Guidelines for Proper Oxygen Device Delivery

Oxygen Delivery Principles

The proper oxygen device should be selected based on the patient's clinical condition, target oxygen saturation range, and risk of hypercapnic respiratory failure, with nasal cannulae being the first-choice delivery device for most patients requiring home or hospital oxygen therapy 1, 2
Oxygen is a treatment for hypoxemia, not breathlessness, and should be administered by staff trained in oxygen administration 3
Oxygen should be prescribed according to a target saturation range, and those administering oxygen therapy should monitor the patient to keep within this target range 3
For most acutely ill patients without risk of hypercapnic respiratory failure, aim for a target saturation of 94-98% 4
For patients with COPD or other risk factors for hypercapnic respiratory failure, aim for a target saturation of 88-92% 5, 4

Nasal cannulae are recommended as the first-choice delivery device for most patients requiring oxygen therapy 1, 2
The flow rate for nasal cannulae should be adjusted between 2-6 L/min for medium-concentration oxygen therapy to achieve desired target saturation 2
For patients at risk of hypercapnic respiratory failure, use 1-2 L/min with nasal cannulae 2, 6
Simple face masks deliver oxygen concentrations of 40-60% at flow rates of 5-10 L/min, but flow rates should never be below 5 L/min due to risk of carbon dioxide rebreathing 2, 7
Venturi masks are recommended for patients requiring precise control of FiO₂ and can deliver constant FiO₂ of 24%, 28%, 31%, 35%, 40%, and 60% oxygen 2, 7
High-concentration reservoir masks deliver oxygen concentrations of 60-90% at a flow rate of 15 L/min, but are not suitable for patients at risk of hypercapnic respiratory failure 2, 6, 7

Oxygen saturation should be observed for at least 5 minutes after starting oxygen therapy or after changing concentration 1
Record oxygen saturation, delivery system, and flow rate on the patient's monitoring chart 1, 3
Most stable patients should have saturation measured after 1 hour of oxygen therapy and then four-hourly 1
Patients with signs of critical illness should have oxygen saturation monitored continuously 8
Pulse oximetry should be available in all locations where emergency oxygen is used 3
For patients at risk of hypercapnic respiratory failure, arterial or arterialised capillary blood gases should be measured 30-60 minutes after an increase in oxygen therapy 8

For perioperative and postoperative care, medium-concentration masks or nasal cannulae are usually sufficient, except for COPD patients 6
In emergency departments, consider the risk of hypercapnic respiratory failure when selecting devices 6
For general and respiratory wards, device selection depends on expected duration of treatment, type of respiratory illness, breathing pattern, need for humidification, risk of CO₂ retention, and patient compliance 6

Ensure all clinicians prescribing oxygen have appropriate training 8
Every hospital should have a training program to ensure clinical staff are familiar with oxygen administration policies 8
For home oxygen therapy, ensure patients/caregivers understand safety recommendations including proper storage of cylinders, no smoking near oxygen, and avoiding naked flames 6