhs.uk/wp-content/uploads/2019/12/Patient_Safety_Alert_-_Placement_of_oximetry_probes_FINAL.pdf