Oxygen Use, Delivery Devices, and the CNA Monitoring Role
Key Takeaways
- Oxygen is a drug that requires a physician order; the CNA never adjusts the flow rate, turns oxygen on or off, or changes the delivery device — those are licensed-nurse tasks — but the CNA does monitor, report, and assist with comfort and safety.
- A nasal cannula delivers low-flow oxygen at 1–6 L/min through two prongs in the nostrils; the CNA checks that prongs sit properly in the nares, tubing is not kinked, and the cannula is padded behind the ears to prevent skin breakdown.
- Oxygen supports combustion — no open flames (candles, lighters, matches, gas stoves), no smoking, and no petroleum-based lip balm or lotion on the resident's face (use water-based products) within 5–10 feet of an oxygen source.
- Portable oxygen tanks must be secured upright in a stand or cart (never laid flat or propped in a wheelchair) and turned off when not in use; concentrators need a working electrical outlet and a battery backup if the resident is on continuous oxygen.
- CPAP and BiPAP are non-invasive ventilatory support devices the CNA monitors but does not adjust; report mask leaks, skin breakdown at the bridge of the nose, resident refusal to wear the mask, or any alarm immediately to the nurse.
Oxygen is a drug — and the CNA's role is monitoring, not adjusting
Under Indiana's 410 IAC 16.2 Standard 14, oxygen is a medication. The CNA does not start, stop, or adjust oxygen flow rates, change the delivery device, or apply oxygen to a resident. The licensed nurse sets the flow rate, fits the device, and verifies the order. The CNA does observe the resident receiving oxygen, keep the device comfortable and in place, maintain safety, and report changes immediately. Knowing this boundary protects both the resident (wrong flow rates can cause CO2 narcosis in COPD residents or fail to deliver enough oxygen) and the CNA (a scope violation is a substantiated finding on the Indiana Nurse Aide Registry).
Delivery devices the CNA recognizes
The CNA should recognize the common oxygen delivery devices and know what to monitor for each.
| Device | How it works | What the CNA monitors |
|---|---|---|
| Nasal cannula | Low-flow oxygen 1–6 L/min through two prongs in the nostrils; most common device | Prongs seated in nares, tubing not kinked, ears padded to prevent skin breakdown, humidification bottle filled if ordered |
| Simple face mask | Oxygen at 5–8 L/min covers nose and mouth; delivers higher concentration than cannula | Mask fits snugly without pressure sores, resident not claustrophobic, mask removed for meals if allowed, skin under mask edge intact |
| Non-rebreather mask | Has a reservoir bag and one-way valves; delivers high oxygen for emergencies | Reservoir bag stays inflated (report a flat bag), valves intact, mask on face |
| Oxygen concentrator | Electric device that extracts oxygen from room air; common for long-term residents | Power cord intact, airflow at the output, no overheating, backup cylinder available in case of power failure |
| Liquid oxygen reservoir | Stores oxygen as a very cold liquid that warms to gas on delivery | Reservoir fill level, no frost on connections, portables refilled per schedule |
| Portable oxygen tank (compressed gas cylinder) | Steel or aluminum cylinder of compressed O2; green tank in the U.S. | Tank secured upright in a stand or cart (NEVER laid flat or unsecured), valve open when in use, gauge shows contents, turned off when not in use |
The no-open-flame rule
Oxygen itself is not flammable, but it vigorously supports combustion — a fire that would be small in normal air becomes large and fast in an oxygen-enriched area. The CNA enforces the following safety rules in any room where oxygen is in use:
- No open flames within 5–10 feet of the oxygen source: no candles, no gas stove use, no lighter or match use, no smoking. Post the "Oxygen in Use — No Smoking" sign on the resident's door.
- No smoking by anyone — resident, visitor, or staff — in the room. Smoking near oxygen is a leading cause of fatal fires in long-term care.
- No petroleum-based products on the resident's face or upper chest. Petroleum (Vaseline, petroleum jelly, oil-based lip balm, oil-based lotions) is combustible; oxygen-enriched skin and nasal passages ignite petroleum products easily. Use only water-based lip balm and lotions.
- No electrical appliances that spark (hair dryers, electric razors, heating pads with open coils) within several feet of oxygen. Use battery-powered razors.
- Keep a working fire extinguisher nearby (Class ABC) and know the facility fire plan.
- Secure portable tanks upright in a stand or cart — a tank that falls and breaks its valve becomes a projectile (the compressed gas escaping acts like a rocket).
CPAP and BiPAP awareness
Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) are non-invasive ventilatory support devices, most often used for obstructive sleep apnea and sometimes for COPD. The CNA does not adjust pressures, change settings, or interpret the machine — the nurse and respiratory therapist manage those. The CNA does:
- Help the resident apply the mask for sleep and remove it on waking, per the care plan.
- Check that the mask fits without pressure sores at the bridge of the nose (a common breakdown site); apply a barrier dressing only if the nurse has ordered one — Standard 14 prohibits the CNA from applying dressings.
- Keep the tubing free of kinks.
- Report any alarm, mask leak, resident refusal to wear the mask, skin breakdown, or respiratory distress immediately.
The CNA's monitoring and reporting role
Throughout the shift the CNA monitors any resident on supplemental oxygen and reports promptly:
- Breathing changes — rate outside 12–20 breaths per minute, labored breathing, retractions, nasal flaring, pursed-lip breathing, accessory muscle use.
- Color changes — cyanosis (blue or gray lips, nail beds, earlobes) is an emergency; report and call for help.
- Mental status changes — new confusion, drowsiness, or unresponsiveness can signal CO2 narcosis in COPD residents on too-high oxygen, or hypoxia from too-low oxygen. Either is an emergency.
- Device problems — cannula out of the nares, mask off the face, tubing kinked, humidifier dry, tank empty or low, concentrator alarming or off, portable tank not upright.
- Discomfort — dry nares (ask the nurse about sterile saline drops), ear or face soreness from tubing or mask, sore throat.
- Fire-safety violations — anyone smoking or using a flame near the oxygen source; remove the source and report.
Document the resident's response to oxygen, the flow rate observed (do not change it), the device in place, and any changes reported. When a portable tank is in use, check the gauge at the start and end of the shift and report a tank approaching empty so the nurse can arrange a replacement. Never allow a resident on continuous oxygen to be without a backup oxygen source during a power outage or concentrator failure — report immediately so a portable tank is brought.
A resident receiving oxygen by nasal cannula at 3 L/min complains of dry, sore nasal passages and asks the CNA to turn the oxygen up to 5 L/min for comfort. What is the CNA's correct response?
Which of the following is permitted in a resident's room when oxygen is in use?
A portable compressed-gas oxygen tank in a wheelchair must be positioned how?