Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [198], C).
2. 2.Show
   Decontaminate hands with an alcohol‐based handrub. Hands should be cleansed before and after each patient contact.
   To minimize the risk of healthcare‐associated infection (NHS England and NHSI [179], C).
3. 3.Show
   Monitor the patient's oxygen saturations and respiratory rate to determine whether a low‐, medium‐ or high‐flow device is required. Take into consideration the advantages and disadvantages (as described in Table 12.5) to help guide the choice of device. Seek expert help if required.
   To ensure that the most appropriate device for oxygen delivery is chosen to suit the patient's condition and requirements (O'Driscoll et al. [209], C).
4. 4.Show
   Except in emergency situations, ensure an oxygen prescription is in place with clear target oxygen saturations.
   Medical oxygen is a drug and so requires a prescription (Brill and Wedzicha [31], C).

   Patients at risk of hypercapnic respiratory failure should have target saturations of 88–92% (GOLD [91], C).

   Those not at risk should have target saturations of 94–98% (O'Driscoll et al. [209], C).

   Oxygen can be administered in an emergency without a prescription; however, it should be prescribed at the earliest opportunity (Dhruve et al. [65], C).

Procedure

1. 5.Show
   Attach oxygen tubing to the port on the wall or cylinder (and not to the medical air port).
   To ensure oxygen will be delivered. E

   The administration of air rather than oxygen will cause hypoxia (NHS Improvement [180], C).
2. 6.Show
   If a cylinder is used, remove the plastic side cap and turn the valve before adjusting the flow to the desired setting.

   If wall oxygen is used, set the flow meter to the desired setting.

   Check oxygen is flowing through the system by using fingertips.
   To ensure the system is turned on and oxygen is being delivered (NHS Improvement [181], C).
3. 7.Show
   Either:
    
   Apply a nasal cannula by gently placing the nasal prongs of the cannula into the patient's nostrils. Drape the tubing over the patient's ears and slide the fit connector up under the chin to hold the tubing securely in place.
   To ensure the cannula is correctly applied and to ensure maximum oxygen delivery. E
   Or:
    
   Apply an oxygen mask by placing the mask over the patient's mouth and nose, then pull the elastic strap over the head and adjust the strap on both sides to secure the mask in a position that seals it against the face.
   To ensure the mask is correctly fitted and is comfortable for the patient. E
   Or:
    
   On a reservoir mask, first cover the one‐way valve with fingers until the reservoir bag is fully inflated. Then apply the mask as described above.
   To ensure the reservoir is fully inflated before applying the reservoir mask onto the patient. E

Post‐procedure

1. 8.Show
   Record what device has been used, as well as the flow rate and concentration (if applicable). Record what time the therapy was commenced.
   To maintain accurate records (NMC [198], C).

   To help guide treatment. E
2. 9.Show
   Check patient observations and National Early Warning Score (NEWS) 5 minutes and again 1 hour after starting oxygen therapy as a minimum.
   To observe for any deterioration in the patient's condition, to assess the effectiveness of the intervention and to help guide treatment (O'Driscoll et al. [209], C).
3. 10.Show
   Increase or reduce oxygen flow and/or concentration to achieve the target oxygen saturations.
   Oxygen should be titrated up to overcome hypoxia but avoid hyperoxia, especially in patients with known chronic obstructive pulmonary disease (Brill and Wedzicha [31], C).
4. 11.Show
   Provide continued reassurance to the patient and allow them the opportunity to ask questions.
   To minimize apprehension and anxiety and to improve concordance with treatment. E
5. 12.Show
   Inspect the patient's skin regularly around the face, ears and back of head.
   To ensure pressure sores are not developing where the oxygen device comes into contact with the patient's skin. E