Oxygen Administration with an Oxygen Tank

Emergency Intervention, Respiratory

Discussion: Just in Time Learning

 

Considerations:

  • Medical oxygen is classified by the Food and Drug Administration (FDA) as a drug; therefore, a prescription from a health care provider is required.
  • Portable liquid oxygen tanks can be refilled from a home-based liquid oxygen system.
  • These tanks are student specific and only indicated as part of the student’s Individualized Health Care Plan (IHCP) and Emergency Action Plan (EAP)/heatlh care provider’s order.
  • The school nurses should establish a schedule to periodically check the oxygen tank to ensure that there is sufficient oxygen.
  • School nurse should notify the fire marshal about the presence of an oxygen tank in the school and ask about instructions regarding signage and storage.

Supplies:

  • Oxygen tank
  • Oxygen delivery method
  • Oxygen tubing
  • Health care providers order
  • Individualized Health Care Plan (IHCP) and/or Emergency Action Plan (EAP)/Health care provider’s orders
  • Parent/Guardian authorization form

Methods of Oxygen Delivery:

Nasal Cannula:

  • Plastic tube that connects on one end to an oxygen source (tank) with the other end having two short prongs that each fit into the nostrils
  • Generally indicated as an option for planned use of continuous or intermittent oxygen

Mask: 

  • A plastic face mask with tubing connected to an oxygen source
  • The two main sizes of oxygen masks are pediatric and adult
    • They are generally indicated for emergency situations

Tracheostomy Mask:

  • A plastic mask designed to fit over a tracheostomy cannula and secured by an elastic strap around the neck (over the tracheostomy ties)
  • This may be indicated for planned use of continuous or intermittent oxygen

Mechanical Ventilation:

  • A variety of portable mechanical ventilation devices may be used for children who attend school
  • They are attached to the student via a tracheostomy and may or may not involve the routine delivery of supplemental oxygen

Ambu Bag (Manual Resuscitation):

  • In the case of extreme medical emergency (i.e., severe oxygen desaturation, impending respiratory failure, or respiratory or cardiac arrest), oxygen can be delivered at full flow (> 10 L/min.) with an Ambu Bag using an appropriately sized sealed face mask or fitted directly onto a tracheostomy cannula

High pressure tanks (standard metal oxygen tanks): (standard metal oxygen tanks):

Require a regulator that has:

  1. A valve to turn the oxygen source on and off
  2. A flow meter to measure and adjust the flow of oxygen
  3. A pressure gauge to determine the amount of oxygen remaining in the tank

Administering Oxygen with an Oxygen Tank Procedure:

  1. Call for assistance, if needed
  2. Wash hands, if possible
  3. Position the student to provide as much privacy as possible
  4. Explain procedure to student at a level they will understand
  5. Review the health care provider’s order to determine:
  • Dose of oxygen
  • Route of administration
  • Duration of administration
  1. Review the six rights of medication administration to ensure it is:
    1. The right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  2. Ensure proper documentation of parent/guardian authorization to administer medication
  3. Open the tank by turning the valve at the top counterclockwise until the needle on the pressure gauge moves
    1. When the oxygen tank is turned on and working properly the pressure gauge needle should be resting between 1800-2200 psi
  4. Review the six rights of medication administration again to ensure it is:
    1. The right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  5. Set the flow meter to the prescribed rate (liters/minute) by turning the dial to the number or until the ball rises to the correct level on the scale
  6. Connect the oxygen tubing to the oxygen tank

If using a nasal cannula:

  1. Place prongs into nose so they follow the curve of the nostrils
  2. Place tubing over and behind each ear with adjustor comfortably under the student’s chin
    1. When using nasal cannula, take care not to put undue pressure on the nasal tissue from tightening the attachment too much

If using a face mask (face masks are for short-term oxygen therapy):

  1. Place mask over nose and mouth
  2. Secure with elastic strap around the head and above the ears
  3. The mask needs to be comfortably, but firmly against the face
  4. Adjust the elastic strap so that the mask fits snugly but comfortably on the face

If using a tracheostomy mask:

  1. Follow the same procedure as a facemask, except cover the tracheostomy cannula with the mask and secure it around the neck

If using an Ambu Bag:

  • This is considered an advanced procedure and should be performed by someone who has been trained in advanced care
  1. Turn oxygen flow rate to 10-15 L/min
  2. Ensure that the mask is connected to the bag device, the oxygen tubing is connected to the oxygen source
    1. This can be done by visualizing or listening to the open end of the reservoir or tail
      1. If air is heard flowing the oxygen tubing is attached an is turned on
    2. If possible and not contraindicated, slightly hyperextend the student’s neck
    3. If unable to hyperextend, use jaw-thrust maneuver to open the airway
    4. Place mask over the student’s face with opening over oral cavity
    5. If mask is teardrop-shaped, the narrow portion should be placed over the bridge of the nose
    6. Use the thumb and index finger of one hand to make a “C” on the side of the mask, pressing the edges of the mask to the face to form a seal around the student’s face.
    7. Use the remaining three fingers on the same hand to lift the angles of the jay to open the airway and press the mask to the face
    8. Using the remaining hand, squeeze the bag to give a breath over 1 second, watching the chest for symmetric rise
    9. Deliver the breaths with the student’s own inspiratory effort, if present
    10. Avoid delivering breaths when the student exhales
    11. Deliver one breath every 5 to 6 seconds if student’s own respiratory effort is absent
    12. Continue delivering breaths until the student’s respiratory rate returns or until rescue personnel arrive and take over care

Procedure to Close the Tank:

  1. Disconnect oxygen from the student
  2. Turn the valve clockwise until it cannot go any further. The flow meter should steadily decrease to zero, indicating that no oxygen is flowing (or leaking) from the tank (referred to as “bleeding” the tank off)
  3. Turn the flow meter dial to zero
  4. A tank is turned off when the pressure gauge needle turns to zero
  5. Tank needs to be stored in a secured upright position to prevent it from falling or tipping over
    1. The company that supplies the oxygen tank can provide specific storage instructions
  6. Storage area for oxygen tank must be free of petroleum products

Post Procedure Instructions:

  1. Dispose of all used materials in proper receptacles
  2. Remove gloves and wash hands
  3. Follow up with the parent or guardian and health care provider, as needed
  4. Document medication administration in the student’s medication administration log
  5. Check student’s health care orders or discuss with health care provider regarding how often oxygen tubing is replaced

References:

Lynn, P. (2019). Using a manual resuscitation bag and mask. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 338-339).

Lynn, P. (2019). Administering oxygen by mask. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (p. 313).

Lynn, P. (2019). Administering oxygen by nasal cannula. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (p. 312).

Pediatric Home Services. (2007). Deliver oxygen with an oxygen tank (Cómo administrar oxígeno con un tanque de oxígeno). Retrieved June 6, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/deliver-oxygen-with-an-oxygen-tank/?play=1

Pediatric Home Services. (2007). Oxygen connections (Conexiones de oxígeno). Retrieved June 6, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/deliver-oxygen-with-an-oxygen-tank/?play=1

Pediatric Home Services. (2007). Using a resuscitation bag (Bolsa de reanimación). Retrieved June 6, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/using-a-resuscitation-bag/?play=1

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Applying an oxygen-delivery device. In Clinical nursing skills and techniques. (10th ed.). (pp. 712-719). St. Louis, MO: Elsevier.

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Using home oxygen equipment. In Clinical nursing skills and techniques. (10th ed.). (pp. 1248-1255). St. Louis, MO: Elsevier.

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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing


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Page last updated: February 16, 2024/no video

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