Which Oxygen Delivery Device Should I Choose?

Oxygen Delivery Devices

The four oxygen delivery devices are:

1. Nasal cannula
2. High-flow nasal cannula
3. Simple face mask
4. Venturi mask

Clinicians may also use a non-rebreather mask.

Four Oxygen Delivery Devices

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Nasal Cannula

The nasal cannula is one of the most commonly used oxygen devices. It is a two-prong system that fits into the patient’s nose, and it’s hooked up to the oxygen on the wall. A clinician sets the nasal cannula according to liters per minute, otherwise known as the flow rate. A nasal cannula allows the patient to continue to eat, drink, and talk.

A nasal cannula is a two-prong system that delivers oxygen into the patient’s nose.

It’s important that providers note flow rate is not the amount of oxygen a patient is receiving, it’s the flow rate programmed by the clinician in the wall dial. A typical flow is between 1–6 liters per minute, so the patient receives anywhere between 25–45% FiO₂. That is the actual amount of oxygen the patient receives.

The nasal cannula is considered a low-flow device, so it delivers a low amount of oxygen into the nose. Low-flow devices are not able to deliver a precise amount of oxygen.

High-flow devices deliver a high amount of oxygen into the patient at a precise amount.

The nasal cannula fits into the patient’s nostrils.

Clinicians use a nasal cannula for stable patients, setting the flow rate so the patient receives approximately 25% FiO₂.

A patient experiencing respiratory distress has an elevated respiratory rate. The tachypnea greatly reduces their FiO₂. Clinicians can’t control how much FiO₂ this patient receives, so a nasal cannula is insufficient. Nasal cannulas do not help with ventilation or the removal of CO₂, so clinicians should only use them for stable patients.

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High-Flow Nasal Cannula

The high-flow nasal cannula is gaining popularity. It’s useful for patients with COPD because it can apply a positive end-expiratory pressure (PEEP) effect.

The PEEP effect keeps the alveoli open at the end of expiration by continuing to apply pressure, assisting with ventilation and CO₂ removal. 

The high-flow nasal cannula is a high-flow device. Clinicians can set a flow rate up to 60 L/min, giving the patient up to 100% FiO₂. But providers should not put anyone on 100% FiO₂ because it can lead to oxygen toxicity, acute respiratory distress syndrome (ARDS), and other complications.

A high-flow nasal cannula administers heated, humidified oxygen — a panacea for a patient’s nasal passages. A standard nasal cannula may dry out the nasal passage, which is problematic for patients on blood thinners. They may experience nosebleeds due to the higher risk of bleeding. 

A high-flow nasal cannula has longer tubing and looks different than the typical nasal cannula, but the patient can still talk, eat, and communicate.

A note on the Oxygen Flow rate for patients with COPD

The provider should not set the cannula oxygen flow rate above 6 L/min for patients with COPD. These patients breathe differently compared to a patient without COPD.

In a patient without COPD, CO₂ builds up in the body and stimulates their breathing. Patients with COPD become tolerant to the higher levels of CO₂, so it doesn’t stimulate their drive to breathe. Instead, hypoxemia stimulates COPD patients breathing, so their drive to breathe is called a hypoxic drive.

Simple Face Mask

Clinicians use simple face masks for patients that aren’t responding well to a nasal cannula due to mouth breathing. A simple face mask can administer more FiO₂, but it’s not the preferred choice for a few reasons: 

• It’s harder for the patient to talk.
• It hinders the patient’s ability to eat.
• Claustrophobic patients may not tolerate a simple face mask.

The simple face mask is useful for people who prefer to breathe through their mouths.

Venturi Mask

The Venturi mask is considered a high-flow device. It’s connected to blue-green plastic tubing and allows providers to select the precise amount of FiO₂.

The Venturi mask is adjustable and delivers a specific amount of FiO₂.

The Venturi mask is designed to offer different levels of FiO₂ using different color-coded adaptors. By attaching different color adaptors, the mask directs a specific amount of FiO₂. For example, the yellow adaptor administers 35% FiO₂. Some Venturi masks have a dial to adjust the FiO₂.

The Venturi mask flow rate is between 4-8 L/min. The mask doesn’t determine how much oxygen the patient is receiving. Instead, FiO₂ determines how much oxygen the patient is receiving, and the Venturi mask precisely delivers specific levels of FiO₂.

Non-Rebreather Mask

The non-rebreather mask is an oxygen delivery device used in emergency situations and consists of a face mask connected to a reservoir bag.

Non-rebreather masks have:

• A flow rate of up to 15 L/min.
• An FiO₂ level up to 100%.
• A low-flow device classification.
• A one-way valve to prevent breathing in exhaled air.

Often, a non-rebreather mask is used if a patient requires mechanical ventilation and is about to be intubated. Clinicians may use the non-rebreather mask to keep the patient’s oxygen saturation up during pre-intubation.

A non-rebreather mask is typically used in emergency situations.

Providers must make sure the non-rebreather mask’s bag is fully inflated. They also should not leave a patient on a rebreather mask for longer than 24 hours. These masks are short-term fixes, and if a patient continuously requires a non-rebreather, they should receive a more invasive oxygen delivery intervention, such as intubation or mechanical ventilation.

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Summary

The four main types of oxygen delivery devices are nasal cannula, high-flow nasal cannula, Venturi, and a simple face mask. 

The nasal cannula and simple face mask are low-flow devices providers typically use on stable patients or mouth breathers.

High-flow devices include the high-flow cannula and Venturi masks, and providers use them to more accurately maintain FiO₂.